|
PR ENDOSCOPIC INJECTION/IMPLANT
|
Professional
|
Both
|
$631.88
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
z51715
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$339.14 |
| Rate for Payer: Aetna Commercial |
$186.65
|
| Rate for Payer: Aetna Medicare |
$186.65
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$109.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$337.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$214.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.31
|
| Rate for Payer: Cash Price |
$379.13
|
| Rate for Payer: Centivo All Commercial |
$289.31
|
| Rate for Payer: Cigna All Commercial |
$186.65
|
| Rate for Payer: CORVEL All Commercial |
$186.65
|
| Rate for Payer: Coventry All Commercial |
$223.98
|
| Rate for Payer: Encore All Commercial |
$186.65
|
| Rate for Payer: Frontpath All Commercial |
$257.73
|
| Rate for Payer: Humana ChoiceCare |
$194.04
|
| Rate for Payer: Humana Medicare |
$186.65
|
| Rate for Payer: Lucent All Commercial |
$261.31
|
| Rate for Payer: Managed Health Services Medicaid |
$337.34
|
| Rate for Payer: MDWise Medicaid |
$337.34
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$109.27
|
| Rate for Payer: PHCS All Commercial |
$186.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.65
|
| Rate for Payer: Sagamore Health Network All Products |
$186.65
|
| Rate for Payer: United Healthcare Commercial |
$247.18
|
| Rate for Payer: United Healthcare Medicare |
$339.14
|
|
|
PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING
|
Professional
|
Both
|
$706.82
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
z44378
|
| Min. Negotiated Rate |
$347.65 |
| Max. Negotiated Rate |
$562.79 |
| Rate for Payer: Aetna Commercial |
$363.09
|
| Rate for Payer: Aetna Commercial |
$363.09
|
| Rate for Payer: Aetna Medicare |
$363.09
|
| Rate for Payer: Aetna Medicare |
$363.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$347.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$347.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.40
|
| Rate for Payer: Cash Price |
$417.54
|
| Rate for Payer: Cash Price |
$424.09
|
| Rate for Payer: Centivo All Commercial |
$562.79
|
| Rate for Payer: Centivo All Commercial |
$562.79
|
| Rate for Payer: Cigna All Commercial |
$363.09
|
| Rate for Payer: Cigna All Commercial |
$363.09
|
| Rate for Payer: CORVEL All Commercial |
$363.09
|
| Rate for Payer: CORVEL All Commercial |
$363.09
|
| Rate for Payer: Coventry All Commercial |
$435.71
|
| Rate for Payer: Coventry All Commercial |
$435.71
|
| Rate for Payer: Encore All Commercial |
$363.09
|
| Rate for Payer: Encore All Commercial |
$363.09
|
| Rate for Payer: Frontpath All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.83
|
| Rate for Payer: Humana ChoiceCare |
$444.24
|
| Rate for Payer: Humana ChoiceCare |
$444.24
|
| Rate for Payer: Humana Medicare |
$363.09
|
| Rate for Payer: Humana Medicare |
$363.09
|
| Rate for Payer: Lucent All Commercial |
$508.33
|
| Rate for Payer: Lucent All Commercial |
$508.33
|
| Rate for Payer: Managed Health Services Medicaid |
$347.65
|
| Rate for Payer: Managed Health Services Medicaid |
$347.65
|
| Rate for Payer: MDWise Medicaid |
$347.65
|
| Rate for Payer: MDWise Medicaid |
$347.65
|
| Rate for Payer: PHCS All Commercial |
$363.09
|
| Rate for Payer: PHCS All Commercial |
$363.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$363.09
|
| Rate for Payer: United Healthcare Commercial |
$476.99
|
| Rate for Payer: United Healthcare Commercial |
$476.99
|
| Rate for Payer: United Healthcare Medicare |
$347.95
|
| Rate for Payer: United Healthcare Medicare |
$347.95
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING
|
Professional
|
Both
|
$441.44
|
|
|
Service Code
|
CPT 44366
|
| Hospital Charge Code |
z44366
|
| Min. Negotiated Rate |
$217.11 |
| Max. Negotiated Rate |
$350.01 |
| Rate for Payer: Aetna Commercial |
$225.81
|
| Rate for Payer: Aetna Commercial |
$225.81
|
| Rate for Payer: Aetna Medicare |
$225.81
|
| Rate for Payer: Aetna Medicare |
$225.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$217.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$217.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$248.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$248.39
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cash Price |
$264.86
|
| Rate for Payer: Centivo All Commercial |
$350.01
|
| Rate for Payer: Centivo All Commercial |
$350.01
|
| Rate for Payer: Cigna All Commercial |
$225.81
|
| Rate for Payer: Cigna All Commercial |
$225.81
|
| Rate for Payer: CORVEL All Commercial |
$225.81
|
| Rate for Payer: CORVEL All Commercial |
$225.81
|
| Rate for Payer: Coventry All Commercial |
$270.97
|
| Rate for Payer: Coventry All Commercial |
$270.97
|
| Rate for Payer: Encore All Commercial |
$225.81
|
| Rate for Payer: Encore All Commercial |
$225.81
|
| Rate for Payer: Frontpath All Commercial |
$307.61
|
| Rate for Payer: Frontpath All Commercial |
$307.61
|
| Rate for Payer: Humana ChoiceCare |
$277.44
|
| Rate for Payer: Humana ChoiceCare |
$277.44
|
| Rate for Payer: Humana Medicare |
$225.81
|
| Rate for Payer: Humana Medicare |
$225.81
|
| Rate for Payer: Lucent All Commercial |
$316.13
|
| Rate for Payer: Lucent All Commercial |
$316.13
|
| Rate for Payer: Managed Health Services Medicaid |
$217.11
|
| Rate for Payer: Managed Health Services Medicaid |
$217.11
|
| Rate for Payer: MDWise Medicaid |
$217.11
|
| Rate for Payer: MDWise Medicaid |
$217.11
|
| Rate for Payer: PHCS All Commercial |
$225.81
|
| Rate for Payer: PHCS All Commercial |
$225.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.81
|
| Rate for Payer: Sagamore Health Network All Products |
$225.81
|
| Rate for Payer: Sagamore Health Network All Products |
$225.81
|
| Rate for Payer: United Healthcare Commercial |
$300.95
|
| Rate for Payer: United Healthcare Commercial |
$300.95
|
| Rate for Payer: United Healthcare Medicare |
$217.32
|
| Rate for Payer: United Healthcare Medicare |
$217.32
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$352.78
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
z44363
|
| Min. Negotiated Rate |
$173.47 |
| Max. Negotiated Rate |
$279.91 |
| Rate for Payer: Aetna Commercial |
$180.59
|
| Rate for Payer: Aetna Commercial |
$180.59
|
| Rate for Payer: Aetna Medicare |
$180.59
|
| Rate for Payer: Aetna Medicare |
$180.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$173.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$173.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.65
|
| Rate for Payer: Cash Price |
$208.16
|
| Rate for Payer: Cash Price |
$211.67
|
| Rate for Payer: Centivo All Commercial |
$279.91
|
| Rate for Payer: Centivo All Commercial |
$279.91
|
| Rate for Payer: Cigna All Commercial |
$180.59
|
| Rate for Payer: Cigna All Commercial |
$180.59
|
| Rate for Payer: CORVEL All Commercial |
$180.59
|
| Rate for Payer: CORVEL All Commercial |
$180.59
|
| Rate for Payer: Coventry All Commercial |
$216.71
|
| Rate for Payer: Coventry All Commercial |
$216.71
|
| Rate for Payer: Encore All Commercial |
$180.59
|
| Rate for Payer: Encore All Commercial |
$180.59
|
| Rate for Payer: Frontpath All Commercial |
$246.87
|
| Rate for Payer: Frontpath All Commercial |
$246.87
|
| Rate for Payer: Humana ChoiceCare |
$220.38
|
| Rate for Payer: Humana ChoiceCare |
$220.38
|
| Rate for Payer: Humana Medicare |
$180.59
|
| Rate for Payer: Humana Medicare |
$180.59
|
| Rate for Payer: Lucent All Commercial |
$252.83
|
| Rate for Payer: Lucent All Commercial |
$252.83
|
| Rate for Payer: Managed Health Services Medicaid |
$173.51
|
| Rate for Payer: Managed Health Services Medicaid |
$173.51
|
| Rate for Payer: MDWise Medicaid |
$173.51
|
| Rate for Payer: MDWise Medicaid |
$173.51
|
| Rate for Payer: PHCS All Commercial |
$180.59
|
| Rate for Payer: PHCS All Commercial |
$180.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.59
|
| Rate for Payer: Sagamore Health Network All Products |
$180.59
|
| Rate for Payer: Sagamore Health Network All Products |
$180.59
|
| Rate for Payer: United Healthcare Commercial |
$237.06
|
| Rate for Payer: United Healthcare Commercial |
$237.06
|
| Rate for Payer: United Healthcare Medicare |
$173.47
|
| Rate for Payer: United Healthcare Medicare |
$173.47
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE
|
Professional
|
Both
|
$376.16
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
z44364
|
| Min. Negotiated Rate |
$185.01 |
| Max. Negotiated Rate |
$298.34 |
| Rate for Payer: Aetna Commercial |
$192.48
|
| Rate for Payer: Aetna Commercial |
$192.48
|
| Rate for Payer: Aetna Medicare |
$192.48
|
| Rate for Payer: Aetna Medicare |
$192.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$185.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$185.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.73
|
| Rate for Payer: Cash Price |
$222.05
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Centivo All Commercial |
$298.34
|
| Rate for Payer: Centivo All Commercial |
$298.34
|
| Rate for Payer: Cigna All Commercial |
$192.48
|
| Rate for Payer: Cigna All Commercial |
$192.48
|
| Rate for Payer: CORVEL All Commercial |
$192.48
|
| Rate for Payer: CORVEL All Commercial |
$192.48
|
| Rate for Payer: Coventry All Commercial |
$230.98
|
| Rate for Payer: Coventry All Commercial |
$230.98
|
| Rate for Payer: Encore All Commercial |
$192.48
|
| Rate for Payer: Encore All Commercial |
$192.48
|
| Rate for Payer: Frontpath All Commercial |
$262.68
|
| Rate for Payer: Frontpath All Commercial |
$262.68
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$192.48
|
| Rate for Payer: Humana Medicare |
$192.48
|
| Rate for Payer: Lucent All Commercial |
$269.47
|
| Rate for Payer: Lucent All Commercial |
$269.47
|
| Rate for Payer: Managed Health Services Medicaid |
$185.01
|
| Rate for Payer: Managed Health Services Medicaid |
$185.01
|
| Rate for Payer: MDWise Medicaid |
$185.01
|
| Rate for Payer: MDWise Medicaid |
$185.01
|
| Rate for Payer: PHCS All Commercial |
$192.48
|
| Rate for Payer: PHCS All Commercial |
$192.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.48
|
| Rate for Payer: Sagamore Health Network All Products |
$192.48
|
| Rate for Payer: Sagamore Health Network All Products |
$192.48
|
| Rate for Payer: United Healthcare Commercial |
$255.33
|
| Rate for Payer: United Healthcare Commercial |
$255.33
|
| Rate for Payer: United Healthcare Medicare |
$185.04
|
| Rate for Payer: United Healthcare Medicare |
$185.04
|
|
|
PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
z93640
|
| Min. Negotiated Rate |
$254.27 |
| Max. Negotiated Rate |
$632.50 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$632.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$632.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$632.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$254.27
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Frontpath All Commercial |
$413.67
|
| Rate for Payer: Humana ChoiceCare |
$594.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.05
|
| Rate for Payer: Managed Health Services Medicaid |
$254.27
|
| Rate for Payer: MDWise Medicaid |
$254.27
|
| Rate for Payer: Signature Care EPO |
$329.06
|
| Rate for Payer: Signature Care PPO |
$329.06
|
| Rate for Payer: United Healthcare Commercial |
$529.93
|
|
|
PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN
|
Professional
|
Both
|
$547.94
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
z93641
|
| Min. Negotiated Rate |
$465.75 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$830.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$830.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$830.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$830.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$607.84
|
| Rate for Payer: Cash Price |
$328.76
|
| Rate for Payer: Cash Price |
$328.76
|
| Rate for Payer: Frontpath All Commercial |
$642.64
|
| Rate for Payer: Humana ChoiceCare |
$767.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.75
|
| Rate for Payer: Managed Health Services Medicaid |
$607.84
|
| Rate for Payer: MDWise Medicaid |
$607.84
|
| Rate for Payer: Signature Care EPO |
$573.28
|
| Rate for Payer: Signature Care PPO |
$573.28
|
| Rate for Payer: United Healthcare Commercial |
$682.89
|
|
|
PR EPI AUTOGRFT FACE/NCK/HND/FT/GEN <100 SQCM
|
Professional
|
Both
|
$1,500.76
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
z15115
|
| Min. Negotiated Rate |
$414.37 |
| Max. Negotiated Rate |
$77,200.00 |
| Rate for Payer: Aetna Commercial |
$645.43
|
| Rate for Payer: Aetna Commercial |
$645.43
|
| Rate for Payer: Aetna Medicare |
$645.43
|
| Rate for Payer: Aetna Medicare |
$645.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$845.27
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$414.37
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$414.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$738.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$738.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$742.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$742.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$709.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$709.97
|
| Rate for Payer: Cash Price |
$877.64
|
| Rate for Payer: Cash Price |
$900.46
|
| Rate for Payer: Centivo All Commercial |
$1,000.42
|
| Rate for Payer: Centivo All Commercial |
$1,000.42
|
| Rate for Payer: Cigna All Commercial |
$645.43
|
| Rate for Payer: Cigna All Commercial |
$645.43
|
| Rate for Payer: CORVEL All Commercial |
$645.43
|
| Rate for Payer: CORVEL All Commercial |
$645.43
|
| Rate for Payer: Coventry All Commercial |
$774.52
|
| Rate for Payer: Coventry All Commercial |
$774.52
|
| Rate for Payer: Encore All Commercial |
$645.43
|
| Rate for Payer: Encore All Commercial |
$645.43
|
| Rate for Payer: Frontpath All Commercial |
$893.68
|
| Rate for Payer: Frontpath All Commercial |
$893.68
|
| Rate for Payer: Humana ChoiceCare |
$643.83
|
| Rate for Payer: Humana ChoiceCare |
$643.83
|
| Rate for Payer: Humana Medicare |
$645.43
|
| Rate for Payer: Humana Medicare |
$645.43
|
| Rate for Payer: Lucent All Commercial |
$903.60
|
| Rate for Payer: Lucent All Commercial |
$903.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$836.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$836.00
|
| Rate for Payer: Managed Health Services Medicaid |
$738.14
|
| Rate for Payer: Managed Health Services Medicaid |
$738.14
|
| Rate for Payer: MDWise Medicaid |
$738.14
|
| Rate for Payer: MDWise Medicaid |
$738.14
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$414.37
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$414.37
|
| Rate for Payer: PHCS All Commercial |
$645.43
|
| Rate for Payer: PHCS All Commercial |
$645.43
|
| Rate for Payer: PHP All Commercial |
$878.44
|
| Rate for Payer: PHP All Commercial |
$878.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$645.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$645.43
|
| Rate for Payer: Sagamore Health Network All Products |
$645.43
|
| Rate for Payer: Sagamore Health Network All Products |
$645.43
|
| Rate for Payer: Signature Care EPO |
$788.80
|
| Rate for Payer: Signature Care EPO |
$788.80
|
| Rate for Payer: Signature Care PPO |
$788.80
|
| Rate for Payer: Signature Care PPO |
$788.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77,200.00
|
| Rate for Payer: United Healthcare Commercial |
$819.45
|
| Rate for Payer: United Healthcare Commercial |
$819.45
|
| Rate for Payer: United Healthcare Medicare |
$731.37
|
| Rate for Payer: United Healthcare Medicare |
$731.37
|
|
|
PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING
|
Professional
|
Both
|
$418.20
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
z59300
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$17,300.00 |
| Rate for Payer: Aetna Commercial |
$132.96
|
| Rate for Payer: Aetna Commercial |
$132.96
|
| Rate for Payer: Aetna Medicare |
$132.96
|
| Rate for Payer: Aetna Medicare |
$132.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.58
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.92
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$205.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$205.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.26
|
| Rate for Payer: Cash Price |
$247.97
|
| Rate for Payer: Cash Price |
$250.92
|
| Rate for Payer: Centivo All Commercial |
$206.09
|
| Rate for Payer: Centivo All Commercial |
$206.09
|
| Rate for Payer: Cigna All Commercial |
$132.96
|
| Rate for Payer: Cigna All Commercial |
$132.96
|
| Rate for Payer: CORVEL All Commercial |
$132.96
|
| Rate for Payer: CORVEL All Commercial |
$132.96
|
| Rate for Payer: Coventry All Commercial |
$159.55
|
| Rate for Payer: Coventry All Commercial |
$159.55
|
| Rate for Payer: Encore All Commercial |
$132.96
|
| Rate for Payer: Encore All Commercial |
$132.96
|
| Rate for Payer: Frontpath All Commercial |
$189.85
|
| Rate for Payer: Frontpath All Commercial |
$189.85
|
| Rate for Payer: Humana ChoiceCare |
$133.71
|
| Rate for Payer: Humana ChoiceCare |
$133.71
|
| Rate for Payer: Humana Medicare |
$132.96
|
| Rate for Payer: Humana Medicare |
$132.96
|
| Rate for Payer: Lucent All Commercial |
$186.14
|
| Rate for Payer: Lucent All Commercial |
$186.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: Managed Health Services Medicaid |
$205.69
|
| Rate for Payer: Managed Health Services Medicaid |
$205.69
|
| Rate for Payer: MDWise Medicaid |
$205.69
|
| Rate for Payer: MDWise Medicaid |
$205.69
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$74.92
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$74.92
|
| Rate for Payer: PHCS All Commercial |
$132.96
|
| Rate for Payer: PHCS All Commercial |
$132.96
|
| Rate for Payer: PHP All Commercial |
$170.99
|
| Rate for Payer: PHP All Commercial |
$170.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.96
|
| Rate for Payer: Sagamore Health Network All Products |
$132.96
|
| Rate for Payer: Sagamore Health Network All Products |
$132.96
|
| Rate for Payer: Signature Care EPO |
$225.25
|
| Rate for Payer: Signature Care EPO |
$225.25
|
| Rate for Payer: Signature Care PPO |
$225.25
|
| Rate for Payer: Signature Care PPO |
$225.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,300.00
|
| Rate for Payer: United Healthcare Commercial |
$165.01
|
| Rate for Payer: United Healthcare Commercial |
$165.01
|
| Rate for Payer: United Healthcare Medicare |
$206.64
|
| Rate for Payer: United Healthcare Medicare |
$206.64
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
Both
|
$741.50
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
z43236
|
| Min. Negotiated Rate |
$129.71 |
| Max. Negotiated Rate |
$17,900.00 |
| Rate for Payer: Aetna Commercial |
$129.71
|
| Rate for Payer: Aetna Commercial |
$129.71
|
| Rate for Payer: Aetna Medicare |
$129.71
|
| Rate for Payer: Aetna Medicare |
$129.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$139.12
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$139.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$364.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$364.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.68
|
| Rate for Payer: Cash Price |
$440.36
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Centivo All Commercial |
$201.05
|
| Rate for Payer: Centivo All Commercial |
$201.05
|
| Rate for Payer: Cigna All Commercial |
$129.71
|
| Rate for Payer: Cigna All Commercial |
$129.71
|
| Rate for Payer: CORVEL All Commercial |
$129.71
|
| Rate for Payer: CORVEL All Commercial |
$129.71
|
| Rate for Payer: Coventry All Commercial |
$155.65
|
| Rate for Payer: Coventry All Commercial |
$155.65
|
| Rate for Payer: Encore All Commercial |
$129.71
|
| Rate for Payer: Encore All Commercial |
$129.71
|
| Rate for Payer: Frontpath All Commercial |
$176.51
|
| Rate for Payer: Frontpath All Commercial |
$176.51
|
| Rate for Payer: Humana ChoiceCare |
$186.76
|
| Rate for Payer: Humana ChoiceCare |
$186.76
|
| Rate for Payer: Humana Medicare |
$129.71
|
| Rate for Payer: Humana Medicare |
$129.71
|
| Rate for Payer: Lucent All Commercial |
$181.59
|
| Rate for Payer: Lucent All Commercial |
$181.59
|
| 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 |
$364.70
|
| Rate for Payer: Managed Health Services Medicaid |
$364.70
|
| Rate for Payer: MDWise Medicaid |
$364.70
|
| Rate for Payer: MDWise Medicaid |
$364.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$139.12
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$139.12
|
| Rate for Payer: PHCS All Commercial |
$129.71
|
| Rate for Payer: PHCS All Commercial |
$129.71
|
| Rate for Payer: PHP All Commercial |
$218.43
|
| Rate for Payer: PHP All Commercial |
$218.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.71
|
| Rate for Payer: Sagamore Health Network All Products |
$129.71
|
| Rate for Payer: Sagamore Health Network All Products |
$129.71
|
| Rate for Payer: Signature Care EPO |
$504.05
|
| Rate for Payer: Signature Care EPO |
$504.05
|
| Rate for Payer: Signature Care PPO |
$504.05
|
| Rate for Payer: Signature Care PPO |
$504.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: United Healthcare Commercial |
$202.70
|
| Rate for Payer: United Healthcare Commercial |
$202.70
|
| Rate for Payer: United Healthcare Medicare |
$366.97
|
| Rate for Payer: United Healthcare Medicare |
$366.97
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$533.02
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
z43235
|
| Min. Negotiated Rate |
$115.28 |
| Max. Negotiated Rate |
$15,900.00 |
| Rate for Payer: Aetna Commercial |
$115.28
|
| Rate for Payer: Aetna Commercial |
$115.28
|
| Rate for Payer: Aetna Medicare |
$115.28
|
| Rate for Payer: Aetna Medicare |
$115.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$124.24
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$124.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$262.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$262.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.81
|
| Rate for Payer: Cash Price |
$315.88
|
| Rate for Payer: Cash Price |
$319.81
|
| Rate for Payer: Centivo All Commercial |
$178.68
|
| Rate for Payer: Centivo All Commercial |
$178.68
|
| Rate for Payer: Cigna All Commercial |
$115.28
|
| Rate for Payer: Cigna All Commercial |
$115.28
|
| Rate for Payer: CORVEL All Commercial |
$115.28
|
| Rate for Payer: CORVEL All Commercial |
$115.28
|
| Rate for Payer: Coventry All Commercial |
$138.34
|
| Rate for Payer: Coventry All Commercial |
$138.34
|
| Rate for Payer: Encore All Commercial |
$115.28
|
| Rate for Payer: Encore All Commercial |
$115.28
|
| Rate for Payer: Frontpath All Commercial |
$157.68
|
| Rate for Payer: Frontpath All Commercial |
$157.68
|
| Rate for Payer: Humana ChoiceCare |
$154.10
|
| Rate for Payer: Humana ChoiceCare |
$154.10
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: Lucent All Commercial |
$161.39
|
| Rate for Payer: Lucent All Commercial |
$161.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: Managed Health Services Medicaid |
$262.16
|
| Rate for Payer: Managed Health Services Medicaid |
$262.16
|
| Rate for Payer: MDWise Medicaid |
$262.16
|
| Rate for Payer: MDWise Medicaid |
$262.16
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$124.24
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$124.24
|
| Rate for Payer: PHCS All Commercial |
$115.28
|
| Rate for Payer: PHCS All Commercial |
$115.28
|
| Rate for Payer: PHP All Commercial |
$193.95
|
| Rate for Payer: PHP All Commercial |
$193.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.28
|
| Rate for Payer: Sagamore Health Network All Products |
$115.28
|
| Rate for Payer: Sagamore Health Network All Products |
$115.28
|
| Rate for Payer: Signature Care EPO |
$406.30
|
| Rate for Payer: Signature Care EPO |
$406.30
|
| Rate for Payer: Signature Care PPO |
$406.30
|
| Rate for Payer: Signature Care PPO |
$406.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,900.00
|
| Rate for Payer: United Healthcare Commercial |
$166.69
|
| Rate for Payer: United Healthcare Commercial |
$166.69
|
| Rate for Payer: United Healthcare Medicare |
$263.23
|
| Rate for Payer: United Healthcare Medicare |
$263.23
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$517.50
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
z43215
|
| Min. Negotiated Rate |
$132.01 |
| Max. Negotiated Rate |
$358.75 |
| Rate for Payer: Aetna Commercial |
$132.13
|
| Rate for Payer: Aetna Commercial |
$132.13
|
| Rate for Payer: Aetna Medicare |
$132.13
|
| Rate for Payer: Aetna Medicare |
$132.13
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$132.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$132.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$355.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$355.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.34
|
| Rate for Payer: Cash Price |
$433.72
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Centivo All Commercial |
$204.80
|
| Rate for Payer: Centivo All Commercial |
$204.80
|
| Rate for Payer: Cigna All Commercial |
$132.13
|
| Rate for Payer: Cigna All Commercial |
$132.13
|
| Rate for Payer: CORVEL All Commercial |
$132.13
|
| Rate for Payer: CORVEL All Commercial |
$132.13
|
| Rate for Payer: Coventry All Commercial |
$158.56
|
| Rate for Payer: Coventry All Commercial |
$158.56
|
| Rate for Payer: Encore All Commercial |
$132.13
|
| Rate for Payer: Encore All Commercial |
$132.13
|
| Rate for Payer: Frontpath All Commercial |
$183.01
|
| Rate for Payer: Frontpath All Commercial |
$183.01
|
| Rate for Payer: Humana ChoiceCare |
$171.61
|
| Rate for Payer: Humana ChoiceCare |
$171.61
|
| Rate for Payer: Humana Medicare |
$132.13
|
| Rate for Payer: Humana Medicare |
$132.13
|
| Rate for Payer: Lucent All Commercial |
$184.98
|
| Rate for Payer: Lucent All Commercial |
$184.98
|
| Rate for Payer: Managed Health Services Medicaid |
$355.53
|
| Rate for Payer: Managed Health Services Medicaid |
$355.53
|
| Rate for Payer: MDWise Medicaid |
$355.53
|
| Rate for Payer: MDWise Medicaid |
$355.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$132.01
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$132.01
|
| Rate for Payer: PHCS All Commercial |
$132.13
|
| Rate for Payer: PHCS All Commercial |
$132.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.13
|
| Rate for Payer: Sagamore Health Network All Products |
$132.13
|
| Rate for Payer: Sagamore Health Network All Products |
$132.13
|
| Rate for Payer: United Healthcare Commercial |
$176.55
|
| Rate for Payer: United Healthcare Commercial |
$176.55
|
| Rate for Payer: United Healthcare Medicare |
$358.75
|
| Rate for Payer: United Healthcare Medicare |
$358.75
|
|
|
PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE
|
Professional
|
Both
|
$777.74
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
z43217
|
| Min. Negotiated Rate |
$150.78 |
| Max. Negotiated Rate |
$384.77 |
| Rate for Payer: Aetna Commercial |
$150.78
|
| Rate for Payer: Aetna Commercial |
$150.78
|
| Rate for Payer: Aetna Medicare |
$150.78
|
| Rate for Payer: Aetna Medicare |
$150.78
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$152.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$152.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$382.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$382.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.86
|
| Rate for Payer: Cash Price |
$461.72
|
| Rate for Payer: Cash Price |
$466.64
|
| Rate for Payer: Centivo All Commercial |
$233.71
|
| Rate for Payer: Centivo All Commercial |
$233.71
|
| Rate for Payer: Cigna All Commercial |
$150.78
|
| Rate for Payer: Cigna All Commercial |
$150.78
|
| Rate for Payer: CORVEL All Commercial |
$150.78
|
| Rate for Payer: CORVEL All Commercial |
$150.78
|
| Rate for Payer: Coventry All Commercial |
$180.94
|
| Rate for Payer: Coventry All Commercial |
$180.94
|
| Rate for Payer: Encore All Commercial |
$150.78
|
| Rate for Payer: Encore All Commercial |
$150.78
|
| Rate for Payer: Frontpath All Commercial |
$205.71
|
| Rate for Payer: Frontpath All Commercial |
$205.71
|
| Rate for Payer: Humana ChoiceCare |
$185.61
|
| Rate for Payer: Humana ChoiceCare |
$185.61
|
| Rate for Payer: Humana Medicare |
$150.78
|
| Rate for Payer: Humana Medicare |
$150.78
|
| Rate for Payer: Lucent All Commercial |
$211.09
|
| Rate for Payer: Lucent All Commercial |
$211.09
|
| Rate for Payer: Managed Health Services Medicaid |
$382.52
|
| Rate for Payer: Managed Health Services Medicaid |
$382.52
|
| Rate for Payer: MDWise Medicaid |
$382.52
|
| Rate for Payer: MDWise Medicaid |
$382.52
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$152.62
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$152.62
|
| Rate for Payer: PHCS All Commercial |
$150.78
|
| Rate for Payer: PHCS All Commercial |
$150.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.78
|
| Rate for Payer: Sagamore Health Network All Products |
$150.78
|
| Rate for Payer: Sagamore Health Network All Products |
$150.78
|
| Rate for Payer: United Healthcare Commercial |
$194.05
|
| Rate for Payer: United Healthcare Commercial |
$194.05
|
| Rate for Payer: United Healthcare Medicare |
$384.77
|
| Rate for Payer: United Healthcare Medicare |
$384.77
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$656.58
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
z43202
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$326.42 |
| Rate for Payer: Aetna Commercial |
$96.55
|
| Rate for Payer: Aetna Medicare |
$96.55
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$97.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$322.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.20
|
| Rate for Payer: Cash Price |
$393.95
|
| Rate for Payer: Centivo All Commercial |
$149.65
|
| Rate for Payer: Cigna All Commercial |
$96.55
|
| Rate for Payer: CORVEL All Commercial |
$96.55
|
| Rate for Payer: Coventry All Commercial |
$115.86
|
| Rate for Payer: Encore All Commercial |
$96.55
|
| Rate for Payer: Frontpath All Commercial |
$132.65
|
| Rate for Payer: Humana ChoiceCare |
$127.34
|
| Rate for Payer: Humana Medicare |
$96.55
|
| Rate for Payer: Lucent All Commercial |
$135.17
|
| Rate for Payer: Managed Health Services Medicaid |
$322.93
|
| Rate for Payer: MDWise Medicaid |
$322.93
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$97.44
|
| Rate for Payer: PHCS All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$96.55
|
| Rate for Payer: United Healthcare Commercial |
$130.65
|
| Rate for Payer: United Healthcare Medicare |
$326.42
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ
|
Professional
|
Both
|
$480.12
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
z43201
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$237.58 |
| Rate for Payer: Aetna Commercial |
$96.56
|
| Rate for Payer: Aetna Commercial |
$96.56
|
| Rate for Payer: Aetna Medicare |
$96.56
|
| Rate for Payer: Aetna Medicare |
$96.56
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.86
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.22
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Cash Price |
$288.07
|
| Rate for Payer: Centivo All Commercial |
$149.67
|
| Rate for Payer: Centivo All Commercial |
$149.67
|
| Rate for Payer: Cigna All Commercial |
$96.56
|
| Rate for Payer: Cigna All Commercial |
$96.56
|
| Rate for Payer: CORVEL All Commercial |
$96.56
|
| Rate for Payer: CORVEL All Commercial |
$96.56
|
| Rate for Payer: Coventry All Commercial |
$115.87
|
| Rate for Payer: Coventry All Commercial |
$115.87
|
| Rate for Payer: Encore All Commercial |
$96.56
|
| Rate for Payer: Encore All Commercial |
$96.56
|
| Rate for Payer: Frontpath All Commercial |
$133.22
|
| Rate for Payer: Frontpath All Commercial |
$133.22
|
| Rate for Payer: Humana ChoiceCare |
$142.98
|
| Rate for Payer: Humana ChoiceCare |
$142.98
|
| Rate for Payer: Humana Medicare |
$96.56
|
| Rate for Payer: Humana Medicare |
$96.56
|
| Rate for Payer: Lucent All Commercial |
$135.18
|
| Rate for Payer: Lucent All Commercial |
$135.18
|
| Rate for Payer: Managed Health Services Medicaid |
$236.14
|
| Rate for Payer: Managed Health Services Medicaid |
$236.14
|
| Rate for Payer: MDWise Medicaid |
$236.14
|
| Rate for Payer: MDWise Medicaid |
$236.14
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.86
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.86
|
| Rate for Payer: PHCS All Commercial |
$96.56
|
| Rate for Payer: PHCS All Commercial |
$96.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.56
|
| Rate for Payer: Sagamore Health Network All Products |
$96.56
|
| Rate for Payer: Sagamore Health Network All Products |
$96.56
|
| Rate for Payer: United Healthcare Commercial |
$147.94
|
| Rate for Payer: United Healthcare Commercial |
$147.94
|
| Rate for Payer: United Healthcare Medicare |
$237.58
|
| Rate for Payer: United Healthcare Medicare |
$237.58
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL
|
Professional
|
Both
|
$1,093.16
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
z43227
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$543.34 |
| Rate for Payer: Aetna Commercial |
$155.00
|
| Rate for Payer: Aetna Commercial |
$155.00
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$537.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$537.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.50
|
| Rate for Payer: Cash Price |
$652.01
|
| Rate for Payer: Cash Price |
$655.90
|
| Rate for Payer: Centivo All Commercial |
$240.25
|
| Rate for Payer: Centivo All Commercial |
$240.25
|
| Rate for Payer: Cigna All Commercial |
$155.00
|
| Rate for Payer: Cigna All Commercial |
$155.00
|
| Rate for Payer: CORVEL All Commercial |
$155.00
|
| Rate for Payer: CORVEL All Commercial |
$155.00
|
| Rate for Payer: Coventry All Commercial |
$186.00
|
| Rate for Payer: Coventry All Commercial |
$186.00
|
| Rate for Payer: Encore All Commercial |
$155.00
|
| Rate for Payer: Encore All Commercial |
$155.00
|
| Rate for Payer: Frontpath All Commercial |
$212.06
|
| Rate for Payer: Frontpath All Commercial |
$212.06
|
| Rate for Payer: Humana ChoiceCare |
$227.98
|
| Rate for Payer: Humana ChoiceCare |
$227.98
|
| Rate for Payer: Humana Medicare |
$155.00
|
| Rate for Payer: Humana Medicare |
$155.00
|
| Rate for Payer: Lucent All Commercial |
$217.00
|
| Rate for Payer: Lucent All Commercial |
$217.00
|
| Rate for Payer: Managed Health Services Medicaid |
$537.66
|
| Rate for Payer: Managed Health Services Medicaid |
$537.66
|
| Rate for Payer: MDWise Medicaid |
$537.66
|
| Rate for Payer: MDWise Medicaid |
$537.66
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$161.87
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$161.87
|
| Rate for Payer: PHCS All Commercial |
$155.00
|
| Rate for Payer: PHCS All Commercial |
$155.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.00
|
| Rate for Payer: Sagamore Health Network All Products |
$155.00
|
| Rate for Payer: Sagamore Health Network All Products |
$155.00
|
| Rate for Payer: United Healthcare Commercial |
$241.43
|
| Rate for Payer: United Healthcare Commercial |
$241.43
|
| Rate for Payer: United Healthcare Medicare |
$543.34
|
| Rate for Payer: United Healthcare Medicare |
$543.34
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
Both
|
$342.90
|
|
|
Service Code
|
CPT 43195
|
| Hospital Charge Code |
z43195
|
| Min. Negotiated Rate |
$168.64 |
| Max. Negotiated Rate |
$267.61 |
| Rate for Payer: Aetna Commercial |
$172.65
|
| Rate for Payer: Aetna Commercial |
$172.65
|
| Rate for Payer: Aetna Medicare |
$172.65
|
| Rate for Payer: Aetna Medicare |
$172.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$168.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$168.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.91
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cash Price |
$205.74
|
| Rate for Payer: Centivo All Commercial |
$267.61
|
| Rate for Payer: Centivo All Commercial |
$267.61
|
| Rate for Payer: Cigna All Commercial |
$172.65
|
| Rate for Payer: Cigna All Commercial |
$172.65
|
| Rate for Payer: CORVEL All Commercial |
$172.65
|
| Rate for Payer: CORVEL All Commercial |
$172.65
|
| Rate for Payer: Coventry All Commercial |
$207.18
|
| Rate for Payer: Coventry All Commercial |
$207.18
|
| Rate for Payer: Encore All Commercial |
$172.65
|
| Rate for Payer: Encore All Commercial |
$172.65
|
| Rate for Payer: Frontpath All Commercial |
$237.73
|
| Rate for Payer: Frontpath All Commercial |
$237.73
|
| Rate for Payer: Humana ChoiceCare |
$210.61
|
| Rate for Payer: Humana ChoiceCare |
$210.61
|
| Rate for Payer: Humana Medicare |
$172.65
|
| Rate for Payer: Humana Medicare |
$172.65
|
| Rate for Payer: Lucent All Commercial |
$241.71
|
| Rate for Payer: Lucent All Commercial |
$241.71
|
| Rate for Payer: Managed Health Services Medicaid |
$168.66
|
| Rate for Payer: Managed Health Services Medicaid |
$168.66
|
| Rate for Payer: MDWise Medicaid |
$168.66
|
| Rate for Payer: MDWise Medicaid |
$168.66
|
| Rate for Payer: PHCS All Commercial |
$172.65
|
| Rate for Payer: PHCS All Commercial |
$172.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.65
|
| Rate for Payer: Sagamore Health Network All Products |
$172.65
|
| Rate for Payer: Sagamore Health Network All Products |
$172.65
|
| Rate for Payer: United Healthcare Commercial |
$220.88
|
| Rate for Payer: United Healthcare Commercial |
$220.88
|
| Rate for Payer: United Healthcare Medicare |
$168.64
|
| Rate for Payer: United Healthcare Medicare |
$168.64
|
|
|
PR EVACUATE MOLE OF UTERUS
|
Professional
|
Both
|
$977.40
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
z59870
|
| Min. Negotiated Rate |
$405.01 |
| Max. Negotiated Rate |
$64,000.00 |
| Rate for Payer: Aetna Commercial |
$494.47
|
| Rate for Payer: Aetna Commercial |
$494.47
|
| Rate for Payer: Aetna Medicare |
$494.47
|
| Rate for Payer: Aetna Medicare |
$494.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$480.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$480.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$568.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$568.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.92
|
| Rate for Payer: Cash Price |
$586.44
|
| Rate for Payer: Cash Price |
$576.24
|
| Rate for Payer: Centivo All Commercial |
$766.43
|
| Rate for Payer: Centivo All Commercial |
$766.43
|
| Rate for Payer: Cigna All Commercial |
$494.47
|
| Rate for Payer: Cigna All Commercial |
$494.47
|
| Rate for Payer: CORVEL All Commercial |
$494.47
|
| Rate for Payer: CORVEL All Commercial |
$494.47
|
| Rate for Payer: Coventry All Commercial |
$593.36
|
| Rate for Payer: Coventry All Commercial |
$593.36
|
| Rate for Payer: Encore All Commercial |
$494.47
|
| Rate for Payer: Encore All Commercial |
$494.47
|
| Rate for Payer: Frontpath All Commercial |
$689.41
|
| Rate for Payer: Frontpath All Commercial |
$689.41
|
| Rate for Payer: Humana ChoiceCare |
$405.01
|
| Rate for Payer: Humana ChoiceCare |
$405.01
|
| Rate for Payer: Humana Medicare |
$494.47
|
| Rate for Payer: Humana Medicare |
$494.47
|
| Rate for Payer: Lucent All Commercial |
$692.26
|
| Rate for Payer: Lucent All Commercial |
$692.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$689.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$689.00
|
| Rate for Payer: Managed Health Services Medicaid |
$480.72
|
| Rate for Payer: Managed Health Services Medicaid |
$480.72
|
| Rate for Payer: MDWise Medicaid |
$480.72
|
| Rate for Payer: MDWise Medicaid |
$480.72
|
| Rate for Payer: PHCS All Commercial |
$494.47
|
| Rate for Payer: PHCS All Commercial |
$494.47
|
| Rate for Payer: PHP All Commercial |
$633.86
|
| Rate for Payer: PHP All Commercial |
$633.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$494.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$494.47
|
| Rate for Payer: Sagamore Health Network All Products |
$494.47
|
| Rate for Payer: Sagamore Health Network All Products |
$494.47
|
| Rate for Payer: Signature Care EPO |
$510.00
|
| Rate for Payer: Signature Care EPO |
$510.00
|
| Rate for Payer: Signature Care PPO |
$510.00
|
| Rate for Payer: Signature Care PPO |
$510.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64,000.00
|
| Rate for Payer: United Healthcare Commercial |
$518.50
|
| Rate for Payer: United Healthcare Commercial |
$518.50
|
| Rate for Payer: United Healthcare Medicare |
$480.20
|
| Rate for Payer: United Healthcare Medicare |
$480.20
|
|
|
PR EVOKED AUDITORY TEST,COMPREHSV
|
Professional
|
Both
|
$63.50
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
z92588
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$32.75
|
| Rate for Payer: Aetna Commercial |
$32.75
|
| Rate for Payer: Aetna Medicare |
$32.75
|
| Rate for Payer: Aetna Medicare |
$32.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.02
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Centivo All Commercial |
$50.76
|
| Rate for Payer: Centivo All Commercial |
$50.76
|
| Rate for Payer: Cigna All Commercial |
$32.75
|
| Rate for Payer: Cigna All Commercial |
$32.75
|
| Rate for Payer: CORVEL All Commercial |
$32.75
|
| Rate for Payer: CORVEL All Commercial |
$32.75
|
| Rate for Payer: Coventry All Commercial |
$39.30
|
| Rate for Payer: Coventry All Commercial |
$39.30
|
| Rate for Payer: Encore All Commercial |
$32.75
|
| Rate for Payer: Encore All Commercial |
$32.75
|
| Rate for Payer: Frontpath All Commercial |
$36.72
|
| Rate for Payer: Frontpath All Commercial |
$36.72
|
| Rate for Payer: Humana ChoiceCare |
$84.15
|
| Rate for Payer: Humana ChoiceCare |
$84.15
|
| Rate for Payer: Humana Medicare |
$32.75
|
| Rate for Payer: Humana Medicare |
$32.75
|
| Rate for Payer: Lucent All Commercial |
$45.85
|
| Rate for Payer: Lucent All Commercial |
$45.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.01
|
| Rate for Payer: Managed Health Services Medicaid |
$31.01
|
| Rate for Payer: MDWise Medicaid |
$31.01
|
| Rate for Payer: MDWise Medicaid |
$31.01
|
| Rate for Payer: PHCS All Commercial |
$32.75
|
| Rate for Payer: PHCS All Commercial |
$32.75
|
| Rate for Payer: PHP All Commercial |
$46.04
|
| Rate for Payer: PHP All Commercial |
$46.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.75
|
| Rate for Payer: Sagamore Health Network All Products |
$32.75
|
| Rate for Payer: Sagamore Health Network All Products |
$32.75
|
| Rate for Payer: Signature Care EPO |
$54.33
|
| Rate for Payer: Signature Care EPO |
$54.33
|
| Rate for Payer: Signature Care PPO |
$54.33
|
| Rate for Payer: Signature Care PPO |
$54.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare Commercial |
$71.33
|
| Rate for Payer: United Healthcare Commercial |
$71.33
|
|
|
PR EVOKED AUDITORY TEST,LIMITED
|
Professional
|
Both
|
$40.64
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
z92587
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$21.15
|
| Rate for Payer: Aetna Commercial |
$21.15
|
| Rate for Payer: Aetna Medicare |
$21.15
|
| Rate for Payer: Aetna Medicare |
$21.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.27
|
| Rate for Payer: Cash Price |
$24.31
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Centivo All Commercial |
$32.78
|
| Rate for Payer: Centivo All Commercial |
$32.78
|
| Rate for Payer: Cigna All Commercial |
$21.15
|
| Rate for Payer: Cigna All Commercial |
$21.15
|
| Rate for Payer: CORVEL All Commercial |
$21.15
|
| Rate for Payer: CORVEL All Commercial |
$21.15
|
| Rate for Payer: Coventry All Commercial |
$25.38
|
| Rate for Payer: Coventry All Commercial |
$25.38
|
| Rate for Payer: Encore All Commercial |
$21.15
|
| Rate for Payer: Encore All Commercial |
$21.15
|
| Rate for Payer: Frontpath All Commercial |
$23.89
|
| Rate for Payer: Frontpath All Commercial |
$23.89
|
| Rate for Payer: Humana ChoiceCare |
$63.12
|
| Rate for Payer: Humana ChoiceCare |
$63.12
|
| Rate for Payer: Humana Medicare |
$21.15
|
| Rate for Payer: Humana Medicare |
$21.15
|
| Rate for Payer: Lucent All Commercial |
$29.61
|
| Rate for Payer: Lucent All Commercial |
$29.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.00
|
| Rate for Payer: Managed Health Services Medicaid |
$19.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.93
|
| Rate for Payer: MDWise Medicaid |
$19.93
|
| Rate for Payer: MDWise Medicaid |
$19.93
|
| Rate for Payer: PHCS All Commercial |
$21.15
|
| Rate for Payer: PHCS All Commercial |
$21.15
|
| Rate for Payer: PHP All Commercial |
$29.46
|
| Rate for Payer: PHP All Commercial |
$29.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.15
|
| Rate for Payer: Sagamore Health Network All Products |
$21.15
|
| Rate for Payer: Sagamore Health Network All Products |
$21.15
|
| Rate for Payer: Signature Care EPO |
$35.46
|
| Rate for Payer: Signature Care EPO |
$35.46
|
| Rate for Payer: Signature Care PPO |
$35.46
|
| Rate for Payer: Signature Care PPO |
$35.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,500.00
|
| Rate for Payer: United Healthcare Commercial |
$43.04
|
| Rate for Payer: United Healthcare Commercial |
$43.04
|
|
|
PR EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS
|
Professional
|
Both
|
$17.28
|
|
|
Service Code
|
CPT 92558
|
| Hospital Charge Code |
z92558
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$11.45 |
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Frontpath All Commercial |
$9.05
|
| Rate for Payer: Humana ChoiceCare |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
| Rate for Payer: United Healthcare Medicare |
$8.79
|
|
|
PR EXCIS BARTHOLIN GLAND/CYST
|
Professional
|
Both
|
$585.56
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
z56740
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$38,400.00 |
| Rate for Payer: Aetna Commercial |
$298.26
|
| Rate for Payer: Aetna Commercial |
$298.26
|
| Rate for Payer: Aetna Medicare |
$298.26
|
| Rate for Payer: Aetna Medicare |
$298.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$376.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$288.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$288.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$343.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$343.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$328.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$328.09
|
| Rate for Payer: Cash Price |
$351.34
|
| Rate for Payer: Cash Price |
$345.67
|
| Rate for Payer: Centivo All Commercial |
$462.30
|
| Rate for Payer: Centivo All Commercial |
$462.30
|
| Rate for Payer: Cigna All Commercial |
$298.26
|
| Rate for Payer: Cigna All Commercial |
$298.26
|
| Rate for Payer: CORVEL All Commercial |
$298.26
|
| Rate for Payer: CORVEL All Commercial |
$298.26
|
| Rate for Payer: Coventry All Commercial |
$357.91
|
| Rate for Payer: Coventry All Commercial |
$357.91
|
| Rate for Payer: Encore All Commercial |
$298.26
|
| Rate for Payer: Encore All Commercial |
$298.26
|
| Rate for Payer: Frontpath All Commercial |
$413.69
|
| Rate for Payer: Frontpath All Commercial |
$413.69
|
| Rate for Payer: Humana ChoiceCare |
$316.26
|
| Rate for Payer: Humana ChoiceCare |
$316.26
|
| Rate for Payer: Humana Medicare |
$298.26
|
| Rate for Payer: Humana Medicare |
$298.26
|
| Rate for Payer: Lucent All Commercial |
$417.56
|
| Rate for Payer: Lucent All Commercial |
$417.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$413.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$413.00
|
| Rate for Payer: Managed Health Services Medicaid |
$288.00
|
| Rate for Payer: Managed Health Services Medicaid |
$288.00
|
| Rate for Payer: MDWise Medicaid |
$288.00
|
| Rate for Payer: MDWise Medicaid |
$288.00
|
| Rate for Payer: PHCS All Commercial |
$298.26
|
| Rate for Payer: PHCS All Commercial |
$298.26
|
| Rate for Payer: PHP All Commercial |
$380.24
|
| Rate for Payer: PHP All Commercial |
$380.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$298.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$298.26
|
| Rate for Payer: Sagamore Health Network All Products |
$298.26
|
| Rate for Payer: Sagamore Health Network All Products |
$298.26
|
| Rate for Payer: Signature Care EPO |
$348.50
|
| Rate for Payer: Signature Care EPO |
$348.50
|
| Rate for Payer: Signature Care PPO |
$348.50
|
| Rate for Payer: Signature Care PPO |
$348.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38,400.00
|
| Rate for Payer: United Healthcare Commercial |
$333.45
|
| Rate for Payer: United Healthcare Commercial |
$333.45
|
| Rate for Payer: United Healthcare Medicare |
$288.06
|
| Rate for Payer: United Healthcare Medicare |
$288.06
|
|
|
PR EXCIS BENIGN BONE LESN,METACARPAL
|
Professional
|
Both
|
$847.44
|
|
|
Service Code
|
CPT 26200
|
| Hospital Charge Code |
z26200
|
| Min. Negotiated Rate |
$413.95 |
| Max. Negotiated Rate |
$63,700.00 |
| Rate for Payer: Aetna Commercial |
$421.25
|
| Rate for Payer: Aetna Commercial |
$421.25
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$651.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$416.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$416.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$484.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$484.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$463.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$463.38
|
| Rate for Payer: Cash Price |
$508.46
|
| Rate for Payer: Cash Price |
$496.74
|
| Rate for Payer: Centivo All Commercial |
$652.94
|
| Rate for Payer: Centivo All Commercial |
$652.94
|
| Rate for Payer: Cigna All Commercial |
$421.25
|
| Rate for Payer: Cigna All Commercial |
$421.25
|
| Rate for Payer: CORVEL All Commercial |
$421.25
|
| Rate for Payer: CORVEL All Commercial |
$421.25
|
| Rate for Payer: Coventry All Commercial |
$505.50
|
| Rate for Payer: Coventry All Commercial |
$505.50
|
| Rate for Payer: Encore All Commercial |
$421.25
|
| Rate for Payer: Encore All Commercial |
$421.25
|
| Rate for Payer: Frontpath All Commercial |
$580.97
|
| Rate for Payer: Frontpath All Commercial |
$580.97
|
| Rate for Payer: Humana ChoiceCare |
$469.28
|
| Rate for Payer: Humana ChoiceCare |
$469.28
|
| Rate for Payer: Humana Medicare |
$421.25
|
| Rate for Payer: Humana Medicare |
$421.25
|
| Rate for Payer: Lucent All Commercial |
$589.75
|
| Rate for Payer: Lucent All Commercial |
$589.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.00
|
| Rate for Payer: Managed Health Services Medicaid |
$416.81
|
| Rate for Payer: Managed Health Services Medicaid |
$416.81
|
| Rate for Payer: MDWise Medicaid |
$416.81
|
| Rate for Payer: MDWise Medicaid |
$416.81
|
| Rate for Payer: PHCS All Commercial |
$421.25
|
| Rate for Payer: PHCS All Commercial |
$421.25
|
| Rate for Payer: PHP All Commercial |
$720.28
|
| Rate for Payer: PHP All Commercial |
$720.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$421.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$421.25
|
| Rate for Payer: Sagamore Health Network All Products |
$421.25
|
| Rate for Payer: Sagamore Health Network All Products |
$421.25
|
| Rate for Payer: Signature Care EPO |
$625.60
|
| Rate for Payer: Signature Care EPO |
$625.60
|
| Rate for Payer: Signature Care PPO |
$625.60
|
| Rate for Payer: Signature Care PPO |
$625.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63,700.00
|
| Rate for Payer: United Healthcare Commercial |
$477.23
|
| Rate for Payer: United Healthcare Commercial |
$477.23
|
| Rate for Payer: United Healthcare Medicare |
$413.95
|
| Rate for Payer: United Healthcare Medicare |
$413.95
|
|
|
PR EXCIS BENIGN LESN CARPALS
|
Professional
|
Both
|
$849.90
|
|
|
Service Code
|
CPT 25130
|
| Hospital Charge Code |
z25130
|
| Min. Negotiated Rate |
$414.77 |
| Max. Negotiated Rate |
$656.30 |
| Rate for Payer: Aetna Commercial |
$423.42
|
| Rate for Payer: Aetna Commercial |
$423.42
|
| Rate for Payer: Aetna Medicare |
$423.42
|
| Rate for Payer: Aetna Medicare |
$423.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$418.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$418.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$486.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$486.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$465.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$465.76
|
| Rate for Payer: Cash Price |
$497.72
|
| Rate for Payer: Cash Price |
$509.94
|
| Rate for Payer: Centivo All Commercial |
$656.30
|
| Rate for Payer: Centivo All Commercial |
$656.30
|
| Rate for Payer: Cigna All Commercial |
$423.42
|
| Rate for Payer: Cigna All Commercial |
$423.42
|
| Rate for Payer: CORVEL All Commercial |
$423.42
|
| Rate for Payer: CORVEL All Commercial |
$423.42
|
| Rate for Payer: Coventry All Commercial |
$508.10
|
| Rate for Payer: Coventry All Commercial |
$508.10
|
| Rate for Payer: Encore All Commercial |
$423.42
|
| Rate for Payer: Encore All Commercial |
$423.42
|
| Rate for Payer: Frontpath All Commercial |
$582.58
|
| Rate for Payer: Frontpath All Commercial |
$582.58
|
| Rate for Payer: Humana ChoiceCare |
$499.16
|
| Rate for Payer: Humana ChoiceCare |
$499.16
|
| Rate for Payer: Humana Medicare |
$423.42
|
| Rate for Payer: Humana Medicare |
$423.42
|
| Rate for Payer: Lucent All Commercial |
$592.79
|
| Rate for Payer: Lucent All Commercial |
$592.79
|
| Rate for Payer: Managed Health Services Medicaid |
$418.01
|
| Rate for Payer: Managed Health Services Medicaid |
$418.01
|
| Rate for Payer: MDWise Medicaid |
$418.01
|
| Rate for Payer: MDWise Medicaid |
$418.01
|
| Rate for Payer: PHCS All Commercial |
$423.42
|
| Rate for Payer: PHCS All Commercial |
$423.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$423.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$423.42
|
| Rate for Payer: Sagamore Health Network All Products |
$423.42
|
| Rate for Payer: Sagamore Health Network All Products |
$423.42
|
| Rate for Payer: United Healthcare Commercial |
$478.31
|
| Rate for Payer: United Healthcare Commercial |
$478.31
|
| Rate for Payer: United Healthcare Medicare |
$414.77
|
| Rate for Payer: United Healthcare Medicare |
$414.77
|
|
|
PR EXCIS/CURET BENIGN ELBOW LESN
|
Professional
|
Both
|
$997.28
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
z24120
|
| Min. Negotiated Rate |
$487.44 |
| Max. Negotiated Rate |
$773.62 |
| Rate for Payer: Aetna Commercial |
$499.11
|
| Rate for Payer: Aetna Commercial |
$499.11
|
| Rate for Payer: Aetna Medicare |
$499.11
|
| Rate for Payer: Aetna Medicare |
$499.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$490.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$490.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$573.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$573.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$549.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$549.02
|
| Rate for Payer: Cash Price |
$584.93
|
| Rate for Payer: Cash Price |
$598.37
|
| Rate for Payer: Centivo All Commercial |
$773.62
|
| Rate for Payer: Centivo All Commercial |
$773.62
|
| Rate for Payer: Cigna All Commercial |
$499.11
|
| Rate for Payer: Cigna All Commercial |
$499.11
|
| Rate for Payer: CORVEL All Commercial |
$499.11
|
| Rate for Payer: CORVEL All Commercial |
$499.11
|
| Rate for Payer: Coventry All Commercial |
$598.93
|
| Rate for Payer: Coventry All Commercial |
$598.93
|
| Rate for Payer: Encore All Commercial |
$499.11
|
| Rate for Payer: Encore All Commercial |
$499.11
|
| Rate for Payer: Frontpath All Commercial |
$691.02
|
| Rate for Payer: Frontpath All Commercial |
$691.02
|
| Rate for Payer: Humana ChoiceCare |
$545.78
|
| Rate for Payer: Humana ChoiceCare |
$545.78
|
| Rate for Payer: Humana Medicare |
$499.11
|
| Rate for Payer: Humana Medicare |
$499.11
|
| Rate for Payer: Lucent All Commercial |
$698.75
|
| Rate for Payer: Lucent All Commercial |
$698.75
|
| Rate for Payer: Managed Health Services Medicaid |
$490.50
|
| Rate for Payer: Managed Health Services Medicaid |
$490.50
|
| Rate for Payer: MDWise Medicaid |
$490.50
|
| Rate for Payer: MDWise Medicaid |
$490.50
|
| Rate for Payer: PHCS All Commercial |
$499.11
|
| Rate for Payer: PHCS All Commercial |
$499.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.11
|
| Rate for Payer: Sagamore Health Network All Products |
$499.11
|
| Rate for Payer: Sagamore Health Network All Products |
$499.11
|
| Rate for Payer: United Healthcare Commercial |
$557.35
|
| Rate for Payer: United Healthcare Commercial |
$557.35
|
| Rate for Payer: United Healthcare Medicare |
$487.44
|
| Rate for Payer: United Healthcare Medicare |
$487.44
|
|
