|
PR HYPNOTHERAPY
|
Professional
|
Both
|
$198.68
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
z90880
|
| Min. Negotiated Rate |
$87.08 |
| Max. Negotiated Rate |
$10,200.00 |
| Rate for Payer: Aetna Commercial |
$87.83
|
| Rate for Payer: Aetna Commercial |
$87.83
|
| Rate for Payer: Aetna Medicare |
$87.83
|
| Rate for Payer: Aetna Medicare |
$87.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.61
|
| Rate for Payer: Cash Price |
$118.01
|
| Rate for Payer: Cash Price |
$119.21
|
| Rate for Payer: Centivo All Commercial |
$136.14
|
| Rate for Payer: Centivo All Commercial |
$136.14
|
| Rate for Payer: Cigna All Commercial |
$87.83
|
| Rate for Payer: Cigna All Commercial |
$87.83
|
| Rate for Payer: CORVEL All Commercial |
$87.83
|
| Rate for Payer: CORVEL All Commercial |
$87.83
|
| Rate for Payer: Coventry All Commercial |
$105.40
|
| Rate for Payer: Coventry All Commercial |
$105.40
|
| Rate for Payer: Encore All Commercial |
$87.83
|
| Rate for Payer: Encore All Commercial |
$87.83
|
| Rate for Payer: Frontpath All Commercial |
$98.93
|
| Rate for Payer: Frontpath All Commercial |
$98.93
|
| Rate for Payer: Humana ChoiceCare |
$87.08
|
| Rate for Payer: Humana ChoiceCare |
$87.08
|
| Rate for Payer: Humana Medicare |
$87.83
|
| Rate for Payer: Humana Medicare |
$87.83
|
| Rate for Payer: Lucent All Commercial |
$122.96
|
| Rate for Payer: Lucent All Commercial |
$122.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.00
|
| Rate for Payer: PHCS All Commercial |
$87.83
|
| Rate for Payer: PHCS All Commercial |
$87.83
|
| Rate for Payer: PHP All Commercial |
$90.78
|
| Rate for Payer: PHP All Commercial |
$90.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.83
|
| Rate for Payer: Sagamore Health Network All Products |
$87.83
|
| Rate for Payer: Sagamore Health Network All Products |
$87.83
|
| Rate for Payer: Signature Care EPO |
$133.45
|
| Rate for Payer: Signature Care EPO |
$133.45
|
| Rate for Payer: Signature Care PPO |
$133.45
|
| Rate for Payer: Signature Care PPO |
$133.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,200.00
|
| Rate for Payer: United Healthcare Commercial |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$119.95
|
| Rate for Payer: United Healthcare Medicare |
$98.34
|
| Rate for Payer: United Healthcare Medicare |
$98.34
|
|
|
PR HYSTEROSCOPY,DX,SEP PROC
|
Professional
|
Both
|
$666.34
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
z58555
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$18,300.00 |
| Rate for Payer: Aetna Commercial |
$141.13
|
| Rate for Payer: Aetna Commercial |
$141.13
|
| Rate for Payer: Aetna Medicare |
$141.13
|
| Rate for Payer: Aetna Medicare |
$141.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$81.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$81.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$327.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$327.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.24
|
| Rate for Payer: Cash Price |
$398.22
|
| Rate for Payer: Cash Price |
$399.80
|
| Rate for Payer: Centivo All Commercial |
$218.75
|
| Rate for Payer: Centivo All Commercial |
$218.75
|
| Rate for Payer: Cigna All Commercial |
$141.13
|
| Rate for Payer: Cigna All Commercial |
$141.13
|
| Rate for Payer: CORVEL All Commercial |
$141.13
|
| Rate for Payer: CORVEL All Commercial |
$141.13
|
| Rate for Payer: Coventry All Commercial |
$169.36
|
| Rate for Payer: Coventry All Commercial |
$169.36
|
| Rate for Payer: Encore All Commercial |
$141.13
|
| Rate for Payer: Encore All Commercial |
$141.13
|
| Rate for Payer: Frontpath All Commercial |
$196.16
|
| Rate for Payer: Frontpath All Commercial |
$196.16
|
| Rate for Payer: Humana ChoiceCare |
$217.66
|
| Rate for Payer: Humana ChoiceCare |
$217.66
|
| Rate for Payer: Humana Medicare |
$141.13
|
| Rate for Payer: Humana Medicare |
$141.13
|
| Rate for Payer: Lucent All Commercial |
$197.58
|
| Rate for Payer: Lucent All Commercial |
$197.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.00
|
| Rate for Payer: Managed Health Services Medicaid |
$327.73
|
| Rate for Payer: Managed Health Services Medicaid |
$327.73
|
| Rate for Payer: MDWise Medicaid |
$327.73
|
| Rate for Payer: MDWise Medicaid |
$327.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$81.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$81.22
|
| Rate for Payer: PHCS All Commercial |
$141.13
|
| Rate for Payer: PHCS All Commercial |
$141.13
|
| Rate for Payer: PHP All Commercial |
$181.22
|
| Rate for Payer: PHP All Commercial |
$181.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.13
|
| Rate for Payer: Sagamore Health Network All Products |
$141.13
|
| Rate for Payer: Sagamore Health Network All Products |
$141.13
|
| Rate for Payer: Signature Care EPO |
$296.28
|
| Rate for Payer: Signature Care EPO |
$296.28
|
| Rate for Payer: Signature Care PPO |
$296.28
|
| Rate for Payer: Signature Care PPO |
$296.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,300.00
|
| Rate for Payer: United Healthcare Commercial |
$216.80
|
| Rate for Payer: United Healthcare Commercial |
$216.80
|
| Rate for Payer: United Healthcare Medicare |
$331.85
|
| Rate for Payer: United Healthcare Medicare |
$331.85
|
|
|
PR HYSTEROSCOPY,LYSIS ADHESIONS
|
Professional
|
Both
|
$522.54
|
|
|
Service Code
|
CPT 58559
|
| Hospital Charge Code |
z58559
|
| Min. Negotiated Rate |
$257.00 |
| Max. Negotiated Rate |
$34,300.00 |
| Rate for Payer: Aetna Commercial |
$266.67
|
| Rate for Payer: Aetna Commercial |
$266.67
|
| Rate for Payer: Aetna Medicare |
$266.67
|
| Rate for Payer: Aetna Medicare |
$266.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$257.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$257.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$293.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$293.34
|
| Rate for Payer: Cash Price |
$313.52
|
| Rate for Payer: Cash Price |
$309.23
|
| Rate for Payer: Centivo All Commercial |
$413.34
|
| Rate for Payer: Centivo All Commercial |
$413.34
|
| Rate for Payer: Cigna All Commercial |
$266.67
|
| Rate for Payer: Cigna All Commercial |
$266.67
|
| Rate for Payer: CORVEL All Commercial |
$266.67
|
| Rate for Payer: CORVEL All Commercial |
$266.67
|
| Rate for Payer: Coventry All Commercial |
$320.00
|
| Rate for Payer: Coventry All Commercial |
$320.00
|
| Rate for Payer: Encore All Commercial |
$266.67
|
| Rate for Payer: Encore All Commercial |
$266.67
|
| Rate for Payer: Frontpath All Commercial |
$372.37
|
| Rate for Payer: Frontpath All Commercial |
$372.37
|
| Rate for Payer: Humana ChoiceCare |
$397.51
|
| Rate for Payer: Humana ChoiceCare |
$397.51
|
| Rate for Payer: Humana Medicare |
$266.67
|
| Rate for Payer: Humana Medicare |
$266.67
|
| Rate for Payer: Lucent All Commercial |
$373.34
|
| Rate for Payer: Lucent All Commercial |
$373.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$370.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$370.00
|
| Rate for Payer: Managed Health Services Medicaid |
$257.00
|
| Rate for Payer: Managed Health Services Medicaid |
$257.00
|
| Rate for Payer: MDWise Medicaid |
$257.00
|
| Rate for Payer: MDWise Medicaid |
$257.00
|
| Rate for Payer: PHCS All Commercial |
$266.67
|
| Rate for Payer: PHCS All Commercial |
$266.67
|
| Rate for Payer: PHP All Commercial |
$340.15
|
| Rate for Payer: PHP All Commercial |
$340.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$266.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$266.67
|
| Rate for Payer: Sagamore Health Network All Products |
$266.67
|
| Rate for Payer: Sagamore Health Network All Products |
$266.67
|
| Rate for Payer: Signature Care EPO |
$442.00
|
| Rate for Payer: Signature Care EPO |
$442.00
|
| Rate for Payer: Signature Care PPO |
$442.00
|
| Rate for Payer: Signature Care PPO |
$442.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,300.00
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare |
$257.69
|
| Rate for Payer: United Healthcare Medicare |
$257.69
|
|
|
PR HYSTEROSCOPY,RMV FB
|
Professional
|
Both
|
$796.50
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
z58562
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$26,800.00 |
| Rate for Payer: Aetna Commercial |
$207.44
|
| Rate for Payer: Aetna Commercial |
$207.44
|
| Rate for Payer: Aetna Medicare |
$207.44
|
| Rate for Payer: Aetna Medicare |
$207.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.94
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$112.99
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$112.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$391.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$391.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$238.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$238.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.18
|
| Rate for Payer: Cash Price |
$475.44
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Centivo All Commercial |
$321.53
|
| Rate for Payer: Centivo All Commercial |
$321.53
|
| Rate for Payer: Cigna All Commercial |
$207.44
|
| Rate for Payer: Cigna All Commercial |
$207.44
|
| Rate for Payer: CORVEL All Commercial |
$207.44
|
| Rate for Payer: CORVEL All Commercial |
$207.44
|
| Rate for Payer: Coventry All Commercial |
$248.93
|
| Rate for Payer: Coventry All Commercial |
$248.93
|
| Rate for Payer: Encore All Commercial |
$207.44
|
| Rate for Payer: Encore All Commercial |
$207.44
|
| Rate for Payer: Frontpath All Commercial |
$289.16
|
| Rate for Payer: Frontpath All Commercial |
$289.16
|
| Rate for Payer: Humana ChoiceCare |
$337.56
|
| Rate for Payer: Humana ChoiceCare |
$337.56
|
| Rate for Payer: Humana Medicare |
$207.44
|
| Rate for Payer: Humana Medicare |
$207.44
|
| Rate for Payer: Lucent All Commercial |
$290.42
|
| Rate for Payer: Lucent All Commercial |
$290.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.00
|
| Rate for Payer: Managed Health Services Medicaid |
$391.75
|
| Rate for Payer: Managed Health Services Medicaid |
$391.75
|
| Rate for Payer: MDWise Medicaid |
$391.75
|
| Rate for Payer: MDWise Medicaid |
$391.75
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$112.99
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$112.99
|
| Rate for Payer: PHCS All Commercial |
$207.44
|
| Rate for Payer: PHCS All Commercial |
$207.44
|
| Rate for Payer: PHP All Commercial |
$265.37
|
| Rate for Payer: PHP All Commercial |
$265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.44
|
| Rate for Payer: Sagamore Health Network All Products |
$207.44
|
| Rate for Payer: Sagamore Health Network All Products |
$207.44
|
| Rate for Payer: Signature Care EPO |
$372.30
|
| Rate for Payer: Signature Care EPO |
$372.30
|
| Rate for Payer: Signature Care PPO |
$372.30
|
| Rate for Payer: Signature Care PPO |
$372.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26,800.00
|
| Rate for Payer: United Healthcare Commercial |
$333.39
|
| Rate for Payer: United Healthcare Commercial |
$333.39
|
| Rate for Payer: United Healthcare Medicare |
$396.20
|
| Rate for Payer: United Healthcare Medicare |
$396.20
|
|
|
PR HYSTEROSCOPY,RMV MYOMA
|
Professional
|
Both
|
$658.18
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
z58561
|
| Min. Negotiated Rate |
$323.72 |
| Max. Negotiated Rate |
$43,200.00 |
| Rate for Payer: Aetna Commercial |
$335.32
|
| Rate for Payer: Aetna Commercial |
$335.32
|
| Rate for Payer: Aetna Medicare |
$335.32
|
| Rate for Payer: Aetna Medicare |
$335.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,077.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$323.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$323.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$385.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$385.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$368.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$368.85
|
| Rate for Payer: Cash Price |
$394.91
|
| Rate for Payer: Cash Price |
$389.18
|
| Rate for Payer: Centivo All Commercial |
$519.75
|
| Rate for Payer: Centivo All Commercial |
$519.75
|
| Rate for Payer: Cigna All Commercial |
$335.32
|
| Rate for Payer: Cigna All Commercial |
$335.32
|
| Rate for Payer: CORVEL All Commercial |
$335.32
|
| Rate for Payer: CORVEL All Commercial |
$335.32
|
| Rate for Payer: Coventry All Commercial |
$402.38
|
| Rate for Payer: Coventry All Commercial |
$402.38
|
| Rate for Payer: Encore All Commercial |
$335.32
|
| Rate for Payer: Encore All Commercial |
$335.32
|
| Rate for Payer: Frontpath All Commercial |
$467.88
|
| Rate for Payer: Frontpath All Commercial |
$467.88
|
| Rate for Payer: Humana ChoiceCare |
$638.69
|
| Rate for Payer: Humana ChoiceCare |
$638.69
|
| Rate for Payer: Humana Medicare |
$335.32
|
| Rate for Payer: Humana Medicare |
$335.32
|
| Rate for Payer: Lucent All Commercial |
$469.45
|
| Rate for Payer: Lucent All Commercial |
$469.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.00
|
| Rate for Payer: Managed Health Services Medicaid |
$323.72
|
| Rate for Payer: Managed Health Services Medicaid |
$323.72
|
| Rate for Payer: MDWise Medicaid |
$323.72
|
| Rate for Payer: MDWise Medicaid |
$323.72
|
| Rate for Payer: PHCS All Commercial |
$335.32
|
| Rate for Payer: PHCS All Commercial |
$335.32
|
| Rate for Payer: PHP All Commercial |
$428.11
|
| Rate for Payer: PHP All Commercial |
$428.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.32
|
| Rate for Payer: Sagamore Health Network All Products |
$335.32
|
| Rate for Payer: Sagamore Health Network All Products |
$335.32
|
| Rate for Payer: Signature Care EPO |
$570.04
|
| Rate for Payer: Signature Care EPO |
$570.04
|
| Rate for Payer: Signature Care PPO |
$570.04
|
| Rate for Payer: Signature Care PPO |
$570.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43,200.00
|
| Rate for Payer: United Healthcare Commercial |
$629.56
|
| Rate for Payer: United Healthcare Commercial |
$629.56
|
| Rate for Payer: United Healthcare Medicare |
$324.32
|
| Rate for Payer: United Healthcare Medicare |
$324.32
|
|
|
PR HYSTEROSCOPY, STERILIZE W IMPLANTS
|
Professional
|
Both
|
$3,064.88
|
|
|
Service Code
|
CPT 58565
|
| Hospital Charge Code |
z58565
|
| Min. Negotiated Rate |
$330.83 |
| Max. Negotiated Rate |
$55,800.00 |
| Rate for Payer: Aetna Commercial |
$432.79
|
| Rate for Payer: Aetna Commercial |
$432.79
|
| Rate for Payer: Aetna Medicare |
$432.79
|
| Rate for Payer: Aetna Medicare |
$432.79
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$330.83
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$330.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,501.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,501.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$497.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$497.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$476.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$476.07
|
| Rate for Payer: Cash Price |
$1,838.93
|
| Rate for Payer: Cash Price |
$1,831.85
|
| Rate for Payer: Centivo All Commercial |
$670.82
|
| Rate for Payer: Centivo All Commercial |
$670.82
|
| Rate for Payer: Cigna All Commercial |
$432.79
|
| Rate for Payer: Cigna All Commercial |
$432.79
|
| Rate for Payer: CORVEL All Commercial |
$432.79
|
| Rate for Payer: CORVEL All Commercial |
$432.79
|
| Rate for Payer: Coventry All Commercial |
$519.35
|
| Rate for Payer: Coventry All Commercial |
$519.35
|
| Rate for Payer: Encore All Commercial |
$432.79
|
| Rate for Payer: Encore All Commercial |
$432.79
|
| Rate for Payer: Frontpath All Commercial |
$598.87
|
| Rate for Payer: Frontpath All Commercial |
$598.87
|
| Rate for Payer: Humana ChoiceCare |
$491.34
|
| Rate for Payer: Humana ChoiceCare |
$491.34
|
| Rate for Payer: Humana Medicare |
$432.79
|
| Rate for Payer: Humana Medicare |
$432.79
|
| Rate for Payer: Lucent All Commercial |
$605.91
|
| Rate for Payer: Lucent All Commercial |
$605.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,501.62
|
| Rate for Payer: Managed Health Services Medicaid |
$1,501.62
|
| Rate for Payer: MDWise Medicaid |
$1,501.62
|
| Rate for Payer: MDWise Medicaid |
$1,501.62
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$330.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$330.83
|
| Rate for Payer: PHCS All Commercial |
$432.79
|
| Rate for Payer: PHCS All Commercial |
$432.79
|
| Rate for Payer: PHP All Commercial |
$553.04
|
| Rate for Payer: PHP All Commercial |
$553.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$432.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$432.79
|
| Rate for Payer: Sagamore Health Network All Products |
$432.79
|
| Rate for Payer: Sagamore Health Network All Products |
$432.79
|
| Rate for Payer: Signature Care EPO |
$2,655.40
|
| Rate for Payer: Signature Care EPO |
$2,655.40
|
| Rate for Payer: Signature Care PPO |
$2,655.40
|
| Rate for Payer: Signature Care PPO |
$2,655.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,800.00
|
| Rate for Payer: United Healthcare Commercial |
$499.00
|
| Rate for Payer: United Healthcare Commercial |
$499.00
|
| Rate for Payer: United Healthcare Medicare |
$1,532.44
|
| Rate for Payer: United Healthcare Medicare |
$1,532.44
|
|
|
PR HYSTEROSCOPY,UTERUS,UNL PROC
|
Professional
|
Both
|
$663.70
|
|
|
Service Code
|
CPT 58579
|
| Hospital Charge Code |
z58579
|
| Rate for Payer: Cash Price |
$398.22
|
|
|
PR HYSTEROSCOPY,W/ENDO BX
|
Professional
|
Both
|
$2,444.22
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
z58558
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$28,000.00 |
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna Medicare |
$216.13
|
| Rate for Payer: Aetna Medicare |
$216.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,934.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$117.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$117.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,194.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,194.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.74
|
| Rate for Payer: Cash Price |
$1,457.20
|
| Rate for Payer: Cash Price |
$1,466.53
|
| Rate for Payer: Centivo All Commercial |
$335.00
|
| Rate for Payer: Centivo All Commercial |
$335.00
|
| Rate for Payer: Cigna All Commercial |
$216.13
|
| Rate for Payer: Cigna All Commercial |
$216.13
|
| Rate for Payer: CORVEL All Commercial |
$216.13
|
| Rate for Payer: CORVEL All Commercial |
$216.13
|
| Rate for Payer: Coventry All Commercial |
$259.36
|
| Rate for Payer: Coventry All Commercial |
$259.36
|
| Rate for Payer: Encore All Commercial |
$216.13
|
| Rate for Payer: Encore All Commercial |
$216.13
|
| Rate for Payer: Frontpath All Commercial |
$301.08
|
| Rate for Payer: Frontpath All Commercial |
$301.08
|
| Rate for Payer: Humana ChoiceCare |
$308.76
|
| Rate for Payer: Humana ChoiceCare |
$308.76
|
| Rate for Payer: Humana Medicare |
$216.13
|
| Rate for Payer: Humana Medicare |
$216.13
|
| Rate for Payer: Lucent All Commercial |
$302.58
|
| Rate for Payer: Lucent All Commercial |
$302.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,194.51
|
| Rate for Payer: Managed Health Services Medicaid |
$1,194.51
|
| Rate for Payer: MDWise Medicaid |
$1,194.51
|
| Rate for Payer: MDWise Medicaid |
$1,194.51
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$117.66
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$117.66
|
| Rate for Payer: PHCS All Commercial |
$216.13
|
| Rate for Payer: PHCS All Commercial |
$216.13
|
| Rate for Payer: PHP All Commercial |
$276.99
|
| Rate for Payer: PHP All Commercial |
$276.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$216.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$216.13
|
| Rate for Payer: Sagamore Health Network All Products |
$216.13
|
| Rate for Payer: Sagamore Health Network All Products |
$216.13
|
| Rate for Payer: Signature Care EPO |
$1,638.55
|
| Rate for Payer: Signature Care EPO |
$1,638.55
|
| Rate for Payer: Signature Care PPO |
$1,638.55
|
| Rate for Payer: Signature Care PPO |
$1,638.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28,000.00
|
| Rate for Payer: United Healthcare Commercial |
$305.65
|
| Rate for Payer: United Healthcare Commercial |
$305.65
|
| Rate for Payer: United Healthcare Medicare |
$1,222.11
|
| Rate for Payer: United Healthcare Medicare |
$1,222.11
|
|
|
PR HYSTEROSCOPY,W/ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$3,887.22
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
z58563
|
| Min. Negotiated Rate |
$230.29 |
| Max. Negotiated Rate |
$29,700.00 |
| Rate for Payer: Aetna Commercial |
$230.29
|
| Rate for Payer: Aetna Commercial |
$230.29
|
| Rate for Payer: Aetna Medicare |
$230.29
|
| Rate for Payer: Aetna Medicare |
$230.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,197.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$230.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$230.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,892.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,892.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$264.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$264.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.32
|
| Rate for Payer: Cash Price |
$2,308.56
|
| Rate for Payer: Cash Price |
$2,332.33
|
| Rate for Payer: Centivo All Commercial |
$356.95
|
| Rate for Payer: Centivo All Commercial |
$356.95
|
| Rate for Payer: Cigna All Commercial |
$230.29
|
| Rate for Payer: Cigna All Commercial |
$230.29
|
| Rate for Payer: CORVEL All Commercial |
$230.29
|
| Rate for Payer: CORVEL All Commercial |
$230.29
|
| Rate for Payer: Coventry All Commercial |
$276.35
|
| Rate for Payer: Coventry All Commercial |
$276.35
|
| Rate for Payer: Encore All Commercial |
$230.29
|
| Rate for Payer: Encore All Commercial |
$230.29
|
| Rate for Payer: Frontpath All Commercial |
$321.23
|
| Rate for Payer: Frontpath All Commercial |
$321.23
|
| Rate for Payer: Humana ChoiceCare |
$398.31
|
| Rate for Payer: Humana ChoiceCare |
$398.31
|
| Rate for Payer: Humana Medicare |
$230.29
|
| Rate for Payer: Humana Medicare |
$230.29
|
| Rate for Payer: Lucent All Commercial |
$322.41
|
| Rate for Payer: Lucent All Commercial |
$322.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,892.40
|
| Rate for Payer: Managed Health Services Medicaid |
$1,892.40
|
| Rate for Payer: MDWise Medicaid |
$1,892.40
|
| Rate for Payer: MDWise Medicaid |
$1,892.40
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$230.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$230.63
|
| Rate for Payer: PHCS All Commercial |
$230.29
|
| Rate for Payer: PHCS All Commercial |
$230.29
|
| Rate for Payer: PHP All Commercial |
$294.69
|
| Rate for Payer: PHP All Commercial |
$294.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.29
|
| Rate for Payer: Sagamore Health Network All Products |
$230.29
|
| Rate for Payer: Sagamore Health Network All Products |
$230.29
|
| Rate for Payer: Signature Care EPO |
$2,404.65
|
| Rate for Payer: Signature Care EPO |
$2,404.65
|
| Rate for Payer: Signature Care PPO |
$2,404.65
|
| Rate for Payer: Signature Care PPO |
$2,404.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,700.00
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare |
$1,943.61
|
| Rate for Payer: United Healthcare Medicare |
$1,943.61
|
|
|
PR I&D BARTHOLIN GLAND ABSCESS
|
Professional
|
Both
|
$346.08
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
z56420
|
| Min. Negotiated Rate |
$57.62 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna Medicare |
$104.93
|
| Rate for Payer: Aetna Medicare |
$104.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.47
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$57.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$57.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$170.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$170.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.42
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cash Price |
$207.65
|
| Rate for Payer: Centivo All Commercial |
$162.64
|
| Rate for Payer: Centivo All Commercial |
$162.64
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$104.93
|
| Rate for Payer: Coventry All Commercial |
$125.92
|
| Rate for Payer: Coventry All Commercial |
$125.92
|
| Rate for Payer: Encore All Commercial |
$104.93
|
| Rate for Payer: Encore All Commercial |
$104.93
|
| Rate for Payer: Frontpath All Commercial |
$144.44
|
| Rate for Payer: Frontpath All Commercial |
$144.44
|
| Rate for Payer: Humana ChoiceCare |
$106.51
|
| Rate for Payer: Humana ChoiceCare |
$106.51
|
| Rate for Payer: Humana Medicare |
$104.93
|
| Rate for Payer: Humana Medicare |
$104.93
|
| Rate for Payer: Lucent All Commercial |
$146.90
|
| Rate for Payer: Lucent All Commercial |
$146.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.00
|
| Rate for Payer: Managed Health Services Medicaid |
$170.21
|
| Rate for Payer: Managed Health Services Medicaid |
$170.21
|
| Rate for Payer: MDWise Medicaid |
$170.21
|
| Rate for Payer: MDWise Medicaid |
$170.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$57.62
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$57.62
|
| Rate for Payer: PHCS All Commercial |
$104.93
|
| Rate for Payer: PHCS All Commercial |
$104.93
|
| Rate for Payer: PHP All Commercial |
$134.02
|
| Rate for Payer: PHP All Commercial |
$134.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.93
|
| Rate for Payer: Sagamore Health Network All Products |
$104.93
|
| Rate for Payer: Sagamore Health Network All Products |
$104.93
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,500.00
|
| Rate for Payer: United Healthcare Commercial |
$103.06
|
| Rate for Payer: United Healthcare Commercial |
$103.06
|
| Rate for Payer: United Healthcare Medicare |
$170.20
|
| Rate for Payer: United Healthcare Medicare |
$170.20
|
|
|
PR IDENTIFY SENTINEL NODE
|
Professional
|
Both
|
$152.66
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
z38792
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$4,600.00 |
| Rate for Payer: Aetna Commercial |
$31.11
|
| Rate for Payer: Aetna Commercial |
$31.11
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.22
|
| Rate for Payer: Cash Price |
$90.18
|
| Rate for Payer: Cash Price |
$91.60
|
| Rate for Payer: Centivo All Commercial |
$48.22
|
| Rate for Payer: Centivo All Commercial |
$48.22
|
| Rate for Payer: Cigna All Commercial |
$31.11
|
| Rate for Payer: Cigna All Commercial |
$31.11
|
| Rate for Payer: CORVEL All Commercial |
$31.11
|
| Rate for Payer: CORVEL All Commercial |
$31.11
|
| Rate for Payer: Coventry All Commercial |
$37.33
|
| Rate for Payer: Coventry All Commercial |
$37.33
|
| Rate for Payer: Encore All Commercial |
$31.11
|
| Rate for Payer: Encore All Commercial |
$31.11
|
| Rate for Payer: Frontpath All Commercial |
$43.12
|
| Rate for Payer: Frontpath All Commercial |
$43.12
|
| Rate for Payer: Humana ChoiceCare |
$46.73
|
| Rate for Payer: Humana ChoiceCare |
$46.73
|
| Rate for Payer: Humana Medicare |
$31.11
|
| Rate for Payer: Humana Medicare |
$31.11
|
| Rate for Payer: Lucent All Commercial |
$43.55
|
| Rate for Payer: Lucent All Commercial |
$43.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Managed Health Services Medicaid |
$75.09
|
| Rate for Payer: Managed Health Services Medicaid |
$75.09
|
| Rate for Payer: MDWise Medicaid |
$75.09
|
| Rate for Payer: MDWise Medicaid |
$75.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.63
|
| Rate for Payer: PHCS All Commercial |
$31.11
|
| Rate for Payer: PHCS All Commercial |
$31.11
|
| Rate for Payer: PHP All Commercial |
$41.54
|
| Rate for Payer: PHP All Commercial |
$41.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.11
|
| Rate for Payer: Sagamore Health Network All Products |
$31.11
|
| Rate for Payer: Sagamore Health Network All Products |
$31.11
|
| Rate for Payer: Signature Care EPO |
$65.88
|
| Rate for Payer: Signature Care EPO |
$65.88
|
| Rate for Payer: Signature Care PPO |
$65.88
|
| Rate for Payer: Signature Care PPO |
$65.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,600.00
|
| Rate for Payer: United Healthcare Commercial |
$44.93
|
| Rate for Payer: United Healthcare Commercial |
$44.93
|
| Rate for Payer: United Healthcare Medicare |
$75.15
|
| Rate for Payer: United Healthcare Medicare |
$75.15
|
|
|
PR I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
Both
|
$316.38
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
z10140
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$13,200.00 |
| Rate for Payer: Aetna Commercial |
$110.38
|
| Rate for Payer: Aetna Commercial |
$110.38
|
| Rate for Payer: Aetna Medicare |
$110.38
|
| Rate for Payer: Aetna Medicare |
$110.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$60.04
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$60.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$155.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$155.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.42
|
| Rate for Payer: Cash Price |
$185.36
|
| Rate for Payer: Cash Price |
$189.83
|
| Rate for Payer: Centivo All Commercial |
$171.09
|
| Rate for Payer: Centivo All Commercial |
$171.09
|
| Rate for Payer: Cigna All Commercial |
$110.38
|
| Rate for Payer: Cigna All Commercial |
$110.38
|
| Rate for Payer: CORVEL All Commercial |
$110.38
|
| Rate for Payer: CORVEL All Commercial |
$110.38
|
| Rate for Payer: Coventry All Commercial |
$132.46
|
| Rate for Payer: Coventry All Commercial |
$132.46
|
| Rate for Payer: Encore All Commercial |
$110.38
|
| Rate for Payer: Encore All Commercial |
$110.38
|
| Rate for Payer: Frontpath All Commercial |
$150.42
|
| Rate for Payer: Frontpath All Commercial |
$150.42
|
| Rate for Payer: Humana ChoiceCare |
$105.41
|
| Rate for Payer: Humana ChoiceCare |
$105.41
|
| Rate for Payer: Humana Medicare |
$110.38
|
| Rate for Payer: Humana Medicare |
$110.38
|
| Rate for Payer: Lucent All Commercial |
$154.53
|
| Rate for Payer: Lucent All Commercial |
$154.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: Managed Health Services Medicaid |
$155.60
|
| Rate for Payer: Managed Health Services Medicaid |
$155.60
|
| Rate for Payer: MDWise Medicaid |
$155.60
|
| Rate for Payer: MDWise Medicaid |
$155.60
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$60.04
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$60.04
|
| Rate for Payer: PHCS All Commercial |
$110.38
|
| Rate for Payer: PHCS All Commercial |
$110.38
|
| Rate for Payer: PHP All Commercial |
$150.47
|
| Rate for Payer: PHP All Commercial |
$150.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.38
|
| Rate for Payer: Sagamore Health Network All Products |
$110.38
|
| Rate for Payer: Sagamore Health Network All Products |
$110.38
|
| Rate for Payer: Signature Care EPO |
$136.18
|
| Rate for Payer: Signature Care EPO |
$136.18
|
| Rate for Payer: Signature Care PPO |
$136.18
|
| Rate for Payer: Signature Care PPO |
$136.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,200.00
|
| Rate for Payer: United Healthcare Commercial |
$127.99
|
| Rate for Payer: United Healthcare Commercial |
$127.99
|
| Rate for Payer: United Healthcare Medicare |
$154.47
|
| Rate for Payer: United Healthcare Medicare |
$154.47
|
|
|
PR I&D OF VULVA/PERINEUM ABSCESS
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
z56405
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$15,500.00 |
| Rate for Payer: Aetna Commercial |
$119.75
|
| Rate for Payer: Aetna Commercial |
$119.75
|
| Rate for Payer: Aetna Medicare |
$119.75
|
| Rate for Payer: Aetna Medicare |
$119.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.91
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$69.25
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$69.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.72
|
| Rate for Payer: Cash Price |
$162.13
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Centivo All Commercial |
$185.61
|
| Rate for Payer: Centivo All Commercial |
$185.61
|
| Rate for Payer: Cigna All Commercial |
$119.75
|
| Rate for Payer: Cigna All Commercial |
$119.75
|
| Rate for Payer: CORVEL All Commercial |
$119.75
|
| Rate for Payer: CORVEL All Commercial |
$119.75
|
| Rate for Payer: Coventry All Commercial |
$143.70
|
| Rate for Payer: Coventry All Commercial |
$143.70
|
| Rate for Payer: Encore All Commercial |
$119.75
|
| Rate for Payer: Encore All Commercial |
$119.75
|
| Rate for Payer: Frontpath All Commercial |
$163.94
|
| Rate for Payer: Frontpath All Commercial |
$163.94
|
| Rate for Payer: Humana ChoiceCare |
$112.93
|
| Rate for Payer: Humana ChoiceCare |
$112.93
|
| Rate for Payer: Humana Medicare |
$119.75
|
| Rate for Payer: Humana Medicare |
$119.75
|
| Rate for Payer: Lucent All Commercial |
$167.65
|
| Rate for Payer: Lucent All Commercial |
$167.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.27
|
| Rate for Payer: Managed Health Services Medicaid |
$134.27
|
| Rate for Payer: MDWise Medicaid |
$134.27
|
| Rate for Payer: MDWise Medicaid |
$134.27
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$69.25
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$69.25
|
| Rate for Payer: PHCS All Commercial |
$119.75
|
| Rate for Payer: PHCS All Commercial |
$119.75
|
| Rate for Payer: PHP All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$153.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.75
|
| Rate for Payer: Sagamore Health Network All Products |
$119.75
|
| Rate for Payer: Sagamore Health Network All Products |
$119.75
|
| Rate for Payer: Signature Care EPO |
$136.00
|
| Rate for Payer: Signature Care EPO |
$136.00
|
| Rate for Payer: Signature Care PPO |
$136.00
|
| Rate for Payer: Signature Care PPO |
$136.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,500.00
|
| Rate for Payer: United Healthcare Commercial |
$118.43
|
| Rate for Payer: United Healthcare Commercial |
$118.43
|
| Rate for Payer: United Healthcare Medicare |
$135.11
|
| Rate for Payer: United Healthcare Medicare |
$135.11
|
|
|
PR I&D PERIANAL ABSCESS,SUPERFICIAL
|
Professional
|
Both
|
$436.50
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
z46050
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$13,100.00 |
| Rate for Payer: Aetna Commercial |
$93.49
|
| Rate for Payer: Aetna Commercial |
$93.49
|
| Rate for Payer: Aetna Medicare |
$93.49
|
| Rate for Payer: Aetna Medicare |
$93.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$214.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$214.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.84
|
| Rate for Payer: Cash Price |
$258.47
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Centivo All Commercial |
$144.91
|
| Rate for Payer: Centivo All Commercial |
$144.91
|
| Rate for Payer: Cigna All Commercial |
$93.49
|
| Rate for Payer: Cigna All Commercial |
$93.49
|
| Rate for Payer: CORVEL All Commercial |
$93.49
|
| Rate for Payer: CORVEL All Commercial |
$93.49
|
| Rate for Payer: Coventry All Commercial |
$112.19
|
| Rate for Payer: Coventry All Commercial |
$112.19
|
| Rate for Payer: Encore All Commercial |
$93.49
|
| Rate for Payer: Encore All Commercial |
$93.49
|
| Rate for Payer: Frontpath All Commercial |
$129.21
|
| Rate for Payer: Frontpath All Commercial |
$129.21
|
| Rate for Payer: Humana ChoiceCare |
$91.27
|
| Rate for Payer: Humana ChoiceCare |
$91.27
|
| Rate for Payer: Humana Medicare |
$93.49
|
| Rate for Payer: Humana Medicare |
$93.49
|
| Rate for Payer: Lucent All Commercial |
$130.89
|
| Rate for Payer: Lucent All Commercial |
$130.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.00
|
| Rate for Payer: Managed Health Services Medicaid |
$214.69
|
| Rate for Payer: Managed Health Services Medicaid |
$214.69
|
| Rate for Payer: MDWise Medicaid |
$214.69
|
| Rate for Payer: MDWise Medicaid |
$214.69
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.82
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.82
|
| Rate for Payer: PHCS All Commercial |
$93.49
|
| Rate for Payer: PHCS All Commercial |
$93.49
|
| Rate for Payer: PHP All Commercial |
$160.31
|
| Rate for Payer: PHP All Commercial |
$160.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.49
|
| Rate for Payer: Sagamore Health Network All Products |
$93.49
|
| Rate for Payer: Sagamore Health Network All Products |
$93.49
|
| Rate for Payer: Signature Care EPO |
$206.55
|
| Rate for Payer: Signature Care EPO |
$206.55
|
| Rate for Payer: Signature Care PPO |
$206.55
|
| Rate for Payer: Signature Care PPO |
$206.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,100.00
|
| Rate for Payer: United Healthcare Commercial |
$97.24
|
| Rate for Payer: United Healthcare Commercial |
$97.24
|
| Rate for Payer: United Healthcare Medicare |
$215.39
|
| Rate for Payer: United Healthcare Medicare |
$215.39
|
|
|
PR I&D PERIRECTAL ABSCESS
|
Professional
|
Both
|
$1,022.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
z46040
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$55,200.00 |
| Rate for Payer: Aetna Commercial |
$397.60
|
| Rate for Payer: Aetna Commercial |
$397.60
|
| Rate for Payer: Aetna Medicare |
$397.60
|
| Rate for Payer: Aetna Medicare |
$397.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$419.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$220.27
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$220.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$502.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$502.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.36
|
| Rate for Payer: Cash Price |
$603.35
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Centivo All Commercial |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$397.60
|
| Rate for Payer: Cigna All Commercial |
$397.60
|
| Rate for Payer: CORVEL All Commercial |
$397.60
|
| Rate for Payer: CORVEL All Commercial |
$397.60
|
| Rate for Payer: Coventry All Commercial |
$477.12
|
| Rate for Payer: Coventry All Commercial |
$477.12
|
| Rate for Payer: Encore All Commercial |
$397.60
|
| Rate for Payer: Encore All Commercial |
$397.60
|
| Rate for Payer: Frontpath All Commercial |
$553.33
|
| Rate for Payer: Frontpath All Commercial |
$553.33
|
| Rate for Payer: Humana ChoiceCare |
$384.36
|
| Rate for Payer: Humana ChoiceCare |
$384.36
|
| Rate for Payer: Humana Medicare |
$397.60
|
| Rate for Payer: Humana Medicare |
$397.60
|
| Rate for Payer: Lucent All Commercial |
$556.64
|
| Rate for Payer: Lucent All Commercial |
$556.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.00
|
| Rate for Payer: Managed Health Services Medicaid |
$502.66
|
| Rate for Payer: Managed Health Services Medicaid |
$502.66
|
| Rate for Payer: MDWise Medicaid |
$502.66
|
| Rate for Payer: MDWise Medicaid |
$502.66
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$220.27
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$220.27
|
| Rate for Payer: PHCS All Commercial |
$397.60
|
| Rate for Payer: PHCS All Commercial |
$397.60
|
| Rate for Payer: PHP All Commercial |
$672.74
|
| Rate for Payer: PHP All Commercial |
$672.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.60
|
| Rate for Payer: Sagamore Health Network All Products |
$397.60
|
| Rate for Payer: Sagamore Health Network All Products |
$397.60
|
| Rate for Payer: Signature Care EPO |
$577.15
|
| Rate for Payer: Signature Care EPO |
$577.15
|
| Rate for Payer: Signature Care PPO |
$577.15
|
| Rate for Payer: Signature Care PPO |
$577.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,200.00
|
| Rate for Payer: United Healthcare Commercial |
$415.70
|
| Rate for Payer: United Healthcare Commercial |
$415.70
|
| Rate for Payer: United Healthcare Medicare |
$502.79
|
| Rate for Payer: United Healthcare Medicare |
$502.79
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$549.86
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
z44382
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Aetna Commercial |
$68.58
|
| Rate for Payer: Aetna Commercial |
$68.58
|
| Rate for Payer: Aetna Medicare |
$68.58
|
| Rate for Payer: Aetna Medicare |
$68.58
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$56.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$56.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$270.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$270.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.44
|
| Rate for Payer: Cash Price |
$327.19
|
| Rate for Payer: Cash Price |
$329.92
|
| Rate for Payer: Centivo All Commercial |
$106.30
|
| Rate for Payer: Centivo All Commercial |
$106.30
|
| Rate for Payer: Cigna All Commercial |
$68.58
|
| Rate for Payer: Cigna All Commercial |
$68.58
|
| Rate for Payer: CORVEL All Commercial |
$68.58
|
| Rate for Payer: CORVEL All Commercial |
$68.58
|
| Rate for Payer: Coventry All Commercial |
$82.30
|
| Rate for Payer: Coventry All Commercial |
$82.30
|
| Rate for Payer: Encore All Commercial |
$68.58
|
| Rate for Payer: Encore All Commercial |
$68.58
|
| Rate for Payer: Frontpath All Commercial |
$93.04
|
| Rate for Payer: Frontpath All Commercial |
$93.04
|
| Rate for Payer: Humana ChoiceCare |
$85.87
|
| Rate for Payer: Humana ChoiceCare |
$85.87
|
| Rate for Payer: Humana Medicare |
$68.58
|
| Rate for Payer: Humana Medicare |
$68.58
|
| Rate for Payer: Lucent All Commercial |
$96.01
|
| Rate for Payer: Lucent All Commercial |
$96.01
|
| Rate for Payer: Managed Health Services Medicaid |
$270.44
|
| Rate for Payer: Managed Health Services Medicaid |
$270.44
|
| Rate for Payer: MDWise Medicaid |
$270.44
|
| Rate for Payer: MDWise Medicaid |
$270.44
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$56.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$56.22
|
| Rate for Payer: PHCS All Commercial |
$68.58
|
| Rate for Payer: PHCS All Commercial |
$68.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.58
|
| Rate for Payer: Sagamore Health Network All Products |
$68.58
|
| Rate for Payer: Sagamore Health Network All Products |
$68.58
|
| Rate for Payer: United Healthcare Commercial |
$94.85
|
| Rate for Payer: United Healthcare Commercial |
$94.85
|
| Rate for Payer: United Healthcare Medicare |
$272.66
|
| Rate for Payer: United Healthcare Medicare |
$272.66
|
|
|
PRIMIDONE 50 MG ORAL TAB
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna Commercial |
$2.03
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Centivo All Commercial |
$1.31
|
| Rate for Payer: Cigna All Commercial |
$2.08
|
| Rate for Payer: CORVEL All Commercial |
$2.24
|
| Rate for Payer: Coventry All Commercial |
$2.12
|
| Rate for Payer: Encore All Commercial |
$2.22
|
| Rate for Payer: Frontpath All Commercial |
$2.22
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Humana Medicare |
$0.77
|
| Rate for Payer: Lucent All Commercial |
$1.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.17
|
| Rate for Payer: PHCS All Commercial |
$1.81
|
| Rate for Payer: PHP All Commercial |
$1.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1.86
|
| Rate for Payer: Signature Care EPO |
$2.00
|
| Rate for Payer: Signature Care PPO |
$2.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.05
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
|
|
PRIMIDONE 50 MG ORAL TAB
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna All Commercial |
$2.08
|
| Rate for Payer: CORVEL All Commercial |
$2.24
|
| Rate for Payer: Coventry All Commercial |
$2.12
|
| Rate for Payer: Encore All Commercial |
$2.22
|
| Rate for Payer: Frontpath All Commercial |
$2.22
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.17
|
| Rate for Payer: PHCS All Commercial |
$1.81
|
| Rate for Payer: PHP All Commercial |
$1.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1.86
|
| Rate for Payer: Signature Care EPO |
$2.00
|
| Rate for Payer: Signature Care PPO |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
|
|
PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Professional
|
Both
|
$38.64
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
z90471
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$22.12
|
| Rate for Payer: Centivo All Commercial |
$24.34
|
| Rate for Payer: Centivo All Commercial |
$24.34
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$15.70
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Encore All Commercial |
$15.70
|
| Rate for Payer: Encore All Commercial |
$15.70
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Lucent All Commercial |
$21.98
|
| Rate for Payer: Lucent All Commercial |
$21.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHP All Commercial |
$26.72
|
| Rate for Payer: PHP All Commercial |
$26.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.70
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Signature Care EPO |
$15.00
|
| Rate for Payer: Signature Care EPO |
$15.00
|
| Rate for Payer: Signature Care PPO |
$15.00
|
| Rate for Payer: Signature Care PPO |
$15.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,300.00
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Medicare |
$18.43
|
| Rate for Payer: United Healthcare Medicare |
$18.43
|
|
|
PR IMMUNIZ,ADMIN,EACH ADDL
|
Professional
|
Both
|
$27.50
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
z90472
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$11.89
|
| Rate for Payer: Aetna Commercial |
$11.89
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.08
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Centivo All Commercial |
$18.43
|
| Rate for Payer: Centivo All Commercial |
$18.43
|
| Rate for Payer: Cigna All Commercial |
$11.89
|
| Rate for Payer: Cigna All Commercial |
$11.89
|
| Rate for Payer: CORVEL All Commercial |
$11.89
|
| Rate for Payer: CORVEL All Commercial |
$11.89
|
| Rate for Payer: Coventry All Commercial |
$14.27
|
| Rate for Payer: Coventry All Commercial |
$14.27
|
| Rate for Payer: Encore All Commercial |
$11.89
|
| Rate for Payer: Encore All Commercial |
$11.89
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Lucent All Commercial |
$16.65
|
| Rate for Payer: Lucent All Commercial |
$16.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHP All Commercial |
$19.21
|
| Rate for Payer: PHP All Commercial |
$19.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Signature Care EPO |
$7.50
|
| Rate for Payer: Signature Care EPO |
$7.50
|
| Rate for Payer: Signature Care PPO |
$7.50
|
| Rate for Payer: Signature Care PPO |
$7.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,600.00
|
| Rate for Payer: United Healthcare Commercial |
$7.61
|
| Rate for Payer: United Healthcare Commercial |
$7.61
|
| Rate for Payer: United Healthcare Medicare |
$13.25
|
| Rate for Payer: United Healthcare Medicare |
$13.25
|
|
|
PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX
|
Professional
|
Both
|
$31.28
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
z90473
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cash Price |
$18.13
|
| Rate for Payer: Centivo All Commercial |
$24.34
|
| Rate for Payer: Centivo All Commercial |
$24.34
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$15.70
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Encore All Commercial |
$15.70
|
| Rate for Payer: Encore All Commercial |
$15.70
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Lucent All Commercial |
$21.98
|
| Rate for Payer: Lucent All Commercial |
$21.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHP All Commercial |
$21.92
|
| Rate for Payer: PHP All Commercial |
$21.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.70
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,900.00
|
| Rate for Payer: United Healthcare Commercial |
$8.00
|
| Rate for Payer: United Healthcare Commercial |
$8.00
|
| Rate for Payer: United Healthcare Medicare |
$15.11
|
| Rate for Payer: United Healthcare Medicare |
$15.11
|
|
|
PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL
|
Professional
|
Both
|
$22.58
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
z90474
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$11.89
|
| Rate for Payer: Aetna Commercial |
$11.89
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.08
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centivo All Commercial |
$18.43
|
| Rate for Payer: Centivo All Commercial |
$18.43
|
| Rate for Payer: Cigna All Commercial |
$11.89
|
| Rate for Payer: Cigna All Commercial |
$11.89
|
| Rate for Payer: CORVEL All Commercial |
$11.89
|
| Rate for Payer: CORVEL All Commercial |
$11.89
|
| Rate for Payer: Coventry All Commercial |
$14.27
|
| Rate for Payer: Coventry All Commercial |
$14.27
|
| Rate for Payer: Encore All Commercial |
$11.89
|
| Rate for Payer: Encore All Commercial |
$11.89
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Lucent All Commercial |
$16.65
|
| Rate for Payer: Lucent All Commercial |
$16.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHP All Commercial |
$15.72
|
| Rate for Payer: PHP All Commercial |
$15.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.00
|
| Rate for Payer: United Healthcare Commercial |
$7.28
|
| Rate for Payer: United Healthcare Commercial |
$7.28
|
| Rate for Payer: United Healthcare Medicare |
$10.84
|
| Rate for Payer: United Healthcare Medicare |
$10.84
|
|
|
PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Professional
|
Both
|
$41.20
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
z90460
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cash Price |
$24.72
|
| Rate for Payer: Centivo All Commercial |
$24.34
|
| Rate for Payer: Centivo All Commercial |
$24.34
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$15.70
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Encore All Commercial |
$15.70
|
| Rate for Payer: Encore All Commercial |
$15.70
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Lucent All Commercial |
$21.98
|
| Rate for Payer: Lucent All Commercial |
$21.98
|
| 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 |
$21.16
|
| Rate for Payer: Managed Health Services Medicaid |
$21.16
|
| Rate for Payer: MDWise Medicaid |
$21.16
|
| Rate for Payer: MDWise Medicaid |
$21.16
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHP All Commercial |
$29.87
|
| Rate for Payer: PHP All Commercial |
$29.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.70
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$23.75
|
| 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 |
$22.90
|
| Rate for Payer: United Healthcare Commercial |
$22.90
|
| Rate for Payer: United Healthcare Medicare |
$20.60
|
| Rate for Payer: United Healthcare Medicare |
$20.60
|
|
|
PR IMMUNIZ ADMIN THRU AGE 18 ANY ROUTE,W COUNSEL EA ADD VACCINE/TOXOID
|
Professional
|
Both
|
$18.84
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
z90461
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.89
|
| Rate for Payer: Aetna Commercial |
$11.89
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.08
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Centivo All Commercial |
$18.43
|
| Rate for Payer: Centivo All Commercial |
$18.43
|
| Rate for Payer: Cigna All Commercial |
$11.89
|
| Rate for Payer: Cigna All Commercial |
$11.89
|
| Rate for Payer: CORVEL All Commercial |
$11.89
|
| Rate for Payer: CORVEL All Commercial |
$11.89
|
| Rate for Payer: Coventry All Commercial |
$14.27
|
| Rate for Payer: Coventry All Commercial |
$14.27
|
| Rate for Payer: Encore All Commercial |
$11.89
|
| Rate for Payer: Encore All Commercial |
$11.89
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Lucent All Commercial |
$16.65
|
| Rate for Payer: Lucent All Commercial |
$16.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Managed Health Services Medicaid |
$8.17
|
| Rate for Payer: Managed Health Services Medicaid |
$8.17
|
| Rate for Payer: MDWise Medicaid |
$8.17
|
| Rate for Payer: MDWise Medicaid |
$8.17
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHP All Commercial |
$13.66
|
| Rate for Payer: PHP All Commercial |
$13.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Signature Care EPO |
$12.17
|
| Rate for Payer: Signature Care EPO |
$12.17
|
| Rate for Payer: Signature Care PPO |
$12.17
|
| Rate for Payer: Signature Care PPO |
$12.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$9.42
|
| Rate for Payer: United Healthcare Medicare |
$9.42
|
|
|
PR IMMUNIZE COUNSEL 16-30 MINS
|
Professional
|
Both
|
$115.76
|
|
|
Service Code
|
CPT G0311
|
| Hospital Charge Code |
zG0311
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$56.72 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$56.72
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Managed Health Services Medicaid |
$56.72
|
| Rate for Payer: MDWise Medicaid |
$56.72
|
|
