|
PR LYSIS OF LABIAL LESION(S)
|
Professional
|
Both
|
$342.46
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
z56441
|
| Min. Negotiated Rate |
$145.90 |
| Max. Negotiated Rate |
$18,900.00 |
| Rate for Payer: Aetna Commercial |
$145.90
|
| Rate for Payer: Aetna Commercial |
$145.90
|
| Rate for Payer: Aetna Medicare |
$145.90
|
| Rate for Payer: Aetna Medicare |
$145.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$168.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$168.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.49
|
| Rate for Payer: Cash Price |
$205.48
|
| Rate for Payer: Cash Price |
$201.80
|
| Rate for Payer: Centivo All Commercial |
$226.15
|
| Rate for Payer: Centivo All Commercial |
$226.15
|
| Rate for Payer: Cigna All Commercial |
$145.90
|
| Rate for Payer: Cigna All Commercial |
$145.90
|
| Rate for Payer: CORVEL All Commercial |
$145.90
|
| Rate for Payer: CORVEL All Commercial |
$145.90
|
| Rate for Payer: Coventry All Commercial |
$175.08
|
| Rate for Payer: Coventry All Commercial |
$175.08
|
| Rate for Payer: Encore All Commercial |
$145.90
|
| Rate for Payer: Encore All Commercial |
$145.90
|
| Rate for Payer: Frontpath All Commercial |
$199.78
|
| Rate for Payer: Frontpath All Commercial |
$199.78
|
| Rate for Payer: Humana ChoiceCare |
$147.86
|
| Rate for Payer: Humana ChoiceCare |
$147.86
|
| Rate for Payer: Humana Medicare |
$145.90
|
| Rate for Payer: Humana Medicare |
$145.90
|
| Rate for Payer: Lucent All Commercial |
$204.26
|
| Rate for Payer: Lucent All Commercial |
$204.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.00
|
| Rate for Payer: Managed Health Services Medicaid |
$168.44
|
| Rate for Payer: Managed Health Services Medicaid |
$168.44
|
| Rate for Payer: MDWise Medicaid |
$168.44
|
| Rate for Payer: MDWise Medicaid |
$168.44
|
| Rate for Payer: PHCS All Commercial |
$145.90
|
| Rate for Payer: PHCS All Commercial |
$145.90
|
| Rate for Payer: PHP All Commercial |
$187.00
|
| Rate for Payer: PHP All Commercial |
$187.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.90
|
| Rate for Payer: Sagamore Health Network All Products |
$145.90
|
| Rate for Payer: Sagamore Health Network All Products |
$145.90
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,900.00
|
| Rate for Payer: United Healthcare Commercial |
$158.85
|
| Rate for Payer: United Healthcare Commercial |
$158.85
|
| Rate for Payer: United Healthcare Medicare |
$168.17
|
| Rate for Payer: United Healthcare Medicare |
$168.17
|
|
|
PR MANIPULATE FINGER JT W/ ANESTH,EACH
|
Professional
|
Both
|
$677.68
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
z26340
|
| Min. Negotiated Rate |
$309.99 |
| Max. Negotiated Rate |
$50,200.00 |
| Rate for Payer: Aetna Commercial |
$329.82
|
| Rate for Payer: Aetna Commercial |
$329.82
|
| Rate for Payer: Aetna Medicare |
$329.82
|
| Rate for Payer: Aetna Medicare |
$329.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$333.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$333.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$379.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$379.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.80
|
| Rate for Payer: Cash Price |
$406.61
|
| Rate for Payer: Cash Price |
$391.76
|
| Rate for Payer: Centivo All Commercial |
$511.22
|
| Rate for Payer: Centivo All Commercial |
$511.22
|
| Rate for Payer: Cigna All Commercial |
$329.82
|
| Rate for Payer: Cigna All Commercial |
$329.82
|
| Rate for Payer: CORVEL All Commercial |
$329.82
|
| Rate for Payer: CORVEL All Commercial |
$329.82
|
| Rate for Payer: Coventry All Commercial |
$395.78
|
| Rate for Payer: Coventry All Commercial |
$395.78
|
| Rate for Payer: Encore All Commercial |
$329.82
|
| Rate for Payer: Encore All Commercial |
$329.82
|
| Rate for Payer: Frontpath All Commercial |
$447.71
|
| Rate for Payer: Frontpath All Commercial |
$447.71
|
| Rate for Payer: Humana ChoiceCare |
$309.99
|
| Rate for Payer: Humana ChoiceCare |
$309.99
|
| Rate for Payer: Humana Medicare |
$329.82
|
| Rate for Payer: Humana Medicare |
$329.82
|
| Rate for Payer: Lucent All Commercial |
$461.75
|
| Rate for Payer: Lucent All Commercial |
$461.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.00
|
| Rate for Payer: Managed Health Services Medicaid |
$333.31
|
| Rate for Payer: Managed Health Services Medicaid |
$333.31
|
| Rate for Payer: MDWise Medicaid |
$333.31
|
| Rate for Payer: MDWise Medicaid |
$333.31
|
| Rate for Payer: PHCS All Commercial |
$329.82
|
| Rate for Payer: PHCS All Commercial |
$329.82
|
| Rate for Payer: PHP All Commercial |
$568.05
|
| Rate for Payer: PHP All Commercial |
$568.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$329.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$329.82
|
| Rate for Payer: Sagamore Health Network All Products |
$329.82
|
| Rate for Payer: Sagamore Health Network All Products |
$329.82
|
| Rate for Payer: Signature Care EPO |
$408.85
|
| Rate for Payer: Signature Care EPO |
$408.85
|
| Rate for Payer: Signature Care PPO |
$408.85
|
| Rate for Payer: Signature Care PPO |
$408.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,200.00
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Medicare |
$326.47
|
| Rate for Payer: United Healthcare Medicare |
$326.47
|
|
|
PR MANIPULATE WRIST W/ANESTHES
|
Professional
|
Both
|
$819.52
|
|
|
Service Code
|
CPT 25259
|
| Hospital Charge Code |
z25259
|
| Min. Negotiated Rate |
$397.43 |
| Max. Negotiated Rate |
$61,100.00 |
| Rate for Payer: Aetna Commercial |
$403.53
|
| Rate for Payer: Aetna Commercial |
$403.53
|
| Rate for Payer: Aetna Medicare |
$403.53
|
| Rate for Payer: Aetna Medicare |
$403.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$403.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$403.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$464.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$464.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$443.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$443.88
|
| Rate for Payer: Cash Price |
$491.71
|
| Rate for Payer: Cash Price |
$476.92
|
| Rate for Payer: Centivo All Commercial |
$625.47
|
| Rate for Payer: Centivo All Commercial |
$625.47
|
| Rate for Payer: Cigna All Commercial |
$403.53
|
| Rate for Payer: Cigna All Commercial |
$403.53
|
| Rate for Payer: CORVEL All Commercial |
$403.53
|
| Rate for Payer: CORVEL All Commercial |
$403.53
|
| Rate for Payer: Coventry All Commercial |
$484.24
|
| Rate for Payer: Coventry All Commercial |
$484.24
|
| Rate for Payer: Encore All Commercial |
$403.53
|
| Rate for Payer: Encore All Commercial |
$403.53
|
| Rate for Payer: Frontpath All Commercial |
$550.54
|
| Rate for Payer: Frontpath All Commercial |
$550.54
|
| Rate for Payer: Humana ChoiceCare |
$402.12
|
| Rate for Payer: Humana ChoiceCare |
$402.12
|
| Rate for Payer: Humana Medicare |
$403.53
|
| Rate for Payer: Humana Medicare |
$403.53
|
| Rate for Payer: Lucent All Commercial |
$564.94
|
| Rate for Payer: Lucent All Commercial |
$564.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$652.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$652.00
|
| Rate for Payer: Managed Health Services Medicaid |
$403.07
|
| Rate for Payer: Managed Health Services Medicaid |
$403.07
|
| Rate for Payer: MDWise Medicaid |
$403.07
|
| Rate for Payer: MDWise Medicaid |
$403.07
|
| Rate for Payer: PHCS All Commercial |
$403.53
|
| Rate for Payer: PHCS All Commercial |
$403.53
|
| Rate for Payer: PHP All Commercial |
$691.53
|
| Rate for Payer: PHP All Commercial |
$691.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$403.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$403.53
|
| Rate for Payer: Sagamore Health Network All Products |
$403.53
|
| Rate for Payer: Sagamore Health Network All Products |
$403.53
|
| Rate for Payer: Signature Care EPO |
$527.00
|
| Rate for Payer: Signature Care EPO |
$527.00
|
| Rate for Payer: Signature Care PPO |
$527.00
|
| Rate for Payer: Signature Care PPO |
$527.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,100.00
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
| Rate for Payer: United Healthcare Medicare |
$397.43
|
| Rate for Payer: United Healthcare Medicare |
$397.43
|
|
|
PR MANIPULATN KNEE JT+ANESTHESIA
|
Professional
|
Both
|
$287.02
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
z27570
|
| Min. Negotiated Rate |
$139.53 |
| Max. Negotiated Rate |
$21,500.00 |
| Rate for Payer: Aetna Commercial |
$142.03
|
| Rate for Payer: Aetna Commercial |
$142.03
|
| Rate for Payer: Aetna Medicare |
$142.03
|
| Rate for Payer: Aetna Medicare |
$142.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.23
|
| Rate for Payer: Cash Price |
$172.21
|
| Rate for Payer: Cash Price |
$167.44
|
| Rate for Payer: Centivo All Commercial |
$220.15
|
| Rate for Payer: Centivo All Commercial |
$220.15
|
| Rate for Payer: Cigna All Commercial |
$142.03
|
| Rate for Payer: Cigna All Commercial |
$142.03
|
| Rate for Payer: CORVEL All Commercial |
$142.03
|
| Rate for Payer: CORVEL All Commercial |
$142.03
|
| Rate for Payer: Coventry All Commercial |
$170.44
|
| Rate for Payer: Coventry All Commercial |
$170.44
|
| Rate for Payer: Encore All Commercial |
$142.03
|
| Rate for Payer: Encore All Commercial |
$142.03
|
| Rate for Payer: Frontpath All Commercial |
$196.50
|
| Rate for Payer: Frontpath All Commercial |
$196.50
|
| Rate for Payer: Humana ChoiceCare |
$152.09
|
| Rate for Payer: Humana ChoiceCare |
$152.09
|
| Rate for Payer: Humana Medicare |
$142.03
|
| Rate for Payer: Humana Medicare |
$142.03
|
| Rate for Payer: Lucent All Commercial |
$198.84
|
| Rate for Payer: Lucent All Commercial |
$198.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.00
|
| Rate for Payer: Managed Health Services Medicaid |
$141.17
|
| Rate for Payer: Managed Health Services Medicaid |
$141.17
|
| Rate for Payer: MDWise Medicaid |
$141.17
|
| Rate for Payer: MDWise Medicaid |
$141.17
|
| Rate for Payer: PHCS All Commercial |
$142.03
|
| Rate for Payer: PHCS All Commercial |
$142.03
|
| Rate for Payer: PHP All Commercial |
$242.77
|
| Rate for Payer: PHP All Commercial |
$242.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.03
|
| Rate for Payer: Sagamore Health Network All Products |
$142.03
|
| Rate for Payer: Sagamore Health Network All Products |
$142.03
|
| Rate for Payer: Signature Care EPO |
$205.70
|
| Rate for Payer: Signature Care EPO |
$205.70
|
| Rate for Payer: Signature Care PPO |
$205.70
|
| Rate for Payer: Signature Care PPO |
$205.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,500.00
|
| Rate for Payer: United Healthcare Commercial |
$156.98
|
| Rate for Payer: United Healthcare Commercial |
$156.98
|
| Rate for Payer: United Healthcare Medicare |
$139.53
|
| Rate for Payer: United Healthcare Medicare |
$139.53
|
|
|
PR MANIPULATN SHLDR JT W ANESTHESIA
|
Professional
|
Both
|
$364.64
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
z23700
|
| Min. Negotiated Rate |
$178.35 |
| Max. Negotiated Rate |
$27,400.00 |
| Rate for Payer: Aetna Commercial |
$182.80
|
| Rate for Payer: Aetna Commercial |
$182.80
|
| Rate for Payer: Aetna Medicare |
$182.80
|
| Rate for Payer: Aetna Medicare |
$182.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$179.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$179.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$210.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$210.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$201.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$201.08
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cash Price |
$214.02
|
| Rate for Payer: Centivo All Commercial |
$283.34
|
| Rate for Payer: Centivo All Commercial |
$283.34
|
| Rate for Payer: Cigna All Commercial |
$182.80
|
| Rate for Payer: Cigna All Commercial |
$182.80
|
| Rate for Payer: CORVEL All Commercial |
$182.80
|
| Rate for Payer: CORVEL All Commercial |
$182.80
|
| Rate for Payer: Coventry All Commercial |
$219.36
|
| Rate for Payer: Coventry All Commercial |
$219.36
|
| Rate for Payer: Encore All Commercial |
$182.80
|
| Rate for Payer: Encore All Commercial |
$182.80
|
| Rate for Payer: Frontpath All Commercial |
$253.67
|
| Rate for Payer: Frontpath All Commercial |
$253.67
|
| Rate for Payer: Humana ChoiceCare |
$204.62
|
| Rate for Payer: Humana ChoiceCare |
$204.62
|
| Rate for Payer: Humana Medicare |
$182.80
|
| Rate for Payer: Humana Medicare |
$182.80
|
| Rate for Payer: Lucent All Commercial |
$255.92
|
| Rate for Payer: Lucent All Commercial |
$255.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.00
|
| Rate for Payer: Managed Health Services Medicaid |
$179.34
|
| Rate for Payer: Managed Health Services Medicaid |
$179.34
|
| Rate for Payer: MDWise Medicaid |
$179.34
|
| Rate for Payer: MDWise Medicaid |
$179.34
|
| Rate for Payer: PHCS All Commercial |
$182.80
|
| Rate for Payer: PHCS All Commercial |
$182.80
|
| Rate for Payer: PHP All Commercial |
$310.34
|
| Rate for Payer: PHP All Commercial |
$310.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.80
|
| Rate for Payer: Sagamore Health Network All Products |
$182.80
|
| Rate for Payer: Sagamore Health Network All Products |
$182.80
|
| Rate for Payer: Signature Care EPO |
$280.50
|
| Rate for Payer: Signature Care EPO |
$280.50
|
| Rate for Payer: Signature Care PPO |
$280.50
|
| Rate for Payer: Signature Care PPO |
$280.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27,400.00
|
| Rate for Payer: United Healthcare Commercial |
$209.16
|
| Rate for Payer: United Healthcare Commercial |
$209.16
|
| Rate for Payer: United Healthcare Medicare |
$178.35
|
| Rate for Payer: United Healthcare Medicare |
$178.35
|
|
|
PR MANUAL PREP&INSJ I-ARTIC DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$272.14
|
|
|
Service Code
|
CPT 20704
|
| Hospital Charge Code |
z20704
|
| Min. Negotiated Rate |
$131.90 |
| Max. Negotiated Rate |
$20,300.00 |
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: Aetna Medicare |
$140.09
|
| Rate for Payer: Aetna Medicare |
$140.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$133.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$133.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.10
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cash Price |
$158.28
|
| Rate for Payer: Centivo All Commercial |
$217.14
|
| Rate for Payer: Centivo All Commercial |
$217.14
|
| Rate for Payer: Cigna All Commercial |
$140.09
|
| Rate for Payer: Cigna All Commercial |
$140.09
|
| Rate for Payer: CORVEL All Commercial |
$140.09
|
| Rate for Payer: CORVEL All Commercial |
$140.09
|
| Rate for Payer: Coventry All Commercial |
$168.11
|
| Rate for Payer: Coventry All Commercial |
$168.11
|
| Rate for Payer: Encore All Commercial |
$140.09
|
| Rate for Payer: Encore All Commercial |
$140.09
|
| Rate for Payer: Frontpath All Commercial |
$198.17
|
| Rate for Payer: Frontpath All Commercial |
$198.17
|
| Rate for Payer: Humana ChoiceCare |
$160.02
|
| Rate for Payer: Humana ChoiceCare |
$160.02
|
| Rate for Payer: Humana Medicare |
$140.09
|
| Rate for Payer: Humana Medicare |
$140.09
|
| Rate for Payer: Lucent All Commercial |
$196.13
|
| Rate for Payer: Lucent All Commercial |
$196.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.00
|
| Rate for Payer: Managed Health Services Medicaid |
$133.85
|
| Rate for Payer: Managed Health Services Medicaid |
$133.85
|
| Rate for Payer: MDWise Medicaid |
$133.85
|
| Rate for Payer: MDWise Medicaid |
$133.85
|
| Rate for Payer: PHCS All Commercial |
$140.09
|
| Rate for Payer: PHCS All Commercial |
$140.09
|
| Rate for Payer: PHP All Commercial |
$184.66
|
| Rate for Payer: PHP All Commercial |
$184.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.09
|
| Rate for Payer: Sagamore Health Network All Products |
$140.09
|
| Rate for Payer: Sagamore Health Network All Products |
$140.09
|
| Rate for Payer: Signature Care EPO |
$197.12
|
| Rate for Payer: Signature Care EPO |
$197.12
|
| Rate for Payer: Signature Care PPO |
$197.12
|
| Rate for Payer: Signature Care PPO |
$197.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,300.00
|
| Rate for Payer: United Healthcare Commercial |
$177.78
|
| Rate for Payer: United Healthcare Commercial |
$177.78
|
| Rate for Payer: United Healthcare Medicare |
$131.90
|
| Rate for Payer: United Healthcare Medicare |
$131.90
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,060.16
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
z19300
|
| Min. Negotiated Rate |
$229.22 |
| Max. Negotiated Rate |
$48,000.00 |
| Rate for Payer: Aetna Commercial |
$401.80
|
| Rate for Payer: Aetna Commercial |
$401.80
|
| Rate for Payer: Aetna Commercial |
$401.80
|
| Rate for Payer: Aetna Commercial |
$401.80
|
| Rate for Payer: Aetna Medicare |
$401.80
|
| Rate for Payer: Aetna Medicare |
$401.80
|
| Rate for Payer: Aetna Medicare |
$401.80
|
| Rate for Payer: Aetna Medicare |
$401.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$229.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$229.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$229.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$229.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$521.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$521.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$521.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$521.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$462.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$462.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$462.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$462.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.98
|
| Rate for Payer: Cash Price |
$1,263.53
|
| Rate for Payer: Cash Price |
$636.10
|
| Rate for Payer: Cash Price |
$1,272.19
|
| Rate for Payer: Cash Price |
$631.76
|
| Rate for Payer: Centivo All Commercial |
$622.79
|
| Rate for Payer: Centivo All Commercial |
$622.79
|
| Rate for Payer: Centivo All Commercial |
$622.79
|
| Rate for Payer: Centivo All Commercial |
$622.79
|
| Rate for Payer: Cigna All Commercial |
$401.80
|
| Rate for Payer: Cigna All Commercial |
$401.80
|
| Rate for Payer: Cigna All Commercial |
$401.80
|
| Rate for Payer: Cigna All Commercial |
$401.80
|
| Rate for Payer: CORVEL All Commercial |
$401.80
|
| Rate for Payer: CORVEL All Commercial |
$401.80
|
| Rate for Payer: CORVEL All Commercial |
$401.80
|
| Rate for Payer: CORVEL All Commercial |
$401.80
|
| Rate for Payer: Coventry All Commercial |
$482.16
|
| Rate for Payer: Coventry All Commercial |
$482.16
|
| Rate for Payer: Coventry All Commercial |
$482.16
|
| Rate for Payer: Coventry All Commercial |
$482.16
|
| Rate for Payer: Encore All Commercial |
$401.80
|
| Rate for Payer: Encore All Commercial |
$401.80
|
| Rate for Payer: Encore All Commercial |
$401.80
|
| Rate for Payer: Encore All Commercial |
$401.80
|
| Rate for Payer: Frontpath All Commercial |
$561.14
|
| Rate for Payer: Frontpath All Commercial |
$561.14
|
| Rate for Payer: Frontpath All Commercial |
$561.14
|
| Rate for Payer: Frontpath All Commercial |
$561.14
|
| Rate for Payer: Humana ChoiceCare |
$309.02
|
| Rate for Payer: Humana ChoiceCare |
$309.02
|
| Rate for Payer: Humana ChoiceCare |
$309.02
|
| Rate for Payer: Humana ChoiceCare |
$309.02
|
| Rate for Payer: Humana Medicare |
$401.80
|
| Rate for Payer: Humana Medicare |
$401.80
|
| Rate for Payer: Humana Medicare |
$401.80
|
| Rate for Payer: Humana Medicare |
$401.80
|
| Rate for Payer: Lucent All Commercial |
$562.52
|
| Rate for Payer: Lucent All Commercial |
$562.52
|
| Rate for Payer: Lucent All Commercial |
$562.52
|
| Rate for Payer: Lucent All Commercial |
$562.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$520.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$520.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$520.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$520.00
|
| Rate for Payer: Managed Health Services Medicaid |
$521.43
|
| Rate for Payer: Managed Health Services Medicaid |
$521.43
|
| Rate for Payer: Managed Health Services Medicaid |
$521.43
|
| Rate for Payer: Managed Health Services Medicaid |
$521.43
|
| Rate for Payer: MDWise Medicaid |
$521.43
|
| Rate for Payer: MDWise Medicaid |
$521.43
|
| Rate for Payer: MDWise Medicaid |
$521.43
|
| Rate for Payer: MDWise Medicaid |
$521.43
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$229.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$229.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$229.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$229.22
|
| Rate for Payer: PHCS All Commercial |
$401.80
|
| Rate for Payer: PHCS All Commercial |
$401.80
|
| Rate for Payer: PHCS All Commercial |
$401.80
|
| Rate for Payer: PHCS All Commercial |
$401.80
|
| Rate for Payer: PHP All Commercial |
$546.47
|
| Rate for Payer: PHP All Commercial |
$546.47
|
| Rate for Payer: PHP All Commercial |
$546.47
|
| Rate for Payer: PHP All Commercial |
$546.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.80
|
| Rate for Payer: Sagamore Health Network All Products |
$401.80
|
| Rate for Payer: Sagamore Health Network All Products |
$401.80
|
| Rate for Payer: Sagamore Health Network All Products |
$401.80
|
| Rate for Payer: Sagamore Health Network All Products |
$401.80
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,000.00
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Medicare |
$526.47
|
| Rate for Payer: United Healthcare Medicare |
$526.47
|
| Rate for Payer: United Healthcare Medicare |
$526.47
|
| Rate for Payer: United Healthcare Medicare |
$526.47
|
|
|
PR MASTECTOMY, PARTIAL
|
Professional
|
Both
|
$1,201.48
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
z19301
|
| Min. Negotiated Rate |
$337.65 |
| Max. Negotiated Rate |
$72,600.00 |
| Rate for Payer: Aetna Commercial |
$612.24
|
| Rate for Payer: Aetna Commercial |
$612.24
|
| Rate for Payer: Aetna Medicare |
$612.24
|
| Rate for Payer: Aetna Medicare |
$612.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$590.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$590.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.46
|
| Rate for Payer: Cash Price |
$720.89
|
| Rate for Payer: Cash Price |
$707.93
|
| Rate for Payer: Centivo All Commercial |
$948.97
|
| Rate for Payer: Centivo All Commercial |
$948.97
|
| Rate for Payer: Cigna All Commercial |
$612.24
|
| Rate for Payer: Cigna All Commercial |
$612.24
|
| Rate for Payer: CORVEL All Commercial |
$612.24
|
| Rate for Payer: CORVEL All Commercial |
$612.24
|
| Rate for Payer: Coventry All Commercial |
$734.69
|
| Rate for Payer: Coventry All Commercial |
$734.69
|
| Rate for Payer: Encore All Commercial |
$612.24
|
| Rate for Payer: Encore All Commercial |
$612.24
|
| Rate for Payer: Frontpath All Commercial |
$870.80
|
| Rate for Payer: Frontpath All Commercial |
$870.80
|
| Rate for Payer: Humana ChoiceCare |
$337.65
|
| Rate for Payer: Humana ChoiceCare |
$337.65
|
| Rate for Payer: Humana Medicare |
$612.24
|
| Rate for Payer: Humana Medicare |
$612.24
|
| Rate for Payer: Lucent All Commercial |
$857.14
|
| Rate for Payer: Lucent All Commercial |
$857.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$786.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$786.00
|
| Rate for Payer: Managed Health Services Medicaid |
$590.93
|
| Rate for Payer: Managed Health Services Medicaid |
$590.93
|
| Rate for Payer: MDWise Medicaid |
$590.93
|
| Rate for Payer: MDWise Medicaid |
$590.93
|
| Rate for Payer: PHCS All Commercial |
$612.24
|
| Rate for Payer: PHCS All Commercial |
$612.24
|
| Rate for Payer: PHP All Commercial |
$825.92
|
| Rate for Payer: PHP All Commercial |
$825.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.24
|
| Rate for Payer: Sagamore Health Network All Products |
$612.24
|
| Rate for Payer: Sagamore Health Network All Products |
$612.24
|
| Rate for Payer: Signature Care EPO |
$527.06
|
| Rate for Payer: Signature Care EPO |
$527.06
|
| Rate for Payer: Signature Care PPO |
$527.06
|
| Rate for Payer: Signature Care PPO |
$527.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,600.00
|
| Rate for Payer: United Healthcare Commercial |
$655.51
|
| Rate for Payer: United Healthcare Commercial |
$655.51
|
| Rate for Payer: United Healthcare Medicare |
$589.94
|
| Rate for Payer: United Healthcare Medicare |
$589.94
|
|
|
PR MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,649.08
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
z19302
|
| Min. Negotiated Rate |
$718.67 |
| Max. Negotiated Rate |
$99,600.00 |
| Rate for Payer: Aetna Commercial |
$840.38
|
| Rate for Payer: Aetna Commercial |
$840.38
|
| Rate for Payer: Aetna Medicare |
$840.38
|
| Rate for Payer: Aetna Medicare |
$840.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$948.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$811.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$811.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$966.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$966.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$924.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$924.42
|
| Rate for Payer: Cash Price |
$989.45
|
| Rate for Payer: Cash Price |
$971.86
|
| Rate for Payer: Centivo All Commercial |
$1,302.59
|
| Rate for Payer: Centivo All Commercial |
$1,302.59
|
| Rate for Payer: Cigna All Commercial |
$840.38
|
| Rate for Payer: Cigna All Commercial |
$840.38
|
| Rate for Payer: CORVEL All Commercial |
$840.38
|
| Rate for Payer: CORVEL All Commercial |
$840.38
|
| Rate for Payer: Coventry All Commercial |
$1,008.46
|
| Rate for Payer: Coventry All Commercial |
$1,008.46
|
| Rate for Payer: Encore All Commercial |
$840.38
|
| Rate for Payer: Encore All Commercial |
$840.38
|
| Rate for Payer: Frontpath All Commercial |
$1,196.61
|
| Rate for Payer: Frontpath All Commercial |
$1,196.61
|
| Rate for Payer: Humana ChoiceCare |
$718.67
|
| Rate for Payer: Humana ChoiceCare |
$718.67
|
| Rate for Payer: Humana Medicare |
$840.38
|
| Rate for Payer: Humana Medicare |
$840.38
|
| Rate for Payer: Lucent All Commercial |
$1,176.53
|
| Rate for Payer: Lucent All Commercial |
$1,176.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,079.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,079.00
|
| Rate for Payer: Managed Health Services Medicaid |
$811.08
|
| Rate for Payer: Managed Health Services Medicaid |
$811.08
|
| Rate for Payer: MDWise Medicaid |
$811.08
|
| Rate for Payer: MDWise Medicaid |
$811.08
|
| Rate for Payer: PHCS All Commercial |
$840.38
|
| Rate for Payer: PHCS All Commercial |
$840.38
|
| Rate for Payer: PHP All Commercial |
$1,133.83
|
| Rate for Payer: PHP All Commercial |
$1,133.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$840.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$840.38
|
| Rate for Payer: Sagamore Health Network All Products |
$840.38
|
| Rate for Payer: Sagamore Health Network All Products |
$840.38
|
| Rate for Payer: Signature Care EPO |
$800.70
|
| Rate for Payer: Signature Care EPO |
$800.70
|
| Rate for Payer: Signature Care PPO |
$800.70
|
| Rate for Payer: Signature Care PPO |
$800.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99,600.00
|
| Rate for Payer: United Healthcare Commercial |
$937.16
|
| Rate for Payer: United Healthcare Commercial |
$937.16
|
| Rate for Payer: United Healthcare Medicare |
$809.88
|
| Rate for Payer: United Healthcare Medicare |
$809.88
|
|
|
PR MASTECTOMY, SIMPLE, COMPLETE
|
Professional
|
Both
|
$1,740.92
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
z19303
|
| Min. Negotiated Rate |
$743.11 |
| Max. Negotiated Rate |
$105,200.00 |
| Rate for Payer: Aetna Commercial |
$886.83
|
| Rate for Payer: Aetna Commercial |
$886.83
|
| Rate for Payer: Aetna Medicare |
$886.83
|
| Rate for Payer: Aetna Medicare |
$886.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$980.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$856.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$856.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,019.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,019.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$975.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$975.51
|
| Rate for Payer: Cash Price |
$1,044.55
|
| Rate for Payer: Cash Price |
$1,026.04
|
| Rate for Payer: Centivo All Commercial |
$1,374.59
|
| Rate for Payer: Centivo All Commercial |
$1,374.59
|
| Rate for Payer: Cigna All Commercial |
$886.83
|
| Rate for Payer: Cigna All Commercial |
$886.83
|
| Rate for Payer: CORVEL All Commercial |
$886.83
|
| Rate for Payer: CORVEL All Commercial |
$886.83
|
| Rate for Payer: Coventry All Commercial |
$1,064.20
|
| Rate for Payer: Coventry All Commercial |
$1,064.20
|
| Rate for Payer: Encore All Commercial |
$886.83
|
| Rate for Payer: Encore All Commercial |
$886.83
|
| Rate for Payer: Frontpath All Commercial |
$1,264.21
|
| Rate for Payer: Frontpath All Commercial |
$1,264.21
|
| Rate for Payer: Humana ChoiceCare |
$743.11
|
| Rate for Payer: Humana ChoiceCare |
$743.11
|
| Rate for Payer: Humana Medicare |
$886.83
|
| Rate for Payer: Humana Medicare |
$886.83
|
| Rate for Payer: Lucent All Commercial |
$1,241.56
|
| Rate for Payer: Lucent All Commercial |
$1,241.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,139.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,139.00
|
| Rate for Payer: Managed Health Services Medicaid |
$856.26
|
| Rate for Payer: Managed Health Services Medicaid |
$856.26
|
| Rate for Payer: MDWise Medicaid |
$856.26
|
| Rate for Payer: MDWise Medicaid |
$856.26
|
| Rate for Payer: PHCS All Commercial |
$886.83
|
| Rate for Payer: PHCS All Commercial |
$886.83
|
| Rate for Payer: PHP All Commercial |
$1,197.04
|
| Rate for Payer: PHP All Commercial |
$1,197.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$886.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$886.83
|
| Rate for Payer: Sagamore Health Network All Products |
$886.83
|
| Rate for Payer: Sagamore Health Network All Products |
$886.83
|
| Rate for Payer: Signature Care EPO |
$827.90
|
| Rate for Payer: Signature Care EPO |
$827.90
|
| Rate for Payer: Signature Care PPO |
$827.90
|
| Rate for Payer: Signature Care PPO |
$827.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,014.36
|
| Rate for Payer: United Healthcare Commercial |
$1,014.36
|
| Rate for Payer: United Healthcare Medicare |
$855.03
|
| Rate for Payer: United Healthcare Medicare |
$855.03
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$863.24
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
z19020
|
| Min. Negotiated Rate |
$161.09 |
| Max. Negotiated Rate |
$34,700.00 |
| Rate for Payer: Aetna Commercial |
$289.82
|
| Rate for Payer: Aetna Commercial |
$289.82
|
| Rate for Payer: Aetna Medicare |
$289.82
|
| Rate for Payer: Aetna Medicare |
$289.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$540.23
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.09
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$424.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$424.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$318.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$318.80
|
| Rate for Payer: Cash Price |
$510.26
|
| Rate for Payer: Cash Price |
$517.94
|
| Rate for Payer: Centivo All Commercial |
$449.22
|
| Rate for Payer: Centivo All Commercial |
$449.22
|
| Rate for Payer: Cigna All Commercial |
$289.82
|
| Rate for Payer: Cigna All Commercial |
$289.82
|
| Rate for Payer: CORVEL All Commercial |
$289.82
|
| Rate for Payer: CORVEL All Commercial |
$289.82
|
| Rate for Payer: Coventry All Commercial |
$347.78
|
| Rate for Payer: Coventry All Commercial |
$347.78
|
| Rate for Payer: Encore All Commercial |
$289.82
|
| Rate for Payer: Encore All Commercial |
$289.82
|
| Rate for Payer: Frontpath All Commercial |
$404.64
|
| Rate for Payer: Frontpath All Commercial |
$404.64
|
| Rate for Payer: Humana ChoiceCare |
$234.37
|
| Rate for Payer: Humana ChoiceCare |
$234.37
|
| Rate for Payer: Humana Medicare |
$289.82
|
| Rate for Payer: Humana Medicare |
$289.82
|
| Rate for Payer: Lucent All Commercial |
$405.75
|
| Rate for Payer: Lucent All Commercial |
$405.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$376.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$376.00
|
| Rate for Payer: Managed Health Services Medicaid |
$424.57
|
| Rate for Payer: Managed Health Services Medicaid |
$424.57
|
| Rate for Payer: MDWise Medicaid |
$424.57
|
| Rate for Payer: MDWise Medicaid |
$424.57
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$161.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$161.09
|
| Rate for Payer: PHCS All Commercial |
$289.82
|
| Rate for Payer: PHCS All Commercial |
$289.82
|
| Rate for Payer: PHP All Commercial |
$395.02
|
| Rate for Payer: PHP All Commercial |
$395.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.82
|
| Rate for Payer: Sagamore Health Network All Products |
$289.82
|
| Rate for Payer: Sagamore Health Network All Products |
$289.82
|
| Rate for Payer: Signature Care EPO |
$389.30
|
| Rate for Payer: Signature Care EPO |
$389.30
|
| Rate for Payer: Signature Care PPO |
$389.30
|
| Rate for Payer: Signature Care PPO |
$389.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,700.00
|
| Rate for Payer: United Healthcare Commercial |
$303.26
|
| Rate for Payer: United Healthcare Commercial |
$303.26
|
| Rate for Payer: United Healthcare Medicare |
$425.22
|
| Rate for Payer: United Healthcare Medicare |
$425.22
|
|
|
PR MD CERTIFICATION HHA PATIENT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
CPT G0180
|
| Hospital Charge Code |
zG0180
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna Commercial |
$49.84
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.82
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Centivo All Commercial |
$77.25
|
| Rate for Payer: Cigna All Commercial |
$49.84
|
| Rate for Payer: CORVEL All Commercial |
$49.84
|
| Rate for Payer: Coventry All Commercial |
$59.81
|
| Rate for Payer: Encore All Commercial |
$49.84
|
| Rate for Payer: Humana ChoiceCare |
$41.89
|
| Rate for Payer: Humana Medicare |
$49.84
|
| Rate for Payer: Lucent All Commercial |
$69.78
|
| Rate for Payer: PHCS All Commercial |
$49.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.84
|
| Rate for Payer: Sagamore Health Network All Products |
$49.84
|
| Rate for Payer: United Healthcare Commercial |
$61.23
|
|
|
PR MD RECERTIFICATION HHA PT
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT G0179
|
| Hospital Charge Code |
zG0179
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$59.41 |
| Rate for Payer: Aetna Commercial |
$38.33
|
| Rate for Payer: Aetna Medicare |
$38.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.16
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Centivo All Commercial |
$59.41
|
| Rate for Payer: Cigna All Commercial |
$38.33
|
| Rate for Payer: CORVEL All Commercial |
$38.33
|
| Rate for Payer: Coventry All Commercial |
$46.00
|
| Rate for Payer: Encore All Commercial |
$38.33
|
| Rate for Payer: Humana ChoiceCare |
$32.93
|
| Rate for Payer: Humana Medicare |
$38.33
|
| Rate for Payer: Lucent All Commercial |
$53.66
|
| Rate for Payer: PHCS All Commercial |
$38.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.33
|
| Rate for Payer: Sagamore Health Network All Products |
$38.33
|
| Rate for Payer: United Healthcare Commercial |
$46.08
|
|
|
PR MD SERVICE REQUIRED FOR PMD
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT G0372
|
| Hospital Charge Code |
zG0372
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$8.54
|
| Rate for Payer: Aetna Medicare |
$8.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.39
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Centivo All Commercial |
$13.24
|
| Rate for Payer: Cigna All Commercial |
$8.54
|
| Rate for Payer: CORVEL All Commercial |
$8.54
|
| Rate for Payer: Coventry All Commercial |
$10.25
|
| Rate for Payer: Encore All Commercial |
$8.54
|
| Rate for Payer: Humana ChoiceCare |
$7.13
|
| Rate for Payer: Humana Medicare |
$8.54
|
| Rate for Payer: Lucent All Commercial |
$11.96
|
| Rate for Payer: Managed Health Services Medicaid |
$8.14
|
| Rate for Payer: MDWise Medicaid |
$8.14
|
| Rate for Payer: PHCS All Commercial |
$8.54
|
| Rate for Payer: PHP All Commercial |
$8.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.54
|
| Rate for Payer: Sagamore Health Network All Products |
$8.54
|
| Rate for Payer: Signature Care EPO |
$38.25
|
| Rate for Payer: Signature Care PPO |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
PR MEAS,POST-VOID RES,US,NON-IMAGING
|
Professional
|
Both
|
$20.32
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
z51798
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.45
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: Centivo All Commercial |
$14.72
|
| Rate for Payer: Cigna All Commercial |
$9.50
|
| Rate for Payer: CORVEL All Commercial |
$9.50
|
| Rate for Payer: Coventry All Commercial |
$11.40
|
| Rate for Payer: Encore All Commercial |
$9.50
|
| Rate for Payer: Frontpath All Commercial |
$12.82
|
| Rate for Payer: Humana ChoiceCare |
$11.51
|
| Rate for Payer: Humana Medicare |
$9.50
|
| Rate for Payer: Lucent All Commercial |
$13.30
|
| Rate for Payer: Managed Health Services Medicaid |
$10.12
|
| Rate for Payer: MDWise Medicaid |
$10.12
|
| Rate for Payer: PHCS All Commercial |
$9.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.50
|
| Rate for Payer: Sagamore Health Network All Products |
$9.50
|
| Rate for Payer: United Healthcare Commercial |
$23.69
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
|
|
PR MOBILIZE SPLENIC FLEX
|
Professional
|
Both
|
$215.56
|
|
|
Service Code
|
CPT 44139
|
| Hospital Charge Code |
z44139
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$15,300.00 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Medicare |
$111.38
|
| Rate for Payer: Aetna Medicare |
$111.38
|
| 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: CareSource Indiana of IN Hoosier Healthwise/HIP |
$106.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$106.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.52
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Centivo All Commercial |
$172.64
|
| Rate for Payer: Centivo All Commercial |
$172.64
|
| Rate for Payer: Cigna All Commercial |
$111.38
|
| Rate for Payer: Cigna All Commercial |
$111.38
|
| Rate for Payer: CORVEL All Commercial |
$111.38
|
| Rate for Payer: CORVEL All Commercial |
$111.38
|
| Rate for Payer: Coventry All Commercial |
$133.66
|
| Rate for Payer: Coventry All Commercial |
$133.66
|
| Rate for Payer: Encore All Commercial |
$111.38
|
| Rate for Payer: Encore All Commercial |
$111.38
|
| Rate for Payer: Frontpath All Commercial |
$159.43
|
| Rate for Payer: Frontpath All Commercial |
$159.43
|
| Rate for Payer: Humana ChoiceCare |
$137.93
|
| Rate for Payer: Humana ChoiceCare |
$137.93
|
| Rate for Payer: Humana Medicare |
$111.38
|
| Rate for Payer: Humana Medicare |
$111.38
|
| Rate for Payer: Lucent All Commercial |
$155.93
|
| Rate for Payer: Lucent All Commercial |
$155.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.00
|
| Rate for Payer: Managed Health Services Medicaid |
$106.02
|
| Rate for Payer: Managed Health Services Medicaid |
$106.02
|
| Rate for Payer: MDWise Medicaid |
$106.02
|
| Rate for Payer: MDWise Medicaid |
$106.02
|
| Rate for Payer: PHCS All Commercial |
$111.38
|
| Rate for Payer: PHCS All Commercial |
$111.38
|
| Rate for Payer: PHP All Commercial |
$186.76
|
| Rate for Payer: PHP All Commercial |
$186.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.38
|
| Rate for Payer: Sagamore Health Network All Products |
$111.38
|
| Rate for Payer: Sagamore Health Network All Products |
$111.38
|
| 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 |
$15,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,300.00
|
| Rate for Payer: United Healthcare Commercial |
$134.59
|
| Rate for Payer: United Healthcare Commercial |
$134.59
|
| Rate for Payer: United Healthcare Medicare |
$106.72
|
| Rate for Payer: United Healthcare Medicare |
$106.72
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$139.90
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
z99156
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$8,600.00 |
| Rate for Payer: Aetna Commercial |
$72.46
|
| Rate for Payer: Aetna Commercial |
$72.46
|
| Rate for Payer: Aetna Medicare |
$72.46
|
| Rate for Payer: Aetna Medicare |
$72.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.71
|
| Rate for Payer: Cash Price |
$83.94
|
| Rate for Payer: Cash Price |
$83.68
|
| Rate for Payer: Centivo All Commercial |
$112.31
|
| Rate for Payer: Centivo All Commercial |
$112.31
|
| Rate for Payer: Cigna All Commercial |
$72.46
|
| Rate for Payer: Cigna All Commercial |
$72.46
|
| Rate for Payer: CORVEL All Commercial |
$72.46
|
| Rate for Payer: CORVEL All Commercial |
$72.46
|
| Rate for Payer: Coventry All Commercial |
$86.95
|
| Rate for Payer: Coventry All Commercial |
$86.95
|
| Rate for Payer: Encore All Commercial |
$72.46
|
| Rate for Payer: Encore All Commercial |
$72.46
|
| Rate for Payer: Frontpath All Commercial |
$79.61
|
| Rate for Payer: Frontpath All Commercial |
$79.61
|
| Rate for Payer: Humana ChoiceCare |
$88.58
|
| Rate for Payer: Humana ChoiceCare |
$88.58
|
| Rate for Payer: Humana Medicare |
$72.46
|
| Rate for Payer: Humana Medicare |
$72.46
|
| Rate for Payer: Lucent All Commercial |
$101.44
|
| Rate for Payer: Lucent All Commercial |
$101.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: Managed Health Services Medicaid |
$68.80
|
| Rate for Payer: Managed Health Services Medicaid |
$68.80
|
| Rate for Payer: MDWise Medicaid |
$68.80
|
| Rate for Payer: MDWise Medicaid |
$68.80
|
| Rate for Payer: PHCS All Commercial |
$72.46
|
| Rate for Payer: PHCS All Commercial |
$72.46
|
| Rate for Payer: PHP All Commercial |
$83.67
|
| Rate for Payer: PHP All Commercial |
$83.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.46
|
| Rate for Payer: Sagamore Health Network All Products |
$72.46
|
| Rate for Payer: Sagamore Health Network All Products |
$72.46
|
| Rate for Payer: Signature Care EPO |
$96.14
|
| Rate for Payer: Signature Care EPO |
$96.14
|
| Rate for Payer: Signature Care PPO |
$96.14
|
| Rate for Payer: Signature Care PPO |
$96.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: United Healthcare Commercial |
$92.93
|
| Rate for Payer: United Healthcare Commercial |
$92.93
|
| Rate for Payer: United Healthcare Medicare |
$69.73
|
| Rate for Payer: United Healthcare Medicare |
$69.73
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$20.90
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
z99153
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.64
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Centivo All Commercial |
$14.99
|
| Rate for Payer: Centivo All Commercial |
$14.99
|
| Rate for Payer: Cigna All Commercial |
$9.67
|
| Rate for Payer: Cigna All Commercial |
$9.67
|
| Rate for Payer: CORVEL All Commercial |
$9.67
|
| Rate for Payer: CORVEL All Commercial |
$9.67
|
| Rate for Payer: Coventry All Commercial |
$11.60
|
| Rate for Payer: Coventry All Commercial |
$11.60
|
| Rate for Payer: Encore All Commercial |
$9.67
|
| Rate for Payer: Encore All Commercial |
$9.67
|
| Rate for Payer: Frontpath All Commercial |
$10.65
|
| Rate for Payer: Frontpath All Commercial |
$10.65
|
| Rate for Payer: Humana ChoiceCare |
$12.16
|
| Rate for Payer: Humana ChoiceCare |
$12.16
|
| Rate for Payer: Humana Medicare |
$9.67
|
| Rate for Payer: Humana Medicare |
$9.67
|
| Rate for Payer: Lucent All Commercial |
$13.54
|
| Rate for Payer: Lucent All Commercial |
$13.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Managed Health Services Medicaid |
$10.28
|
| Rate for Payer: Managed Health Services Medicaid |
$10.28
|
| Rate for Payer: MDWise Medicaid |
$10.28
|
| Rate for Payer: MDWise Medicaid |
$10.28
|
| Rate for Payer: PHCS All Commercial |
$9.67
|
| Rate for Payer: PHCS All Commercial |
$9.67
|
| Rate for Payer: PHP All Commercial |
$11.58
|
| Rate for Payer: PHP All Commercial |
$11.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.67
|
| Rate for Payer: Sagamore Health Network All Products |
$9.67
|
| Rate for Payer: Sagamore Health Network All Products |
$9.67
|
| Rate for Payer: Signature Care EPO |
$13.28
|
| Rate for Payer: Signature Care EPO |
$13.28
|
| Rate for Payer: Signature Care PPO |
$13.28
|
| Rate for Payer: Signature Care PPO |
$13.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Commercial |
$12.69
|
| Rate for Payer: United Healthcare Commercial |
$12.69
|
| Rate for Payer: United Healthcare Medicare |
$9.65
|
| Rate for Payer: United Healthcare Medicare |
$9.65
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$93.12
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
z99152
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$10.11
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$10.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.97
|
| Rate for Payer: Cash Price |
$54.41
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Centivo All Commercial |
$18.27
|
| Rate for Payer: Centivo All Commercial |
$18.27
|
| Rate for Payer: Cigna All Commercial |
$11.79
|
| Rate for Payer: Cigna All Commercial |
$11.79
|
| Rate for Payer: CORVEL All Commercial |
$11.79
|
| Rate for Payer: CORVEL All Commercial |
$11.79
|
| Rate for Payer: Coventry All Commercial |
$14.15
|
| Rate for Payer: Coventry All Commercial |
$14.15
|
| Rate for Payer: Encore All Commercial |
$11.79
|
| Rate for Payer: Encore All Commercial |
$11.79
|
| Rate for Payer: Frontpath All Commercial |
$13.20
|
| Rate for Payer: Frontpath All Commercial |
$13.20
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$11.79
|
| Rate for Payer: Humana Medicare |
$11.79
|
| Rate for Payer: Lucent All Commercial |
$16.51
|
| Rate for Payer: Lucent All Commercial |
$16.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.00
|
| Rate for Payer: Managed Health Services Medicaid |
$45.80
|
| Rate for Payer: Managed Health Services Medicaid |
$45.80
|
| Rate for Payer: MDWise Medicaid |
$45.80
|
| Rate for Payer: MDWise Medicaid |
$45.80
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$10.11
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$10.11
|
| Rate for Payer: PHCS All Commercial |
$11.79
|
| Rate for Payer: PHCS All Commercial |
$11.79
|
| Rate for Payer: PHP All Commercial |
$13.56
|
| Rate for Payer: PHP All Commercial |
$13.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11.79
|
| Rate for Payer: Signature Care EPO |
$63.62
|
| Rate for Payer: Signature Care EPO |
$63.62
|
| Rate for Payer: Signature Care PPO |
$63.62
|
| Rate for Payer: Signature Care PPO |
$63.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,400.00
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Medicare |
$45.34
|
| Rate for Payer: United Healthcare Medicare |
$45.34
|
|
|
PR MULTIP FAMILY-GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
z90849
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Medicare |
$27.28
|
| Rate for Payer: Aetna Medicare |
$27.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.92
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.01
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Centivo All Commercial |
$42.28
|
| Rate for Payer: Centivo All Commercial |
$42.28
|
| Rate for Payer: Cigna All Commercial |
$27.28
|
| Rate for Payer: Cigna All Commercial |
$27.28
|
| Rate for Payer: CORVEL All Commercial |
$27.28
|
| Rate for Payer: CORVEL All Commercial |
$27.28
|
| Rate for Payer: Coventry All Commercial |
$32.74
|
| Rate for Payer: Coventry All Commercial |
$32.74
|
| Rate for Payer: Encore All Commercial |
$27.28
|
| Rate for Payer: Encore All Commercial |
$27.28
|
| Rate for Payer: Frontpath All Commercial |
$30.59
|
| Rate for Payer: Frontpath All Commercial |
$30.59
|
| Rate for Payer: Humana ChoiceCare |
$25.05
|
| Rate for Payer: Humana ChoiceCare |
$25.05
|
| Rate for Payer: Humana Medicare |
$27.28
|
| Rate for Payer: Humana Medicare |
$27.28
|
| Rate for Payer: Lucent All Commercial |
$38.19
|
| Rate for Payer: Lucent All Commercial |
$38.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.00
|
| Rate for Payer: Managed Health Services Medicaid |
$35.41
|
| Rate for Payer: Managed Health Services Medicaid |
$35.41
|
| Rate for Payer: MDWise Medicaid |
$35.41
|
| Rate for Payer: MDWise Medicaid |
$35.41
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.92
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.92
|
| Rate for Payer: PHCS All Commercial |
$27.28
|
| Rate for Payer: PHCS All Commercial |
$27.28
|
| Rate for Payer: PHP All Commercial |
$29.48
|
| Rate for Payer: PHP All Commercial |
$29.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.28
|
| Rate for Payer: Sagamore Health Network All Products |
$27.28
|
| Rate for Payer: Sagamore Health Network All Products |
$27.28
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Medicare |
$34.58
|
| Rate for Payer: United Healthcare Medicare |
$34.58
|
|
|
PR MULTIPLE SLEEP LATENCY TEST
|
Professional
|
Both
|
$797.08
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
z95805
|
| Min. Negotiated Rate |
$386.38 |
| Max. Negotiated Rate |
$46,400.00 |
| Rate for Payer: Aetna Commercial |
$386.38
|
| Rate for Payer: Aetna Commercial |
$386.38
|
| Rate for Payer: Aetna Medicare |
$386.38
|
| Rate for Payer: Aetna Medicare |
$386.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$392.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$392.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.02
|
| Rate for Payer: Cash Price |
$453.06
|
| Rate for Payer: Cash Price |
$478.25
|
| Rate for Payer: Centivo All Commercial |
$598.89
|
| Rate for Payer: Centivo All Commercial |
$598.89
|
| Rate for Payer: Cigna All Commercial |
$386.38
|
| Rate for Payer: Cigna All Commercial |
$386.38
|
| Rate for Payer: CORVEL All Commercial |
$386.38
|
| Rate for Payer: CORVEL All Commercial |
$386.38
|
| Rate for Payer: Coventry All Commercial |
$463.66
|
| Rate for Payer: Coventry All Commercial |
$463.66
|
| Rate for Payer: Encore All Commercial |
$386.38
|
| Rate for Payer: Encore All Commercial |
$386.38
|
| Rate for Payer: Frontpath All Commercial |
$433.82
|
| Rate for Payer: Frontpath All Commercial |
$433.82
|
| Rate for Payer: Humana ChoiceCare |
$877.86
|
| Rate for Payer: Humana ChoiceCare |
$877.86
|
| Rate for Payer: Humana Medicare |
$386.38
|
| Rate for Payer: Humana Medicare |
$386.38
|
| Rate for Payer: Lucent All Commercial |
$540.93
|
| Rate for Payer: Lucent All Commercial |
$540.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.00
|
| Rate for Payer: Managed Health Services Medicaid |
$392.04
|
| Rate for Payer: Managed Health Services Medicaid |
$392.04
|
| Rate for Payer: MDWise Medicaid |
$392.04
|
| Rate for Payer: MDWise Medicaid |
$392.04
|
| Rate for Payer: PHCS All Commercial |
$386.38
|
| Rate for Payer: PHCS All Commercial |
$386.38
|
| Rate for Payer: PHP All Commercial |
$622.95
|
| Rate for Payer: PHP All Commercial |
$622.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.38
|
| Rate for Payer: Sagamore Health Network All Products |
$386.38
|
| Rate for Payer: Sagamore Health Network All Products |
$386.38
|
| Rate for Payer: Signature Care EPO |
$656.85
|
| Rate for Payer: Signature Care EPO |
$656.85
|
| Rate for Payer: Signature Care PPO |
$656.85
|
| Rate for Payer: Signature Care PPO |
$656.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46,400.00
|
| Rate for Payer: United Healthcare Commercial |
$484.58
|
| Rate for Payer: United Healthcare Commercial |
$484.58
|
|
|
PR MUSCLE-SKIN FLAP,TRUNK
|
Professional
|
Both
|
$2,737.36
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
z15734
|
| Min. Negotiated Rate |
$770.16 |
| Max. Negotiated Rate |
$165,600.00 |
| Rate for Payer: Aetna Commercial |
$1,392.12
|
| Rate for Payer: Aetna Commercial |
$1,392.12
|
| Rate for Payer: Aetna Medicare |
$1,392.12
|
| Rate for Payer: Aetna Medicare |
$1,392.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,659.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$770.16
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$770.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,346.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,346.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,600.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,600.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,531.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,531.33
|
| Rate for Payer: Cash Price |
$1,615.93
|
| Rate for Payer: Cash Price |
$1,642.42
|
| Rate for Payer: Centivo All Commercial |
$2,157.79
|
| Rate for Payer: Centivo All Commercial |
$2,157.79
|
| Rate for Payer: Cigna All Commercial |
$1,392.12
|
| Rate for Payer: Cigna All Commercial |
$1,392.12
|
| Rate for Payer: CORVEL All Commercial |
$1,392.12
|
| Rate for Payer: CORVEL All Commercial |
$1,392.12
|
| Rate for Payer: Coventry All Commercial |
$1,670.54
|
| Rate for Payer: Coventry All Commercial |
$1,670.54
|
| Rate for Payer: Encore All Commercial |
$1,392.12
|
| Rate for Payer: Encore All Commercial |
$1,392.12
|
| Rate for Payer: Frontpath All Commercial |
$1,958.12
|
| Rate for Payer: Frontpath All Commercial |
$1,958.12
|
| Rate for Payer: Humana ChoiceCare |
$1,142.28
|
| Rate for Payer: Humana ChoiceCare |
$1,142.28
|
| Rate for Payer: Humana Medicare |
$1,392.12
|
| Rate for Payer: Humana Medicare |
$1,392.12
|
| Rate for Payer: Lucent All Commercial |
$1,948.97
|
| Rate for Payer: Lucent All Commercial |
$1,948.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,794.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,794.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,346.34
|
| Rate for Payer: Managed Health Services Medicaid |
$1,346.34
|
| Rate for Payer: MDWise Medicaid |
$1,346.34
|
| Rate for Payer: MDWise Medicaid |
$1,346.34
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$770.16
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$770.16
|
| Rate for Payer: PHCS All Commercial |
$1,392.12
|
| Rate for Payer: PHCS All Commercial |
$1,392.12
|
| Rate for Payer: PHP All Commercial |
$1,885.25
|
| Rate for Payer: PHP All Commercial |
$1,885.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,392.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,392.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,392.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,392.12
|
| Rate for Payer: Signature Care EPO |
$1,477.30
|
| Rate for Payer: Signature Care EPO |
$1,477.30
|
| Rate for Payer: Signature Care PPO |
$1,477.30
|
| Rate for Payer: Signature Care PPO |
$1,477.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165,600.00
|
| Rate for Payer: United Healthcare Commercial |
$1,458.96
|
| Rate for Payer: United Healthcare Commercial |
$1,458.96
|
| Rate for Payer: United Healthcare Medicare |
$1,346.61
|
| Rate for Payer: United Healthcare Medicare |
$1,346.61
|
|
|
PR MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH
|
Professional
|
Both
|
$1,709.22
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
z58140
|
| Min. Negotiated Rate |
$840.66 |
| Max. Negotiated Rate |
$113,500.00 |
| Rate for Payer: Aetna Commercial |
$880.48
|
| Rate for Payer: Aetna Commercial |
$880.48
|
| Rate for Payer: Aetna Medicare |
$880.48
|
| Rate for Payer: Aetna Medicare |
$880.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$840.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$840.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,012.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,012.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$968.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$968.53
|
| Rate for Payer: Cash Price |
$1,025.53
|
| Rate for Payer: Cash Price |
$1,021.96
|
| Rate for Payer: Centivo All Commercial |
$1,364.74
|
| Rate for Payer: Centivo All Commercial |
$1,364.74
|
| Rate for Payer: Cigna All Commercial |
$880.48
|
| Rate for Payer: Cigna All Commercial |
$880.48
|
| Rate for Payer: CORVEL All Commercial |
$880.48
|
| Rate for Payer: CORVEL All Commercial |
$880.48
|
| Rate for Payer: Coventry All Commercial |
$1,056.58
|
| Rate for Payer: Coventry All Commercial |
$1,056.58
|
| Rate for Payer: Encore All Commercial |
$880.48
|
| Rate for Payer: Encore All Commercial |
$880.48
|
| Rate for Payer: Frontpath All Commercial |
$1,227.04
|
| Rate for Payer: Frontpath All Commercial |
$1,227.04
|
| Rate for Payer: Humana ChoiceCare |
$967.50
|
| Rate for Payer: Humana ChoiceCare |
$967.50
|
| Rate for Payer: Humana Medicare |
$880.48
|
| Rate for Payer: Humana Medicare |
$880.48
|
| Rate for Payer: Lucent All Commercial |
$1,232.67
|
| Rate for Payer: Lucent All Commercial |
$1,232.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,222.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,222.00
|
| Rate for Payer: Managed Health Services Medicaid |
$840.66
|
| Rate for Payer: Managed Health Services Medicaid |
$840.66
|
| Rate for Payer: MDWise Medicaid |
$840.66
|
| Rate for Payer: MDWise Medicaid |
$840.66
|
| Rate for Payer: PHCS All Commercial |
$880.48
|
| Rate for Payer: PHCS All Commercial |
$880.48
|
| Rate for Payer: PHP All Commercial |
$1,124.15
|
| Rate for Payer: PHP All Commercial |
$1,124.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$880.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$880.48
|
| Rate for Payer: Sagamore Health Network All Products |
$880.48
|
| Rate for Payer: Sagamore Health Network All Products |
$880.48
|
| Rate for Payer: Signature Care EPO |
$1,087.15
|
| Rate for Payer: Signature Care EPO |
$1,087.15
|
| Rate for Payer: Signature Care PPO |
$1,087.15
|
| Rate for Payer: Signature Care PPO |
$1,087.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,029.24
|
| Rate for Payer: United Healthcare Commercial |
$1,029.24
|
| Rate for Payer: United Healthcare Medicare |
$851.63
|
| Rate for Payer: United Healthcare Medicare |
$851.63
|
|
|
PR MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH
|
Professional
|
Both
|
$2,138.28
|
|
|
Service Code
|
CPT 58146
|
| Hospital Charge Code |
z58146
|
| Min. Negotiated Rate |
$1,051.69 |
| Max. Negotiated Rate |
$140,500.00 |
| Rate for Payer: Aetna Commercial |
$1,091.52
|
| Rate for Payer: Aetna Commercial |
$1,091.52
|
| Rate for Payer: Aetna Medicare |
$1,091.52
|
| Rate for Payer: Aetna Medicare |
$1,091.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,484.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,051.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,051.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,255.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,255.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,200.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,200.67
|
| Rate for Payer: Cash Price |
$1,282.97
|
| Rate for Payer: Cash Price |
$1,265.65
|
| Rate for Payer: Centivo All Commercial |
$1,691.86
|
| Rate for Payer: Centivo All Commercial |
$1,691.86
|
| Rate for Payer: Cigna All Commercial |
$1,091.52
|
| Rate for Payer: Cigna All Commercial |
$1,091.52
|
| Rate for Payer: CORVEL All Commercial |
$1,091.52
|
| Rate for Payer: CORVEL All Commercial |
$1,091.52
|
| Rate for Payer: Coventry All Commercial |
$1,309.82
|
| Rate for Payer: Coventry All Commercial |
$1,309.82
|
| Rate for Payer: Encore All Commercial |
$1,091.52
|
| Rate for Payer: Encore All Commercial |
$1,091.52
|
| Rate for Payer: Frontpath All Commercial |
$1,519.75
|
| Rate for Payer: Frontpath All Commercial |
$1,519.75
|
| Rate for Payer: Humana ChoiceCare |
$1,248.74
|
| Rate for Payer: Humana ChoiceCare |
$1,248.74
|
| Rate for Payer: Humana Medicare |
$1,091.52
|
| Rate for Payer: Humana Medicare |
$1,091.52
|
| Rate for Payer: Lucent All Commercial |
$1,528.13
|
| Rate for Payer: Lucent All Commercial |
$1,528.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,514.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,514.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,051.69
|
| Rate for Payer: Managed Health Services Medicaid |
$1,051.69
|
| Rate for Payer: MDWise Medicaid |
$1,051.69
|
| Rate for Payer: MDWise Medicaid |
$1,051.69
|
| Rate for Payer: PHCS All Commercial |
$1,091.52
|
| Rate for Payer: PHCS All Commercial |
$1,091.52
|
| Rate for Payer: PHP All Commercial |
$1,392.22
|
| Rate for Payer: PHP All Commercial |
$1,392.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,091.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,091.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.52
|
| Rate for Payer: Signature Care EPO |
$1,380.40
|
| Rate for Payer: Signature Care EPO |
$1,380.40
|
| Rate for Payer: Signature Care PPO |
$1,380.40
|
| Rate for Payer: Signature Care PPO |
$1,380.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,311.88
|
| Rate for Payer: United Healthcare Commercial |
$1,311.88
|
| Rate for Payer: United Healthcare Medicare |
$1,054.71
|
| Rate for Payer: United Healthcare Medicare |
$1,054.71
|
|
|
PR MYRINGOPLASTY
|
Professional
|
Both
|
$1,379.76
|
|
|
Service Code
|
CPT 69620
|
| Hospital Charge Code |
z69620
|
| Min. Negotiated Rate |
$255.05 |
| Max. Negotiated Rate |
$69,900.00 |
| Rate for Payer: Aetna Commercial |
$466.86
|
| Rate for Payer: Aetna Commercial |
$466.86
|
| Rate for Payer: Aetna Medicare |
$466.86
|
| Rate for Payer: Aetna Medicare |
$466.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.56
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$255.05
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$255.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$678.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$678.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$536.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$536.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.55
|
| Rate for Payer: Cash Price |
$819.25
|
| Rate for Payer: Cash Price |
$827.86
|
| Rate for Payer: Centivo All Commercial |
$723.63
|
| Rate for Payer: Centivo All Commercial |
$723.63
|
| Rate for Payer: Cigna All Commercial |
$466.86
|
| Rate for Payer: Cigna All Commercial |
$466.86
|
| Rate for Payer: CORVEL All Commercial |
$466.86
|
| Rate for Payer: CORVEL All Commercial |
$466.86
|
| Rate for Payer: Coventry All Commercial |
$560.23
|
| Rate for Payer: Coventry All Commercial |
$560.23
|
| Rate for Payer: Encore All Commercial |
$466.86
|
| Rate for Payer: Encore All Commercial |
$466.86
|
| Rate for Payer: Frontpath All Commercial |
$636.12
|
| Rate for Payer: Frontpath All Commercial |
$636.12
|
| Rate for Payer: Humana ChoiceCare |
$495.29
|
| Rate for Payer: Humana ChoiceCare |
$495.29
|
| Rate for Payer: Humana Medicare |
$466.86
|
| Rate for Payer: Humana Medicare |
$466.86
|
| Rate for Payer: Lucent All Commercial |
$653.60
|
| Rate for Payer: Lucent All Commercial |
$653.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$746.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$746.00
|
| Rate for Payer: Managed Health Services Medicaid |
$678.62
|
| Rate for Payer: Managed Health Services Medicaid |
$678.62
|
| Rate for Payer: MDWise Medicaid |
$678.62
|
| Rate for Payer: MDWise Medicaid |
$678.62
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$255.05
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$255.05
|
| Rate for Payer: PHCS All Commercial |
$466.86
|
| Rate for Payer: PHCS All Commercial |
$466.86
|
| Rate for Payer: PHP All Commercial |
$591.12
|
| Rate for Payer: PHP All Commercial |
$591.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$466.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$466.86
|
| Rate for Payer: Sagamore Health Network All Products |
$466.86
|
| Rate for Payer: Sagamore Health Network All Products |
$466.86
|
| Rate for Payer: Signature Care EPO |
$598.83
|
| Rate for Payer: Signature Care EPO |
$598.83
|
| Rate for Payer: Signature Care PPO |
$598.83
|
| Rate for Payer: Signature Care PPO |
$598.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69,900.00
|
| Rate for Payer: United Healthcare Commercial |
$528.66
|
| Rate for Payer: United Healthcare Commercial |
$528.66
|
| Rate for Payer: United Healthcare Medicare |
$682.71
|
| Rate for Payer: United Healthcare Medicare |
$682.71
|
|
