|
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 |
$1,305.65
|
| Rate for Payer: Cash Price |
$657.30
|
| Rate for Payer: Cash Price |
$1,314.60
|
| Rate for Payer: Cash Price |
$652.82
|
| 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 Medicare |
$229.22
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$229.22
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$229.22
|
| Rate for Payer: Molina Healthcare of OH 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 |
$744.92
|
| Rate for Payer: Cash Price |
$731.53
|
| 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 |
$1,022.43
|
| Rate for Payer: Cash Price |
$1,004.25
|
| 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 |
$1,079.37
|
| Rate for Payer: Cash Price |
$1,060.24
|
| 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 |
$527.27
|
| Rate for Payer: Cash Price |
$535.21
|
| 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 Medicare |
$161.09
|
| Rate for Payer: Molina Healthcare of OH 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 |
$56.42
|
| 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 |
$47.12
|
| 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 |
$37.20
|
| 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 |
$12.60
|
| 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 |
$133.65
|
| Rate for Payer: Cash Price |
$132.33
|
| 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 |
$86.74
|
| Rate for Payer: Cash Price |
$86.47
|
| 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 |
$12.96
|
| Rate for Payer: Cash Price |
$11.97
|
| 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 |
$56.22
|
| Rate for Payer: Cash Price |
$57.73
|
| 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 Medicare |
$10.11
|
| Rate for Payer: Molina Healthcare of OH 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 |
$42.88
|
| Rate for Payer: Cash Price |
$44.64
|
| 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 Medicare |
$22.92
|
| Rate for Payer: Molina Healthcare of OH 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 |
$468.16
|
| Rate for Payer: Cash Price |
$494.19
|
| 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 |
$1,669.80
|
| Rate for Payer: Cash Price |
$1,697.16
|
| 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 Medicare |
$770.16
|
| Rate for Payer: Molina Healthcare of OH 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 |
$1,059.72
|
| Rate for Payer: Cash Price |
$1,056.02
|
| 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 |
$1,325.73
|
| Rate for Payer: Cash Price |
$1,307.84
|
| 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 |
$846.56
|
| Rate for Payer: Cash Price |
$855.45
|
| 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 Medicare |
$255.05
|
| Rate for Payer: Molina Healthcare of OH 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
|
|
|
PR NARCOSYNTHESIS
|
Professional
|
Both
|
$308.66
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
z90865
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$14,300.00 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$121.85
|
| Rate for Payer: Aetna Medicare |
$121.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$160.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.03
|
| Rate for Payer: Cash Price |
$188.60
|
| Rate for Payer: Cash Price |
$191.37
|
| Rate for Payer: Centivo All Commercial |
$188.87
|
| Rate for Payer: Centivo All Commercial |
$188.87
|
| Rate for Payer: Cigna All Commercial |
$121.85
|
| Rate for Payer: Cigna All Commercial |
$121.85
|
| Rate for Payer: CORVEL All Commercial |
$121.85
|
| Rate for Payer: CORVEL All Commercial |
$121.85
|
| Rate for Payer: Coventry All Commercial |
$146.22
|
| Rate for Payer: Coventry All Commercial |
$146.22
|
| Rate for Payer: Encore All Commercial |
$121.85
|
| Rate for Payer: Encore All Commercial |
$121.85
|
| Rate for Payer: Frontpath All Commercial |
$137.02
|
| Rate for Payer: Frontpath All Commercial |
$137.02
|
| Rate for Payer: Humana ChoiceCare |
$114.10
|
| Rate for Payer: Humana ChoiceCare |
$114.10
|
| Rate for Payer: Humana Medicare |
$121.85
|
| Rate for Payer: Humana Medicare |
$121.85
|
| Rate for Payer: Lucent All Commercial |
$170.59
|
| Rate for Payer: Lucent All Commercial |
$170.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.00
|
| Rate for Payer: PHCS All Commercial |
$121.85
|
| Rate for Payer: PHCS All Commercial |
$121.85
|
| Rate for Payer: PHP All Commercial |
$126.39
|
| Rate for Payer: PHP All Commercial |
$126.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.85
|
| Rate for Payer: Sagamore Health Network All Products |
$121.85
|
| Rate for Payer: Sagamore Health Network All Products |
$121.85
|
| Rate for Payer: Signature Care EPO |
$181.90
|
| Rate for Payer: Signature Care EPO |
$181.90
|
| Rate for Payer: Signature Care PPO |
$181.90
|
| Rate for Payer: Signature Care PPO |
$181.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,300.00
|
| Rate for Payer: United Healthcare Commercial |
$161.49
|
| Rate for Payer: United Healthcare Commercial |
$161.49
|
| Rate for Payer: United Healthcare Medicare |
$152.10
|
| Rate for Payer: United Healthcare Medicare |
$152.10
|
|
|
PR NASAL ENDOSCOPY,DX
|
Professional
|
Both
|
$346.64
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
z31231
|
| Min. Negotiated Rate |
$32.36 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna Commercial |
$59.94
|
| Rate for Payer: Aetna Commercial |
$59.94
|
| Rate for Payer: Aetna Medicare |
$59.94
|
| Rate for Payer: Aetna Medicare |
$59.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$224.03
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$32.36
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$32.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$170.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$170.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.93
|
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Centivo All Commercial |
$92.91
|
| Rate for Payer: Centivo All Commercial |
$92.91
|
| Rate for Payer: Cigna All Commercial |
$59.94
|
| Rate for Payer: Cigna All Commercial |
$59.94
|
| Rate for Payer: CORVEL All Commercial |
$59.94
|
| Rate for Payer: CORVEL All Commercial |
$59.94
|
| Rate for Payer: Coventry All Commercial |
$71.93
|
| Rate for Payer: Coventry All Commercial |
$71.93
|
| Rate for Payer: Encore All Commercial |
$59.94
|
| Rate for Payer: Encore All Commercial |
$59.94
|
| Rate for Payer: Frontpath All Commercial |
$82.25
|
| Rate for Payer: Frontpath All Commercial |
$82.25
|
| Rate for Payer: Humana ChoiceCare |
$89.17
|
| Rate for Payer: Humana ChoiceCare |
$89.17
|
| Rate for Payer: Humana Medicare |
$59.94
|
| Rate for Payer: Humana Medicare |
$59.94
|
| Rate for Payer: Lucent All Commercial |
$83.92
|
| Rate for Payer: Lucent All Commercial |
$83.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.00
|
| Rate for Payer: Managed Health Services Medicaid |
$170.49
|
| Rate for Payer: Managed Health Services Medicaid |
$170.49
|
| Rate for Payer: MDWise Medicaid |
$170.49
|
| Rate for Payer: MDWise Medicaid |
$170.49
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$32.36
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$32.36
|
| Rate for Payer: PHCS All Commercial |
$59.94
|
| Rate for Payer: PHCS All Commercial |
$59.94
|
| Rate for Payer: PHP All Commercial |
$82.48
|
| Rate for Payer: PHP All Commercial |
$82.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.94
|
| Rate for Payer: Sagamore Health Network All Products |
$59.94
|
| Rate for Payer: Sagamore Health Network All Products |
$59.94
|
| Rate for Payer: Signature Care EPO |
$237.15
|
| Rate for Payer: Signature Care EPO |
$237.15
|
| Rate for Payer: Signature Care PPO |
$237.15
|
| Rate for Payer: Signature Care PPO |
$237.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,100.00
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Medicare |
$172.46
|
| Rate for Payer: United Healthcare Medicare |
$172.46
|
|
|
PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
Both
|
$477.54
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
z31237
|
| Min. Negotiated Rate |
$83.69 |
| Max. Negotiated Rate |
$22,400.00 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Medicare |
$149.19
|
| Rate for Payer: Aetna Medicare |
$149.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$300.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$83.69
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$83.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$234.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$234.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$171.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$171.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.11
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cash Price |
$296.07
|
| Rate for Payer: Centivo All Commercial |
$231.24
|
| Rate for Payer: Centivo All Commercial |
$231.24
|
| Rate for Payer: Cigna All Commercial |
$149.19
|
| Rate for Payer: Cigna All Commercial |
$149.19
|
| Rate for Payer: CORVEL All Commercial |
$149.19
|
| Rate for Payer: CORVEL All Commercial |
$149.19
|
| Rate for Payer: Coventry All Commercial |
$179.03
|
| Rate for Payer: Coventry All Commercial |
$179.03
|
| Rate for Payer: Encore All Commercial |
$149.19
|
| Rate for Payer: Encore All Commercial |
$149.19
|
| Rate for Payer: Frontpath All Commercial |
$205.41
|
| Rate for Payer: Frontpath All Commercial |
$205.41
|
| Rate for Payer: Humana ChoiceCare |
$221.68
|
| Rate for Payer: Humana ChoiceCare |
$221.68
|
| Rate for Payer: Humana Medicare |
$149.19
|
| Rate for Payer: Humana Medicare |
$149.19
|
| Rate for Payer: Lucent All Commercial |
$208.87
|
| Rate for Payer: Lucent All Commercial |
$208.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.00
|
| Rate for Payer: Managed Health Services Medicaid |
$234.87
|
| Rate for Payer: Managed Health Services Medicaid |
$234.87
|
| Rate for Payer: MDWise Medicaid |
$234.87
|
| Rate for Payer: MDWise Medicaid |
$234.87
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$83.69
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$83.69
|
| Rate for Payer: PHCS All Commercial |
$149.19
|
| Rate for Payer: PHCS All Commercial |
$149.19
|
| Rate for Payer: PHP All Commercial |
$203.95
|
| Rate for Payer: PHP All Commercial |
$203.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.19
|
| Rate for Payer: Sagamore Health Network All Products |
$149.19
|
| Rate for Payer: Sagamore Health Network All Products |
$149.19
|
| Rate for Payer: Signature Care EPO |
$409.82
|
| Rate for Payer: Signature Care EPO |
$409.82
|
| Rate for Payer: Signature Care PPO |
$409.82
|
| Rate for Payer: Signature Care PPO |
$409.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,400.00
|
| Rate for Payer: United Healthcare Commercial |
$206.48
|
| Rate for Payer: United Healthcare Commercial |
$206.48
|
| Rate for Payer: United Healthcare Medicare |
$234.83
|
| Rate for Payer: United Healthcare Medicare |
$234.83
|
|
|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$464.80
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
z31238
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$23,400.00 |
| Rate for Payer: Aetna Commercial |
$156.22
|
| Rate for Payer: Aetna Commercial |
$156.22
|
| Rate for Payer: Aetna Medicare |
$156.22
|
| Rate for Payer: Aetna Medicare |
$156.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$331.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$94.84
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$94.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$228.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$228.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.84
|
| Rate for Payer: Cash Price |
$284.43
|
| Rate for Payer: Cash Price |
$288.18
|
| Rate for Payer: Centivo All Commercial |
$242.14
|
| Rate for Payer: Centivo All Commercial |
$242.14
|
| Rate for Payer: Cigna All Commercial |
$156.22
|
| Rate for Payer: Cigna All Commercial |
$156.22
|
| Rate for Payer: CORVEL All Commercial |
$156.22
|
| Rate for Payer: CORVEL All Commercial |
$156.22
|
| Rate for Payer: Coventry All Commercial |
$187.46
|
| Rate for Payer: Coventry All Commercial |
$187.46
|
| Rate for Payer: Encore All Commercial |
$156.22
|
| Rate for Payer: Encore All Commercial |
$156.22
|
| Rate for Payer: Frontpath All Commercial |
$215.16
|
| Rate for Payer: Frontpath All Commercial |
$215.16
|
| Rate for Payer: Humana ChoiceCare |
$243.13
|
| Rate for Payer: Humana ChoiceCare |
$243.13
|
| Rate for Payer: Humana Medicare |
$156.22
|
| Rate for Payer: Humana Medicare |
$156.22
|
| Rate for Payer: Lucent All Commercial |
$218.71
|
| Rate for Payer: Lucent All Commercial |
$218.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$228.61
|
| Rate for Payer: Managed Health Services Medicaid |
$228.61
|
| Rate for Payer: MDWise Medicaid |
$228.61
|
| Rate for Payer: MDWise Medicaid |
$228.61
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$94.84
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$94.84
|
| Rate for Payer: PHCS All Commercial |
$156.22
|
| Rate for Payer: PHCS All Commercial |
$156.22
|
| Rate for Payer: PHP All Commercial |
$213.18
|
| Rate for Payer: PHP All Commercial |
$213.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.22
|
| Rate for Payer: Sagamore Health Network All Products |
$156.22
|
| Rate for Payer: Sagamore Health Network All Products |
$156.22
|
| Rate for Payer: Signature Care EPO |
$400.61
|
| Rate for Payer: Signature Care EPO |
$400.61
|
| Rate for Payer: Signature Care PPO |
$400.61
|
| Rate for Payer: Signature Care PPO |
$400.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,400.00
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Medicare |
$229.38
|
| Rate for Payer: United Healthcare Medicare |
$229.38
|
|
|
PR NASOPHARYNGOSCOPY
|
Professional
|
Both
|
$218.06
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
z92511
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$35.77
|
| Rate for Payer: Aetna Commercial |
$35.77
|
| Rate for Payer: Aetna Medicare |
$35.77
|
| Rate for Payer: Aetna Medicare |
$35.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.91
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$24.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$24.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$107.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$107.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.35
|
| Rate for Payer: Cash Price |
$133.72
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Centivo All Commercial |
$55.44
|
| Rate for Payer: Centivo All Commercial |
$55.44
|
| Rate for Payer: Cigna All Commercial |
$35.77
|
| Rate for Payer: Cigna All Commercial |
$35.77
|
| Rate for Payer: CORVEL All Commercial |
$35.77
|
| Rate for Payer: CORVEL All Commercial |
$35.77
|
| Rate for Payer: Coventry All Commercial |
$42.92
|
| Rate for Payer: Coventry All Commercial |
$42.92
|
| Rate for Payer: Encore All Commercial |
$35.77
|
| Rate for Payer: Encore All Commercial |
$35.77
|
| Rate for Payer: Frontpath All Commercial |
$40.52
|
| Rate for Payer: Frontpath All Commercial |
$40.52
|
| Rate for Payer: Humana ChoiceCare |
$69.16
|
| Rate for Payer: Humana ChoiceCare |
$69.16
|
| Rate for Payer: Humana Medicare |
$35.77
|
| Rate for Payer: Humana Medicare |
$35.77
|
| Rate for Payer: Lucent All Commercial |
$50.08
|
| Rate for Payer: Lucent All Commercial |
$50.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.00
|
| Rate for Payer: Managed Health Services Medicaid |
$107.25
|
| Rate for Payer: Managed Health Services Medicaid |
$107.25
|
| Rate for Payer: MDWise Medicaid |
$107.25
|
| Rate for Payer: MDWise Medicaid |
$107.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$24.62
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$24.62
|
| Rate for Payer: PHCS All Commercial |
$35.77
|
| Rate for Payer: PHCS All Commercial |
$35.77
|
| Rate for Payer: PHP All Commercial |
$50.68
|
| Rate for Payer: PHP All Commercial |
$50.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.77
|
| Rate for Payer: Sagamore Health Network All Products |
$35.77
|
| Rate for Payer: Sagamore Health Network All Products |
$35.77
|
| Rate for Payer: Signature Care EPO |
$165.75
|
| Rate for Payer: Signature Care EPO |
$165.75
|
| Rate for Payer: Signature Care PPO |
$165.75
|
| Rate for Payer: Signature Care PPO |
$165.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,300.00
|
| Rate for Payer: United Healthcare Commercial |
$67.65
|
| Rate for Payer: United Healthcare Commercial |
$67.65
|
| Rate for Payer: United Healthcare Medicare |
$107.84
|
| Rate for Payer: United Healthcare Medicare |
$107.84
|
|
|
PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$573.12
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
z44386
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$284.18 |
| Rate for Payer: Aetna Commercial |
$83.78
|
| Rate for Payer: Aetna Commercial |
$83.78
|
| Rate for Payer: Aetna Medicare |
$83.78
|
| Rate for Payer: Aetna Medicare |
$83.78
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$90.67
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$90.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$281.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$281.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.16
|
| Rate for Payer: Cash Price |
$352.38
|
| Rate for Payer: Cash Price |
$355.33
|
| Rate for Payer: Centivo All Commercial |
$129.86
|
| Rate for Payer: Centivo All Commercial |
$129.86
|
| Rate for Payer: Cigna All Commercial |
$83.78
|
| Rate for Payer: Cigna All Commercial |
$83.78
|
| Rate for Payer: CORVEL All Commercial |
$83.78
|
| Rate for Payer: CORVEL All Commercial |
$83.78
|
| Rate for Payer: Coventry All Commercial |
$100.54
|
| Rate for Payer: Coventry All Commercial |
$100.54
|
| Rate for Payer: Encore All Commercial |
$83.78
|
| Rate for Payer: Encore All Commercial |
$83.78
|
| Rate for Payer: Frontpath All Commercial |
$115.12
|
| Rate for Payer: Frontpath All Commercial |
$115.12
|
| Rate for Payer: Humana ChoiceCare |
$136.29
|
| Rate for Payer: Humana ChoiceCare |
$136.29
|
| Rate for Payer: Humana Medicare |
$83.78
|
| Rate for Payer: Humana Medicare |
$83.78
|
| Rate for Payer: Lucent All Commercial |
$117.29
|
| Rate for Payer: Lucent All Commercial |
$117.29
|
| Rate for Payer: Managed Health Services Medicaid |
$281.88
|
| Rate for Payer: Managed Health Services Medicaid |
$281.88
|
| Rate for Payer: MDWise Medicaid |
$281.88
|
| Rate for Payer: MDWise Medicaid |
$281.88
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$90.67
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$90.67
|
| Rate for Payer: PHCS All Commercial |
$83.78
|
| Rate for Payer: PHCS All Commercial |
$83.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.78
|
| Rate for Payer: Sagamore Health Network All Products |
$83.78
|
| Rate for Payer: Sagamore Health Network All Products |
$83.78
|
| Rate for Payer: United Healthcare Commercial |
$142.78
|
| Rate for Payer: United Healthcare Commercial |
$142.78
|
| Rate for Payer: United Healthcare Medicare |
$284.18
|
| Rate for Payer: United Healthcare Medicare |
$284.18
|
|
