|
PR HEARING AID CHECK, BOTH EARS
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
z92593
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$55.39
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Frontpath All Commercial |
$37.76
|
| Rate for Payer: Humana ChoiceCare |
$30.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: Managed Health Services Medicaid |
$55.39
|
| Rate for Payer: MDWise Medicaid |
$55.39
|
| Rate for Payer: Signature Care EPO |
$46.75
|
| Rate for Payer: Signature Care PPO |
$46.75
|
| Rate for Payer: United Healthcare Commercial |
$35.85
|
|
|
PR HEARING AID CHECK, ONE EAR
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
z92592
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$48.92 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.92
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Frontpath All Commercial |
$22.70
|
| Rate for Payer: Humana ChoiceCare |
$19.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.50
|
| Rate for Payer: Managed Health Services Medicaid |
$48.92
|
| Rate for Payer: MDWise Medicaid |
$48.92
|
| Rate for Payer: Signature Care EPO |
$31.45
|
| Rate for Payer: Signature Care PPO |
$31.45
|
| Rate for Payer: United Healthcare Commercial |
$21.90
|
|
|
PR HEARING AID EXAM, BOTH EARS
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
z92591
|
| Min. Negotiated Rate |
$63.09 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$110.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$63.09
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Frontpath All Commercial |
$73.10
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.50
|
| Rate for Payer: Managed Health Services Medicaid |
$63.09
|
| Rate for Payer: MDWise Medicaid |
$63.09
|
| Rate for Payer: Signature Care EPO |
$106.25
|
| Rate for Payer: Signature Care PPO |
$106.25
|
| Rate for Payer: United Healthcare Commercial |
$69.58
|
|
|
PR HEARING AID EXAM, ONE EAR
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
z92590
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$70.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.85
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Frontpath All Commercial |
$57.33
|
| Rate for Payer: Humana ChoiceCare |
$45.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.50
|
| Rate for Payer: Managed Health Services Medicaid |
$53.85
|
| Rate for Payer: MDWise Medicaid |
$53.85
|
| Rate for Payer: Signature Care EPO |
$70.55
|
| Rate for Payer: Signature Care PPO |
$70.55
|
| Rate for Payer: United Healthcare Commercial |
$54.34
|
|
|
PR HEARING AID MONAURAL BTE
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
CPT V5181
|
| Hospital Charge Code |
zV5181
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$848.84 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$840.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$840.00
|
| Rate for Payer: United Healthcare Commercial |
$848.84
|
|
|
PR HEART/LUNG RESUSCITATION (CPR)
|
Professional
|
Both
|
$605.16
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
z92950
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$25,900.00 |
| Rate for Payer: Aetna Commercial |
$175.70
|
| Rate for Payer: Aetna Commercial |
$175.70
|
| Rate for Payer: Aetna Medicare |
$175.70
|
| Rate for Payer: Aetna Medicare |
$175.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$93.27
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$93.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$297.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$297.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$202.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$202.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.27
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cash Price |
$371.55
|
| Rate for Payer: Centivo All Commercial |
$272.33
|
| Rate for Payer: Centivo All Commercial |
$272.33
|
| Rate for Payer: Cigna All Commercial |
$175.70
|
| Rate for Payer: Cigna All Commercial |
$175.70
|
| Rate for Payer: CORVEL All Commercial |
$175.70
|
| Rate for Payer: CORVEL All Commercial |
$175.70
|
| Rate for Payer: Coventry All Commercial |
$210.84
|
| Rate for Payer: Coventry All Commercial |
$210.84
|
| Rate for Payer: Encore All Commercial |
$175.70
|
| Rate for Payer: Encore All Commercial |
$175.70
|
| Rate for Payer: Frontpath All Commercial |
$203.34
|
| Rate for Payer: Frontpath All Commercial |
$203.34
|
| Rate for Payer: Humana ChoiceCare |
$246.74
|
| Rate for Payer: Humana ChoiceCare |
$246.74
|
| Rate for Payer: Humana Medicare |
$175.70
|
| Rate for Payer: Humana Medicare |
$175.70
|
| Rate for Payer: Lucent All Commercial |
$245.98
|
| Rate for Payer: Lucent All Commercial |
$245.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.00
|
| Rate for Payer: Managed Health Services Medicaid |
$297.64
|
| Rate for Payer: Managed Health Services Medicaid |
$297.64
|
| Rate for Payer: MDWise Medicaid |
$297.64
|
| Rate for Payer: MDWise Medicaid |
$297.64
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$93.27
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$93.27
|
| Rate for Payer: PHCS All Commercial |
$175.70
|
| Rate for Payer: PHCS All Commercial |
$175.70
|
| Rate for Payer: PHP All Commercial |
$247.44
|
| Rate for Payer: PHP All Commercial |
$247.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.70
|
| Rate for Payer: Sagamore Health Network All Products |
$175.70
|
| Rate for Payer: Sagamore Health Network All Products |
$175.70
|
| Rate for Payer: Signature Care EPO |
$282.20
|
| Rate for Payer: Signature Care EPO |
$282.20
|
| Rate for Payer: Signature Care PPO |
$282.20
|
| Rate for Payer: Signature Care PPO |
$282.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,900.00
|
| Rate for Payer: United Healthcare Commercial |
$213.19
|
| Rate for Payer: United Healthcare Commercial |
$213.19
|
| Rate for Payer: United Healthcare Medicare |
$299.64
|
| Rate for Payer: United Healthcare Medicare |
$299.64
|
|
|
PR HEMORRHOIDECTOMY,INT/EXT, 2+ COLUMNS/GROUPS
|
Professional
|
Both
|
$889.98
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
z46260
|
| Min. Negotiated Rate |
$434.64 |
| Max. Negotiated Rate |
$62,700.00 |
| Rate for Payer: Aetna Commercial |
$453.16
|
| Rate for Payer: Aetna Commercial |
$453.16
|
| Rate for Payer: Aetna Medicare |
$453.16
|
| Rate for Payer: Aetna Medicare |
$453.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$437.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$521.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$521.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$498.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$498.48
|
| Rate for Payer: Cash Price |
$551.79
|
| Rate for Payer: Cash Price |
$542.10
|
| Rate for Payer: Centivo All Commercial |
$702.40
|
| Rate for Payer: Centivo All Commercial |
$702.40
|
| Rate for Payer: Cigna All Commercial |
$453.16
|
| Rate for Payer: Cigna All Commercial |
$453.16
|
| Rate for Payer: CORVEL All Commercial |
$453.16
|
| Rate for Payer: CORVEL All Commercial |
$453.16
|
| Rate for Payer: Coventry All Commercial |
$543.79
|
| Rate for Payer: Coventry All Commercial |
$543.79
|
| Rate for Payer: Encore All Commercial |
$453.16
|
| Rate for Payer: Encore All Commercial |
$453.16
|
| Rate for Payer: Frontpath All Commercial |
$630.20
|
| Rate for Payer: Frontpath All Commercial |
$630.20
|
| Rate for Payer: Humana ChoiceCare |
$434.64
|
| Rate for Payer: Humana ChoiceCare |
$434.64
|
| Rate for Payer: Humana Medicare |
$453.16
|
| Rate for Payer: Humana Medicare |
$453.16
|
| Rate for Payer: Lucent All Commercial |
$634.42
|
| Rate for Payer: Lucent All Commercial |
$634.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$672.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$672.00
|
| Rate for Payer: Managed Health Services Medicaid |
$437.73
|
| Rate for Payer: Managed Health Services Medicaid |
$437.73
|
| Rate for Payer: MDWise Medicaid |
$437.73
|
| Rate for Payer: MDWise Medicaid |
$437.73
|
| Rate for Payer: PHCS All Commercial |
$453.16
|
| Rate for Payer: PHCS All Commercial |
$453.16
|
| Rate for Payer: PHP All Commercial |
$765.06
|
| Rate for Payer: PHP All Commercial |
$765.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.16
|
| Rate for Payer: Sagamore Health Network All Products |
$453.16
|
| Rate for Payer: Sagamore Health Network All Products |
$453.16
|
| Rate for Payer: Signature Care EPO |
$556.75
|
| Rate for Payer: Signature Care EPO |
$556.75
|
| Rate for Payer: Signature Care PPO |
$556.75
|
| Rate for Payer: Signature Care PPO |
$556.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62,700.00
|
| Rate for Payer: United Healthcare Commercial |
$481.33
|
| Rate for Payer: United Healthcare Commercial |
$481.33
|
| Rate for Payer: United Healthcare Medicare |
$437.18
|
| Rate for Payer: United Healthcare Medicare |
$437.18
|
|
|
PR HFO WITHOUT JOINTS PRE CST
|
Professional
|
Both
|
$10.76
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
zL3923
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$143.76 |
| Rate for Payer: Aetna Commercial |
$92.75
|
| Rate for Payer: Aetna Medicare |
$92.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$27.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$103.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.03
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Centivo All Commercial |
$143.76
|
| Rate for Payer: Cigna All Commercial |
$92.75
|
| Rate for Payer: CORVEL All Commercial |
$92.75
|
| Rate for Payer: Coventry All Commercial |
$111.30
|
| Rate for Payer: Encore All Commercial |
$92.75
|
| Rate for Payer: Humana ChoiceCare |
$85.70
|
| Rate for Payer: Humana Medicare |
$92.75
|
| Rate for Payer: Lucent All Commercial |
$129.85
|
| Rate for Payer: Managed Health Services Medicaid |
$103.44
|
| Rate for Payer: MDWise Medicaid |
$103.44
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$27.65
|
| Rate for Payer: PHCS All Commercial |
$92.75
|
| Rate for Payer: PHP All Commercial |
$86.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.75
|
| Rate for Payer: Sagamore Health Network All Products |
$92.75
|
| Rate for Payer: Signature Care EPO |
$10.76
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: United Healthcare Commercial |
$67.66
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$350.54
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
z99350
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$259.89 |
| Rate for Payer: Aetna Commercial |
$167.67
|
| Rate for Payer: Aetna Commercial |
$167.67
|
| Rate for Payer: Aetna Medicare |
$167.67
|
| Rate for Payer: Aetna Medicare |
$167.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$172.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$172.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.44
|
| Rate for Payer: Cash Price |
$214.07
|
| Rate for Payer: Cash Price |
$217.33
|
| Rate for Payer: Centivo All Commercial |
$259.89
|
| Rate for Payer: Centivo All Commercial |
$259.89
|
| Rate for Payer: Cigna All Commercial |
$167.67
|
| Rate for Payer: Cigna All Commercial |
$167.67
|
| Rate for Payer: CORVEL All Commercial |
$167.67
|
| Rate for Payer: CORVEL All Commercial |
$167.67
|
| Rate for Payer: Coventry All Commercial |
$201.20
|
| Rate for Payer: Coventry All Commercial |
$201.20
|
| Rate for Payer: Encore All Commercial |
$167.67
|
| Rate for Payer: Encore All Commercial |
$167.67
|
| Rate for Payer: Frontpath All Commercial |
$180.34
|
| Rate for Payer: Frontpath All Commercial |
$180.34
|
| Rate for Payer: Humana ChoiceCare |
$167.57
|
| Rate for Payer: Humana ChoiceCare |
$167.57
|
| Rate for Payer: Humana Medicare |
$167.67
|
| Rate for Payer: Humana Medicare |
$167.67
|
| Rate for Payer: Lucent All Commercial |
$234.74
|
| Rate for Payer: Lucent All Commercial |
$234.74
|
| Rate for Payer: Managed Health Services Medicaid |
$172.41
|
| Rate for Payer: Managed Health Services Medicaid |
$172.41
|
| Rate for Payer: MDWise Medicaid |
$172.41
|
| Rate for Payer: MDWise Medicaid |
$172.41
|
| Rate for Payer: PHCS All Commercial |
$167.67
|
| Rate for Payer: PHCS All Commercial |
$167.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$167.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$167.67
|
| Rate for Payer: Sagamore Health Network All Products |
$167.67
|
| Rate for Payer: Sagamore Health Network All Products |
$167.67
|
| Rate for Payer: United Healthcare Commercial |
$163.66
|
| Rate for Payer: United Healthcare Commercial |
$163.66
|
| Rate for Payer: United Healthcare Medicare |
$172.64
|
| Rate for Payer: United Healthcare Medicare |
$172.64
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$145.42
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
z99348
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$122.12 |
| Rate for Payer: Aetna Commercial |
$78.79
|
| Rate for Payer: Aetna Commercial |
$78.79
|
| Rate for Payer: Aetna Medicare |
$78.79
|
| Rate for Payer: Aetna Medicare |
$78.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.67
|
| Rate for Payer: Cash Price |
$88.08
|
| Rate for Payer: Cash Price |
$90.16
|
| Rate for Payer: Centivo All Commercial |
$122.12
|
| Rate for Payer: Centivo All Commercial |
$122.12
|
| Rate for Payer: Cigna All Commercial |
$78.79
|
| Rate for Payer: Cigna All Commercial |
$78.79
|
| Rate for Payer: CORVEL All Commercial |
$78.79
|
| Rate for Payer: CORVEL All Commercial |
$78.79
|
| Rate for Payer: Coventry All Commercial |
$94.55
|
| Rate for Payer: Coventry All Commercial |
$94.55
|
| Rate for Payer: Encore All Commercial |
$78.79
|
| Rate for Payer: Encore All Commercial |
$78.79
|
| Rate for Payer: Frontpath All Commercial |
$84.33
|
| Rate for Payer: Frontpath All Commercial |
$84.33
|
| Rate for Payer: Humana ChoiceCare |
$73.05
|
| Rate for Payer: Humana ChoiceCare |
$73.05
|
| Rate for Payer: Humana Medicare |
$78.79
|
| Rate for Payer: Humana Medicare |
$78.79
|
| Rate for Payer: Lucent All Commercial |
$110.31
|
| Rate for Payer: Lucent All Commercial |
$110.31
|
| Rate for Payer: Managed Health Services Medicaid |
$71.52
|
| Rate for Payer: Managed Health Services Medicaid |
$71.52
|
| Rate for Payer: MDWise Medicaid |
$71.52
|
| Rate for Payer: MDWise Medicaid |
$71.52
|
| Rate for Payer: PHCS All Commercial |
$78.79
|
| Rate for Payer: PHCS All Commercial |
$78.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.79
|
| Rate for Payer: Sagamore Health Network All Products |
$78.79
|
| Rate for Payer: Sagamore Health Network All Products |
$78.79
|
| Rate for Payer: United Healthcare Commercial |
$80.60
|
| Rate for Payer: United Healthcare Commercial |
$80.60
|
| Rate for Payer: United Healthcare Medicare |
$71.03
|
| Rate for Payer: United Healthcare Medicare |
$71.03
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$240.66
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
z99349
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$187.84 |
| Rate for Payer: Aetna Commercial |
$121.19
|
| Rate for Payer: Aetna Commercial |
$121.19
|
| Rate for Payer: Aetna Medicare |
$121.19
|
| Rate for Payer: Aetna Medicare |
$121.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$118.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$118.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.31
|
| Rate for Payer: Cash Price |
$146.65
|
| Rate for Payer: Cash Price |
$149.21
|
| Rate for Payer: Centivo All Commercial |
$187.84
|
| Rate for Payer: Centivo All Commercial |
$187.84
|
| Rate for Payer: Cigna All Commercial |
$121.19
|
| Rate for Payer: Cigna All Commercial |
$121.19
|
| Rate for Payer: CORVEL All Commercial |
$121.19
|
| Rate for Payer: CORVEL All Commercial |
$121.19
|
| Rate for Payer: Coventry All Commercial |
$145.43
|
| Rate for Payer: Coventry All Commercial |
$145.43
|
| Rate for Payer: Encore All Commercial |
$121.19
|
| Rate for Payer: Encore All Commercial |
$121.19
|
| Rate for Payer: Frontpath All Commercial |
$129.79
|
| Rate for Payer: Frontpath All Commercial |
$129.79
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$121.19
|
| Rate for Payer: Humana Medicare |
$121.19
|
| Rate for Payer: Lucent All Commercial |
$169.67
|
| Rate for Payer: Lucent All Commercial |
$169.67
|
| Rate for Payer: Managed Health Services Medicaid |
$118.36
|
| Rate for Payer: Managed Health Services Medicaid |
$118.36
|
| Rate for Payer: MDWise Medicaid |
$118.36
|
| Rate for Payer: MDWise Medicaid |
$118.36
|
| Rate for Payer: PHCS All Commercial |
$121.19
|
| Rate for Payer: PHCS All Commercial |
$121.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.19
|
| Rate for Payer: Sagamore Health Network All Products |
$121.19
|
| Rate for Payer: Sagamore Health Network All Products |
$121.19
|
| Rate for Payer: United Healthcare Commercial |
$117.39
|
| Rate for Payer: United Healthcare Commercial |
$117.39
|
| Rate for Payer: United Healthcare Medicare |
$118.27
|
| Rate for Payer: United Healthcare Medicare |
$118.27
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$86.08
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
z99347
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$80.48 |
| Rate for Payer: Aetna Commercial |
$51.92
|
| Rate for Payer: Aetna Commercial |
$51.92
|
| Rate for Payer: Aetna Medicare |
$51.92
|
| Rate for Payer: Aetna Medicare |
$51.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.11
|
| Rate for Payer: Cash Price |
$51.87
|
| Rate for Payer: Cash Price |
$53.37
|
| Rate for Payer: Centivo All Commercial |
$80.48
|
| Rate for Payer: Centivo All Commercial |
$80.48
|
| Rate for Payer: Cigna All Commercial |
$51.92
|
| Rate for Payer: Cigna All Commercial |
$51.92
|
| Rate for Payer: CORVEL All Commercial |
$51.92
|
| Rate for Payer: CORVEL All Commercial |
$51.92
|
| Rate for Payer: Coventry All Commercial |
$62.30
|
| Rate for Payer: Coventry All Commercial |
$62.30
|
| Rate for Payer: Encore All Commercial |
$51.92
|
| Rate for Payer: Encore All Commercial |
$51.92
|
| Rate for Payer: Frontpath All Commercial |
$55.37
|
| Rate for Payer: Frontpath All Commercial |
$55.37
|
| Rate for Payer: Humana ChoiceCare |
$45.96
|
| Rate for Payer: Humana ChoiceCare |
$45.96
|
| Rate for Payer: Humana Medicare |
$51.92
|
| Rate for Payer: Humana Medicare |
$51.92
|
| Rate for Payer: Lucent All Commercial |
$72.69
|
| Rate for Payer: Lucent All Commercial |
$72.69
|
| Rate for Payer: Managed Health Services Medicaid |
$42.34
|
| Rate for Payer: Managed Health Services Medicaid |
$42.34
|
| Rate for Payer: MDWise Medicaid |
$42.34
|
| Rate for Payer: MDWise Medicaid |
$42.34
|
| Rate for Payer: PHCS All Commercial |
$51.92
|
| Rate for Payer: PHCS All Commercial |
$51.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.92
|
| Rate for Payer: Sagamore Health Network All Products |
$51.92
|
| Rate for Payer: Sagamore Health Network All Products |
$51.92
|
| Rate for Payer: United Healthcare Commercial |
$53.38
|
| Rate for Payer: United Healthcare Commercial |
$53.38
|
| Rate for Payer: United Healthcare Medicare |
$41.83
|
| Rate for Payer: United Healthcare Medicare |
$41.83
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$149.26
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
z99342
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$7,700.00 |
| Rate for Payer: Aetna Commercial |
$73.20
|
| Rate for Payer: Aetna Commercial |
$73.20
|
| Rate for Payer: Aetna Medicare |
$73.20
|
| Rate for Payer: Aetna Medicare |
$73.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.52
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cash Price |
$90.48
|
| Rate for Payer: Centivo All Commercial |
$113.46
|
| Rate for Payer: Centivo All Commercial |
$113.46
|
| Rate for Payer: Cigna All Commercial |
$73.20
|
| Rate for Payer: Cigna All Commercial |
$73.20
|
| Rate for Payer: CORVEL All Commercial |
$73.20
|
| Rate for Payer: CORVEL All Commercial |
$73.20
|
| Rate for Payer: Coventry All Commercial |
$87.84
|
| Rate for Payer: Coventry All Commercial |
$87.84
|
| Rate for Payer: Encore All Commercial |
$73.20
|
| Rate for Payer: Encore All Commercial |
$73.20
|
| Rate for Payer: Frontpath All Commercial |
$78.23
|
| Rate for Payer: Frontpath All Commercial |
$78.23
|
| Rate for Payer: Humana ChoiceCare |
$87.37
|
| Rate for Payer: Humana ChoiceCare |
$87.37
|
| Rate for Payer: Humana Medicare |
$73.20
|
| Rate for Payer: Humana Medicare |
$73.20
|
| Rate for Payer: Lucent All Commercial |
$102.48
|
| Rate for Payer: Lucent All Commercial |
$102.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: Managed Health Services Medicaid |
$73.41
|
| Rate for Payer: Managed Health Services Medicaid |
$73.41
|
| Rate for Payer: MDWise Medicaid |
$73.41
|
| Rate for Payer: MDWise Medicaid |
$73.41
|
| Rate for Payer: PHCS All Commercial |
$73.20
|
| Rate for Payer: PHCS All Commercial |
$73.20
|
| Rate for Payer: PHP All Commercial |
$75.16
|
| Rate for Payer: PHP All Commercial |
$75.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.20
|
| Rate for Payer: Sagamore Health Network All Products |
$73.20
|
| Rate for Payer: Sagamore Health Network All Products |
$73.20
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: United Healthcare Commercial |
$79.66
|
| Rate for Payer: United Healthcare Commercial |
$79.66
|
| Rate for Payer: United Healthcare Medicare |
$72.97
|
| Rate for Payer: United Healthcare Medicare |
$72.97
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
Both
|
$392.36
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
z99236
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$20,500.00 |
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: Aetna Medicare |
$200.48
|
| Rate for Payer: Aetna Medicare |
$200.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$192.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$192.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.53
|
| Rate for Payer: Cash Price |
$243.26
|
| Rate for Payer: Cash Price |
$241.13
|
| Rate for Payer: Centivo All Commercial |
$310.74
|
| Rate for Payer: Centivo All Commercial |
$310.74
|
| Rate for Payer: Cigna All Commercial |
$200.48
|
| Rate for Payer: Cigna All Commercial |
$200.48
|
| Rate for Payer: CORVEL All Commercial |
$200.48
|
| Rate for Payer: CORVEL All Commercial |
$200.48
|
| Rate for Payer: Coventry All Commercial |
$240.58
|
| Rate for Payer: Coventry All Commercial |
$240.58
|
| Rate for Payer: Encore All Commercial |
$200.48
|
| Rate for Payer: Encore All Commercial |
$200.48
|
| Rate for Payer: Frontpath All Commercial |
$216.27
|
| Rate for Payer: Frontpath All Commercial |
$216.27
|
| Rate for Payer: Humana ChoiceCare |
$214.03
|
| Rate for Payer: Humana ChoiceCare |
$214.03
|
| Rate for Payer: Humana Medicare |
$200.48
|
| Rate for Payer: Humana Medicare |
$200.48
|
| Rate for Payer: Lucent All Commercial |
$280.67
|
| Rate for Payer: Lucent All Commercial |
$280.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$209.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$209.00
|
| Rate for Payer: Managed Health Services Medicaid |
$192.98
|
| Rate for Payer: Managed Health Services Medicaid |
$192.98
|
| Rate for Payer: MDWise Medicaid |
$192.98
|
| Rate for Payer: MDWise Medicaid |
$192.98
|
| Rate for Payer: PHCS All Commercial |
$200.48
|
| Rate for Payer: PHCS All Commercial |
$200.48
|
| Rate for Payer: PHP All Commercial |
$200.29
|
| Rate for Payer: PHP All Commercial |
$200.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.48
|
| Rate for Payer: Sagamore Health Network All Products |
$200.48
|
| Rate for Payer: Sagamore Health Network All Products |
$200.48
|
| Rate for Payer: Signature Care EPO |
$240.55
|
| Rate for Payer: Signature Care EPO |
$240.55
|
| Rate for Payer: Signature Care PPO |
$240.55
|
| Rate for Payer: Signature Care PPO |
$240.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,500.00
|
| Rate for Payer: United Healthcare Commercial |
$210.83
|
| Rate for Payer: United Healthcare Commercial |
$210.83
|
| Rate for Payer: United Healthcare Medicare |
$194.46
|
| Rate for Payer: United Healthcare Medicare |
$194.46
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
Both
|
$300.18
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
z99235
|
| Min. Negotiated Rate |
$147.64 |
| Max. Negotiated Rate |
$15,600.00 |
| Rate for Payer: Aetna Commercial |
$156.48
|
| Rate for Payer: Aetna Commercial |
$156.48
|
| Rate for Payer: Aetna Medicare |
$156.48
|
| Rate for Payer: Aetna Medicare |
$156.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.13
|
| Rate for Payer: Cash Price |
$186.11
|
| Rate for Payer: Cash Price |
$183.62
|
| Rate for Payer: Centivo All Commercial |
$242.54
|
| Rate for Payer: Centivo All Commercial |
$242.54
|
| Rate for Payer: Cigna All Commercial |
$156.48
|
| Rate for Payer: Cigna All Commercial |
$156.48
|
| Rate for Payer: CORVEL All Commercial |
$156.48
|
| Rate for Payer: CORVEL All Commercial |
$156.48
|
| Rate for Payer: Coventry All Commercial |
$187.78
|
| Rate for Payer: Coventry All Commercial |
$187.78
|
| Rate for Payer: Encore All Commercial |
$156.48
|
| Rate for Payer: Encore All Commercial |
$156.48
|
| Rate for Payer: Frontpath All Commercial |
$168.77
|
| Rate for Payer: Frontpath All Commercial |
$168.77
|
| Rate for Payer: Humana ChoiceCare |
$171.36
|
| Rate for Payer: Humana ChoiceCare |
$171.36
|
| Rate for Payer: Humana Medicare |
$156.48
|
| Rate for Payer: Humana Medicare |
$156.48
|
| Rate for Payer: Lucent All Commercial |
$219.07
|
| Rate for Payer: Lucent All Commercial |
$219.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.00
|
| Rate for Payer: Managed Health Services Medicaid |
$147.64
|
| Rate for Payer: Managed Health Services Medicaid |
$147.64
|
| Rate for Payer: MDWise Medicaid |
$147.64
|
| Rate for Payer: MDWise Medicaid |
$147.64
|
| Rate for Payer: PHCS All Commercial |
$156.48
|
| Rate for Payer: PHCS All Commercial |
$156.48
|
| Rate for Payer: PHP All Commercial |
$152.52
|
| Rate for Payer: PHP All Commercial |
$152.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.48
|
| Rate for Payer: Sagamore Health Network All Products |
$156.48
|
| Rate for Payer: Sagamore Health Network All Products |
$156.48
|
| Rate for Payer: Signature Care EPO |
$192.95
|
| Rate for Payer: Signature Care EPO |
$192.95
|
| Rate for Payer: Signature Care PPO |
$192.95
|
| Rate for Payer: Signature Care PPO |
$192.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,600.00
|
| Rate for Payer: United Healthcare Commercial |
$169.62
|
| Rate for Payer: United Healthcare Commercial |
$169.62
|
| Rate for Payer: United Healthcare Medicare |
$148.08
|
| Rate for Payer: United Healthcare Medicare |
$148.08
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$183.44
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
z99234
|
| Min. Negotiated Rate |
$90.23 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Aetna Commercial |
$122.97
|
| Rate for Payer: Aetna Commercial |
$122.97
|
| Rate for Payer: Aetna Medicare |
$122.97
|
| Rate for Payer: Aetna Medicare |
$122.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.27
|
| Rate for Payer: Cash Price |
$113.73
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Centivo All Commercial |
$190.60
|
| Rate for Payer: Centivo All Commercial |
$190.60
|
| Rate for Payer: Cigna All Commercial |
$122.97
|
| Rate for Payer: Cigna All Commercial |
$122.97
|
| Rate for Payer: CORVEL All Commercial |
$122.97
|
| Rate for Payer: CORVEL All Commercial |
$122.97
|
| Rate for Payer: Coventry All Commercial |
$147.56
|
| Rate for Payer: Coventry All Commercial |
$147.56
|
| Rate for Payer: Encore All Commercial |
$122.97
|
| Rate for Payer: Encore All Commercial |
$122.97
|
| Rate for Payer: Frontpath All Commercial |
$133.33
|
| Rate for Payer: Frontpath All Commercial |
$133.33
|
| Rate for Payer: Humana ChoiceCare |
$129.72
|
| Rate for Payer: Humana ChoiceCare |
$129.72
|
| Rate for Payer: Humana Medicare |
$122.97
|
| Rate for Payer: Humana Medicare |
$122.97
|
| Rate for Payer: Lucent All Commercial |
$172.16
|
| Rate for Payer: Lucent All Commercial |
$172.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Managed Health Services Medicaid |
$90.23
|
| Rate for Payer: Managed Health Services Medicaid |
$90.23
|
| Rate for Payer: MDWise Medicaid |
$90.23
|
| Rate for Payer: MDWise Medicaid |
$90.23
|
| Rate for Payer: PHCS All Commercial |
$122.97
|
| Rate for Payer: PHCS All Commercial |
$122.97
|
| Rate for Payer: PHP All Commercial |
$93.97
|
| Rate for Payer: PHP All Commercial |
$93.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.97
|
| Rate for Payer: Sagamore Health Network All Products |
$122.97
|
| Rate for Payer: Sagamore Health Network All Products |
$122.97
|
| Rate for Payer: Signature Care EPO |
$146.20
|
| Rate for Payer: Signature Care EPO |
$146.20
|
| Rate for Payer: Signature Care PPO |
$146.20
|
| Rate for Payer: Signature Care PPO |
$146.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: United Healthcare Commercial |
$129.10
|
| Rate for Payer: United Healthcare Commercial |
$129.10
|
| Rate for Payer: United Healthcare Medicare |
$91.24
|
| Rate for Payer: United Healthcare Medicare |
$91.24
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$215.50
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
z99239
|
| Min. Negotiated Rate |
$92.54 |
| Max. Negotiated Rate |
$11,200.00 |
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: Aetna Medicare |
$99.45
|
| Rate for Payer: Aetna Medicare |
$99.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.39
|
| Rate for Payer: Cash Price |
$133.61
|
| Rate for Payer: Cash Price |
$131.42
|
| Rate for Payer: Centivo All Commercial |
$154.15
|
| Rate for Payer: Centivo All Commercial |
$154.15
|
| Rate for Payer: Cigna All Commercial |
$99.45
|
| Rate for Payer: Cigna All Commercial |
$99.45
|
| Rate for Payer: CORVEL All Commercial |
$99.45
|
| Rate for Payer: CORVEL All Commercial |
$99.45
|
| Rate for Payer: Coventry All Commercial |
$119.34
|
| Rate for Payer: Coventry All Commercial |
$119.34
|
| Rate for Payer: Encore All Commercial |
$99.45
|
| Rate for Payer: Encore All Commercial |
$99.45
|
| Rate for Payer: Frontpath All Commercial |
$106.62
|
| Rate for Payer: Frontpath All Commercial |
$106.62
|
| Rate for Payer: Humana ChoiceCare |
$92.54
|
| Rate for Payer: Humana ChoiceCare |
$92.54
|
| Rate for Payer: Humana Medicare |
$99.45
|
| Rate for Payer: Humana Medicare |
$99.45
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: Managed Health Services Medicaid |
$105.99
|
| Rate for Payer: Managed Health Services Medicaid |
$105.99
|
| Rate for Payer: MDWise Medicaid |
$105.99
|
| Rate for Payer: MDWise Medicaid |
$105.99
|
| Rate for Payer: PHCS All Commercial |
$99.45
|
| Rate for Payer: PHCS All Commercial |
$99.45
|
| Rate for Payer: PHP All Commercial |
$109.16
|
| Rate for Payer: PHP All Commercial |
$109.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.45
|
| Rate for Payer: Sagamore Health Network All Products |
$99.45
|
| Rate for Payer: Sagamore Health Network All Products |
$99.45
|
| Rate for Payer: Signature Care EPO |
$101.15
|
| Rate for Payer: Signature Care EPO |
$101.15
|
| Rate for Payer: Signature Care PPO |
$101.15
|
| Rate for Payer: Signature Care PPO |
$101.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,200.00
|
| Rate for Payer: United Healthcare Commercial |
$97.88
|
| Rate for Payer: United Healthcare Commercial |
$97.88
|
| Rate for Payer: United Healthcare Medicare |
$105.98
|
| Rate for Payer: United Healthcare Medicare |
$105.98
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$152.52
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
z99238
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare |
$67.86
|
| Rate for Payer: Aetna Medicare |
$67.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.65
|
| Rate for Payer: Cash Price |
$94.56
|
| Rate for Payer: Cash Price |
$92.76
|
| Rate for Payer: Centivo All Commercial |
$105.18
|
| Rate for Payer: Centivo All Commercial |
$105.18
|
| Rate for Payer: Cigna All Commercial |
$67.86
|
| Rate for Payer: Cigna All Commercial |
$67.86
|
| Rate for Payer: CORVEL All Commercial |
$67.86
|
| Rate for Payer: CORVEL All Commercial |
$67.86
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Encore All Commercial |
$67.86
|
| Rate for Payer: Encore All Commercial |
$67.86
|
| Rate for Payer: Frontpath All Commercial |
$72.95
|
| Rate for Payer: Frontpath All Commercial |
$72.95
|
| Rate for Payer: Humana ChoiceCare |
$67.88
|
| Rate for Payer: Humana ChoiceCare |
$67.88
|
| Rate for Payer: Humana Medicare |
$67.86
|
| Rate for Payer: Humana Medicare |
$67.86
|
| Rate for Payer: Lucent All Commercial |
$95.00
|
| Rate for Payer: Lucent All Commercial |
$95.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.00
|
| Rate for Payer: Managed Health Services Medicaid |
$75.02
|
| Rate for Payer: Managed Health Services Medicaid |
$75.02
|
| Rate for Payer: MDWise Medicaid |
$75.02
|
| Rate for Payer: MDWise Medicaid |
$75.02
|
| Rate for Payer: PHCS All Commercial |
$67.86
|
| Rate for Payer: PHCS All Commercial |
$67.86
|
| Rate for Payer: PHP All Commercial |
$77.06
|
| Rate for Payer: PHP All Commercial |
$77.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.86
|
| Rate for Payer: Sagamore Health Network All Products |
$67.86
|
| Rate for Payer: Sagamore Health Network All Products |
$67.86
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,900.00
|
| Rate for Payer: United Healthcare Commercial |
$67.34
|
| Rate for Payer: United Healthcare Commercial |
$67.34
|
| Rate for Payer: United Healthcare Medicare |
$74.81
|
| Rate for Payer: United Healthcare Medicare |
$74.81
|
|
|
PR HYMENOTOMY, SIMPLE INCISION
|
Professional
|
Both
|
$87.82
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
z56442
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$43.68
|
| Rate for Payer: Aetna Commercial |
$43.68
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$43.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$43.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.05
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$53.37
|
| Rate for Payer: Centivo All Commercial |
$67.70
|
| Rate for Payer: Centivo All Commercial |
$67.70
|
| Rate for Payer: Cigna All Commercial |
$43.68
|
| Rate for Payer: Cigna All Commercial |
$43.68
|
| Rate for Payer: CORVEL All Commercial |
$43.68
|
| Rate for Payer: CORVEL All Commercial |
$43.68
|
| Rate for Payer: Coventry All Commercial |
$52.42
|
| Rate for Payer: Coventry All Commercial |
$52.42
|
| Rate for Payer: Encore All Commercial |
$43.68
|
| Rate for Payer: Encore All Commercial |
$43.68
|
| Rate for Payer: Frontpath All Commercial |
$60.24
|
| Rate for Payer: Frontpath All Commercial |
$60.24
|
| Rate for Payer: Humana ChoiceCare |
$49.10
|
| Rate for Payer: Humana ChoiceCare |
$49.10
|
| Rate for Payer: Humana Medicare |
$43.68
|
| Rate for Payer: Humana Medicare |
$43.68
|
| Rate for Payer: Lucent All Commercial |
$61.15
|
| Rate for Payer: Lucent All Commercial |
$61.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Managed Health Services Medicaid |
$43.19
|
| Rate for Payer: Managed Health Services Medicaid |
$43.19
|
| Rate for Payer: MDWise Medicaid |
$43.19
|
| Rate for Payer: MDWise Medicaid |
$43.19
|
| Rate for Payer: PHCS All Commercial |
$43.68
|
| Rate for Payer: PHCS All Commercial |
$43.68
|
| Rate for Payer: PHP All Commercial |
$56.81
|
| Rate for Payer: PHP All Commercial |
$56.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.68
|
| Rate for Payer: Sagamore Health Network All Products |
$43.68
|
| Rate for Payer: Sagamore Health Network All Products |
$43.68
|
| Rate for Payer: Signature Care EPO |
$54.40
|
| Rate for Payer: Signature Care EPO |
$54.40
|
| Rate for Payer: Signature Care PPO |
$54.40
|
| Rate for Payer: Signature Care PPO |
$54.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,700.00
|
| Rate for Payer: United Healthcare Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$54.75
|
| Rate for Payer: United Healthcare Medicare |
$43.04
|
| Rate for Payer: United Healthcare Medicare |
$43.04
|
|
|
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 |
$121.94
|
| Rate for Payer: Cash Price |
$123.18
|
| 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 |
$411.49
|
| Rate for Payer: Cash Price |
$413.13
|
| 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 Medicare |
$81.22
|
| Rate for Payer: Molina Healthcare of OH 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 |
$323.97
|
| Rate for Payer: Cash Price |
$319.54
|
| 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 |
$491.29
|
| Rate for Payer: Cash Price |
$493.83
|
| 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 Medicare |
$112.99
|
| Rate for Payer: Molina Healthcare of OH 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 |
$408.07
|
| Rate for Payer: Cash Price |
$402.16
|
| 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 |
$1,900.23
|
| Rate for Payer: Cash Price |
$1,892.91
|
| 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 Medicare |
$330.83
|
| Rate for Payer: Molina Healthcare of OH 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
|
|
