|
PR LAYR CLOS WND REST BODY 12.6-20 CM
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
z12045
|
| Min. Negotiated Rate |
$138.08 |
| Max. Negotiated Rate |
$390.18 |
| Rate for Payer: Aetna Commercial |
$251.73
|
| Rate for Payer: Aetna Commercial |
$251.73
|
| Rate for Payer: Aetna Medicare |
$251.73
|
| Rate for Payer: Aetna Medicare |
$251.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$138.08
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$138.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$375.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$375.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$289.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$289.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$276.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$276.90
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Cash Price |
$473.06
|
| Rate for Payer: Centivo All Commercial |
$390.18
|
| Rate for Payer: Centivo All Commercial |
$390.18
|
| Rate for Payer: Cigna All Commercial |
$251.73
|
| Rate for Payer: Cigna All Commercial |
$251.73
|
| Rate for Payer: CORVEL All Commercial |
$251.73
|
| Rate for Payer: CORVEL All Commercial |
$251.73
|
| Rate for Payer: Coventry All Commercial |
$302.08
|
| Rate for Payer: Coventry All Commercial |
$302.08
|
| Rate for Payer: Encore All Commercial |
$251.73
|
| Rate for Payer: Encore All Commercial |
$251.73
|
| Rate for Payer: Frontpath All Commercial |
$347.74
|
| Rate for Payer: Frontpath All Commercial |
$347.74
|
| Rate for Payer: Humana ChoiceCare |
$222.97
|
| Rate for Payer: Humana ChoiceCare |
$222.97
|
| Rate for Payer: Humana Medicare |
$251.73
|
| Rate for Payer: Humana Medicare |
$251.73
|
| Rate for Payer: Lucent All Commercial |
$352.42
|
| Rate for Payer: Lucent All Commercial |
$352.42
|
| Rate for Payer: Managed Health Services Medicaid |
$375.27
|
| Rate for Payer: Managed Health Services Medicaid |
$375.27
|
| Rate for Payer: MDWise Medicaid |
$375.27
|
| Rate for Payer: MDWise Medicaid |
$375.27
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$138.08
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$138.08
|
| Rate for Payer: PHCS All Commercial |
$251.73
|
| Rate for Payer: PHCS All Commercial |
$251.73
|
| Rate for Payer: PHP All Commercial |
$347.26
|
| Rate for Payer: PHP All Commercial |
$347.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.73
|
| Rate for Payer: Sagamore Health Network All Products |
$251.73
|
| Rate for Payer: Sagamore Health Network All Products |
$251.73
|
| Rate for Payer: Signature Care EPO |
$325.69
|
| Rate for Payer: Signature Care EPO |
$325.69
|
| Rate for Payer: Signature Care PPO |
$325.69
|
| Rate for Payer: Signature Care PPO |
$325.69
|
| Rate for Payer: United Healthcare Commercial |
$265.03
|
| Rate for Payer: United Healthcare Commercial |
$265.03
|
| Rate for Payer: United Healthcare Medicare |
$377.25
|
| Rate for Payer: United Healthcare Medicare |
$377.25
|
|
|
PR LAYR CLOS WND REST BODY <2.5 CM
|
Professional
|
Both
|
$490.10
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
z12041
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$16,300.00 |
| Rate for Payer: Aetna Commercial |
$134.63
|
| Rate for Payer: Aetna Commercial |
$134.63
|
| Rate for Payer: Aetna Medicare |
$134.63
|
| Rate for Payer: Aetna Medicare |
$134.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$72.85
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$72.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$241.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$241.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.09
|
| Rate for Payer: Cash Price |
$300.12
|
| Rate for Payer: Cash Price |
$303.86
|
| Rate for Payer: Centivo All Commercial |
$208.68
|
| Rate for Payer: Centivo All Commercial |
$208.68
|
| Rate for Payer: Cigna All Commercial |
$134.63
|
| Rate for Payer: Cigna All Commercial |
$134.63
|
| Rate for Payer: CORVEL All Commercial |
$134.63
|
| Rate for Payer: CORVEL All Commercial |
$134.63
|
| Rate for Payer: Coventry All Commercial |
$161.56
|
| Rate for Payer: Coventry All Commercial |
$161.56
|
| Rate for Payer: Encore All Commercial |
$134.63
|
| Rate for Payer: Encore All Commercial |
$134.63
|
| Rate for Payer: Frontpath All Commercial |
$183.18
|
| Rate for Payer: Frontpath All Commercial |
$183.18
|
| Rate for Payer: Humana ChoiceCare |
$131.76
|
| Rate for Payer: Humana ChoiceCare |
$131.76
|
| Rate for Payer: Humana Medicare |
$134.63
|
| Rate for Payer: Humana Medicare |
$134.63
|
| Rate for Payer: Lucent All Commercial |
$188.48
|
| Rate for Payer: Lucent All Commercial |
$188.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.00
|
| Rate for Payer: Managed Health Services Medicaid |
$241.05
|
| Rate for Payer: Managed Health Services Medicaid |
$241.05
|
| Rate for Payer: MDWise Medicaid |
$241.05
|
| Rate for Payer: MDWise Medicaid |
$241.05
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$72.85
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$72.85
|
| Rate for Payer: PHCS All Commercial |
$134.63
|
| Rate for Payer: PHCS All Commercial |
$134.63
|
| Rate for Payer: PHP All Commercial |
$185.36
|
| Rate for Payer: PHP All Commercial |
$185.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.63
|
| Rate for Payer: Sagamore Health Network All Products |
$134.63
|
| Rate for Payer: Sagamore Health Network All Products |
$134.63
|
| Rate for Payer: Signature Care EPO |
$212.92
|
| Rate for Payer: Signature Care EPO |
$212.92
|
| Rate for Payer: Signature Care PPO |
$212.92
|
| Rate for Payer: Signature Care PPO |
$212.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,300.00
|
| Rate for Payer: United Healthcare Commercial |
$181.16
|
| Rate for Payer: United Healthcare Commercial |
$181.16
|
| Rate for Payer: United Healthcare Medicare |
$242.03
|
| Rate for Payer: United Healthcare Medicare |
$242.03
|
|
|
PR LAYR CLOS WND REST BODY 2.6-7.5 CM
|
Professional
|
Both
|
$577.58
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
z12042
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$21,900.00 |
| Rate for Payer: Aetna Commercial |
$182.68
|
| Rate for Payer: Aetna Commercial |
$182.68
|
| Rate for Payer: Aetna Medicare |
$182.68
|
| Rate for Payer: Aetna Medicare |
$182.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$289.93
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$98.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$98.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$284.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$284.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$210.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$210.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.95
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Cash Price |
$358.10
|
| Rate for Payer: Centivo All Commercial |
$283.15
|
| Rate for Payer: Centivo All Commercial |
$283.15
|
| Rate for Payer: Cigna All Commercial |
$182.68
|
| Rate for Payer: Cigna All Commercial |
$182.68
|
| Rate for Payer: CORVEL All Commercial |
$182.68
|
| Rate for Payer: CORVEL All Commercial |
$182.68
|
| Rate for Payer: Coventry All Commercial |
$219.22
|
| Rate for Payer: Coventry All Commercial |
$219.22
|
| Rate for Payer: Encore All Commercial |
$182.68
|
| Rate for Payer: Encore All Commercial |
$182.68
|
| Rate for Payer: Frontpath All Commercial |
$248.05
|
| Rate for Payer: Frontpath All Commercial |
$248.05
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Humana Medicare |
$182.68
|
| Rate for Payer: Humana Medicare |
$182.68
|
| Rate for Payer: Lucent All Commercial |
$255.75
|
| Rate for Payer: Lucent All Commercial |
$255.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.00
|
| Rate for Payer: Managed Health Services Medicaid |
$284.08
|
| Rate for Payer: Managed Health Services Medicaid |
$284.08
|
| Rate for Payer: MDWise Medicaid |
$284.08
|
| Rate for Payer: MDWise Medicaid |
$284.08
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$98.80
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$98.80
|
| Rate for Payer: PHCS All Commercial |
$182.68
|
| Rate for Payer: PHCS All Commercial |
$182.68
|
| Rate for Payer: PHP All Commercial |
$249.80
|
| Rate for Payer: PHP All Commercial |
$249.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.68
|
| Rate for Payer: Sagamore Health Network All Products |
$182.68
|
| Rate for Payer: Sagamore Health Network All Products |
$182.68
|
| Rate for Payer: Signature Care EPO |
$249.53
|
| Rate for Payer: Signature Care EPO |
$249.53
|
| Rate for Payer: Signature Care PPO |
$249.53
|
| Rate for Payer: Signature Care PPO |
$249.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,900.00
|
| Rate for Payer: United Healthcare Commercial |
$211.79
|
| Rate for Payer: United Healthcare Commercial |
$211.79
|
| Rate for Payer: United Healthcare Medicare |
$284.14
|
| Rate for Payer: United Healthcare Medicare |
$284.14
|
|
|
PR LAYR CLOS WND REST BODY 7.6-12.5 CMS
|
Professional
|
Both
|
$709.98
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
z12044
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$23,900.00 |
| Rate for Payer: Aetna Commercial |
$198.91
|
| Rate for Payer: Aetna Commercial |
$198.91
|
| Rate for Payer: Aetna Medicare |
$198.91
|
| Rate for Payer: Aetna Medicare |
$198.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$334.48
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$107.97
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$107.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.80
|
| Rate for Payer: Cash Price |
$432.51
|
| Rate for Payer: Cash Price |
$440.19
|
| Rate for Payer: Centivo All Commercial |
$308.31
|
| Rate for Payer: Centivo All Commercial |
$308.31
|
| Rate for Payer: Cigna All Commercial |
$198.91
|
| Rate for Payer: Cigna All Commercial |
$198.91
|
| Rate for Payer: CORVEL All Commercial |
$198.91
|
| Rate for Payer: CORVEL All Commercial |
$198.91
|
| Rate for Payer: Coventry All Commercial |
$238.69
|
| Rate for Payer: Coventry All Commercial |
$238.69
|
| Rate for Payer: Encore All Commercial |
$198.91
|
| Rate for Payer: Encore All Commercial |
$198.91
|
| Rate for Payer: Frontpath All Commercial |
$272.28
|
| Rate for Payer: Frontpath All Commercial |
$272.28
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Humana Medicare |
$198.91
|
| Rate for Payer: Humana Medicare |
$198.91
|
| Rate for Payer: Lucent All Commercial |
$278.47
|
| Rate for Payer: Lucent All Commercial |
$278.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: Managed Health Services Medicaid |
$349.20
|
| Rate for Payer: Managed Health Services Medicaid |
$349.20
|
| Rate for Payer: MDWise Medicaid |
$349.20
|
| Rate for Payer: MDWise Medicaid |
$349.20
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$107.97
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$107.97
|
| Rate for Payer: PHCS All Commercial |
$198.91
|
| Rate for Payer: PHCS All Commercial |
$198.91
|
| Rate for Payer: PHP All Commercial |
$272.01
|
| Rate for Payer: PHP All Commercial |
$272.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.91
|
| Rate for Payer: Sagamore Health Network All Products |
$198.91
|
| Rate for Payer: Sagamore Health Network All Products |
$198.91
|
| Rate for Payer: Signature Care EPO |
$305.41
|
| Rate for Payer: Signature Care EPO |
$305.41
|
| Rate for Payer: Signature Care PPO |
$305.41
|
| Rate for Payer: Signature Care PPO |
$305.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,900.00
|
| Rate for Payer: United Healthcare Commercial |
$228.39
|
| Rate for Payer: United Healthcare Commercial |
$228.39
|
| Rate for Payer: United Healthcare Medicare |
$348.80
|
| Rate for Payer: United Healthcare Medicare |
$348.80
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Professional
|
Both
|
$488.64
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
z12031
|
| Min. Negotiated Rate |
$89.86 |
| Max. Negotiated Rate |
$17,000.00 |
| Rate for Payer: Aetna Commercial |
$140.82
|
| Rate for Payer: Aetna Commercial |
$140.82
|
| Rate for Payer: Aetna Medicare |
$140.82
|
| Rate for Payer: Aetna Medicare |
$140.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$247.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$89.86
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$89.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$240.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$240.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.90
|
| Rate for Payer: Cash Price |
$298.99
|
| Rate for Payer: Cash Price |
$302.96
|
| Rate for Payer: Centivo All Commercial |
$218.27
|
| Rate for Payer: Centivo All Commercial |
$218.27
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$140.82
|
| Rate for Payer: Coventry All Commercial |
$168.98
|
| Rate for Payer: Coventry All Commercial |
$168.98
|
| Rate for Payer: Encore All Commercial |
$140.82
|
| Rate for Payer: Encore All Commercial |
$140.82
|
| Rate for Payer: Frontpath All Commercial |
$191.41
|
| Rate for Payer: Frontpath All Commercial |
$191.41
|
| Rate for Payer: Humana ChoiceCare |
$117.25
|
| Rate for Payer: Humana ChoiceCare |
$117.25
|
| Rate for Payer: Humana Medicare |
$140.82
|
| Rate for Payer: Humana Medicare |
$140.82
|
| Rate for Payer: Lucent All Commercial |
$197.15
|
| Rate for Payer: Lucent All Commercial |
$197.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.00
|
| Rate for Payer: Managed Health Services Medicaid |
$240.33
|
| Rate for Payer: Managed Health Services Medicaid |
$240.33
|
| Rate for Payer: MDWise Medicaid |
$240.33
|
| Rate for Payer: MDWise Medicaid |
$240.33
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$89.86
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$89.86
|
| Rate for Payer: PHCS All Commercial |
$140.82
|
| Rate for Payer: PHCS All Commercial |
$140.82
|
| Rate for Payer: PHP All Commercial |
$193.36
|
| Rate for Payer: PHP All Commercial |
$193.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.82
|
| Rate for Payer: Sagamore Health Network All Products |
$140.82
|
| Rate for Payer: Sagamore Health Network All Products |
$140.82
|
| Rate for Payer: Signature Care EPO |
$211.83
|
| Rate for Payer: Signature Care EPO |
$211.83
|
| Rate for Payer: Signature Care PPO |
$211.83
|
| Rate for Payer: Signature Care PPO |
$211.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,000.00
|
| Rate for Payer: United Healthcare Commercial |
$169.05
|
| Rate for Payer: United Healthcare Commercial |
$169.05
|
| Rate for Payer: United Healthcare Medicare |
$241.12
|
| Rate for Payer: United Healthcare Medicare |
$241.12
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM
|
Professional
|
Both
|
$565.68
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
z12032
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$21,300.00 |
| Rate for Payer: Aetna Commercial |
$176.58
|
| Rate for Payer: Aetna Commercial |
$176.58
|
| Rate for Payer: Aetna Medicare |
$176.58
|
| Rate for Payer: Aetna Medicare |
$176.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$289.36
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$95.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$95.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$278.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$278.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$203.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$203.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$194.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$194.24
|
| Rate for Payer: Cash Price |
$344.98
|
| Rate for Payer: Cash Price |
$350.72
|
| Rate for Payer: Centivo All Commercial |
$273.70
|
| Rate for Payer: Centivo All Commercial |
$273.70
|
| Rate for Payer: Cigna All Commercial |
$176.58
|
| Rate for Payer: Cigna All Commercial |
$176.58
|
| Rate for Payer: CORVEL All Commercial |
$176.58
|
| Rate for Payer: CORVEL All Commercial |
$176.58
|
| Rate for Payer: Coventry All Commercial |
$211.90
|
| Rate for Payer: Coventry All Commercial |
$211.90
|
| Rate for Payer: Encore All Commercial |
$176.58
|
| Rate for Payer: Encore All Commercial |
$176.58
|
| Rate for Payer: Frontpath All Commercial |
$238.80
|
| Rate for Payer: Frontpath All Commercial |
$238.80
|
| Rate for Payer: Humana ChoiceCare |
$158.05
|
| Rate for Payer: Humana ChoiceCare |
$158.05
|
| Rate for Payer: Humana Medicare |
$176.58
|
| Rate for Payer: Humana Medicare |
$176.58
|
| Rate for Payer: Lucent All Commercial |
$247.21
|
| Rate for Payer: Lucent All Commercial |
$247.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.00
|
| Rate for Payer: Managed Health Services Medicaid |
$278.22
|
| Rate for Payer: Managed Health Services Medicaid |
$278.22
|
| Rate for Payer: MDWise Medicaid |
$278.22
|
| Rate for Payer: MDWise Medicaid |
$278.22
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$95.52
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$95.52
|
| Rate for Payer: PHCS All Commercial |
$176.58
|
| Rate for Payer: PHCS All Commercial |
$176.58
|
| Rate for Payer: PHP All Commercial |
$242.34
|
| Rate for Payer: PHP All Commercial |
$242.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$176.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$176.58
|
| Rate for Payer: Sagamore Health Network All Products |
$176.58
|
| Rate for Payer: Sagamore Health Network All Products |
$176.58
|
| Rate for Payer: Signature Care EPO |
$256.70
|
| Rate for Payer: Signature Care EPO |
$256.70
|
| Rate for Payer: Signature Care PPO |
$256.70
|
| Rate for Payer: Signature Care PPO |
$256.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,300.00
|
| Rate for Payer: United Healthcare Commercial |
$207.63
|
| Rate for Payer: United Healthcare Commercial |
$207.63
|
| Rate for Payer: United Healthcare Medicare |
$278.21
|
| Rate for Payer: United Healthcare Medicare |
$278.21
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM
|
Professional
|
Both
|
$621.90
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
z12034
|
| Min. Negotiated Rate |
$103.82 |
| Max. Negotiated Rate |
$23,000.00 |
| Rate for Payer: Aetna Commercial |
$191.13
|
| Rate for Payer: Aetna Commercial |
$191.13
|
| Rate for Payer: Aetna Medicare |
$191.13
|
| Rate for Payer: Aetna Medicare |
$191.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.39
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$103.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$103.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$305.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$305.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.24
|
| Rate for Payer: Cash Price |
$379.02
|
| Rate for Payer: Cash Price |
$385.58
|
| Rate for Payer: Centivo All Commercial |
$296.25
|
| Rate for Payer: Centivo All Commercial |
$296.25
|
| Rate for Payer: Cigna All Commercial |
$191.13
|
| Rate for Payer: Cigna All Commercial |
$191.13
|
| Rate for Payer: CORVEL All Commercial |
$191.13
|
| Rate for Payer: CORVEL All Commercial |
$191.13
|
| Rate for Payer: Coventry All Commercial |
$229.36
|
| Rate for Payer: Coventry All Commercial |
$229.36
|
| Rate for Payer: Encore All Commercial |
$191.13
|
| Rate for Payer: Encore All Commercial |
$191.13
|
| Rate for Payer: Frontpath All Commercial |
$261.33
|
| Rate for Payer: Frontpath All Commercial |
$261.33
|
| Rate for Payer: Humana ChoiceCare |
$164.58
|
| Rate for Payer: Humana ChoiceCare |
$164.58
|
| Rate for Payer: Humana Medicare |
$191.13
|
| Rate for Payer: Humana Medicare |
$191.13
|
| Rate for Payer: Lucent All Commercial |
$267.58
|
| Rate for Payer: Lucent All Commercial |
$267.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.00
|
| Rate for Payer: Managed Health Services Medicaid |
$305.88
|
| Rate for Payer: Managed Health Services Medicaid |
$305.88
|
| Rate for Payer: MDWise Medicaid |
$305.88
|
| Rate for Payer: MDWise Medicaid |
$305.88
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$103.82
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$103.82
|
| Rate for Payer: PHCS All Commercial |
$191.13
|
| Rate for Payer: PHCS All Commercial |
$191.13
|
| Rate for Payer: PHP All Commercial |
$261.37
|
| Rate for Payer: PHP All Commercial |
$261.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.13
|
| Rate for Payer: Sagamore Health Network All Products |
$191.13
|
| Rate for Payer: Sagamore Health Network All Products |
$191.13
|
| Rate for Payer: Signature Care EPO |
$268.35
|
| Rate for Payer: Signature Care EPO |
$268.35
|
| Rate for Payer: Signature Care PPO |
$268.35
|
| Rate for Payer: Signature Care PPO |
$268.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,000.00
|
| Rate for Payer: United Healthcare Commercial |
$217.51
|
| Rate for Payer: United Healthcare Commercial |
$217.51
|
| Rate for Payer: United Healthcare Medicare |
$305.66
|
| Rate for Payer: United Healthcare Medicare |
$305.66
|
|
|
PR LENGTH/SHORT LEG/ANKL TENDON,SINGLE
|
Professional
|
Both
|
$1,224.90
|
|
|
Service Code
|
CPT 27685
|
| Hospital Charge Code |
z27685
|
| Min. Negotiated Rate |
$237.92 |
| Max. Negotiated Rate |
$840.65 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Medicare |
$437.40
|
| Rate for Payer: Aetna Medicare |
$437.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$237.92
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$237.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$602.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$602.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$503.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$503.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$481.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$481.14
|
| Rate for Payer: Cash Price |
$744.05
|
| Rate for Payer: Cash Price |
$759.44
|
| Rate for Payer: Centivo All Commercial |
$677.97
|
| Rate for Payer: Centivo All Commercial |
$677.97
|
| Rate for Payer: Cigna All Commercial |
$437.40
|
| Rate for Payer: Cigna All Commercial |
$437.40
|
| Rate for Payer: CORVEL All Commercial |
$437.40
|
| Rate for Payer: CORVEL All Commercial |
$437.40
|
| Rate for Payer: Coventry All Commercial |
$524.88
|
| Rate for Payer: Coventry All Commercial |
$524.88
|
| Rate for Payer: Encore All Commercial |
$437.40
|
| Rate for Payer: Encore All Commercial |
$437.40
|
| Rate for Payer: Frontpath All Commercial |
$598.52
|
| Rate for Payer: Frontpath All Commercial |
$598.52
|
| Rate for Payer: Humana ChoiceCare |
$518.56
|
| Rate for Payer: Humana ChoiceCare |
$518.56
|
| Rate for Payer: Humana Medicare |
$437.40
|
| Rate for Payer: Humana Medicare |
$437.40
|
| Rate for Payer: Lucent All Commercial |
$612.36
|
| Rate for Payer: Lucent All Commercial |
$612.36
|
| Rate for Payer: Managed Health Services Medicaid |
$602.45
|
| Rate for Payer: Managed Health Services Medicaid |
$602.45
|
| Rate for Payer: MDWise Medicaid |
$602.45
|
| Rate for Payer: MDWise Medicaid |
$602.45
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$237.92
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$237.92
|
| Rate for Payer: PHCS All Commercial |
$437.40
|
| Rate for Payer: PHCS All Commercial |
$437.40
|
| Rate for Payer: PHP All Commercial |
$744.31
|
| Rate for Payer: PHP All Commercial |
$744.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$437.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$437.40
|
| Rate for Payer: Sagamore Health Network All Products |
$437.40
|
| Rate for Payer: Sagamore Health Network All Products |
$437.40
|
| Rate for Payer: Signature Care EPO |
$840.65
|
| Rate for Payer: Signature Care EPO |
$840.65
|
| Rate for Payer: Signature Care PPO |
$840.65
|
| Rate for Payer: Signature Care PPO |
$840.65
|
| Rate for Payer: United Healthcare Commercial |
$521.46
|
| Rate for Payer: United Healthcare Commercial |
$521.46
|
| Rate for Payer: United Healthcare Medicare |
$600.04
|
| Rate for Payer: United Healthcare Medicare |
$600.04
|
|
|
PR LIGATE FALLOPIAN TUBE
|
Professional
|
Both
|
$690.62
|
|
|
Service Code
|
CPT 58600
|
| Hospital Charge Code |
z58600
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$45,200.00 |
| Rate for Payer: Aetna Commercial |
$350.16
|
| Rate for Payer: Aetna Commercial |
$350.16
|
| Rate for Payer: Aetna Medicare |
$350.16
|
| Rate for Payer: Aetna Medicare |
$350.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$469.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$339.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$339.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$402.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$402.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.18
|
| Rate for Payer: Cash Price |
$428.18
|
| Rate for Payer: Cash Price |
$421.02
|
| Rate for Payer: Centivo All Commercial |
$542.75
|
| Rate for Payer: Centivo All Commercial |
$542.75
|
| Rate for Payer: Cigna All Commercial |
$350.16
|
| Rate for Payer: Cigna All Commercial |
$350.16
|
| Rate for Payer: CORVEL All Commercial |
$350.16
|
| Rate for Payer: CORVEL All Commercial |
$350.16
|
| Rate for Payer: Coventry All Commercial |
$420.19
|
| Rate for Payer: Coventry All Commercial |
$420.19
|
| Rate for Payer: Encore All Commercial |
$350.16
|
| Rate for Payer: Encore All Commercial |
$350.16
|
| Rate for Payer: Frontpath All Commercial |
$484.82
|
| Rate for Payer: Frontpath All Commercial |
$484.82
|
| Rate for Payer: Humana ChoiceCare |
$394.79
|
| Rate for Payer: Humana ChoiceCare |
$394.79
|
| Rate for Payer: Humana Medicare |
$350.16
|
| Rate for Payer: Humana Medicare |
$350.16
|
| Rate for Payer: Lucent All Commercial |
$490.22
|
| Rate for Payer: Lucent All Commercial |
$490.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$487.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$487.00
|
| Rate for Payer: Managed Health Services Medicaid |
$339.68
|
| Rate for Payer: Managed Health Services Medicaid |
$339.68
|
| Rate for Payer: MDWise Medicaid |
$339.68
|
| Rate for Payer: MDWise Medicaid |
$339.68
|
| Rate for Payer: PHCS All Commercial |
$350.16
|
| Rate for Payer: PHCS All Commercial |
$350.16
|
| Rate for Payer: PHP All Commercial |
$448.18
|
| Rate for Payer: PHP All Commercial |
$448.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.16
|
| Rate for Payer: Sagamore Health Network All Products |
$350.16
|
| Rate for Payer: Sagamore Health Network All Products |
$350.16
|
| Rate for Payer: Signature Care EPO |
$441.15
|
| Rate for Payer: Signature Care EPO |
$441.15
|
| Rate for Payer: Signature Care PPO |
$441.15
|
| Rate for Payer: Signature Care PPO |
$441.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45,200.00
|
| Rate for Payer: United Healthcare Commercial |
$407.83
|
| Rate for Payer: United Healthcare Commercial |
$407.83
|
| Rate for Payer: United Healthcare Medicare |
$339.53
|
| Rate for Payer: United Healthcare Medicare |
$339.53
|
|
|
PR LIGATE FALLOPIAN TUBE,POSTPARTUM
|
Professional
|
Both
|
$627.94
|
|
|
Service Code
|
CPT 58605
|
| Hospital Charge Code |
z58605
|
| Min. Negotiated Rate |
$308.55 |
| Max. Negotiated Rate |
$41,100.00 |
| Rate for Payer: Aetna Commercial |
$318.82
|
| Rate for Payer: Aetna Commercial |
$318.82
|
| Rate for Payer: Aetna Medicare |
$318.82
|
| Rate for Payer: Aetna Medicare |
$318.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$425.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$308.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$308.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.70
|
| Rate for Payer: Cash Price |
$389.32
|
| Rate for Payer: Cash Price |
$382.60
|
| Rate for Payer: Centivo All Commercial |
$494.17
|
| Rate for Payer: Centivo All Commercial |
$494.17
|
| Rate for Payer: Cigna All Commercial |
$318.82
|
| Rate for Payer: Cigna All Commercial |
$318.82
|
| Rate for Payer: CORVEL All Commercial |
$318.82
|
| Rate for Payer: CORVEL All Commercial |
$318.82
|
| Rate for Payer: Coventry All Commercial |
$382.58
|
| Rate for Payer: Coventry All Commercial |
$382.58
|
| Rate for Payer: Encore All Commercial |
$318.82
|
| Rate for Payer: Encore All Commercial |
$318.82
|
| Rate for Payer: Frontpath All Commercial |
$441.94
|
| Rate for Payer: Frontpath All Commercial |
$441.94
|
| Rate for Payer: Humana ChoiceCare |
$358.00
|
| Rate for Payer: Humana ChoiceCare |
$358.00
|
| Rate for Payer: Humana Medicare |
$318.82
|
| Rate for Payer: Humana Medicare |
$318.82
|
| Rate for Payer: Lucent All Commercial |
$446.35
|
| Rate for Payer: Lucent All Commercial |
$446.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.00
|
| Rate for Payer: Managed Health Services Medicaid |
$308.85
|
| Rate for Payer: Managed Health Services Medicaid |
$308.85
|
| Rate for Payer: MDWise Medicaid |
$308.85
|
| Rate for Payer: MDWise Medicaid |
$308.85
|
| Rate for Payer: PHCS All Commercial |
$318.82
|
| Rate for Payer: PHCS All Commercial |
$318.82
|
| Rate for Payer: PHP All Commercial |
$407.29
|
| Rate for Payer: PHP All Commercial |
$407.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.82
|
| Rate for Payer: Sagamore Health Network All Products |
$318.82
|
| Rate for Payer: Sagamore Health Network All Products |
$318.82
|
| Rate for Payer: Signature Care EPO |
$400.35
|
| Rate for Payer: Signature Care EPO |
$400.35
|
| Rate for Payer: Signature Care PPO |
$400.35
|
| Rate for Payer: Signature Care PPO |
$400.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41,100.00
|
| Rate for Payer: United Healthcare Commercial |
$370.58
|
| Rate for Payer: United Healthcare Commercial |
$370.58
|
| Rate for Payer: United Healthcare Medicare |
$308.55
|
| Rate for Payer: United Healthcare Medicare |
$308.55
|
|
|
PR LIGATION,FALLOPIAN TUBE W/C-SECTION
|
Professional
|
Both
|
$138.66
|
|
|
Service Code
|
CPT 58611
|
| Hospital Charge Code |
z58611
|
| Min. Negotiated Rate |
$68.20 |
| Max. Negotiated Rate |
$9,200.00 |
| Rate for Payer: Aetna Commercial |
$71.17
|
| Rate for Payer: Aetna Commercial |
$71.17
|
| Rate for Payer: Aetna Medicare |
$71.17
|
| Rate for Payer: Aetna Medicare |
$71.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.29
|
| Rate for Payer: Cash Price |
$85.97
|
| Rate for Payer: Cash Price |
$85.23
|
| Rate for Payer: Centivo All Commercial |
$110.31
|
| Rate for Payer: Centivo All Commercial |
$110.31
|
| Rate for Payer: Cigna All Commercial |
$71.17
|
| Rate for Payer: Cigna All Commercial |
$71.17
|
| Rate for Payer: CORVEL All Commercial |
$71.17
|
| Rate for Payer: CORVEL All Commercial |
$71.17
|
| Rate for Payer: Coventry All Commercial |
$85.40
|
| Rate for Payer: Coventry All Commercial |
$85.40
|
| Rate for Payer: Encore All Commercial |
$71.17
|
| Rate for Payer: Encore All Commercial |
$71.17
|
| Rate for Payer: Frontpath All Commercial |
$99.63
|
| Rate for Payer: Frontpath All Commercial |
$99.63
|
| Rate for Payer: Humana ChoiceCare |
$90.68
|
| Rate for Payer: Humana ChoiceCare |
$90.68
|
| Rate for Payer: Humana Medicare |
$71.17
|
| Rate for Payer: Humana Medicare |
$71.17
|
| Rate for Payer: Lucent All Commercial |
$99.64
|
| Rate for Payer: Lucent All Commercial |
$99.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.00
|
| Rate for Payer: Managed Health Services Medicaid |
$68.20
|
| Rate for Payer: Managed Health Services Medicaid |
$68.20
|
| Rate for Payer: MDWise Medicaid |
$68.20
|
| Rate for Payer: MDWise Medicaid |
$68.20
|
| Rate for Payer: PHCS All Commercial |
$71.17
|
| Rate for Payer: PHCS All Commercial |
$71.17
|
| Rate for Payer: PHP All Commercial |
$90.72
|
| Rate for Payer: PHP All Commercial |
$90.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.17
|
| Rate for Payer: Sagamore Health Network All Products |
$71.17
|
| Rate for Payer: Sagamore Health Network All Products |
$71.17
|
| Rate for Payer: Signature Care EPO |
$99.45
|
| Rate for Payer: Signature Care EPO |
$99.45
|
| Rate for Payer: Signature Care PPO |
$99.45
|
| Rate for Payer: Signature Care PPO |
$99.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: United Healthcare Commercial |
$89.28
|
| Rate for Payer: United Healthcare Commercial |
$89.28
|
| Rate for Payer: United Healthcare Medicare |
$68.73
|
| Rate for Payer: United Healthcare Medicare |
$68.73
|
|
|
PR LIGMT REVISION,KNEE,EXTRA-ARTIC
|
Professional
|
Both
|
$1,318.06
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
z27427
|
| Min. Negotiated Rate |
$646.68 |
| Max. Negotiated Rate |
$99,400.00 |
| Rate for Payer: Aetna Commercial |
$664.03
|
| Rate for Payer: Aetna Commercial |
$664.03
|
| Rate for Payer: Aetna Medicare |
$664.03
|
| Rate for Payer: Aetna Medicare |
$664.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$950.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$648.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$648.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$763.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$763.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$730.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$730.43
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cash Price |
$801.88
|
| Rate for Payer: Centivo All Commercial |
$1,029.25
|
| Rate for Payer: Centivo All Commercial |
$1,029.25
|
| Rate for Payer: Cigna All Commercial |
$664.03
|
| Rate for Payer: Cigna All Commercial |
$664.03
|
| Rate for Payer: CORVEL All Commercial |
$664.03
|
| Rate for Payer: CORVEL All Commercial |
$664.03
|
| Rate for Payer: Coventry All Commercial |
$796.84
|
| Rate for Payer: Coventry All Commercial |
$796.84
|
| Rate for Payer: Encore All Commercial |
$664.03
|
| Rate for Payer: Encore All Commercial |
$664.03
|
| Rate for Payer: Frontpath All Commercial |
$923.65
|
| Rate for Payer: Frontpath All Commercial |
$923.65
|
| Rate for Payer: Humana ChoiceCare |
$748.55
|
| Rate for Payer: Humana ChoiceCare |
$748.55
|
| Rate for Payer: Humana Medicare |
$664.03
|
| Rate for Payer: Humana Medicare |
$664.03
|
| Rate for Payer: Lucent All Commercial |
$929.64
|
| Rate for Payer: Lucent All Commercial |
$929.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,061.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,061.00
|
| Rate for Payer: Managed Health Services Medicaid |
$648.27
|
| Rate for Payer: Managed Health Services Medicaid |
$648.27
|
| Rate for Payer: MDWise Medicaid |
$648.27
|
| Rate for Payer: MDWise Medicaid |
$648.27
|
| Rate for Payer: PHCS All Commercial |
$664.03
|
| Rate for Payer: PHCS All Commercial |
$664.03
|
| Rate for Payer: PHP All Commercial |
$1,125.23
|
| Rate for Payer: PHP All Commercial |
$1,125.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$664.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$664.03
|
| Rate for Payer: Sagamore Health Network All Products |
$664.03
|
| Rate for Payer: Sagamore Health Network All Products |
$664.03
|
| Rate for Payer: Signature Care EPO |
$998.75
|
| Rate for Payer: Signature Care EPO |
$998.75
|
| Rate for Payer: Signature Care PPO |
$998.75
|
| Rate for Payer: Signature Care PPO |
$998.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99,400.00
|
| Rate for Payer: United Healthcare Commercial |
$775.06
|
| Rate for Payer: United Healthcare Commercial |
$775.06
|
| Rate for Payer: United Healthcare Medicare |
$646.68
|
| Rate for Payer: United Healthcare Medicare |
$646.68
|
|
|
PR LONG ARM CAST, ADULT
|
Professional
|
Both
|
$38.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050A
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$26.47 |
| Rate for Payer: Cash Price |
$24.13
|
| Rate for Payer: Signature Care EPO |
$26.47
|
| Rate for Payer: Signature Care PPO |
$26.47
|
|
|
PR LONG ARM CAST, PEDIATRIC
|
Professional
|
Both
|
$33.41
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050B
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Signature Care EPO |
$22.72
|
| Rate for Payer: Signature Care PPO |
$22.72
|
|
|
PR LONG LEG CAST, ADULT
|
Professional
|
Both
|
$81.84
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050E
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$55.65 |
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: Signature Care EPO |
$55.65
|
| Rate for Payer: Signature Care PPO |
$55.65
|
|
|
PR LONG LEG CAST, PEDIATRIC
|
Professional
|
Both
|
$55.38
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050F
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$37.66 |
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Signature Care EPO |
$37.66
|
| Rate for Payer: Signature Care PPO |
$37.66
|
|
|
PR LOUDNESS BALANCE TEST
|
Professional
|
Both
|
$85.86
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
z92562
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Aetna Commercial |
$42.21
|
| Rate for Payer: Aetna Commercial |
$42.21
|
| Rate for Payer: Aetna Medicare |
$42.21
|
| Rate for Payer: Aetna Medicare |
$42.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$43.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$43.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.43
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cash Price |
$55.01
|
| Rate for Payer: Centivo All Commercial |
$65.43
|
| Rate for Payer: Centivo All Commercial |
$65.43
|
| Rate for Payer: Cigna All Commercial |
$42.21
|
| Rate for Payer: Cigna All Commercial |
$42.21
|
| Rate for Payer: CORVEL All Commercial |
$42.21
|
| Rate for Payer: CORVEL All Commercial |
$42.21
|
| Rate for Payer: Coventry All Commercial |
$50.65
|
| Rate for Payer: Coventry All Commercial |
$50.65
|
| Rate for Payer: Encore All Commercial |
$42.21
|
| Rate for Payer: Encore All Commercial |
$42.21
|
| Rate for Payer: Frontpath All Commercial |
$47.33
|
| Rate for Payer: Frontpath All Commercial |
$47.33
|
| Rate for Payer: Humana ChoiceCare |
$17.25
|
| Rate for Payer: Humana ChoiceCare |
$17.25
|
| Rate for Payer: Humana Medicare |
$42.21
|
| Rate for Payer: Humana Medicare |
$42.21
|
| Rate for Payer: Lucent All Commercial |
$59.09
|
| Rate for Payer: Lucent All Commercial |
$59.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: Managed Health Services Medicaid |
$43.63
|
| Rate for Payer: Managed Health Services Medicaid |
$43.63
|
| Rate for Payer: MDWise Medicaid |
$43.63
|
| Rate for Payer: MDWise Medicaid |
$43.63
|
| Rate for Payer: PHCS All Commercial |
$42.21
|
| Rate for Payer: PHCS All Commercial |
$42.21
|
| Rate for Payer: PHP All Commercial |
$62.24
|
| Rate for Payer: PHP All Commercial |
$62.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.21
|
| Rate for Payer: Sagamore Health Network All Products |
$42.21
|
| Rate for Payer: Sagamore Health Network All Products |
$42.21
|
| Rate for Payer: Signature Care EPO |
$36.30
|
| Rate for Payer: Signature Care EPO |
$36.30
|
| Rate for Payer: Signature Care PPO |
$36.30
|
| Rate for Payer: Signature Care PPO |
$36.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,300.00
|
| Rate for Payer: United Healthcare Commercial |
$25.09
|
| Rate for Payer: United Healthcare Commercial |
$25.09
|
| Rate for Payer: United Healthcare Medicare |
$42.93
|
| Rate for Payer: United Healthcare Medicare |
$42.93
|
|
|
PR LYSIS ADNEXAL ADHESIONS
|
Professional
|
Both
|
$1,666.96
|
|
|
Service Code
|
CPT 58740
|
| Hospital Charge Code |
z58740
|
| Min. Negotiated Rate |
$819.88 |
| Max. Negotiated Rate |
$109,400.00 |
| Rate for Payer: Aetna Commercial |
$847.17
|
| Rate for Payer: Aetna Commercial |
$847.17
|
| Rate for Payer: Aetna Medicare |
$847.17
|
| Rate for Payer: Aetna Medicare |
$847.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,117.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$819.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$819.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$974.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$974.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$931.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$931.89
|
| Rate for Payer: Cash Price |
$1,033.52
|
| Rate for Payer: Cash Price |
$1,017.59
|
| Rate for Payer: Centivo All Commercial |
$1,313.11
|
| Rate for Payer: Centivo All Commercial |
$1,313.11
|
| Rate for Payer: Cigna All Commercial |
$847.17
|
| Rate for Payer: Cigna All Commercial |
$847.17
|
| Rate for Payer: CORVEL All Commercial |
$847.17
|
| Rate for Payer: CORVEL All Commercial |
$847.17
|
| Rate for Payer: Coventry All Commercial |
$1,016.60
|
| Rate for Payer: Coventry All Commercial |
$1,016.60
|
| Rate for Payer: Encore All Commercial |
$847.17
|
| Rate for Payer: Encore All Commercial |
$847.17
|
| Rate for Payer: Frontpath All Commercial |
$1,182.57
|
| Rate for Payer: Frontpath All Commercial |
$1,182.57
|
| Rate for Payer: Humana ChoiceCare |
$940.17
|
| Rate for Payer: Humana ChoiceCare |
$940.17
|
| Rate for Payer: Humana Medicare |
$847.17
|
| Rate for Payer: Humana Medicare |
$847.17
|
| Rate for Payer: Lucent All Commercial |
$1,186.04
|
| Rate for Payer: Lucent All Commercial |
$1,186.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,178.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,178.00
|
| Rate for Payer: Managed Health Services Medicaid |
$819.88
|
| Rate for Payer: Managed Health Services Medicaid |
$819.88
|
| Rate for Payer: MDWise Medicaid |
$819.88
|
| Rate for Payer: MDWise Medicaid |
$819.88
|
| Rate for Payer: PHCS All Commercial |
$847.17
|
| Rate for Payer: PHCS All Commercial |
$847.17
|
| Rate for Payer: PHP All Commercial |
$1,083.25
|
| Rate for Payer: PHP All Commercial |
$1,083.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$847.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$847.17
|
| Rate for Payer: Sagamore Health Network All Products |
$847.17
|
| Rate for Payer: Sagamore Health Network All Products |
$847.17
|
| Rate for Payer: Signature Care EPO |
$1,035.30
|
| Rate for Payer: Signature Care EPO |
$1,035.30
|
| Rate for Payer: Signature Care PPO |
$1,035.30
|
| Rate for Payer: Signature Care PPO |
$1,035.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,400.00
|
| Rate for Payer: United Healthcare Commercial |
$983.49
|
| Rate for Payer: United Healthcare Commercial |
$983.49
|
| Rate for Payer: United Healthcare Medicare |
$820.64
|
| Rate for Payer: United Healthcare Medicare |
$820.64
|
|
|
PR LYSIS INTRANASAL SYNECHIA
|
Professional
|
Both
|
$595.78
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
z30560
|
| Min. Negotiated Rate |
$78.21 |
| Max. Negotiated Rate |
$21,200.00 |
| Rate for Payer: Aetna Commercial |
$142.30
|
| Rate for Payer: Aetna Commercial |
$142.30
|
| Rate for Payer: Aetna Medicare |
$142.30
|
| Rate for Payer: Aetna Medicare |
$142.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$78.21
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$78.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$293.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$293.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.53
|
| Rate for Payer: Cash Price |
$368.13
|
| Rate for Payer: Cash Price |
$369.38
|
| Rate for Payer: Centivo All Commercial |
$220.56
|
| Rate for Payer: Centivo All Commercial |
$220.56
|
| Rate for Payer: Cigna All Commercial |
$142.30
|
| Rate for Payer: Cigna All Commercial |
$142.30
|
| Rate for Payer: CORVEL All Commercial |
$142.30
|
| Rate for Payer: CORVEL All Commercial |
$142.30
|
| Rate for Payer: Coventry All Commercial |
$170.76
|
| Rate for Payer: Coventry All Commercial |
$170.76
|
| Rate for Payer: Encore All Commercial |
$142.30
|
| Rate for Payer: Encore All Commercial |
$142.30
|
| Rate for Payer: Frontpath All Commercial |
$192.41
|
| Rate for Payer: Frontpath All Commercial |
$192.41
|
| Rate for Payer: Humana ChoiceCare |
$149.30
|
| Rate for Payer: Humana ChoiceCare |
$149.30
|
| Rate for Payer: Humana Medicare |
$142.30
|
| Rate for Payer: Humana Medicare |
$142.30
|
| Rate for Payer: Lucent All Commercial |
$199.22
|
| Rate for Payer: Lucent All Commercial |
$199.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.00
|
| Rate for Payer: Managed Health Services Medicaid |
$293.03
|
| Rate for Payer: Managed Health Services Medicaid |
$293.03
|
| Rate for Payer: MDWise Medicaid |
$293.03
|
| Rate for Payer: MDWise Medicaid |
$293.03
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$78.21
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$78.21
|
| Rate for Payer: PHCS All Commercial |
$142.30
|
| Rate for Payer: PHCS All Commercial |
$142.30
|
| Rate for Payer: PHP All Commercial |
$193.42
|
| Rate for Payer: PHP All Commercial |
$193.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.30
|
| Rate for Payer: Sagamore Health Network All Products |
$142.30
|
| Rate for Payer: Sagamore Health Network All Products |
$142.30
|
| Rate for Payer: Signature Care EPO |
$313.65
|
| Rate for Payer: Signature Care EPO |
$313.65
|
| Rate for Payer: Signature Care PPO |
$313.65
|
| Rate for Payer: Signature Care PPO |
$313.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,200.00
|
| Rate for Payer: United Healthcare Commercial |
$145.25
|
| Rate for Payer: United Healthcare Commercial |
$145.25
|
| Rate for Payer: United Healthcare Medicare |
$296.88
|
| Rate for Payer: United Healthcare Medicare |
$296.88
|
|
|
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 |
$212.33
|
| Rate for Payer: Cash Price |
$208.53
|
| 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 |
$420.16
|
| Rate for Payer: Cash Price |
$404.82
|
| 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 |
$508.10
|
| Rate for Payer: Cash Price |
$492.81
|
| 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 |
$177.95
|
| Rate for Payer: Cash Price |
$173.02
|
| 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 |
$226.08
|
| Rate for Payer: Cash Price |
$221.15
|
| 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 |
$168.73
|
| Rate for Payer: Cash Price |
$163.56
|
| 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
|
|
