|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$283.72
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
z10120
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$11,800.00 |
| Rate for Payer: Aetna Commercial |
$97.10
|
| Rate for Payer: Aetna Commercial |
$97.10
|
| Rate for Payer: Aetna Medicare |
$97.10
|
| Rate for Payer: Aetna Medicare |
$97.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$139.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$139.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.81
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cash Price |
$170.23
|
| Rate for Payer: Centivo All Commercial |
$150.50
|
| Rate for Payer: Centivo All Commercial |
$150.50
|
| Rate for Payer: Cigna All Commercial |
$97.10
|
| Rate for Payer: Cigna All Commercial |
$97.10
|
| Rate for Payer: CORVEL All Commercial |
$97.10
|
| Rate for Payer: CORVEL All Commercial |
$97.10
|
| Rate for Payer: Coventry All Commercial |
$116.52
|
| Rate for Payer: Coventry All Commercial |
$116.52
|
| Rate for Payer: Encore All Commercial |
$97.10
|
| Rate for Payer: Encore All Commercial |
$97.10
|
| Rate for Payer: Frontpath All Commercial |
$130.61
|
| Rate for Payer: Frontpath All Commercial |
$130.61
|
| Rate for Payer: Humana ChoiceCare |
$81.52
|
| Rate for Payer: Humana ChoiceCare |
$81.52
|
| Rate for Payer: Humana Medicare |
$97.10
|
| Rate for Payer: Humana Medicare |
$97.10
|
| Rate for Payer: Lucent All Commercial |
$135.94
|
| Rate for Payer: Lucent All Commercial |
$135.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: Managed Health Services Medicaid |
$139.54
|
| Rate for Payer: Managed Health Services Medicaid |
$139.54
|
| Rate for Payer: MDWise Medicaid |
$139.54
|
| Rate for Payer: MDWise Medicaid |
$139.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$52.60
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$52.60
|
| Rate for Payer: PHCS All Commercial |
$97.10
|
| Rate for Payer: PHCS All Commercial |
$97.10
|
| Rate for Payer: PHP All Commercial |
$134.00
|
| Rate for Payer: PHP All Commercial |
$134.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.10
|
| Rate for Payer: Sagamore Health Network All Products |
$97.10
|
| Rate for Payer: Sagamore Health Network All Products |
$97.10
|
| Rate for Payer: Signature Care EPO |
$122.46
|
| Rate for Payer: Signature Care EPO |
$122.46
|
| Rate for Payer: Signature Care PPO |
$122.46
|
| Rate for Payer: Signature Care PPO |
$122.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,800.00
|
| Rate for Payer: United Healthcare Commercial |
$98.01
|
| Rate for Payer: United Healthcare Commercial |
$98.01
|
| Rate for Payer: United Healthcare Medicare |
$137.88
|
| Rate for Payer: United Healthcare Medicare |
$137.88
|
|
|
PR INCISION SUBCUT TOE TENDON
|
Professional
|
Both
|
$443.34
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
z28010
|
| Min. Negotiated Rate |
$157.84 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: Aetna Commercial |
$195.88
|
| Rate for Payer: Aetna Commercial |
$195.88
|
| Rate for Payer: Aetna Medicare |
$195.88
|
| Rate for Payer: Aetna Medicare |
$195.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$157.84
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$157.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$218.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$218.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.47
|
| Rate for Payer: Cash Price |
$257.71
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Centivo All Commercial |
$303.61
|
| Rate for Payer: Centivo All Commercial |
$303.61
|
| Rate for Payer: Cigna All Commercial |
$195.88
|
| Rate for Payer: Cigna All Commercial |
$195.88
|
| Rate for Payer: CORVEL All Commercial |
$195.88
|
| Rate for Payer: CORVEL All Commercial |
$195.88
|
| Rate for Payer: Coventry All Commercial |
$235.06
|
| Rate for Payer: Coventry All Commercial |
$235.06
|
| Rate for Payer: Encore All Commercial |
$195.88
|
| Rate for Payer: Encore All Commercial |
$195.88
|
| Rate for Payer: Frontpath All Commercial |
$263.39
|
| Rate for Payer: Frontpath All Commercial |
$263.39
|
| Rate for Payer: Humana ChoiceCare |
$224.97
|
| Rate for Payer: Humana ChoiceCare |
$224.97
|
| Rate for Payer: Humana Medicare |
$195.88
|
| Rate for Payer: Humana Medicare |
$195.88
|
| Rate for Payer: Lucent All Commercial |
$274.23
|
| Rate for Payer: Lucent All Commercial |
$274.23
|
| Rate for Payer: Managed Health Services Medicaid |
$218.06
|
| Rate for Payer: Managed Health Services Medicaid |
$218.06
|
| Rate for Payer: MDWise Medicaid |
$218.06
|
| Rate for Payer: MDWise Medicaid |
$218.06
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$157.84
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$157.84
|
| Rate for Payer: PHCS All Commercial |
$195.88
|
| Rate for Payer: PHCS All Commercial |
$195.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$195.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$195.88
|
| Rate for Payer: Sagamore Health Network All Products |
$195.88
|
| Rate for Payer: Sagamore Health Network All Products |
$195.88
|
| Rate for Payer: United Healthcare Commercial |
$236.03
|
| Rate for Payer: United Healthcare Commercial |
$236.03
|
| Rate for Payer: United Healthcare Medicare |
$214.76
|
| Rate for Payer: United Healthcare Medicare |
$214.76
|
|
|
PR INCISION SUBCUT TOE TENDON,>1
|
Professional
|
Both
|
$597.08
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
z28011
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$409.98 |
| Rate for Payer: Aetna Commercial |
$264.50
|
| Rate for Payer: Aetna Commercial |
$264.50
|
| Rate for Payer: Aetna Medicare |
$264.50
|
| Rate for Payer: Aetna Medicare |
$264.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$164.39
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$164.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$293.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$293.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$304.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$304.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.95
|
| Rate for Payer: Cash Price |
$347.36
|
| Rate for Payer: Cash Price |
$358.25
|
| Rate for Payer: Centivo All Commercial |
$409.98
|
| Rate for Payer: Centivo All Commercial |
$409.98
|
| Rate for Payer: Cigna All Commercial |
$264.50
|
| Rate for Payer: Cigna All Commercial |
$264.50
|
| Rate for Payer: CORVEL All Commercial |
$264.50
|
| Rate for Payer: CORVEL All Commercial |
$264.50
|
| Rate for Payer: Coventry All Commercial |
$317.40
|
| Rate for Payer: Coventry All Commercial |
$317.40
|
| Rate for Payer: Encore All Commercial |
$264.50
|
| Rate for Payer: Encore All Commercial |
$264.50
|
| Rate for Payer: Frontpath All Commercial |
$357.23
|
| Rate for Payer: Frontpath All Commercial |
$357.23
|
| Rate for Payer: Humana ChoiceCare |
$322.46
|
| Rate for Payer: Humana ChoiceCare |
$322.46
|
| Rate for Payer: Humana Medicare |
$264.50
|
| Rate for Payer: Humana Medicare |
$264.50
|
| Rate for Payer: Lucent All Commercial |
$370.30
|
| Rate for Payer: Lucent All Commercial |
$370.30
|
| Rate for Payer: Managed Health Services Medicaid |
$293.67
|
| Rate for Payer: Managed Health Services Medicaid |
$293.67
|
| Rate for Payer: MDWise Medicaid |
$293.67
|
| Rate for Payer: MDWise Medicaid |
$293.67
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$164.39
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$164.39
|
| Rate for Payer: PHCS All Commercial |
$264.50
|
| Rate for Payer: PHCS All Commercial |
$264.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$264.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$264.50
|
| Rate for Payer: Sagamore Health Network All Products |
$264.50
|
| Rate for Payer: Sagamore Health Network All Products |
$264.50
|
| Rate for Payer: United Healthcare Commercial |
$333.13
|
| Rate for Payer: United Healthcare Commercial |
$333.13
|
| Rate for Payer: United Healthcare Medicare |
$289.47
|
| Rate for Payer: United Healthcare Medicare |
$289.47
|
|
|
PR INCIS TENDON SHEATH,RADIAL STYLOID
|
Professional
|
Both
|
$654.22
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
z25000
|
| Min. Negotiated Rate |
$318.08 |
| Max. Negotiated Rate |
$48,900.00 |
| Rate for Payer: Aetna Commercial |
$323.15
|
| Rate for Payer: Aetna Commercial |
$323.15
|
| Rate for Payer: Aetna Medicare |
$323.15
|
| Rate for Payer: Aetna Medicare |
$323.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$321.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$321.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$371.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$371.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$355.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$355.46
|
| Rate for Payer: Cash Price |
$392.53
|
| Rate for Payer: Cash Price |
$381.70
|
| Rate for Payer: Centivo All Commercial |
$500.88
|
| Rate for Payer: Centivo All Commercial |
$500.88
|
| Rate for Payer: Cigna All Commercial |
$323.15
|
| Rate for Payer: Cigna All Commercial |
$323.15
|
| Rate for Payer: CORVEL All Commercial |
$323.15
|
| Rate for Payer: CORVEL All Commercial |
$323.15
|
| Rate for Payer: Coventry All Commercial |
$387.78
|
| Rate for Payer: Coventry All Commercial |
$387.78
|
| Rate for Payer: Encore All Commercial |
$323.15
|
| Rate for Payer: Encore All Commercial |
$323.15
|
| Rate for Payer: Frontpath All Commercial |
$442.34
|
| Rate for Payer: Frontpath All Commercial |
$442.34
|
| Rate for Payer: Humana ChoiceCare |
$430.12
|
| Rate for Payer: Humana ChoiceCare |
$430.12
|
| Rate for Payer: Humana Medicare |
$323.15
|
| Rate for Payer: Humana Medicare |
$323.15
|
| Rate for Payer: Lucent All Commercial |
$452.41
|
| Rate for Payer: Lucent All Commercial |
$452.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.00
|
| Rate for Payer: Managed Health Services Medicaid |
$321.77
|
| Rate for Payer: Managed Health Services Medicaid |
$321.77
|
| Rate for Payer: MDWise Medicaid |
$321.77
|
| Rate for Payer: MDWise Medicaid |
$321.77
|
| Rate for Payer: PHCS All Commercial |
$323.15
|
| Rate for Payer: PHCS All Commercial |
$323.15
|
| Rate for Payer: PHP All Commercial |
$553.46
|
| Rate for Payer: PHP All Commercial |
$553.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$323.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$323.15
|
| Rate for Payer: Sagamore Health Network All Products |
$323.15
|
| Rate for Payer: Sagamore Health Network All Products |
$323.15
|
| Rate for Payer: Signature Care EPO |
$542.45
|
| Rate for Payer: Signature Care EPO |
$542.45
|
| Rate for Payer: Signature Care PPO |
$542.45
|
| Rate for Payer: Signature Care PPO |
$542.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,900.00
|
| Rate for Payer: United Healthcare Commercial |
$366.11
|
| Rate for Payer: United Healthcare Commercial |
$366.11
|
| Rate for Payer: United Healthcare Medicare |
$318.08
|
| Rate for Payer: United Healthcare Medicare |
$318.08
|
|
|
PR INDUCED AB BY VAG SUPPOS
|
Professional
|
Both
|
$768.84
|
|
|
Service Code
|
CPT 59855
|
| Hospital Charge Code |
z59855
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$50,300.00 |
| Rate for Payer: Aetna Commercial |
$388.54
|
| Rate for Payer: Aetna Commercial |
$388.54
|
| Rate for Payer: Aetna Medicare |
$388.54
|
| Rate for Payer: Aetna Medicare |
$388.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$543.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$378.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$378.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.39
|
| Rate for Payer: Cash Price |
$461.30
|
| Rate for Payer: Cash Price |
$453.38
|
| Rate for Payer: Centivo All Commercial |
$602.24
|
| Rate for Payer: Centivo All Commercial |
$602.24
|
| Rate for Payer: Cigna All Commercial |
$388.54
|
| Rate for Payer: Cigna All Commercial |
$388.54
|
| Rate for Payer: CORVEL All Commercial |
$388.54
|
| Rate for Payer: CORVEL All Commercial |
$388.54
|
| Rate for Payer: Coventry All Commercial |
$466.25
|
| Rate for Payer: Coventry All Commercial |
$466.25
|
| Rate for Payer: Encore All Commercial |
$388.54
|
| Rate for Payer: Encore All Commercial |
$388.54
|
| Rate for Payer: Frontpath All Commercial |
$551.13
|
| Rate for Payer: Frontpath All Commercial |
$551.13
|
| Rate for Payer: Humana ChoiceCare |
$377.40
|
| Rate for Payer: Humana ChoiceCare |
$377.40
|
| Rate for Payer: Humana Medicare |
$388.54
|
| Rate for Payer: Humana Medicare |
$388.54
|
| Rate for Payer: Lucent All Commercial |
$543.96
|
| Rate for Payer: Lucent All Commercial |
$543.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$542.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$542.00
|
| Rate for Payer: Managed Health Services Medicaid |
$378.15
|
| Rate for Payer: Managed Health Services Medicaid |
$378.15
|
| Rate for Payer: MDWise Medicaid |
$378.15
|
| Rate for Payer: MDWise Medicaid |
$378.15
|
| Rate for Payer: PHCS All Commercial |
$388.54
|
| Rate for Payer: PHCS All Commercial |
$388.54
|
| Rate for Payer: PHP All Commercial |
$498.72
|
| Rate for Payer: PHP All Commercial |
$498.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.54
|
| Rate for Payer: Sagamore Health Network All Products |
$388.54
|
| Rate for Payer: Sagamore Health Network All Products |
$388.54
|
| Rate for Payer: Signature Care EPO |
$485.35
|
| Rate for Payer: Signature Care EPO |
$485.35
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,300.00
|
| Rate for Payer: United Healthcare Commercial |
$462.13
|
| Rate for Payer: United Healthcare Commercial |
$462.13
|
| Rate for Payer: United Healthcare Medicare |
$377.82
|
| Rate for Payer: United Healthcare Medicare |
$377.82
|
|
|
PR INDUCED ABORTN BY DIL/EVAC
|
Professional
|
Both
|
$774.82
|
|
|
Service Code
|
CPT 59841
|
| Hospital Charge Code |
z59841
|
| Min. Negotiated Rate |
$220.16 |
| Max. Negotiated Rate |
$44,100.00 |
| Rate for Payer: Aetna Commercial |
$341.04
|
| Rate for Payer: Aetna Commercial |
$341.04
|
| Rate for Payer: Aetna Medicare |
$341.04
|
| Rate for Payer: Aetna Medicare |
$341.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$220.16
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$220.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$381.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$381.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$392.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$392.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$375.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$375.14
|
| Rate for Payer: Cash Price |
$457.30
|
| Rate for Payer: Cash Price |
$464.89
|
| Rate for Payer: Centivo All Commercial |
$528.61
|
| Rate for Payer: Centivo All Commercial |
$528.61
|
| Rate for Payer: Cigna All Commercial |
$341.04
|
| Rate for Payer: Cigna All Commercial |
$341.04
|
| Rate for Payer: CORVEL All Commercial |
$341.04
|
| Rate for Payer: CORVEL All Commercial |
$341.04
|
| Rate for Payer: Coventry All Commercial |
$409.25
|
| Rate for Payer: Coventry All Commercial |
$409.25
|
| Rate for Payer: Encore All Commercial |
$341.04
|
| Rate for Payer: Encore All Commercial |
$341.04
|
| Rate for Payer: Frontpath All Commercial |
$484.16
|
| Rate for Payer: Frontpath All Commercial |
$484.16
|
| Rate for Payer: Humana ChoiceCare |
$321.01
|
| Rate for Payer: Humana ChoiceCare |
$321.01
|
| Rate for Payer: Humana Medicare |
$341.04
|
| Rate for Payer: Humana Medicare |
$341.04
|
| Rate for Payer: Lucent All Commercial |
$477.46
|
| Rate for Payer: Lucent All Commercial |
$477.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.00
|
| Rate for Payer: Managed Health Services Medicaid |
$381.08
|
| Rate for Payer: Managed Health Services Medicaid |
$381.08
|
| Rate for Payer: MDWise Medicaid |
$381.08
|
| Rate for Payer: MDWise Medicaid |
$381.08
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$220.16
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$220.16
|
| Rate for Payer: PHCS All Commercial |
$341.04
|
| Rate for Payer: PHCS All Commercial |
$341.04
|
| Rate for Payer: PHP All Commercial |
$436.63
|
| Rate for Payer: PHP All Commercial |
$436.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.04
|
| Rate for Payer: Sagamore Health Network All Products |
$341.04
|
| Rate for Payer: Sagamore Health Network All Products |
$341.04
|
| Rate for Payer: Signature Care EPO |
$394.40
|
| Rate for Payer: Signature Care EPO |
$394.40
|
| Rate for Payer: Signature Care PPO |
$394.40
|
| Rate for Payer: Signature Care PPO |
$394.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,100.00
|
| Rate for Payer: United Healthcare Commercial |
$397.18
|
| Rate for Payer: United Healthcare Commercial |
$397.18
|
| Rate for Payer: United Healthcare Medicare |
$381.08
|
| Rate for Payer: United Healthcare Medicare |
$381.08
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$233.16
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
z95076
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna Medicare |
$71.41
|
| Rate for Payer: Aetna Medicare |
$71.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.18
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$56.65
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$56.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.55
|
| Rate for Payer: Cash Price |
$134.36
|
| Rate for Payer: Cash Price |
$139.90
|
| Rate for Payer: Centivo All Commercial |
$110.69
|
| Rate for Payer: Centivo All Commercial |
$110.69
|
| Rate for Payer: Cigna All Commercial |
$71.41
|
| Rate for Payer: Cigna All Commercial |
$71.41
|
| Rate for Payer: CORVEL All Commercial |
$71.41
|
| Rate for Payer: CORVEL All Commercial |
$71.41
|
| Rate for Payer: Coventry All Commercial |
$85.69
|
| Rate for Payer: Coventry All Commercial |
$85.69
|
| Rate for Payer: Encore All Commercial |
$71.41
|
| Rate for Payer: Encore All Commercial |
$71.41
|
| Rate for Payer: Frontpath All Commercial |
$76.13
|
| Rate for Payer: Frontpath All Commercial |
$76.13
|
| Rate for Payer: Humana ChoiceCare |
$147.42
|
| Rate for Payer: Humana ChoiceCare |
$147.42
|
| Rate for Payer: Humana Medicare |
$71.41
|
| Rate for Payer: Humana Medicare |
$71.41
|
| Rate for Payer: Lucent All Commercial |
$99.97
|
| Rate for Payer: Lucent All Commercial |
$99.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Managed Health Services Medicaid |
$114.68
|
| Rate for Payer: Managed Health Services Medicaid |
$114.68
|
| Rate for Payer: MDWise Medicaid |
$114.68
|
| Rate for Payer: MDWise Medicaid |
$114.68
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$56.65
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$56.65
|
| Rate for Payer: PHCS All Commercial |
$71.41
|
| Rate for Payer: PHCS All Commercial |
$71.41
|
| Rate for Payer: PHP All Commercial |
$79.24
|
| Rate for Payer: PHP All Commercial |
$79.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.41
|
| Rate for Payer: Sagamore Health Network All Products |
$71.41
|
| Rate for Payer: Sagamore Health Network All Products |
$71.41
|
| Rate for Payer: Signature Care EPO |
$127.87
|
| Rate for Payer: Signature Care EPO |
$127.87
|
| Rate for Payer: Signature Care PPO |
$127.87
|
| Rate for Payer: Signature Care PPO |
$127.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare |
$111.97
|
| Rate for Payer: United Healthcare Medicare |
$111.97
|
|
|
PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL
|
Professional
|
Both
|
$1,684.60
|
|
|
Service Code
|
CPT 99468
|
| Hospital Charge Code |
z99468
|
| Min. Negotiated Rate |
$828.55 |
| Max. Negotiated Rate |
$314,000.00 |
| Rate for Payer: Aetna Commercial |
$870.57
|
| Rate for Payer: Aetna Commercial |
$870.57
|
| Rate for Payer: Aetna Medicare |
$870.57
|
| Rate for Payer: Aetna Medicare |
$870.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$974.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$828.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$828.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,001.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,001.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$957.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$957.63
|
| Rate for Payer: Cash Price |
$1,010.76
|
| Rate for Payer: Cash Price |
$998.05
|
| Rate for Payer: Centivo All Commercial |
$1,349.38
|
| Rate for Payer: Centivo All Commercial |
$1,349.38
|
| Rate for Payer: Cigna All Commercial |
$870.57
|
| Rate for Payer: Cigna All Commercial |
$870.57
|
| Rate for Payer: CORVEL All Commercial |
$870.57
|
| Rate for Payer: CORVEL All Commercial |
$870.57
|
| Rate for Payer: Coventry All Commercial |
$1,044.68
|
| Rate for Payer: Coventry All Commercial |
$1,044.68
|
| Rate for Payer: Encore All Commercial |
$870.57
|
| Rate for Payer: Encore All Commercial |
$870.57
|
| Rate for Payer: Frontpath All Commercial |
$936.64
|
| Rate for Payer: Frontpath All Commercial |
$936.64
|
| Rate for Payer: Humana ChoiceCare |
$1,277.56
|
| Rate for Payer: Humana ChoiceCare |
$1,277.56
|
| Rate for Payer: Humana Medicare |
$870.57
|
| Rate for Payer: Humana Medicare |
$870.57
|
| Rate for Payer: Lucent All Commercial |
$1,218.80
|
| Rate for Payer: Lucent All Commercial |
$1,218.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,140.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,140.00
|
| Rate for Payer: Managed Health Services Medicaid |
$828.55
|
| Rate for Payer: Managed Health Services Medicaid |
$828.55
|
| Rate for Payer: MDWise Medicaid |
$828.55
|
| Rate for Payer: MDWise Medicaid |
$828.55
|
| Rate for Payer: PHCS All Commercial |
$870.57
|
| Rate for Payer: PHCS All Commercial |
$870.57
|
| Rate for Payer: PHP All Commercial |
$856.66
|
| Rate for Payer: PHP All Commercial |
$856.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$870.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$870.57
|
| Rate for Payer: Sagamore Health Network All Products |
$870.57
|
| Rate for Payer: Sagamore Health Network All Products |
$870.57
|
| Rate for Payer: Signature Care EPO |
$914.46
|
| Rate for Payer: Signature Care EPO |
$914.46
|
| Rate for Payer: Signature Care PPO |
$914.46
|
| Rate for Payer: Signature Care PPO |
$914.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314,000.00
|
| Rate for Payer: United Healthcare Commercial |
$882.53
|
| Rate for Payer: United Healthcare Commercial |
$882.53
|
| Rate for Payer: United Healthcare Medicare |
$831.71
|
| Rate for Payer: United Healthcare Medicare |
$831.71
|
|
|
PR INITIAL HOSP NEONATE 28 DAY OR LESS, NOT CRITICALLY ILL
|
Professional
|
Both
|
$638.34
|
|
|
Service Code
|
CPT 99477
|
| Hospital Charge Code |
z99477
|
| Min. Negotiated Rate |
$296.95 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Aetna Commercial |
$329.84
|
| Rate for Payer: Aetna Commercial |
$329.84
|
| Rate for Payer: Aetna Medicare |
$329.84
|
| Rate for Payer: Aetna Medicare |
$329.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$313.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$313.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$379.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$379.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.82
|
| Rate for Payer: Cash Price |
$383.00
|
| Rate for Payer: Cash Price |
$378.54
|
| Rate for Payer: Centivo All Commercial |
$511.25
|
| Rate for Payer: Centivo All Commercial |
$511.25
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$329.84
|
| Rate for Payer: Coventry All Commercial |
$395.81
|
| Rate for Payer: Coventry All Commercial |
$395.81
|
| Rate for Payer: Encore All Commercial |
$329.84
|
| Rate for Payer: Encore All Commercial |
$329.84
|
| Rate for Payer: Frontpath All Commercial |
$354.43
|
| Rate for Payer: Frontpath All Commercial |
$354.43
|
| Rate for Payer: Humana ChoiceCare |
$329.48
|
| Rate for Payer: Humana ChoiceCare |
$329.48
|
| Rate for Payer: Humana Medicare |
$329.84
|
| Rate for Payer: Humana Medicare |
$329.84
|
| Rate for Payer: Lucent All Commercial |
$461.78
|
| Rate for Payer: Lucent All Commercial |
$461.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,200.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,200.00
|
| Rate for Payer: Managed Health Services Medicaid |
$313.96
|
| Rate for Payer: Managed Health Services Medicaid |
$313.96
|
| Rate for Payer: MDWise Medicaid |
$313.96
|
| Rate for Payer: MDWise Medicaid |
$313.96
|
| Rate for Payer: PHCS All Commercial |
$329.84
|
| Rate for Payer: PHCS All Commercial |
$329.84
|
| Rate for Payer: PHP All Commercial |
$324.91
|
| Rate for Payer: PHP All Commercial |
$324.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$329.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$329.84
|
| Rate for Payer: Sagamore Health Network All Products |
$329.84
|
| Rate for Payer: Sagamore Health Network All Products |
$329.84
|
| Rate for Payer: Signature Care EPO |
$296.95
|
| Rate for Payer: Signature Care EPO |
$296.95
|
| Rate for Payer: Signature Care PPO |
$296.95
|
| Rate for Payer: Signature Care PPO |
$296.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120,000.00
|
| Rate for Payer: United Healthcare Commercial |
$343.61
|
| Rate for Payer: United Healthcare Commercial |
$343.61
|
| Rate for Payer: United Healthcare Medicare |
$315.45
|
| Rate for Payer: United Healthcare Medicare |
$315.45
|
|
|
PR INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH CENTER
|
Professional
|
Both
|
$174.98
|
|
|
Service Code
|
CPT 99460
|
| Hospital Charge Code |
z99460
|
| Min. Negotiated Rate |
$57.27 |
| Max. Negotiated Rate |
$32,500.00 |
| Rate for Payer: Aetna Commercial |
$90.49
|
| Rate for Payer: Aetna Commercial |
$90.49
|
| Rate for Payer: Aetna Medicare |
$90.49
|
| Rate for Payer: Aetna Medicare |
$90.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$86.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$86.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.54
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cash Price |
$103.73
|
| Rate for Payer: Centivo All Commercial |
$140.26
|
| Rate for Payer: Centivo All Commercial |
$140.26
|
| Rate for Payer: Cigna All Commercial |
$90.49
|
| Rate for Payer: Cigna All Commercial |
$90.49
|
| Rate for Payer: CORVEL All Commercial |
$90.49
|
| Rate for Payer: CORVEL All Commercial |
$90.49
|
| Rate for Payer: Coventry All Commercial |
$108.59
|
| Rate for Payer: Coventry All Commercial |
$108.59
|
| Rate for Payer: Encore All Commercial |
$90.49
|
| Rate for Payer: Encore All Commercial |
$90.49
|
| Rate for Payer: Frontpath All Commercial |
$97.16
|
| Rate for Payer: Frontpath All Commercial |
$97.16
|
| Rate for Payer: Humana ChoiceCare |
$82.90
|
| Rate for Payer: Humana ChoiceCare |
$82.90
|
| Rate for Payer: Humana Medicare |
$90.49
|
| Rate for Payer: Humana Medicare |
$90.49
|
| Rate for Payer: Lucent All Commercial |
$126.69
|
| Rate for Payer: Lucent All Commercial |
$126.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.00
|
| Rate for Payer: Managed Health Services Medicaid |
$86.07
|
| Rate for Payer: Managed Health Services Medicaid |
$86.07
|
| Rate for Payer: MDWise Medicaid |
$86.07
|
| Rate for Payer: MDWise Medicaid |
$86.07
|
| Rate for Payer: PHCS All Commercial |
$90.49
|
| Rate for Payer: PHCS All Commercial |
$90.49
|
| Rate for Payer: PHP All Commercial |
$89.04
|
| Rate for Payer: PHP All Commercial |
$89.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.49
|
| Rate for Payer: Sagamore Health Network All Products |
$90.49
|
| Rate for Payer: Sagamore Health Network All Products |
$90.49
|
| Rate for Payer: Signature Care EPO |
$81.97
|
| Rate for Payer: Signature Care EPO |
$81.97
|
| Rate for Payer: Signature Care PPO |
$81.97
|
| Rate for Payer: Signature Care PPO |
$81.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32,500.00
|
| Rate for Payer: United Healthcare Commercial |
$57.27
|
| Rate for Payer: United Healthcare Commercial |
$57.27
|
| Rate for Payer: United Healthcare Medicare |
$86.44
|
| Rate for Payer: United Healthcare Medicare |
$86.44
|
|
|
PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE
|
Professional
|
Both
|
$203.74
|
|
|
Service Code
|
CPT 99463
|
| Hospital Charge Code |
z99463
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$38,000.00 |
| Rate for Payer: Aetna Commercial |
$104.30
|
| Rate for Payer: Aetna Commercial |
$104.30
|
| Rate for Payer: Aetna Medicare |
$104.30
|
| Rate for Payer: Aetna Medicare |
$104.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$100.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$100.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.73
|
| Rate for Payer: Cash Price |
$122.24
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Centivo All Commercial |
$161.66
|
| Rate for Payer: Centivo All Commercial |
$161.66
|
| Rate for Payer: Cigna All Commercial |
$104.30
|
| Rate for Payer: Cigna All Commercial |
$104.30
|
| Rate for Payer: CORVEL All Commercial |
$104.30
|
| Rate for Payer: CORVEL All Commercial |
$104.30
|
| Rate for Payer: Coventry All Commercial |
$125.16
|
| Rate for Payer: Coventry All Commercial |
$125.16
|
| Rate for Payer: Encore All Commercial |
$104.30
|
| Rate for Payer: Encore All Commercial |
$104.30
|
| Rate for Payer: Frontpath All Commercial |
$111.61
|
| Rate for Payer: Frontpath All Commercial |
$111.61
|
| Rate for Payer: Humana ChoiceCare |
$110.87
|
| Rate for Payer: Humana ChoiceCare |
$110.87
|
| Rate for Payer: Humana Medicare |
$104.30
|
| Rate for Payer: Humana Medicare |
$104.30
|
| Rate for Payer: Lucent All Commercial |
$146.02
|
| Rate for Payer: Lucent All Commercial |
$146.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$380.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$380.00
|
| Rate for Payer: Managed Health Services Medicaid |
$100.20
|
| Rate for Payer: Managed Health Services Medicaid |
$100.20
|
| Rate for Payer: MDWise Medicaid |
$100.20
|
| Rate for Payer: MDWise Medicaid |
$100.20
|
| Rate for Payer: PHCS All Commercial |
$104.30
|
| Rate for Payer: PHCS All Commercial |
$104.30
|
| Rate for Payer: PHP All Commercial |
$103.82
|
| Rate for Payer: PHP All Commercial |
$103.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$104.30
|
| Rate for Payer: Signature Care EPO |
$98.34
|
| Rate for Payer: Signature Care EPO |
$98.34
|
| Rate for Payer: Signature Care PPO |
$98.34
|
| Rate for Payer: Signature Care PPO |
$98.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38,000.00
|
| Rate for Payer: United Healthcare Commercial |
$76.59
|
| Rate for Payer: United Healthcare Commercial |
$76.59
|
| Rate for Payer: United Healthcare Medicare |
$100.80
|
| Rate for Payer: United Healthcare Medicare |
$100.80
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
Both
|
$344.18
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
z99306
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$17,900.00 |
| Rate for Payer: Aetna Commercial |
$155.83
|
| Rate for Payer: Aetna Commercial |
$155.83
|
| Rate for Payer: Aetna Medicare |
$155.83
|
| Rate for Payer: Aetna Medicare |
$155.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$169.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$169.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.41
|
| Rate for Payer: Cash Price |
$206.51
|
| Rate for Payer: Cash Price |
$202.99
|
| Rate for Payer: Centivo All Commercial |
$241.54
|
| Rate for Payer: Centivo All Commercial |
$241.54
|
| Rate for Payer: Cigna All Commercial |
$155.83
|
| Rate for Payer: Cigna All Commercial |
$155.83
|
| Rate for Payer: CORVEL All Commercial |
$155.83
|
| Rate for Payer: CORVEL All Commercial |
$155.83
|
| Rate for Payer: Coventry All Commercial |
$187.00
|
| Rate for Payer: Coventry All Commercial |
$187.00
|
| Rate for Payer: Encore All Commercial |
$155.83
|
| Rate for Payer: Encore All Commercial |
$155.83
|
| Rate for Payer: Frontpath All Commercial |
$167.29
|
| Rate for Payer: Frontpath All Commercial |
$167.29
|
| Rate for Payer: Humana ChoiceCare |
$110.03
|
| Rate for Payer: Humana ChoiceCare |
$110.03
|
| Rate for Payer: Humana Medicare |
$155.83
|
| Rate for Payer: Humana Medicare |
$155.83
|
| Rate for Payer: Lucent All Commercial |
$218.16
|
| Rate for Payer: Lucent All Commercial |
$218.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.00
|
| Rate for Payer: Managed Health Services Medicaid |
$169.28
|
| Rate for Payer: Managed Health Services Medicaid |
$169.28
|
| Rate for Payer: MDWise Medicaid |
$169.28
|
| Rate for Payer: MDWise Medicaid |
$169.28
|
| Rate for Payer: PHCS All Commercial |
$155.83
|
| Rate for Payer: PHCS All Commercial |
$155.83
|
| Rate for Payer: PHP All Commercial |
$174.24
|
| Rate for Payer: PHP All Commercial |
$174.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.83
|
| Rate for Payer: Sagamore Health Network All Products |
$155.83
|
| Rate for Payer: Sagamore Health Network All Products |
$155.83
|
| Rate for Payer: Signature Care EPO |
$136.87
|
| Rate for Payer: Signature Care EPO |
$136.87
|
| Rate for Payer: Signature Care PPO |
$136.87
|
| Rate for Payer: Signature Care PPO |
$136.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: United Healthcare Commercial |
$146.59
|
| Rate for Payer: United Healthcare Commercial |
$146.59
|
| Rate for Payer: United Healthcare Medicare |
$169.16
|
| Rate for Payer: United Healthcare Medicare |
$169.16
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$251.72
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
z99305
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$13,000.00 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Medicare |
$121.58
|
| Rate for Payer: Aetna Medicare |
$121.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$123.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$123.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.74
|
| Rate for Payer: Cash Price |
$151.03
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Centivo All Commercial |
$188.45
|
| Rate for Payer: Centivo All Commercial |
$188.45
|
| Rate for Payer: Cigna All Commercial |
$121.58
|
| Rate for Payer: Cigna All Commercial |
$121.58
|
| Rate for Payer: CORVEL All Commercial |
$121.58
|
| Rate for Payer: CORVEL All Commercial |
$121.58
|
| Rate for Payer: Coventry All Commercial |
$145.90
|
| Rate for Payer: Coventry All Commercial |
$145.90
|
| Rate for Payer: Encore All Commercial |
$121.58
|
| Rate for Payer: Encore All Commercial |
$121.58
|
| Rate for Payer: Frontpath All Commercial |
$130.18
|
| Rate for Payer: Frontpath All Commercial |
$130.18
|
| Rate for Payer: Humana ChoiceCare |
$89.16
|
| Rate for Payer: Humana ChoiceCare |
$89.16
|
| Rate for Payer: Humana Medicare |
$121.58
|
| Rate for Payer: Humana Medicare |
$121.58
|
| Rate for Payer: Lucent All Commercial |
$170.21
|
| Rate for Payer: Lucent All Commercial |
$170.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.00
|
| Rate for Payer: Managed Health Services Medicaid |
$123.81
|
| Rate for Payer: Managed Health Services Medicaid |
$123.81
|
| Rate for Payer: MDWise Medicaid |
$123.81
|
| Rate for Payer: MDWise Medicaid |
$123.81
|
| Rate for Payer: PHCS All Commercial |
$121.58
|
| Rate for Payer: PHCS All Commercial |
$121.58
|
| Rate for Payer: PHP All Commercial |
$127.13
|
| Rate for Payer: PHP All Commercial |
$127.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.58
|
| Rate for Payer: Sagamore Health Network All Products |
$121.58
|
| Rate for Payer: Sagamore Health Network All Products |
$121.58
|
| Rate for Payer: Signature Care EPO |
$107.26
|
| Rate for Payer: Signature Care EPO |
$107.26
|
| Rate for Payer: Signature Care PPO |
$107.26
|
| Rate for Payer: Signature Care PPO |
$107.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,000.00
|
| Rate for Payer: United Healthcare Commercial |
$114.07
|
| Rate for Payer: United Healthcare Commercial |
$114.07
|
| Rate for Payer: United Healthcare Medicare |
$123.43
|
| Rate for Payer: United Healthcare Medicare |
$123.43
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$151.30
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
z99304
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$84.06
|
| Rate for Payer: Aetna Commercial |
$84.06
|
| Rate for Payer: Aetna Medicare |
$84.06
|
| Rate for Payer: Aetna Medicare |
$84.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.47
|
| Rate for Payer: Cash Price |
$90.78
|
| Rate for Payer: Cash Price |
$89.41
|
| Rate for Payer: Centivo All Commercial |
$130.29
|
| Rate for Payer: Centivo All Commercial |
$130.29
|
| Rate for Payer: Cigna All Commercial |
$84.06
|
| Rate for Payer: Cigna All Commercial |
$84.06
|
| Rate for Payer: CORVEL All Commercial |
$84.06
|
| Rate for Payer: CORVEL All Commercial |
$84.06
|
| Rate for Payer: Coventry All Commercial |
$100.87
|
| Rate for Payer: Coventry All Commercial |
$100.87
|
| Rate for Payer: Encore All Commercial |
$84.06
|
| Rate for Payer: Encore All Commercial |
$84.06
|
| Rate for Payer: Frontpath All Commercial |
$90.30
|
| Rate for Payer: Frontpath All Commercial |
$90.30
|
| Rate for Payer: Humana ChoiceCare |
$67.17
|
| Rate for Payer: Humana ChoiceCare |
$67.17
|
| Rate for Payer: Humana Medicare |
$84.06
|
| Rate for Payer: Humana Medicare |
$84.06
|
| Rate for Payer: Lucent All Commercial |
$117.68
|
| Rate for Payer: Lucent All Commercial |
$117.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.00
|
| Rate for Payer: Managed Health Services Medicaid |
$74.41
|
| Rate for Payer: Managed Health Services Medicaid |
$74.41
|
| Rate for Payer: MDWise Medicaid |
$74.41
|
| Rate for Payer: MDWise Medicaid |
$74.41
|
| Rate for Payer: PHCS All Commercial |
$84.06
|
| Rate for Payer: PHCS All Commercial |
$84.06
|
| Rate for Payer: PHP All Commercial |
$76.74
|
| Rate for Payer: PHP All Commercial |
$76.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.06
|
| Rate for Payer: Sagamore Health Network All Products |
$84.06
|
| Rate for Payer: Sagamore Health Network All Products |
$84.06
|
| Rate for Payer: Signature Care EPO |
$75.14
|
| Rate for Payer: Signature Care EPO |
$75.14
|
| Rate for Payer: Signature Care PPO |
$75.14
|
| Rate for Payer: Signature Care PPO |
$75.14
|
| 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 |
$81.57
|
| Rate for Payer: United Healthcare Commercial |
$81.57
|
| Rate for Payer: United Healthcare Medicare |
$74.51
|
| Rate for Payer: United Healthcare Medicare |
$74.51
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
zG0402
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$198.26 |
| Rate for Payer: Aetna Commercial |
$127.91
|
| Rate for Payer: Aetna Medicare |
$127.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$87.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.70
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Centivo All Commercial |
$198.26
|
| Rate for Payer: Cigna All Commercial |
$127.91
|
| Rate for Payer: CORVEL All Commercial |
$127.91
|
| Rate for Payer: Coventry All Commercial |
$153.49
|
| Rate for Payer: Encore All Commercial |
$127.91
|
| Rate for Payer: Humana ChoiceCare |
$106.22
|
| Rate for Payer: Humana Medicare |
$127.91
|
| Rate for Payer: Lucent All Commercial |
$179.07
|
| Rate for Payer: Managed Health Services Medicaid |
$154.55
|
| Rate for Payer: MDWise Medicaid |
$154.55
|
| Rate for Payer: PHCS All Commercial |
$127.91
|
| Rate for Payer: PHP All Commercial |
$125.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.91
|
| Rate for Payer: Sagamore Health Network All Products |
$127.91
|
| Rate for Payer: Signature Care EPO |
$135.19
|
| Rate for Payer: Signature Care PPO |
$135.19
|
| Rate for Payer: United Healthcare Commercial |
$92.30
|
|
|
PR INITIAL RX BURN(S) 1ST DEGREE
|
Professional
|
Both
|
$147.86
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
z16000
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$5,100.00 |
| Rate for Payer: Aetna Commercial |
$42.39
|
| Rate for Payer: Aetna Commercial |
$42.39
|
| Rate for Payer: Aetna Medicare |
$42.39
|
| Rate for Payer: Aetna Medicare |
$42.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$24.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$24.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.63
|
| Rate for Payer: Cash Price |
$85.66
|
| Rate for Payer: Cash Price |
$88.72
|
| Rate for Payer: Centivo All Commercial |
$65.70
|
| Rate for Payer: Centivo All Commercial |
$65.70
|
| Rate for Payer: Cigna All Commercial |
$42.39
|
| Rate for Payer: Cigna All Commercial |
$42.39
|
| Rate for Payer: CORVEL All Commercial |
$42.39
|
| Rate for Payer: CORVEL All Commercial |
$42.39
|
| Rate for Payer: Coventry All Commercial |
$50.87
|
| Rate for Payer: Coventry All Commercial |
$50.87
|
| Rate for Payer: Encore All Commercial |
$42.39
|
| Rate for Payer: Encore All Commercial |
$42.39
|
| Rate for Payer: Frontpath All Commercial |
$58.68
|
| Rate for Payer: Frontpath All Commercial |
$58.68
|
| Rate for Payer: Humana ChoiceCare |
$43.98
|
| Rate for Payer: Humana ChoiceCare |
$43.98
|
| Rate for Payer: Humana Medicare |
$42.39
|
| Rate for Payer: Humana Medicare |
$42.39
|
| Rate for Payer: Lucent All Commercial |
$59.35
|
| Rate for Payer: Lucent All Commercial |
$59.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.00
|
| Rate for Payer: Managed Health Services Medicaid |
$72.73
|
| Rate for Payer: Managed Health Services Medicaid |
$72.73
|
| Rate for Payer: MDWise Medicaid |
$72.73
|
| Rate for Payer: MDWise Medicaid |
$72.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$24.35
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$24.35
|
| Rate for Payer: PHCS All Commercial |
$42.39
|
| Rate for Payer: PHCS All Commercial |
$42.39
|
| Rate for Payer: PHP All Commercial |
$58.19
|
| Rate for Payer: PHP All Commercial |
$58.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.39
|
| Rate for Payer: Sagamore Health Network All Products |
$42.39
|
| Rate for Payer: Sagamore Health Network All Products |
$42.39
|
| Rate for Payer: Signature Care EPO |
$72.25
|
| Rate for Payer: Signature Care EPO |
$72.25
|
| Rate for Payer: Signature Care PPO |
$72.25
|
| Rate for Payer: Signature Care PPO |
$72.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare Commercial |
$52.21
|
| Rate for Payer: United Healthcare Commercial |
$52.21
|
| Rate for Payer: United Healthcare Medicare |
$71.38
|
| Rate for Payer: United Healthcare Medicare |
$71.38
|
|
|
PR INJECT CARPAL TUNNEL
|
Professional
|
Both
|
$152.16
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
z20526
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$53.18
|
| Rate for Payer: Aetna Commercial |
$53.18
|
| Rate for Payer: Aetna Commercial |
$53.18
|
| Rate for Payer: Aetna Commercial |
$53.18
|
| Rate for Payer: Aetna Medicare |
$53.18
|
| Rate for Payer: Aetna Medicare |
$53.18
|
| Rate for Payer: Aetna Medicare |
$53.18
|
| Rate for Payer: Aetna Medicare |
$53.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.50
|
| Rate for Payer: Cash Price |
$178.22
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cash Price |
$182.59
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Centivo All Commercial |
$82.43
|
| Rate for Payer: Centivo All Commercial |
$82.43
|
| Rate for Payer: Centivo All Commercial |
$82.43
|
| Rate for Payer: Centivo All Commercial |
$82.43
|
| Rate for Payer: Cigna All Commercial |
$53.18
|
| Rate for Payer: Cigna All Commercial |
$53.18
|
| Rate for Payer: Cigna All Commercial |
$53.18
|
| Rate for Payer: Cigna All Commercial |
$53.18
|
| Rate for Payer: CORVEL All Commercial |
$53.18
|
| Rate for Payer: CORVEL All Commercial |
$53.18
|
| Rate for Payer: CORVEL All Commercial |
$53.18
|
| Rate for Payer: CORVEL All Commercial |
$53.18
|
| Rate for Payer: Coventry All Commercial |
$63.82
|
| Rate for Payer: Coventry All Commercial |
$63.82
|
| Rate for Payer: Coventry All Commercial |
$63.82
|
| Rate for Payer: Coventry All Commercial |
$63.82
|
| Rate for Payer: Encore All Commercial |
$53.18
|
| Rate for Payer: Encore All Commercial |
$53.18
|
| Rate for Payer: Encore All Commercial |
$53.18
|
| Rate for Payer: Encore All Commercial |
$53.18
|
| Rate for Payer: Frontpath All Commercial |
$74.56
|
| Rate for Payer: Frontpath All Commercial |
$74.56
|
| Rate for Payer: Frontpath All Commercial |
$74.56
|
| Rate for Payer: Frontpath All Commercial |
$74.56
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Humana Medicare |
$53.18
|
| Rate for Payer: Humana Medicare |
$53.18
|
| Rate for Payer: Humana Medicare |
$53.18
|
| Rate for Payer: Humana Medicare |
$53.18
|
| Rate for Payer: Lucent All Commercial |
$74.45
|
| Rate for Payer: Lucent All Commercial |
$74.45
|
| Rate for Payer: Lucent All Commercial |
$74.45
|
| Rate for Payer: Lucent All Commercial |
$74.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$74.84
|
| Rate for Payer: Managed Health Services Medicaid |
$74.84
|
| Rate for Payer: Managed Health Services Medicaid |
$74.84
|
| Rate for Payer: Managed Health Services Medicaid |
$74.84
|
| Rate for Payer: MDWise Medicaid |
$74.84
|
| Rate for Payer: MDWise Medicaid |
$74.84
|
| Rate for Payer: MDWise Medicaid |
$74.84
|
| Rate for Payer: MDWise Medicaid |
$74.84
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.01
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.01
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.01
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.01
|
| Rate for Payer: PHCS All Commercial |
$53.18
|
| Rate for Payer: PHCS All Commercial |
$53.18
|
| Rate for Payer: PHCS All Commercial |
$53.18
|
| Rate for Payer: PHCS All Commercial |
$53.18
|
| Rate for Payer: PHP All Commercial |
$89.39
|
| Rate for Payer: PHP All Commercial |
$89.39
|
| Rate for Payer: PHP All Commercial |
$89.39
|
| Rate for Payer: PHP All Commercial |
$89.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.18
|
| Rate for Payer: Sagamore Health Network All Products |
$53.18
|
| Rate for Payer: Sagamore Health Network All Products |
$53.18
|
| Rate for Payer: Sagamore Health Network All Products |
$53.18
|
| Rate for Payer: Sagamore Health Network All Products |
$53.18
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| 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: 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 |
$64.51
|
| Rate for Payer: United Healthcare Commercial |
$64.51
|
| Rate for Payer: United Healthcare Commercial |
$64.51
|
| Rate for Payer: United Healthcare Commercial |
$64.51
|
| Rate for Payer: United Healthcare Medicare |
$74.26
|
| Rate for Payer: United Healthcare Medicare |
$74.26
|
| Rate for Payer: United Healthcare Medicare |
$74.26
|
| Rate for Payer: United Healthcare Medicare |
$74.26
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$107.80
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
z20550
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$36.91
|
| Rate for Payer: Aetna Commercial |
$36.91
|
| Rate for Payer: Aetna Medicare |
$36.91
|
| Rate for Payer: Aetna Medicare |
$36.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.76
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$32.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$32.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.60
|
| Rate for Payer: Cash Price |
$63.44
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Centivo All Commercial |
$57.21
|
| Rate for Payer: Centivo All Commercial |
$57.21
|
| Rate for Payer: Cigna All Commercial |
$36.91
|
| Rate for Payer: Cigna All Commercial |
$36.91
|
| Rate for Payer: CORVEL All Commercial |
$36.91
|
| Rate for Payer: CORVEL All Commercial |
$36.91
|
| Rate for Payer: Coventry All Commercial |
$44.29
|
| Rate for Payer: Coventry All Commercial |
$44.29
|
| Rate for Payer: Encore All Commercial |
$36.91
|
| Rate for Payer: Encore All Commercial |
$36.91
|
| Rate for Payer: Frontpath All Commercial |
$50.99
|
| Rate for Payer: Frontpath All Commercial |
$50.99
|
| Rate for Payer: Humana ChoiceCare |
$43.56
|
| Rate for Payer: Humana ChoiceCare |
$43.56
|
| Rate for Payer: Humana Medicare |
$36.91
|
| Rate for Payer: Humana Medicare |
$36.91
|
| Rate for Payer: Lucent All Commercial |
$51.67
|
| Rate for Payer: Lucent All Commercial |
$51.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Managed Health Services Medicaid |
$53.02
|
| Rate for Payer: Managed Health Services Medicaid |
$53.02
|
| Rate for Payer: MDWise Medicaid |
$53.02
|
| Rate for Payer: MDWise Medicaid |
$53.02
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$32.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$32.70
|
| Rate for Payer: PHCS All Commercial |
$36.91
|
| Rate for Payer: PHCS All Commercial |
$36.91
|
| Rate for Payer: PHP All Commercial |
$57.12
|
| Rate for Payer: PHP All Commercial |
$57.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.91
|
| Rate for Payer: Sagamore Health Network All Products |
$36.91
|
| Rate for Payer: Sagamore Health Network All Products |
$36.91
|
| Rate for Payer: Signature Care EPO |
$83.30
|
| Rate for Payer: Signature Care EPO |
$83.30
|
| Rate for Payer: Signature Care PPO |
$83.30
|
| Rate for Payer: Signature Care PPO |
$83.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: United Healthcare Commercial |
$47.41
|
| Rate for Payer: United Healthcare Commercial |
$47.41
|
| Rate for Payer: United Healthcare Medicare |
$52.87
|
| Rate for Payer: United Healthcare Medicare |
$52.87
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
z64450
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$5,900.00 |
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Medicare |
$39.86
|
| Rate for Payer: Aetna Medicare |
$39.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.61
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.85
|
| Rate for Payer: Cash Price |
$82.22
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Centivo All Commercial |
$61.78
|
| Rate for Payer: Centivo All Commercial |
$61.78
|
| Rate for Payer: Cigna All Commercial |
$39.86
|
| Rate for Payer: Cigna All Commercial |
$39.86
|
| Rate for Payer: CORVEL All Commercial |
$39.86
|
| Rate for Payer: CORVEL All Commercial |
$39.86
|
| Rate for Payer: Coventry All Commercial |
$47.83
|
| Rate for Payer: Coventry All Commercial |
$47.83
|
| Rate for Payer: Encore All Commercial |
$39.86
|
| Rate for Payer: Encore All Commercial |
$39.86
|
| Rate for Payer: Frontpath All Commercial |
$54.60
|
| Rate for Payer: Frontpath All Commercial |
$54.60
|
| Rate for Payer: Humana ChoiceCare |
$90.13
|
| Rate for Payer: Humana ChoiceCare |
$90.13
|
| Rate for Payer: Humana Medicare |
$39.86
|
| Rate for Payer: Humana Medicare |
$39.86
|
| Rate for Payer: Lucent All Commercial |
$55.80
|
| Rate for Payer: Lucent All Commercial |
$55.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: Managed Health Services Medicaid |
$68.86
|
| Rate for Payer: Managed Health Services Medicaid |
$68.86
|
| Rate for Payer: MDWise Medicaid |
$68.86
|
| Rate for Payer: MDWise Medicaid |
$68.86
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$26.61
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$26.61
|
| Rate for Payer: PHCS All Commercial |
$39.86
|
| Rate for Payer: PHCS All Commercial |
$39.86
|
| Rate for Payer: PHP All Commercial |
$61.44
|
| Rate for Payer: PHP All Commercial |
$61.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.86
|
| Rate for Payer: Sagamore Health Network All Products |
$39.86
|
| Rate for Payer: Sagamore Health Network All Products |
$39.86
|
| Rate for Payer: Signature Care EPO |
$121.77
|
| Rate for Payer: Signature Care EPO |
$121.77
|
| Rate for Payer: Signature Care PPO |
$121.77
|
| Rate for Payer: Signature Care PPO |
$121.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,900.00
|
| Rate for Payer: United Healthcare Commercial |
$81.05
|
| Rate for Payer: United Healthcare Commercial |
$81.05
|
| Rate for Payer: United Healthcare Medicare |
$68.52
|
| Rate for Payer: United Healthcare Medicare |
$68.52
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
Both
|
$148.66
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
z64435
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.54
|
| Rate for Payer: Cash Price |
$88.39
|
| Rate for Payer: Cash Price |
$89.20
|
| Rate for Payer: Centivo All Commercial |
$62.76
|
| Rate for Payer: Centivo All Commercial |
$62.76
|
| Rate for Payer: Cigna All Commercial |
$40.49
|
| Rate for Payer: Cigna All Commercial |
$40.49
|
| Rate for Payer: CORVEL All Commercial |
$40.49
|
| Rate for Payer: CORVEL All Commercial |
$40.49
|
| Rate for Payer: Coventry All Commercial |
$48.59
|
| Rate for Payer: Coventry All Commercial |
$48.59
|
| Rate for Payer: Encore All Commercial |
$40.49
|
| Rate for Payer: Encore All Commercial |
$40.49
|
| Rate for Payer: Frontpath All Commercial |
$55.99
|
| Rate for Payer: Frontpath All Commercial |
$55.99
|
| Rate for Payer: Humana ChoiceCare |
$109.74
|
| Rate for Payer: Humana ChoiceCare |
$109.74
|
| Rate for Payer: Humana Medicare |
$40.49
|
| Rate for Payer: Humana Medicare |
$40.49
|
| Rate for Payer: Lucent All Commercial |
$56.69
|
| Rate for Payer: Lucent All Commercial |
$56.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.00
|
| Rate for Payer: Managed Health Services Medicaid |
$73.12
|
| Rate for Payer: Managed Health Services Medicaid |
$73.12
|
| Rate for Payer: MDWise Medicaid |
$73.12
|
| Rate for Payer: MDWise Medicaid |
$73.12
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.35
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.35
|
| Rate for Payer: PHCS All Commercial |
$40.49
|
| Rate for Payer: PHCS All Commercial |
$40.49
|
| Rate for Payer: PHP All Commercial |
$62.93
|
| Rate for Payer: PHP All Commercial |
$62.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.49
|
| Rate for Payer: Sagamore Health Network All Products |
$40.49
|
| Rate for Payer: Sagamore Health Network All Products |
$40.49
|
| Rate for Payer: Signature Care EPO |
$105.62
|
| Rate for Payer: Signature Care EPO |
$105.62
|
| Rate for Payer: Signature Care PPO |
$105.62
|
| Rate for Payer: Signature Care PPO |
$105.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,000.00
|
| Rate for Payer: United Healthcare Commercial |
$94.94
|
| Rate for Payer: United Healthcare Commercial |
$94.94
|
| Rate for Payer: United Healthcare Medicare |
$73.66
|
| Rate for Payer: United Healthcare Medicare |
$73.66
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
Both
|
$182.78
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
z64430
|
| Min. Negotiated Rate |
$34.07 |
| Max. Negotiated Rate |
$7,700.00 |
| Rate for Payer: Aetna Commercial |
$51.33
|
| Rate for Payer: Aetna Commercial |
$51.33
|
| Rate for Payer: Aetna Medicare |
$51.33
|
| Rate for Payer: Aetna Medicare |
$51.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$34.07
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$34.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$89.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$89.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.46
|
| Rate for Payer: Cash Price |
$108.07
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Centivo All Commercial |
$79.56
|
| Rate for Payer: Centivo All Commercial |
$79.56
|
| Rate for Payer: Cigna All Commercial |
$51.33
|
| Rate for Payer: Cigna All Commercial |
$51.33
|
| Rate for Payer: CORVEL All Commercial |
$51.33
|
| Rate for Payer: CORVEL All Commercial |
$51.33
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$51.33
|
| Rate for Payer: Encore All Commercial |
$51.33
|
| Rate for Payer: Frontpath All Commercial |
$70.12
|
| Rate for Payer: Frontpath All Commercial |
$70.12
|
| Rate for Payer: Humana ChoiceCare |
$102.42
|
| Rate for Payer: Humana ChoiceCare |
$102.42
|
| Rate for Payer: Humana Medicare |
$51.33
|
| Rate for Payer: Humana Medicare |
$51.33
|
| Rate for Payer: Lucent All Commercial |
$71.86
|
| Rate for Payer: Lucent All Commercial |
$71.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Managed Health Services Medicaid |
$89.90
|
| Rate for Payer: Managed Health Services Medicaid |
$89.90
|
| Rate for Payer: MDWise Medicaid |
$89.90
|
| Rate for Payer: MDWise Medicaid |
$89.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$34.07
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$34.07
|
| Rate for Payer: PHCS All Commercial |
$51.33
|
| Rate for Payer: PHCS All Commercial |
$51.33
|
| Rate for Payer: PHP All Commercial |
$80.01
|
| Rate for Payer: PHP All Commercial |
$80.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.33
|
| Rate for Payer: Sagamore Health Network All Products |
$51.33
|
| Rate for Payer: Sagamore Health Network All Products |
$51.33
|
| Rate for Payer: Signature Care EPO |
$158.73
|
| Rate for Payer: Signature Care EPO |
$158.73
|
| Rate for Payer: Signature Care PPO |
$158.73
|
| Rate for Payer: Signature Care PPO |
$158.73
|
| 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 |
$99.15
|
| Rate for Payer: United Healthcare Commercial |
$99.15
|
| Rate for Payer: United Healthcare Medicare |
$90.06
|
| Rate for Payer: United Healthcare Medicare |
$90.06
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
Both
|
$207.72
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
z64400
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna Commercial |
$45.99
|
| Rate for Payer: Aetna Commercial |
$45.99
|
| Rate for Payer: Aetna Medicare |
$45.99
|
| Rate for Payer: Aetna Medicare |
$45.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$25.78
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$25.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$102.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$102.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.59
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$124.63
|
| Rate for Payer: Centivo All Commercial |
$71.28
|
| Rate for Payer: Centivo All Commercial |
$71.28
|
| Rate for Payer: Cigna All Commercial |
$45.99
|
| Rate for Payer: Cigna All Commercial |
$45.99
|
| Rate for Payer: CORVEL All Commercial |
$45.99
|
| Rate for Payer: CORVEL All Commercial |
$45.99
|
| Rate for Payer: Coventry All Commercial |
$55.19
|
| Rate for Payer: Coventry All Commercial |
$55.19
|
| Rate for Payer: Encore All Commercial |
$45.99
|
| Rate for Payer: Encore All Commercial |
$45.99
|
| Rate for Payer: Frontpath All Commercial |
$65.77
|
| Rate for Payer: Frontpath All Commercial |
$65.77
|
| Rate for Payer: Humana ChoiceCare |
$78.29
|
| Rate for Payer: Humana ChoiceCare |
$78.29
|
| Rate for Payer: Humana Medicare |
$45.99
|
| Rate for Payer: Humana Medicare |
$45.99
|
| Rate for Payer: Lucent All Commercial |
$64.39
|
| Rate for Payer: Lucent All Commercial |
$64.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.00
|
| Rate for Payer: Managed Health Services Medicaid |
$102.16
|
| Rate for Payer: Managed Health Services Medicaid |
$102.16
|
| Rate for Payer: MDWise Medicaid |
$102.16
|
| Rate for Payer: MDWise Medicaid |
$102.16
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$25.78
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$25.78
|
| Rate for Payer: PHCS All Commercial |
$45.99
|
| Rate for Payer: PHCS All Commercial |
$45.99
|
| Rate for Payer: PHP All Commercial |
$71.43
|
| Rate for Payer: PHP All Commercial |
$71.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.99
|
| Rate for Payer: Sagamore Health Network All Products |
$45.99
|
| Rate for Payer: Sagamore Health Network All Products |
$45.99
|
| Rate for Payer: Signature Care EPO |
$174.25
|
| Rate for Payer: Signature Care EPO |
$174.25
|
| Rate for Payer: Signature Care PPO |
$174.25
|
| Rate for Payer: Signature Care PPO |
$174.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,900.00
|
| Rate for Payer: United Healthcare Commercial |
$70.56
|
| Rate for Payer: United Healthcare Commercial |
$70.56
|
| Rate for Payer: United Healthcare Medicare |
$100.67
|
| Rate for Payer: United Healthcare Medicare |
$100.67
|
|
|
PR INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Professional
|
Both
|
$52.04
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
z96372
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.87
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Centivo All Commercial |
$20.96
|
| Rate for Payer: Centivo All Commercial |
$20.96
|
| Rate for Payer: Cigna All Commercial |
$13.52
|
| Rate for Payer: Cigna All Commercial |
$13.52
|
| Rate for Payer: CORVEL All Commercial |
$13.52
|
| Rate for Payer: CORVEL All Commercial |
$13.52
|
| Rate for Payer: Coventry All Commercial |
$16.22
|
| Rate for Payer: Coventry All Commercial |
$16.22
|
| Rate for Payer: Encore All Commercial |
$13.52
|
| Rate for Payer: Encore All Commercial |
$13.52
|
| Rate for Payer: Frontpath All Commercial |
$15.22
|
| Rate for Payer: Frontpath All Commercial |
$15.22
|
| Rate for Payer: Humana ChoiceCare |
$23.63
|
| Rate for Payer: Humana ChoiceCare |
$23.63
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Lucent All Commercial |
$18.93
|
| Rate for Payer: Lucent All Commercial |
$18.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.27
|
| Rate for Payer: Managed Health Services Medicaid |
$13.27
|
| Rate for Payer: MDWise Medicaid |
$13.27
|
| Rate for Payer: MDWise Medicaid |
$13.27
|
| Rate for Payer: PHCS All Commercial |
$13.52
|
| Rate for Payer: PHCS All Commercial |
$13.52
|
| Rate for Payer: PHP All Commercial |
$19.51
|
| Rate for Payer: PHP All Commercial |
$19.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.52
|
| Rate for Payer: Sagamore Health Network All Products |
$13.52
|
| Rate for Payer: Sagamore Health Network All Products |
$13.52
|
| Rate for Payer: Signature Care EPO |
$22.98
|
| Rate for Payer: Signature Care EPO |
$22.98
|
| Rate for Payer: Signature Care PPO |
$22.98
|
| Rate for Payer: Signature Care PPO |
$22.98
|
| 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 |
$24.49
|
| Rate for Payer: United Healthcare Commercial |
$24.49
|
| Rate for Payer: United Healthcare Medicare |
$13.01
|
| Rate for Payer: United Healthcare Medicare |
$13.01
|
|
|
PR INJECT PLATELET RICH PLASMA W/IMG HARVEST/PREPARATOIN
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
z0232T
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$188.36 |
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Frontpath All Commercial |
$188.36
|
| Rate for Payer: Humana ChoiceCare |
$38.11
|
| Rate for Payer: United Healthcare Commercial |
$56.25
|
|
|
PR INJECT TENDON ORIGIN/INSERT
|
Professional
|
Both
|
$107.46
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
z20551
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$37.06
|
| Rate for Payer: Aetna Commercial |
$37.06
|
| Rate for Payer: Aetna Commercial |
$37.06
|
| Rate for Payer: Aetna Commercial |
$37.06
|
| Rate for Payer: Aetna Medicare |
$37.06
|
| Rate for Payer: Aetna Medicare |
$37.06
|
| Rate for Payer: Aetna Medicare |
$37.06
|
| Rate for Payer: Aetna Medicare |
$37.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.71
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.71
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.71
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.77
|
| Rate for Payer: Cash Price |
$126.89
|
| Rate for Payer: Cash Price |
$64.48
|
| Rate for Payer: Cash Price |
$128.95
|
| Rate for Payer: Cash Price |
$63.44
|
| Rate for Payer: Centivo All Commercial |
$57.44
|
| Rate for Payer: Centivo All Commercial |
$57.44
|
| Rate for Payer: Centivo All Commercial |
$57.44
|
| Rate for Payer: Centivo All Commercial |
$57.44
|
| Rate for Payer: Cigna All Commercial |
$37.06
|
| Rate for Payer: Cigna All Commercial |
$37.06
|
| Rate for Payer: Cigna All Commercial |
$37.06
|
| Rate for Payer: Cigna All Commercial |
$37.06
|
| Rate for Payer: CORVEL All Commercial |
$37.06
|
| Rate for Payer: CORVEL All Commercial |
$37.06
|
| Rate for Payer: CORVEL All Commercial |
$37.06
|
| Rate for Payer: CORVEL All Commercial |
$37.06
|
| Rate for Payer: Coventry All Commercial |
$44.47
|
| Rate for Payer: Coventry All Commercial |
$44.47
|
| Rate for Payer: Coventry All Commercial |
$44.47
|
| Rate for Payer: Coventry All Commercial |
$44.47
|
| Rate for Payer: Encore All Commercial |
$37.06
|
| Rate for Payer: Encore All Commercial |
$37.06
|
| Rate for Payer: Encore All Commercial |
$37.06
|
| Rate for Payer: Encore All Commercial |
$37.06
|
| Rate for Payer: Frontpath All Commercial |
$50.91
|
| Rate for Payer: Frontpath All Commercial |
$50.91
|
| Rate for Payer: Frontpath All Commercial |
$50.91
|
| Rate for Payer: Frontpath All Commercial |
$50.91
|
| Rate for Payer: Humana ChoiceCare |
$47.32
|
| Rate for Payer: Humana ChoiceCare |
$47.32
|
| Rate for Payer: Humana ChoiceCare |
$47.32
|
| Rate for Payer: Humana ChoiceCare |
$47.32
|
| Rate for Payer: Humana Medicare |
$37.06
|
| Rate for Payer: Humana Medicare |
$37.06
|
| Rate for Payer: Humana Medicare |
$37.06
|
| Rate for Payer: Humana Medicare |
$37.06
|
| Rate for Payer: Lucent All Commercial |
$51.88
|
| Rate for Payer: Lucent All Commercial |
$51.88
|
| Rate for Payer: Lucent All Commercial |
$51.88
|
| Rate for Payer: Lucent All Commercial |
$51.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Managed Health Services Medicaid |
$52.86
|
| Rate for Payer: Managed Health Services Medicaid |
$52.86
|
| Rate for Payer: Managed Health Services Medicaid |
$52.86
|
| Rate for Payer: Managed Health Services Medicaid |
$52.86
|
| Rate for Payer: MDWise Medicaid |
$52.86
|
| Rate for Payer: MDWise Medicaid |
$52.86
|
| Rate for Payer: MDWise Medicaid |
$52.86
|
| Rate for Payer: MDWise Medicaid |
$52.86
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$33.71
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$33.71
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$33.71
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$33.71
|
| Rate for Payer: PHCS All Commercial |
$37.06
|
| Rate for Payer: PHCS All Commercial |
$37.06
|
| Rate for Payer: PHCS All Commercial |
$37.06
|
| Rate for Payer: PHCS All Commercial |
$37.06
|
| Rate for Payer: PHP All Commercial |
$62.12
|
| Rate for Payer: PHP All Commercial |
$62.12
|
| Rate for Payer: PHP All Commercial |
$62.12
|
| Rate for Payer: PHP All Commercial |
$62.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.06
|
| Rate for Payer: Sagamore Health Network All Products |
$37.06
|
| Rate for Payer: Sagamore Health Network All Products |
$37.06
|
| Rate for Payer: Sagamore Health Network All Products |
$37.06
|
| Rate for Payer: Sagamore Health Network All Products |
$37.06
|
| Rate for Payer: Signature Care EPO |
$81.60
|
| Rate for Payer: Signature Care EPO |
$81.60
|
| Rate for Payer: Signature Care EPO |
$81.60
|
| Rate for Payer: Signature Care EPO |
$81.60
|
| Rate for Payer: Signature Care PPO |
$81.60
|
| Rate for Payer: Signature Care PPO |
$81.60
|
| Rate for Payer: Signature Care PPO |
$81.60
|
| Rate for Payer: Signature Care PPO |
$81.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: United Healthcare Commercial |
$48.39
|
| Rate for Payer: United Healthcare Commercial |
$48.39
|
| Rate for Payer: United Healthcare Commercial |
$48.39
|
| Rate for Payer: United Healthcare Commercial |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$52.87
|
| Rate for Payer: United Healthcare Medicare |
$52.87
|
| Rate for Payer: United Healthcare Medicare |
$52.87
|
| Rate for Payer: United Healthcare Medicare |
$52.87
|
|
