|
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 |
$138.84
|
| Rate for Payer: Cash Price |
$144.56
|
| 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 Medicare |
$56.65
|
| Rate for Payer: Molina Healthcare of OH 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 |
$1,044.45
|
| Rate for Payer: Cash Price |
$1,031.32
|
| 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 |
$395.77
|
| Rate for Payer: Cash Price |
$391.16
|
| 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 |
$108.49
|
| Rate for Payer: Cash Price |
$107.19
|
| 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 |
$126.32
|
| Rate for Payer: Cash Price |
$124.99
|
| 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 |
$213.39
|
| Rate for Payer: Cash Price |
$209.76
|
| 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 |
$156.07
|
| Rate for Payer: Cash Price |
$153.05
|
| 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 |
$93.81
|
| Rate for Payer: Cash Price |
$92.39
|
| 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 |
$222.58
|
| 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 |
$88.51
|
| Rate for Payer: Cash Price |
$91.67
|
| 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 Medicare |
$24.35
|
| Rate for Payer: Molina Healthcare of OH 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 |
$184.16
|
| Rate for Payer: Cash Price |
$94.34
|
| Rate for Payer: Cash Price |
$188.68
|
| Rate for Payer: Cash Price |
$92.08
|
| 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 Medicare |
$35.01
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$35.01
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$35.01
|
| Rate for Payer: Molina Healthcare of OH 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 |
$65.56
|
| Rate for Payer: Cash Price |
$66.84
|
| 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 Medicare |
$32.70
|
| Rate for Payer: Molina Healthcare of OH 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 |
$84.96
|
| Rate for Payer: Cash Price |
$86.80
|
| 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 Medicare |
$26.61
|
| Rate for Payer: Molina Healthcare of OH 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 |
$91.34
|
| Rate for Payer: Cash Price |
$92.17
|
| 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 Medicare |
$30.35
|
| Rate for Payer: Molina Healthcare of OH 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 |
$111.67
|
| Rate for Payer: Cash Price |
$113.32
|
| 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 Medicare |
$34.07
|
| Rate for Payer: Molina Healthcare of OH 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 |
$124.83
|
| Rate for Payer: Cash Price |
$128.79
|
| 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 Medicare |
$25.78
|
| Rate for Payer: Molina Healthcare of OH 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 |
$32.26
|
| Rate for Payer: Cash Price |
$16.73
|
| 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 |
$511.50
|
| 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 |
$131.12
|
| Rate for Payer: Cash Price |
$66.63
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$65.56
|
| 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 Medicare |
$33.71
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.71
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.71
|
| Rate for Payer: Molina Healthcare of OH 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
|
|
|
PR INJECT TRIGGER POINT, 1 OR 2
|
Professional
|
Both
|
$98.08
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
z20552
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$5,200.00 |
| Rate for Payer: Aetna Commercial |
$35.50
|
| Rate for Payer: Aetna Commercial |
$35.50
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| 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 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: Buckeye Health Medicaid OOS |
$28.11
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.05
|
| Rate for Payer: Cash Price |
$59.99
|
| Rate for Payer: Cash Price |
$60.81
|
| Rate for Payer: Centivo All Commercial |
$55.02
|
| Rate for Payer: Centivo All Commercial |
$55.02
|
| Rate for Payer: Cigna All Commercial |
$35.50
|
| Rate for Payer: Cigna All Commercial |
$35.50
|
| Rate for Payer: CORVEL All Commercial |
$35.50
|
| Rate for Payer: CORVEL All Commercial |
$35.50
|
| Rate for Payer: Coventry All Commercial |
$42.60
|
| Rate for Payer: Coventry All Commercial |
$42.60
|
| Rate for Payer: Encore All Commercial |
$35.50
|
| Rate for Payer: Encore All Commercial |
$35.50
|
| Rate for Payer: Frontpath All Commercial |
$48.91
|
| Rate for Payer: Frontpath All Commercial |
$48.91
|
| Rate for Payer: Humana ChoiceCare |
$37.68
|
| Rate for Payer: Humana ChoiceCare |
$37.68
|
| Rate for Payer: Humana Medicare |
$35.50
|
| Rate for Payer: Humana Medicare |
$35.50
|
| Rate for Payer: Lucent All Commercial |
$49.70
|
| Rate for Payer: Lucent All Commercial |
$49.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Managed Health Services Medicaid |
$48.24
|
| Rate for Payer: Managed Health Services Medicaid |
$48.24
|
| Rate for Payer: MDWise Medicaid |
$48.24
|
| Rate for Payer: MDWise Medicaid |
$48.24
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$28.11
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$28.11
|
| Rate for Payer: PHCS All Commercial |
$35.50
|
| Rate for Payer: PHCS All Commercial |
$35.50
|
| Rate for Payer: PHP All Commercial |
$54.27
|
| Rate for Payer: PHP All Commercial |
$54.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.50
|
| Rate for Payer: Sagamore Health Network All Products |
$35.50
|
| Rate for Payer: Sagamore Health Network All Products |
$35.50
|
| Rate for Payer: Signature Care EPO |
$79.05
|
| Rate for Payer: Signature Care EPO |
$79.05
|
| Rate for Payer: Signature Care PPO |
$79.05
|
| Rate for Payer: Signature Care PPO |
$79.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,200.00
|
| Rate for Payer: United Healthcare Commercial |
$41.04
|
| Rate for Payer: United Healthcare Commercial |
$41.04
|
| Rate for Payer: United Healthcare Medicare |
$48.38
|
| Rate for Payer: United Healthcare Medicare |
$48.38
|
|
|
PR INJECT TRIGGER POINTS, > 3
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
z20553
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$62.51 |
| Rate for Payer: Aetna Commercial |
$40.33
|
| Rate for Payer: Aetna Commercial |
$40.33
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$55.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$55.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.36
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Cash Price |
$70.06
|
| Rate for Payer: Centivo All Commercial |
$62.51
|
| Rate for Payer: Centivo All Commercial |
$62.51
|
| Rate for Payer: Cigna All Commercial |
$40.33
|
| Rate for Payer: Cigna All Commercial |
$40.33
|
| Rate for Payer: CORVEL All Commercial |
$40.33
|
| Rate for Payer: CORVEL All Commercial |
$40.33
|
| Rate for Payer: Coventry All Commercial |
$48.40
|
| Rate for Payer: Coventry All Commercial |
$48.40
|
| Rate for Payer: Encore All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$40.33
|
| Rate for Payer: Frontpath All Commercial |
$55.50
|
| Rate for Payer: Frontpath All Commercial |
$55.50
|
| Rate for Payer: Humana ChoiceCare |
$42.21
|
| Rate for Payer: Humana ChoiceCare |
$42.21
|
| Rate for Payer: Humana Medicare |
$40.33
|
| Rate for Payer: Humana Medicare |
$40.33
|
| Rate for Payer: Lucent All Commercial |
$56.46
|
| Rate for Payer: Lucent All Commercial |
$56.46
|
| Rate for Payer: Managed Health Services Medicaid |
$55.57
|
| Rate for Payer: Managed Health Services Medicaid |
$55.57
|
| Rate for Payer: MDWise Medicaid |
$55.57
|
| Rate for Payer: MDWise Medicaid |
$55.57
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.88
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.88
|
| Rate for Payer: PHCS All Commercial |
$40.33
|
| Rate for Payer: PHCS All Commercial |
$40.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.33
|
| Rate for Payer: Sagamore Health Network All Products |
$40.33
|
| Rate for Payer: Sagamore Health Network All Products |
$40.33
|
| Rate for Payer: United Healthcare Commercial |
$45.65
|
| Rate for Payer: United Healthcare Commercial |
$45.65
|
| Rate for Payer: United Healthcare Medicare |
$55.88
|
| Rate for Payer: United Healthcare Medicare |
$55.88
|
|
|
PR INJ,LUMB EPIDUR,BLOOD/CLOT PATCH
|
Professional
|
Both
|
$314.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
z62273
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$16,000.00 |
| Rate for Payer: Aetna Commercial |
$107.37
|
| Rate for Payer: Aetna Commercial |
$107.37
|
| Rate for Payer: Aetna Medicare |
$107.37
|
| Rate for Payer: Aetna Medicare |
$107.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$57.28
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$57.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.11
|
| Rate for Payer: Cash Price |
$192.14
|
| Rate for Payer: Cash Price |
$194.77
|
| Rate for Payer: Centivo All Commercial |
$166.42
|
| Rate for Payer: Centivo All Commercial |
$166.42
|
| Rate for Payer: Cigna All Commercial |
$107.37
|
| Rate for Payer: Cigna All Commercial |
$107.37
|
| Rate for Payer: CORVEL All Commercial |
$107.37
|
| Rate for Payer: CORVEL All Commercial |
$107.37
|
| Rate for Payer: Coventry All Commercial |
$128.84
|
| Rate for Payer: Coventry All Commercial |
$128.84
|
| Rate for Payer: Encore All Commercial |
$107.37
|
| Rate for Payer: Encore All Commercial |
$107.37
|
| Rate for Payer: Frontpath All Commercial |
$146.08
|
| Rate for Payer: Frontpath All Commercial |
$146.08
|
| Rate for Payer: Humana ChoiceCare |
$145.81
|
| Rate for Payer: Humana ChoiceCare |
$145.81
|
| Rate for Payer: Humana Medicare |
$107.37
|
| Rate for Payer: Humana Medicare |
$107.37
|
| Rate for Payer: Lucent All Commercial |
$150.32
|
| Rate for Payer: Lucent All Commercial |
$150.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: Managed Health Services Medicaid |
$154.50
|
| Rate for Payer: Managed Health Services Medicaid |
$154.50
|
| Rate for Payer: MDWise Medicaid |
$154.50
|
| Rate for Payer: MDWise Medicaid |
$154.50
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$57.28
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$57.28
|
| Rate for Payer: PHCS All Commercial |
$107.37
|
| Rate for Payer: PHCS All Commercial |
$107.37
|
| Rate for Payer: PHP All Commercial |
$166.00
|
| Rate for Payer: PHP All Commercial |
$166.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.37
|
| Rate for Payer: Sagamore Health Network All Products |
$107.37
|
| Rate for Payer: Sagamore Health Network All Products |
$107.37
|
| Rate for Payer: Signature Care EPO |
$272.54
|
| Rate for Payer: Signature Care EPO |
$272.54
|
| Rate for Payer: Signature Care PPO |
$272.54
|
| Rate for Payer: Signature Care PPO |
$272.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,000.00
|
| Rate for Payer: United Healthcare Commercial |
$126.51
|
| Rate for Payer: United Healthcare Commercial |
$126.51
|
| Rate for Payer: United Healthcare Medicare |
$154.95
|
| Rate for Payer: United Healthcare Medicare |
$154.95
|
|
|
PR INSERT AND REMOVE BONE PIN
|
Professional
|
Both
|
$431.36
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
z20650
|
| Min. Negotiated Rate |
$82.37 |
| Max. Negotiated Rate |
$22,900.00 |
| Rate for Payer: Aetna Commercial |
$151.02
|
| Rate for Payer: Aetna Commercial |
$151.02
|
| Rate for Payer: Aetna Medicare |
$151.02
|
| Rate for Payer: Aetna Medicare |
$151.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$82.37
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$82.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$212.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$212.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.12
|
| Rate for Payer: Cash Price |
$256.02
|
| Rate for Payer: Cash Price |
$267.44
|
| Rate for Payer: Centivo All Commercial |
$234.08
|
| Rate for Payer: Centivo All Commercial |
$234.08
|
| Rate for Payer: Cigna All Commercial |
$151.02
|
| Rate for Payer: Cigna All Commercial |
$151.02
|
| Rate for Payer: CORVEL All Commercial |
$151.02
|
| Rate for Payer: CORVEL All Commercial |
$151.02
|
| Rate for Payer: Coventry All Commercial |
$181.22
|
| Rate for Payer: Coventry All Commercial |
$181.22
|
| Rate for Payer: Encore All Commercial |
$151.02
|
| Rate for Payer: Encore All Commercial |
$151.02
|
| Rate for Payer: Frontpath All Commercial |
$207.21
|
| Rate for Payer: Frontpath All Commercial |
$207.21
|
| Rate for Payer: Humana ChoiceCare |
$164.56
|
| Rate for Payer: Humana ChoiceCare |
$164.56
|
| Rate for Payer: Humana Medicare |
$151.02
|
| Rate for Payer: Humana Medicare |
$151.02
|
| Rate for Payer: Lucent All Commercial |
$211.43
|
| Rate for Payer: Lucent All Commercial |
$211.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.00
|
| Rate for Payer: Managed Health Services Medicaid |
$212.16
|
| Rate for Payer: Managed Health Services Medicaid |
$212.16
|
| Rate for Payer: MDWise Medicaid |
$212.16
|
| Rate for Payer: MDWise Medicaid |
$212.16
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$82.37
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$82.37
|
| Rate for Payer: PHCS All Commercial |
$151.02
|
| Rate for Payer: PHCS All Commercial |
$151.02
|
| Rate for Payer: PHP All Commercial |
$259.68
|
| Rate for Payer: PHP All Commercial |
$259.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.02
|
| Rate for Payer: Sagamore Health Network All Products |
$151.02
|
| Rate for Payer: Sagamore Health Network All Products |
$151.02
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,900.00
|
| Rate for Payer: United Healthcare Commercial |
$171.06
|
| Rate for Payer: United Healthcare Commercial |
$171.06
|
| Rate for Payer: United Healthcare Medicare |
$206.47
|
| Rate for Payer: United Healthcare Medicare |
$206.47
|
|
|
PR INSERT CATH,ART,PERCUT,SHORTTERM
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
z36620
|
| Min. Negotiated Rate |
$40.51 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Aetna Commercial |
$42.28
|
| Rate for Payer: Aetna Medicare |
$42.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.51
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Centivo All Commercial |
$65.53
|
| Rate for Payer: Cigna All Commercial |
$42.28
|
| Rate for Payer: CORVEL All Commercial |
$42.28
|
| Rate for Payer: Coventry All Commercial |
$50.74
|
| Rate for Payer: Encore All Commercial |
$42.28
|
| Rate for Payer: Frontpath All Commercial |
$57.63
|
| Rate for Payer: Humana ChoiceCare |
$68.70
|
| Rate for Payer: Humana Medicare |
$42.28
|
| Rate for Payer: Lucent All Commercial |
$59.19
|
| Rate for Payer: Managed Health Services Medicaid |
$40.51
|
| Rate for Payer: MDWise Medicaid |
$40.51
|
| Rate for Payer: PHCS All Commercial |
$42.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.28
|
| Rate for Payer: Sagamore Health Network All Products |
$42.28
|
| Rate for Payer: United Healthcare Commercial |
$60.78
|
| Rate for Payer: United Healthcare Medicare |
$40.96
|
|
|
PR INSERT CERVICAL DILATOR
|
Professional
|
Both
|
$191.38
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
z59200
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$5,200.00 |
| Rate for Payer: Aetna Commercial |
$40.22
|
| Rate for Payer: Aetna Commercial |
$40.22
|
| Rate for Payer: Aetna Medicare |
$40.22
|
| Rate for Payer: Aetna Medicare |
$40.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.67
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$94.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$94.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.24
|
| Rate for Payer: Cash Price |
$118.09
|
| Rate for Payer: Cash Price |
$118.66
|
| Rate for Payer: Centivo All Commercial |
$62.34
|
| Rate for Payer: Centivo All Commercial |
$62.34
|
| Rate for Payer: Cigna All Commercial |
$40.22
|
| Rate for Payer: Cigna All Commercial |
$40.22
|
| Rate for Payer: CORVEL All Commercial |
$40.22
|
| Rate for Payer: CORVEL All Commercial |
$40.22
|
| Rate for Payer: Coventry All Commercial |
$48.26
|
| Rate for Payer: Coventry All Commercial |
$48.26
|
| Rate for Payer: Encore All Commercial |
$40.22
|
| Rate for Payer: Encore All Commercial |
$40.22
|
| Rate for Payer: Frontpath All Commercial |
$57.79
|
| Rate for Payer: Frontpath All Commercial |
$57.79
|
| Rate for Payer: Humana ChoiceCare |
$43.38
|
| Rate for Payer: Humana ChoiceCare |
$43.38
|
| Rate for Payer: Humana Medicare |
$40.22
|
| Rate for Payer: Humana Medicare |
$40.22
|
| Rate for Payer: Lucent All Commercial |
$56.31
|
| Rate for Payer: Lucent All Commercial |
$56.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Managed Health Services Medicaid |
$94.13
|
| Rate for Payer: Managed Health Services Medicaid |
$94.13
|
| Rate for Payer: MDWise Medicaid |
$94.13
|
| Rate for Payer: MDWise Medicaid |
$94.13
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$22.67
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$22.67
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$51.36
|
| Rate for Payer: PHP All Commercial |
$51.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.22
|
| Rate for Payer: Sagamore Health Network All Products |
$40.22
|
| Rate for Payer: Sagamore Health Network All Products |
$40.22
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,200.00
|
| Rate for Payer: United Healthcare Commercial |
$51.09
|
| Rate for Payer: United Healthcare Commercial |
$51.09
|
| Rate for Payer: United Healthcare Medicare |
$95.23
|
| Rate for Payer: United Healthcare Medicare |
$95.23
|
|
