|
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 |
$339.72
|
| Rate for Payer: Cash Price |
$339.72
|
| 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 |
$906.90
|
| Rate for Payer: Cash Price |
$930.47
|
| 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 Medicare |
$414.37
|
| Rate for Payer: Molina Healthcare of OH 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 |
$256.23
|
| Rate for Payer: Cash Price |
$259.28
|
| 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 Medicare |
$74.92
|
| Rate for Payer: Molina Healthcare of OH 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 |
$455.04
|
| Rate for Payer: Cash Price |
$459.73
|
| 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 Medicare |
$139.12
|
| Rate for Payer: Molina Healthcare of OH 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 |
$326.41
|
| Rate for Payer: Cash Price |
$330.47
|
| 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 Medicare |
$124.24
|
| Rate for Payer: Molina Healthcare of OH 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 |
$448.17
|
| Rate for Payer: Cash Price |
$320.85
|
| 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 Medicare |
$132.01
|
| Rate for Payer: Molina Healthcare of OH 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 |
$477.11
|
| Rate for Payer: Cash Price |
$482.20
|
| 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 Medicare |
$152.62
|
| Rate for Payer: Molina Healthcare of OH 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 |
$407.08
|
| 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 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 |
$294.60
|
| Rate for Payer: Cash Price |
$297.67
|
| 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 Medicare |
$104.86
|
| Rate for Payer: Molina Healthcare of OH 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 |
$673.74
|
| Rate for Payer: Cash Price |
$677.76
|
| 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 Medicare |
$161.87
|
| Rate for Payer: Molina Healthcare of OH 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 |
$209.11
|
| Rate for Payer: Cash Price |
$212.60
|
| 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 |
$605.99
|
| Rate for Payer: Cash Price |
$595.45
|
| 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 |
$39.08
|
| Rate for Payer: Cash Price |
$39.37
|
| 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 |
$25.12
|
| Rate for Payer: Cash Price |
$25.20
|
| 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 |
$10.71
|
| 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 |
$363.05
|
| Rate for Payer: Cash Price |
$357.19
|
| 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 |
$525.41
|
| Rate for Payer: Cash Price |
$513.30
|
| 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 |
$514.31
|
| Rate for Payer: Cash Price |
$526.94
|
| 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 |
$604.43
|
| Rate for Payer: Cash Price |
$618.31
|
| 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
|
|
|
PR EXCIS/CURET BENIGN TUMR CLAV/SCAPULA
|
Professional
|
Both
|
$1,037.42
|
|
|
Service Code
|
CPT 23140
|
| Hospital Charge Code |
z23140
|
| Min. Negotiated Rate |
$506.78 |
| Max. Negotiated Rate |
$77,900.00 |
| Rate for Payer: Aetna Commercial |
$518.90
|
| Rate for Payer: Aetna Commercial |
$518.90
|
| Rate for Payer: Aetna Medicare |
$518.90
|
| Rate for Payer: Aetna Medicare |
$518.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$510.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$510.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$596.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$596.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$570.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$570.79
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$628.41
|
| Rate for Payer: Centivo All Commercial |
$804.29
|
| Rate for Payer: Centivo All Commercial |
$804.29
|
| Rate for Payer: Cigna All Commercial |
$518.90
|
| Rate for Payer: Cigna All Commercial |
$518.90
|
| Rate for Payer: CORVEL All Commercial |
$518.90
|
| Rate for Payer: CORVEL All Commercial |
$518.90
|
| Rate for Payer: Coventry All Commercial |
$622.68
|
| Rate for Payer: Coventry All Commercial |
$622.68
|
| Rate for Payer: Encore All Commercial |
$518.90
|
| Rate for Payer: Encore All Commercial |
$518.90
|
| Rate for Payer: Frontpath All Commercial |
$720.85
|
| Rate for Payer: Frontpath All Commercial |
$720.85
|
| Rate for Payer: Humana ChoiceCare |
$528.19
|
| Rate for Payer: Humana ChoiceCare |
$528.19
|
| Rate for Payer: Humana Medicare |
$518.90
|
| Rate for Payer: Humana Medicare |
$518.90
|
| Rate for Payer: Lucent All Commercial |
$726.46
|
| Rate for Payer: Lucent All Commercial |
$726.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.00
|
| Rate for Payer: Managed Health Services Medicaid |
$510.24
|
| Rate for Payer: Managed Health Services Medicaid |
$510.24
|
| Rate for Payer: MDWise Medicaid |
$510.24
|
| Rate for Payer: MDWise Medicaid |
$510.24
|
| Rate for Payer: PHCS All Commercial |
$518.90
|
| Rate for Payer: PHCS All Commercial |
$518.90
|
| Rate for Payer: PHP All Commercial |
$881.80
|
| Rate for Payer: PHP All Commercial |
$881.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$518.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$518.90
|
| Rate for Payer: Sagamore Health Network All Products |
$518.90
|
| Rate for Payer: Sagamore Health Network All Products |
$518.90
|
| Rate for Payer: Signature Care EPO |
$715.70
|
| Rate for Payer: Signature Care EPO |
$715.70
|
| Rate for Payer: Signature Care PPO |
$715.70
|
| Rate for Payer: Signature Care PPO |
$715.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77,900.00
|
| Rate for Payer: United Healthcare Commercial |
$551.71
|
| Rate for Payer: United Healthcare Commercial |
$551.71
|
| Rate for Payer: United Healthcare Medicare |
$506.78
|
| Rate for Payer: United Healthcare Medicare |
$506.78
|
|
|
PR EXCIS/DEST INTRANAS LESION; INT APP
|
Professional
|
Both
|
$1,828.90
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
z30117
|
| Min. Negotiated Rate |
$177.52 |
| Max. Negotiated Rate |
$47,000.00 |
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: Aetna Medicare |
$312.38
|
| Rate for Payer: Aetna Medicare |
$312.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$177.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$177.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$899.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$899.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$359.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$359.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.62
|
| Rate for Payer: Cash Price |
$1,101.29
|
| Rate for Payer: Cash Price |
$1,133.92
|
| Rate for Payer: Centivo All Commercial |
$484.19
|
| Rate for Payer: Centivo All Commercial |
$484.19
|
| Rate for Payer: Cigna All Commercial |
$312.38
|
| Rate for Payer: Cigna All Commercial |
$312.38
|
| Rate for Payer: CORVEL All Commercial |
$312.38
|
| Rate for Payer: CORVEL All Commercial |
$312.38
|
| Rate for Payer: Coventry All Commercial |
$374.86
|
| Rate for Payer: Coventry All Commercial |
$374.86
|
| Rate for Payer: Encore All Commercial |
$312.38
|
| Rate for Payer: Encore All Commercial |
$312.38
|
| Rate for Payer: Frontpath All Commercial |
$422.15
|
| Rate for Payer: Frontpath All Commercial |
$422.15
|
| Rate for Payer: Humana ChoiceCare |
$344.29
|
| Rate for Payer: Humana ChoiceCare |
$344.29
|
| Rate for Payer: Humana Medicare |
$312.38
|
| Rate for Payer: Humana Medicare |
$312.38
|
| Rate for Payer: Lucent All Commercial |
$437.33
|
| Rate for Payer: Lucent All Commercial |
$437.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$501.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$501.00
|
| Rate for Payer: Managed Health Services Medicaid |
$899.53
|
| Rate for Payer: Managed Health Services Medicaid |
$899.53
|
| Rate for Payer: MDWise Medicaid |
$899.53
|
| Rate for Payer: MDWise Medicaid |
$899.53
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$177.52
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$177.52
|
| Rate for Payer: PHCS All Commercial |
$312.38
|
| Rate for Payer: PHCS All Commercial |
$312.38
|
| Rate for Payer: PHP All Commercial |
$427.91
|
| Rate for Payer: PHP All Commercial |
$427.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.38
|
| Rate for Payer: Sagamore Health Network All Products |
$312.38
|
| Rate for Payer: Sagamore Health Network All Products |
$312.38
|
| Rate for Payer: Signature Care EPO |
$788.11
|
| Rate for Payer: Signature Care EPO |
$788.11
|
| Rate for Payer: Signature Care PPO |
$788.11
|
| Rate for Payer: Signature Care PPO |
$788.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47,000.00
|
| Rate for Payer: United Healthcare Commercial |
$351.19
|
| Rate for Payer: United Healthcare Commercial |
$351.19
|
| Rate for Payer: United Healthcare Medicare |
$888.14
|
| Rate for Payer: United Healthcare Medicare |
$888.14
|
|
|
PR EXCISE BREAST CYST
|
Professional
|
Both
|
$953.52
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
z19120
|
| Min. Negotiated Rate |
$215.08 |
| Max. Negotiated Rate |
$46,000.00 |
| Rate for Payer: Aetna Commercial |
$386.10
|
| Rate for Payer: Aetna Commercial |
$386.10
|
| Rate for Payer: Aetna Medicare |
$386.10
|
| Rate for Payer: Aetna Medicare |
$386.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$215.08
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$215.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$468.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$468.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$424.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$424.71
|
| Rate for Payer: Cash Price |
$578.84
|
| Rate for Payer: Cash Price |
$591.18
|
| Rate for Payer: Centivo All Commercial |
$598.46
|
| Rate for Payer: Centivo All Commercial |
$598.46
|
| Rate for Payer: Cigna All Commercial |
$386.10
|
| Rate for Payer: Cigna All Commercial |
$386.10
|
| Rate for Payer: CORVEL All Commercial |
$386.10
|
| Rate for Payer: CORVEL All Commercial |
$386.10
|
| Rate for Payer: Coventry All Commercial |
$463.32
|
| Rate for Payer: Coventry All Commercial |
$463.32
|
| Rate for Payer: Encore All Commercial |
$386.10
|
| Rate for Payer: Encore All Commercial |
$386.10
|
| Rate for Payer: Frontpath All Commercial |
$545.36
|
| Rate for Payer: Frontpath All Commercial |
$545.36
|
| Rate for Payer: Humana ChoiceCare |
$327.80
|
| Rate for Payer: Humana ChoiceCare |
$327.80
|
| Rate for Payer: Humana Medicare |
$386.10
|
| Rate for Payer: Humana Medicare |
$386.10
|
| Rate for Payer: Lucent All Commercial |
$540.54
|
| Rate for Payer: Lucent All Commercial |
$540.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$499.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$468.98
|
| Rate for Payer: Managed Health Services Medicaid |
$468.98
|
| Rate for Payer: MDWise Medicaid |
$468.98
|
| Rate for Payer: MDWise Medicaid |
$468.98
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$215.08
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$215.08
|
| Rate for Payer: PHCS All Commercial |
$386.10
|
| Rate for Payer: PHCS All Commercial |
$386.10
|
| Rate for Payer: PHP All Commercial |
$524.08
|
| Rate for Payer: PHP All Commercial |
$524.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.10
|
| Rate for Payer: Sagamore Health Network All Products |
$386.10
|
| Rate for Payer: Sagamore Health Network All Products |
$386.10
|
| Rate for Payer: Signature Care EPO |
$455.60
|
| Rate for Payer: Signature Care EPO |
$455.60
|
| Rate for Payer: Signature Care PPO |
$455.60
|
| Rate for Payer: Signature Care PPO |
$455.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46,000.00
|
| Rate for Payer: United Healthcare Commercial |
$421.65
|
| Rate for Payer: United Healthcare Commercial |
$421.65
|
| Rate for Payer: United Healthcare Medicare |
$466.81
|
| Rate for Payer: United Healthcare Medicare |
$466.81
|
|
|
PR EXCISE BREAST LES W XRAY MARKER
|
Professional
|
Both
|
$1,049.32
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
z19125
|
| Min. Negotiated Rate |
$238.61 |
| Max. Negotiated Rate |
$50,900.00 |
| Rate for Payer: Aetna Commercial |
$427.66
|
| Rate for Payer: Aetna Commercial |
$427.66
|
| Rate for Payer: Aetna Medicare |
$427.66
|
| Rate for Payer: Aetna Medicare |
$427.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$649.64
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$238.61
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$238.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$516.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$516.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$491.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$491.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$470.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$470.43
|
| Rate for Payer: Cash Price |
$637.10
|
| Rate for Payer: Cash Price |
$650.58
|
| Rate for Payer: Centivo All Commercial |
$662.87
|
| Rate for Payer: Centivo All Commercial |
$662.87
|
| Rate for Payer: Cigna All Commercial |
$427.66
|
| Rate for Payer: Cigna All Commercial |
$427.66
|
| Rate for Payer: CORVEL All Commercial |
$427.66
|
| Rate for Payer: CORVEL All Commercial |
$427.66
|
| Rate for Payer: Coventry All Commercial |
$513.19
|
| Rate for Payer: Coventry All Commercial |
$513.19
|
| Rate for Payer: Encore All Commercial |
$427.66
|
| Rate for Payer: Encore All Commercial |
$427.66
|
| Rate for Payer: Frontpath All Commercial |
$606.11
|
| Rate for Payer: Frontpath All Commercial |
$606.11
|
| Rate for Payer: Humana ChoiceCare |
$355.46
|
| Rate for Payer: Humana ChoiceCare |
$355.46
|
| Rate for Payer: Humana Medicare |
$427.66
|
| Rate for Payer: Humana Medicare |
$427.66
|
| Rate for Payer: Lucent All Commercial |
$598.72
|
| Rate for Payer: Lucent All Commercial |
$598.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.00
|
| Rate for Payer: Managed Health Services Medicaid |
$516.10
|
| Rate for Payer: Managed Health Services Medicaid |
$516.10
|
| Rate for Payer: MDWise Medicaid |
$516.10
|
| Rate for Payer: MDWise Medicaid |
$516.10
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$238.61
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$238.61
|
| Rate for Payer: PHCS All Commercial |
$427.66
|
| Rate for Payer: PHCS All Commercial |
$427.66
|
| Rate for Payer: PHP All Commercial |
$579.32
|
| Rate for Payer: PHP All Commercial |
$579.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.66
|
| Rate for Payer: Sagamore Health Network All Products |
$427.66
|
| Rate for Payer: Sagamore Health Network All Products |
$427.66
|
| Rate for Payer: Signature Care EPO |
$485.35
|
| Rate for Payer: Signature Care EPO |
$485.35
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,900.00
|
| Rate for Payer: United Healthcare Commercial |
$468.11
|
| Rate for Payer: United Healthcare Commercial |
$468.11
|
| Rate for Payer: United Healthcare Medicare |
$513.79
|
| Rate for Payer: United Healthcare Medicare |
$513.79
|
|
|
PR EXCISE BREAST LES XRAY MARK ADDNL
|
Professional
|
Both
|
$286.48
|
|
|
Service Code
|
CPT 19126
|
| Hospital Charge Code |
z19126
|
| Min. Negotiated Rate |
$140.90 |
| Max. Negotiated Rate |
$17,400.00 |
| Rate for Payer: Aetna Commercial |
$147.71
|
| Rate for Payer: Aetna Commercial |
$147.71
|
| Rate for Payer: Aetna Medicare |
$147.71
|
| Rate for Payer: Aetna Medicare |
$147.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$140.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$140.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$169.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$169.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.48
|
| Rate for Payer: Cash Price |
$177.62
|
| Rate for Payer: Cash Price |
$175.21
|
| Rate for Payer: Centivo All Commercial |
$228.95
|
| Rate for Payer: Centivo All Commercial |
$228.95
|
| Rate for Payer: Cigna All Commercial |
$147.71
|
| Rate for Payer: Cigna All Commercial |
$147.71
|
| Rate for Payer: CORVEL All Commercial |
$147.71
|
| Rate for Payer: CORVEL All Commercial |
$147.71
|
| Rate for Payer: Coventry All Commercial |
$177.25
|
| Rate for Payer: Coventry All Commercial |
$177.25
|
| Rate for Payer: Encore All Commercial |
$147.71
|
| Rate for Payer: Encore All Commercial |
$147.71
|
| Rate for Payer: Frontpath All Commercial |
$213.33
|
| Rate for Payer: Frontpath All Commercial |
$213.33
|
| Rate for Payer: Humana ChoiceCare |
$151.65
|
| Rate for Payer: Humana ChoiceCare |
$151.65
|
| Rate for Payer: Humana Medicare |
$147.71
|
| Rate for Payer: Humana Medicare |
$147.71
|
| Rate for Payer: Lucent All Commercial |
$206.79
|
| Rate for Payer: Lucent All Commercial |
$206.79
|
| 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 |
$140.90
|
| Rate for Payer: Managed Health Services Medicaid |
$140.90
|
| Rate for Payer: MDWise Medicaid |
$140.90
|
| Rate for Payer: MDWise Medicaid |
$140.90
|
| Rate for Payer: PHCS All Commercial |
$147.71
|
| Rate for Payer: PHCS All Commercial |
$147.71
|
| Rate for Payer: PHP All Commercial |
$197.83
|
| Rate for Payer: PHP All Commercial |
$197.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.71
|
| Rate for Payer: Sagamore Health Network All Products |
$147.71
|
| Rate for Payer: Sagamore Health Network All Products |
$147.71
|
| Rate for Payer: Signature Care EPO |
$168.30
|
| Rate for Payer: Signature Care EPO |
$168.30
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,400.00
|
| Rate for Payer: United Healthcare Commercial |
$177.54
|
| Rate for Payer: United Healthcare Commercial |
$177.54
|
| Rate for Payer: United Healthcare Medicare |
$141.30
|
| Rate for Payer: United Healthcare Medicare |
$141.30
|
|
|
PR EXCISE CUTANEOUS NEUROMA
|
Professional
|
Both
|
$794.96
|
|
|
Service Code
|
CPT 64774
|
| Hospital Charge Code |
z64774
|
| Min. Negotiated Rate |
$387.78 |
| Max. Negotiated Rate |
$604.98 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Medicare |
$390.31
|
| Rate for Payer: Aetna Medicare |
$390.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$390.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$390.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$448.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$448.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$429.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$429.34
|
| Rate for Payer: Cash Price |
$480.85
|
| Rate for Payer: Cash Price |
$492.88
|
| Rate for Payer: Centivo All Commercial |
$604.98
|
| Rate for Payer: Centivo All Commercial |
$604.98
|
| Rate for Payer: Cigna All Commercial |
$390.31
|
| Rate for Payer: Cigna All Commercial |
$390.31
|
| Rate for Payer: CORVEL All Commercial |
$390.31
|
| Rate for Payer: CORVEL All Commercial |
$390.31
|
| Rate for Payer: Coventry All Commercial |
$468.37
|
| Rate for Payer: Coventry All Commercial |
$468.37
|
| Rate for Payer: Encore All Commercial |
$390.31
|
| Rate for Payer: Encore All Commercial |
$390.31
|
| Rate for Payer: Frontpath All Commercial |
$540.07
|
| Rate for Payer: Frontpath All Commercial |
$540.07
|
| Rate for Payer: Humana ChoiceCare |
$458.50
|
| Rate for Payer: Humana ChoiceCare |
$458.50
|
| Rate for Payer: Humana Medicare |
$390.31
|
| Rate for Payer: Humana Medicare |
$390.31
|
| Rate for Payer: Lucent All Commercial |
$546.43
|
| Rate for Payer: Lucent All Commercial |
$546.43
|
| Rate for Payer: Managed Health Services Medicaid |
$390.99
|
| Rate for Payer: Managed Health Services Medicaid |
$390.99
|
| Rate for Payer: MDWise Medicaid |
$390.99
|
| Rate for Payer: MDWise Medicaid |
$390.99
|
| Rate for Payer: PHCS All Commercial |
$390.31
|
| Rate for Payer: PHCS All Commercial |
$390.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.31
|
| Rate for Payer: Sagamore Health Network All Products |
$390.31
|
| Rate for Payer: Sagamore Health Network All Products |
$390.31
|
| Rate for Payer: United Healthcare Commercial |
$441.68
|
| Rate for Payer: United Healthcare Commercial |
$441.68
|
| Rate for Payer: United Healthcare Medicare |
$387.78
|
| Rate for Payer: United Healthcare Medicare |
$387.78
|
|
