|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$139.86
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
z99242
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.92
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.92
|
| Rate for Payer: Cash Price |
$87.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Frontpath All Commercial |
$67.28
|
| Rate for Payer: Frontpath All Commercial |
$67.28
|
| Rate for Payer: Humana ChoiceCare |
$78.77
|
| Rate for Payer: Humana ChoiceCare |
$78.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.92
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.92
|
| Rate for Payer: PHP All Commercial |
$53.73
|
| Rate for Payer: PHP All Commercial |
$53.73
|
| Rate for Payer: Signature Care EPO |
$95.20
|
| Rate for Payer: Signature Care EPO |
$95.20
|
| Rate for Payer: Signature Care PPO |
$95.20
|
| Rate for Payer: Signature Care PPO |
$95.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: United Healthcare Commercial |
$70.39
|
| Rate for Payer: United Healthcare Commercial |
$70.39
|
| Rate for Payer: United Healthcare Medicare |
$69.93
|
| Rate for Payer: United Healthcare Medicare |
$69.93
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$340.84
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
z99215
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$14,000.00 |
| Rate for Payer: Aetna Commercial |
$138.90
|
| Rate for Payer: Aetna Commercial |
$138.90
|
| Rate for Payer: Aetna Medicare |
$138.90
|
| Rate for Payer: Aetna Medicare |
$138.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$141.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$141.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.38
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$73.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$73.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$167.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$167.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.79
|
| Rate for Payer: Cash Price |
$204.95
|
| Rate for Payer: Cash Price |
$211.32
|
| Rate for Payer: Centivo All Commercial |
$215.29
|
| Rate for Payer: Centivo All Commercial |
$215.29
|
| Rate for Payer: Cigna All Commercial |
$138.90
|
| Rate for Payer: Cigna All Commercial |
$138.90
|
| Rate for Payer: CORVEL All Commercial |
$138.90
|
| Rate for Payer: CORVEL All Commercial |
$138.90
|
| Rate for Payer: Coventry All Commercial |
$166.68
|
| Rate for Payer: Coventry All Commercial |
$166.68
|
| Rate for Payer: Encore All Commercial |
$138.90
|
| Rate for Payer: Encore All Commercial |
$138.90
|
| Rate for Payer: Frontpath All Commercial |
$149.79
|
| Rate for Payer: Frontpath All Commercial |
$149.79
|
| Rate for Payer: Humana ChoiceCare |
$90.72
|
| Rate for Payer: Humana ChoiceCare |
$90.72
|
| Rate for Payer: Humana Medicare |
$138.90
|
| Rate for Payer: Humana Medicare |
$138.90
|
| Rate for Payer: Lucent All Commercial |
$194.46
|
| Rate for Payer: Lucent All Commercial |
$194.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: Managed Health Services Medicaid |
$167.63
|
| Rate for Payer: Managed Health Services Medicaid |
$167.63
|
| Rate for Payer: MDWise Medicaid |
$167.63
|
| Rate for Payer: MDWise Medicaid |
$167.63
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$73.54
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$73.54
|
| Rate for Payer: PHCS All Commercial |
$138.90
|
| Rate for Payer: PHCS All Commercial |
$138.90
|
| Rate for Payer: PHP All Commercial |
$136.74
|
| Rate for Payer: PHP All Commercial |
$136.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.90
|
| Rate for Payer: Sagamore Health Network All Products |
$138.90
|
| Rate for Payer: Sagamore Health Network All Products |
$138.90
|
| Rate for Payer: Signature Care EPO |
$145.60
|
| Rate for Payer: Signature Care EPO |
$145.60
|
| Rate for Payer: Signature Care PPO |
$145.60
|
| Rate for Payer: Signature Care PPO |
$145.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,000.00
|
| Rate for Payer: United Healthcare Commercial |
$100.15
|
| Rate for Payer: United Healthcare Commercial |
$100.15
|
| Rate for Payer: United Healthcare Medicare |
$165.28
|
| Rate for Payer: United Healthcare Medicare |
$165.28
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$171.42
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
z99213
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$6,500.00 |
| Rate for Payer: Aetna Commercial |
$63.73
|
| Rate for Payer: Aetna Commercial |
$63.73
|
| Rate for Payer: Aetna Medicare |
$63.73
|
| Rate for Payer: Aetna Medicare |
$63.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$74.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$74.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.64
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.74
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$84.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$84.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.10
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Cash Price |
$106.28
|
| Rate for Payer: Centivo All Commercial |
$98.78
|
| Rate for Payer: Centivo All Commercial |
$98.78
|
| Rate for Payer: Cigna All Commercial |
$63.73
|
| Rate for Payer: Cigna All Commercial |
$63.73
|
| Rate for Payer: CORVEL All Commercial |
$63.73
|
| Rate for Payer: CORVEL All Commercial |
$63.73
|
| Rate for Payer: Coventry All Commercial |
$76.48
|
| Rate for Payer: Coventry All Commercial |
$76.48
|
| Rate for Payer: Encore All Commercial |
$63.73
|
| Rate for Payer: Encore All Commercial |
$63.73
|
| Rate for Payer: Frontpath All Commercial |
$68.80
|
| Rate for Payer: Frontpath All Commercial |
$68.80
|
| Rate for Payer: Humana ChoiceCare |
$34.13
|
| Rate for Payer: Humana ChoiceCare |
$34.13
|
| Rate for Payer: Humana Medicare |
$63.73
|
| Rate for Payer: Humana Medicare |
$63.73
|
| Rate for Payer: Lucent All Commercial |
$89.22
|
| Rate for Payer: Lucent All Commercial |
$89.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Managed Health Services Medicaid |
$84.31
|
| Rate for Payer: Managed Health Services Medicaid |
$84.31
|
| Rate for Payer: MDWise Medicaid |
$84.31
|
| Rate for Payer: MDWise Medicaid |
$84.31
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.74
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.74
|
| Rate for Payer: PHCS All Commercial |
$63.73
|
| Rate for Payer: PHCS All Commercial |
$63.73
|
| Rate for Payer: PHP All Commercial |
$62.95
|
| Rate for Payer: PHP All Commercial |
$62.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.73
|
| Rate for Payer: Sagamore Health Network All Products |
$63.73
|
| Rate for Payer: Sagamore Health Network All Products |
$63.73
|
| Rate for Payer: Signature Care EPO |
$72.96
|
| Rate for Payer: Signature Care EPO |
$72.96
|
| Rate for Payer: Signature Care PPO |
$72.96
|
| Rate for Payer: Signature Care PPO |
$72.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: United Healthcare Commercial |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$45.60
|
| Rate for Payer: United Healthcare Medicare |
$83.10
|
| Rate for Payer: United Healthcare Medicare |
$83.10
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$242.22
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
z99214
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$93.91
|
| Rate for Payer: Aetna Commercial |
$93.91
|
| Rate for Payer: Aetna Medicare |
$93.91
|
| Rate for Payer: Aetna Medicare |
$93.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$49.49
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$49.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$119.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$119.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.30
|
| Rate for Payer: Cash Price |
$146.05
|
| Rate for Payer: Cash Price |
$150.18
|
| Rate for Payer: Centivo All Commercial |
$145.56
|
| Rate for Payer: Centivo All Commercial |
$145.56
|
| Rate for Payer: Cigna All Commercial |
$93.91
|
| Rate for Payer: Cigna All Commercial |
$93.91
|
| Rate for Payer: CORVEL All Commercial |
$93.91
|
| Rate for Payer: CORVEL All Commercial |
$93.91
|
| Rate for Payer: Coventry All Commercial |
$112.69
|
| Rate for Payer: Coventry All Commercial |
$112.69
|
| Rate for Payer: Encore All Commercial |
$93.91
|
| Rate for Payer: Encore All Commercial |
$93.91
|
| Rate for Payer: Frontpath All Commercial |
$100.78
|
| Rate for Payer: Frontpath All Commercial |
$100.78
|
| Rate for Payer: Humana ChoiceCare |
$56.59
|
| Rate for Payer: Humana ChoiceCare |
$56.59
|
| Rate for Payer: Humana Medicare |
$93.91
|
| Rate for Payer: Humana Medicare |
$93.91
|
| Rate for Payer: Lucent All Commercial |
$131.47
|
| Rate for Payer: Lucent All Commercial |
$131.47
|
| 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 |
$119.13
|
| Rate for Payer: Managed Health Services Medicaid |
$119.13
|
| Rate for Payer: MDWise Medicaid |
$119.13
|
| Rate for Payer: MDWise Medicaid |
$119.13
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$49.49
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$49.49
|
| Rate for Payer: PHCS All Commercial |
$93.91
|
| Rate for Payer: PHCS All Commercial |
$93.91
|
| Rate for Payer: PHP All Commercial |
$93.08
|
| Rate for Payer: PHP All Commercial |
$93.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.91
|
| Rate for Payer: Sagamore Health Network All Products |
$93.91
|
| Rate for Payer: Sagamore Health Network All Products |
$93.91
|
| Rate for Payer: Signature Care EPO |
$103.39
|
| Rate for Payer: Signature Care EPO |
$103.39
|
| Rate for Payer: Signature Care PPO |
$103.39
|
| Rate for Payer: Signature Care PPO |
$103.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,500.00
|
| Rate for Payer: United Healthcare Commercial |
$70.55
|
| Rate for Payer: United Healthcare Commercial |
$70.55
|
| Rate for Payer: United Healthcare Medicare |
$117.78
|
| Rate for Payer: United Healthcare Medicare |
$117.78
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$106.24
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
z99212
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: Aetna Medicare |
$34.38
|
| Rate for Payer: Aetna Medicare |
$34.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$43.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$43.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.82
|
| Rate for Payer: Cash Price |
$64.22
|
| Rate for Payer: Cash Price |
$65.87
|
| Rate for Payer: Centivo All Commercial |
$53.29
|
| Rate for Payer: Centivo All Commercial |
$53.29
|
| Rate for Payer: Cigna All Commercial |
$34.38
|
| Rate for Payer: Cigna All Commercial |
$34.38
|
| Rate for Payer: CORVEL All Commercial |
$34.38
|
| Rate for Payer: CORVEL All Commercial |
$34.38
|
| Rate for Payer: Coventry All Commercial |
$41.26
|
| Rate for Payer: Coventry All Commercial |
$41.26
|
| Rate for Payer: Encore All Commercial |
$34.38
|
| Rate for Payer: Encore All Commercial |
$34.38
|
| Rate for Payer: Frontpath All Commercial |
$37.48
|
| Rate for Payer: Frontpath All Commercial |
$37.48
|
| Rate for Payer: Humana ChoiceCare |
$23.04
|
| Rate for Payer: Humana ChoiceCare |
$23.04
|
| Rate for Payer: Humana Medicare |
$34.38
|
| Rate for Payer: Humana Medicare |
$34.38
|
| Rate for Payer: Lucent All Commercial |
$48.13
|
| Rate for Payer: Lucent All Commercial |
$48.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Managed Health Services Medicaid |
$52.25
|
| Rate for Payer: Managed Health Services Medicaid |
$52.25
|
| Rate for Payer: MDWise Medicaid |
$52.25
|
| Rate for Payer: MDWise Medicaid |
$52.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$18.34
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$18.34
|
| Rate for Payer: PHCS All Commercial |
$34.38
|
| Rate for Payer: PHCS All Commercial |
$34.38
|
| Rate for Payer: PHP All Commercial |
$33.80
|
| Rate for Payer: PHP All Commercial |
$33.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.38
|
| Rate for Payer: Sagamore Health Network All Products |
$34.38
|
| Rate for Payer: Sagamore Health Network All Products |
$34.38
|
| Rate for Payer: Signature Care EPO |
$45.11
|
| Rate for Payer: Signature Care EPO |
$45.11
|
| Rate for Payer: Signature Care PPO |
$45.11
|
| Rate for Payer: Signature Care PPO |
$45.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,500.00
|
| Rate for Payer: United Healthcare Commercial |
$23.29
|
| Rate for Payer: United Healthcare Commercial |
$23.29
|
| Rate for Payer: United Healthcare Medicare |
$51.79
|
| Rate for Payer: United Healthcare Medicare |
$51.79
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$43.62
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
z99211
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$8.57
|
| Rate for Payer: Aetna Medicare |
$8.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$5.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$5.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.43
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Centivo All Commercial |
$13.28
|
| Rate for Payer: Centivo All Commercial |
$13.28
|
| Rate for Payer: Cigna All Commercial |
$8.57
|
| Rate for Payer: Cigna All Commercial |
$8.57
|
| Rate for Payer: CORVEL All Commercial |
$8.57
|
| Rate for Payer: CORVEL All Commercial |
$8.57
|
| Rate for Payer: Coventry All Commercial |
$10.28
|
| Rate for Payer: Coventry All Commercial |
$10.28
|
| Rate for Payer: Encore All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.57
|
| Rate for Payer: Frontpath All Commercial |
$9.17
|
| Rate for Payer: Frontpath All Commercial |
$9.17
|
| Rate for Payer: Humana ChoiceCare |
$8.67
|
| Rate for Payer: Humana ChoiceCare |
$8.67
|
| Rate for Payer: Humana Medicare |
$8.57
|
| Rate for Payer: Humana Medicare |
$8.57
|
| Rate for Payer: Lucent All Commercial |
$12.00
|
| Rate for Payer: Lucent All Commercial |
$12.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.00
|
| Rate for Payer: Managed Health Services Medicaid |
$21.45
|
| Rate for Payer: Managed Health Services Medicaid |
$21.45
|
| Rate for Payer: MDWise Medicaid |
$21.45
|
| Rate for Payer: MDWise Medicaid |
$21.45
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$5.88
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$5.88
|
| Rate for Payer: PHCS All Commercial |
$8.57
|
| Rate for Payer: PHCS All Commercial |
$8.57
|
| Rate for Payer: PHP All Commercial |
$8.46
|
| Rate for Payer: PHP All Commercial |
$8.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.57
|
| Rate for Payer: Sagamore Health Network All Products |
$8.57
|
| Rate for Payer: Sagamore Health Network All Products |
$8.57
|
| Rate for Payer: Signature Care EPO |
$18.40
|
| Rate for Payer: Signature Care EPO |
$18.40
|
| Rate for Payer: Signature Care PPO |
$18.40
|
| Rate for Payer: Signature Care PPO |
$18.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$900.00
|
| Rate for Payer: United Healthcare Commercial |
$8.75
|
| Rate for Payer: United Healthcare Commercial |
$8.75
|
| Rate for Payer: United Healthcare Medicare |
$21.17
|
| Rate for Payer: United Healthcare Medicare |
$21.17
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$414.92
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
z99205
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$17,600.00 |
| Rate for Payer: Aetna Commercial |
$174.24
|
| Rate for Payer: Aetna Commercial |
$174.24
|
| Rate for Payer: Aetna Medicare |
$174.24
|
| Rate for Payer: Aetna Medicare |
$174.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$92.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$92.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$204.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$204.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$191.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$191.66
|
| Rate for Payer: Cash Price |
$250.73
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: Centivo All Commercial |
$270.07
|
| Rate for Payer: Centivo All Commercial |
$270.07
|
| Rate for Payer: Cigna All Commercial |
$174.24
|
| Rate for Payer: Cigna All Commercial |
$174.24
|
| Rate for Payer: CORVEL All Commercial |
$174.24
|
| Rate for Payer: CORVEL All Commercial |
$174.24
|
| Rate for Payer: Coventry All Commercial |
$209.09
|
| Rate for Payer: Coventry All Commercial |
$209.09
|
| Rate for Payer: Encore All Commercial |
$174.24
|
| Rate for Payer: Encore All Commercial |
$174.24
|
| Rate for Payer: Frontpath All Commercial |
$189.17
|
| Rate for Payer: Frontpath All Commercial |
$189.17
|
| Rate for Payer: Humana ChoiceCare |
$136.28
|
| Rate for Payer: Humana ChoiceCare |
$136.28
|
| Rate for Payer: Humana Medicare |
$174.24
|
| Rate for Payer: Humana Medicare |
$174.24
|
| Rate for Payer: Lucent All Commercial |
$243.94
|
| Rate for Payer: Lucent All Commercial |
$243.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.00
|
| Rate for Payer: Managed Health Services Medicaid |
$204.08
|
| Rate for Payer: Managed Health Services Medicaid |
$204.08
|
| Rate for Payer: MDWise Medicaid |
$204.08
|
| Rate for Payer: MDWise Medicaid |
$204.08
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$92.75
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$92.75
|
| Rate for Payer: PHCS All Commercial |
$174.24
|
| Rate for Payer: PHCS All Commercial |
$174.24
|
| Rate for Payer: PHP All Commercial |
$171.97
|
| Rate for Payer: PHP All Commercial |
$171.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.24
|
| Rate for Payer: Sagamore Health Network All Products |
$174.24
|
| Rate for Payer: Sagamore Health Network All Products |
$174.24
|
| Rate for Payer: Signature Care EPO |
$177.75
|
| Rate for Payer: Signature Care EPO |
$177.75
|
| Rate for Payer: Signature Care PPO |
$177.75
|
| Rate for Payer: Signature Care PPO |
$177.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,600.00
|
| Rate for Payer: United Healthcare Commercial |
$150.39
|
| Rate for Payer: United Healthcare Commercial |
$150.39
|
| Rate for Payer: United Healthcare Medicare |
$202.20
|
| Rate for Payer: United Healthcare Medicare |
$202.20
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$209.28
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
z99203
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$8,000.00 |
| Rate for Payer: Aetna Commercial |
$78.97
|
| Rate for Payer: Aetna Commercial |
$78.97
|
| Rate for Payer: Aetna Medicare |
$78.97
|
| Rate for Payer: Aetna Medicare |
$78.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$110.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$110.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.44
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$102.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$102.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.87
|
| Rate for Payer: Cash Price |
$127.16
|
| Rate for Payer: Cash Price |
$129.75
|
| Rate for Payer: Centivo All Commercial |
$122.40
|
| Rate for Payer: Centivo All Commercial |
$122.40
|
| Rate for Payer: Cigna All Commercial |
$78.97
|
| Rate for Payer: Cigna All Commercial |
$78.97
|
| Rate for Payer: CORVEL All Commercial |
$78.97
|
| Rate for Payer: CORVEL All Commercial |
$78.97
|
| Rate for Payer: Coventry All Commercial |
$94.76
|
| Rate for Payer: Coventry All Commercial |
$94.76
|
| Rate for Payer: Encore All Commercial |
$78.97
|
| Rate for Payer: Encore All Commercial |
$78.97
|
| Rate for Payer: Frontpath All Commercial |
$86.29
|
| Rate for Payer: Frontpath All Commercial |
$86.29
|
| Rate for Payer: Humana ChoiceCare |
$68.75
|
| Rate for Payer: Humana ChoiceCare |
$68.75
|
| Rate for Payer: Humana Medicare |
$78.97
|
| Rate for Payer: Humana Medicare |
$78.97
|
| Rate for Payer: Lucent All Commercial |
$110.56
|
| Rate for Payer: Lucent All Commercial |
$110.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Managed Health Services Medicaid |
$102.93
|
| Rate for Payer: Managed Health Services Medicaid |
$102.93
|
| Rate for Payer: MDWise Medicaid |
$102.93
|
| Rate for Payer: MDWise Medicaid |
$102.93
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.22
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.22
|
| Rate for Payer: PHCS All Commercial |
$78.97
|
| Rate for Payer: PHCS All Commercial |
$78.97
|
| Rate for Payer: PHP All Commercial |
$78.33
|
| Rate for Payer: PHP All Commercial |
$78.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.97
|
| Rate for Payer: Sagamore Health Network All Products |
$78.97
|
| Rate for Payer: Sagamore Health Network All Products |
$78.97
|
| Rate for Payer: Signature Care EPO |
$89.63
|
| Rate for Payer: Signature Care EPO |
$89.63
|
| Rate for Payer: Signature Care PPO |
$89.63
|
| Rate for Payer: Signature Care PPO |
$89.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,000.00
|
| Rate for Payer: United Healthcare Commercial |
$68.78
|
| Rate for Payer: United Healthcare Commercial |
$68.78
|
| Rate for Payer: United Healthcare Medicare |
$102.55
|
| Rate for Payer: United Healthcare Medicare |
$102.55
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$314.66
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
z99204
|
| Min. Negotiated Rate |
$68.35 |
| Max. Negotiated Rate |
$13,000.00 |
| Rate for Payer: Aetna Commercial |
$128.41
|
| Rate for Payer: Aetna Commercial |
$128.41
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.17
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$68.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$68.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.25
|
| Rate for Payer: Cash Price |
$189.87
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Centivo All Commercial |
$199.04
|
| Rate for Payer: Centivo All Commercial |
$199.04
|
| Rate for Payer: Cigna All Commercial |
$128.41
|
| Rate for Payer: Cigna All Commercial |
$128.41
|
| Rate for Payer: CORVEL All Commercial |
$128.41
|
| Rate for Payer: CORVEL All Commercial |
$128.41
|
| Rate for Payer: Coventry All Commercial |
$154.09
|
| Rate for Payer: Coventry All Commercial |
$154.09
|
| Rate for Payer: Encore All Commercial |
$128.41
|
| Rate for Payer: Encore All Commercial |
$128.41
|
| Rate for Payer: Frontpath All Commercial |
$139.50
|
| Rate for Payer: Frontpath All Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$102.16
|
| Rate for Payer: Humana ChoiceCare |
$102.16
|
| Rate for Payer: Humana Medicare |
$128.41
|
| Rate for Payer: Humana Medicare |
$128.41
|
| Rate for Payer: Lucent All Commercial |
$179.77
|
| Rate for Payer: Lucent All Commercial |
$179.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.00
|
| Rate for Payer: Managed Health Services Medicaid |
$154.76
|
| Rate for Payer: Managed Health Services Medicaid |
$154.76
|
| Rate for Payer: MDWise Medicaid |
$154.76
|
| Rate for Payer: MDWise Medicaid |
$154.76
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$68.35
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$68.35
|
| Rate for Payer: PHCS All Commercial |
$128.41
|
| Rate for Payer: PHCS All Commercial |
$128.41
|
| Rate for Payer: PHP All Commercial |
$126.69
|
| Rate for Payer: PHP All Commercial |
$126.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.41
|
| Rate for Payer: Sagamore Health Network All Products |
$128.41
|
| Rate for Payer: Sagamore Health Network All Products |
$128.41
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,000.00
|
| Rate for Payer: United Healthcare Commercial |
$115.55
|
| Rate for Payer: United Healthcare Commercial |
$115.55
|
| Rate for Payer: United Healthcare Medicare |
$153.12
|
| Rate for Payer: United Healthcare Medicare |
$153.12
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES
|
Professional
|
Both
|
$135.70
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
z99202
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Medicare |
$46.40
|
| Rate for Payer: Aetna Medicare |
$46.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$24.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$24.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$66.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$66.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.04
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$84.13
|
| Rate for Payer: Centivo All Commercial |
$71.92
|
| Rate for Payer: Centivo All Commercial |
$71.92
|
| Rate for Payer: Cigna All Commercial |
$46.40
|
| Rate for Payer: Cigna All Commercial |
$46.40
|
| Rate for Payer: CORVEL All Commercial |
$46.40
|
| Rate for Payer: CORVEL All Commercial |
$46.40
|
| Rate for Payer: Coventry All Commercial |
$55.68
|
| Rate for Payer: Coventry All Commercial |
$55.68
|
| Rate for Payer: Encore All Commercial |
$46.40
|
| Rate for Payer: Encore All Commercial |
$46.40
|
| Rate for Payer: Frontpath All Commercial |
$50.49
|
| Rate for Payer: Frontpath All Commercial |
$50.49
|
| Rate for Payer: Humana ChoiceCare |
$44.82
|
| Rate for Payer: Humana ChoiceCare |
$44.82
|
| Rate for Payer: Humana Medicare |
$46.40
|
| Rate for Payer: Humana Medicare |
$46.40
|
| Rate for Payer: Lucent All Commercial |
$64.96
|
| Rate for Payer: Lucent All Commercial |
$64.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: Managed Health Services Medicaid |
$66.74
|
| Rate for Payer: Managed Health Services Medicaid |
$66.74
|
| Rate for Payer: MDWise Medicaid |
$66.74
|
| Rate for Payer: MDWise Medicaid |
$66.74
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$24.75
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$24.75
|
| Rate for Payer: PHCS All Commercial |
$46.40
|
| Rate for Payer: PHCS All Commercial |
$46.40
|
| Rate for Payer: PHP All Commercial |
$45.68
|
| Rate for Payer: PHP All Commercial |
$45.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.40
|
| Rate for Payer: Sagamore Health Network All Products |
$46.40
|
| Rate for Payer: Sagamore Health Network All Products |
$46.40
|
| Rate for Payer: Signature Care EPO |
$58.24
|
| Rate for Payer: Signature Care EPO |
$58.24
|
| Rate for Payer: Signature Care PPO |
$58.24
|
| Rate for Payer: Signature Care PPO |
$58.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: United Healthcare Commercial |
$45.58
|
| Rate for Payer: United Healthcare Commercial |
$45.58
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
|
|
PR OMENTAL FLAP,INTRA-ABDOMINAL
|
Professional
|
Both
|
$632.70
|
|
|
Service Code
|
CPT 49905
|
| Hospital Charge Code |
z49905
|
| Min. Negotiated Rate |
$311.19 |
| Max. Negotiated Rate |
$44,900.00 |
| Rate for Payer: Aetna Commercial |
$325.04
|
| Rate for Payer: Aetna Commercial |
$325.04
|
| Rate for Payer: Aetna Medicare |
$325.04
|
| Rate for Payer: Aetna Medicare |
$325.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$484.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$484.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$484.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$484.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$484.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$484.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$484.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$484.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$373.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$373.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$357.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$357.54
|
| Rate for Payer: Cash Price |
$392.27
|
| Rate for Payer: Cash Price |
$387.69
|
| Rate for Payer: Centivo All Commercial |
$503.81
|
| Rate for Payer: Centivo All Commercial |
$503.81
|
| Rate for Payer: Cigna All Commercial |
$325.04
|
| Rate for Payer: Cigna All Commercial |
$325.04
|
| Rate for Payer: CORVEL All Commercial |
$325.04
|
| Rate for Payer: CORVEL All Commercial |
$325.04
|
| Rate for Payer: Coventry All Commercial |
$390.05
|
| Rate for Payer: Coventry All Commercial |
$390.05
|
| Rate for Payer: Encore All Commercial |
$325.04
|
| Rate for Payer: Encore All Commercial |
$325.04
|
| Rate for Payer: Frontpath All Commercial |
$465.56
|
| Rate for Payer: Frontpath All Commercial |
$465.56
|
| Rate for Payer: Humana ChoiceCare |
$406.03
|
| Rate for Payer: Humana ChoiceCare |
$406.03
|
| Rate for Payer: Humana Medicare |
$325.04
|
| Rate for Payer: Humana Medicare |
$325.04
|
| Rate for Payer: Lucent All Commercial |
$455.06
|
| Rate for Payer: Lucent All Commercial |
$455.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$481.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$481.00
|
| Rate for Payer: Managed Health Services Medicaid |
$311.19
|
| Rate for Payer: Managed Health Services Medicaid |
$311.19
|
| Rate for Payer: MDWise Medicaid |
$311.19
|
| Rate for Payer: MDWise Medicaid |
$311.19
|
| Rate for Payer: PHCS All Commercial |
$325.04
|
| Rate for Payer: PHCS All Commercial |
$325.04
|
| Rate for Payer: PHP All Commercial |
$547.13
|
| Rate for Payer: PHP All Commercial |
$547.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$325.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$325.04
|
| Rate for Payer: Sagamore Health Network All Products |
$325.04
|
| Rate for Payer: Sagamore Health Network All Products |
$325.04
|
| Rate for Payer: Signature Care EPO |
$514.25
|
| Rate for Payer: Signature Care EPO |
$514.25
|
| Rate for Payer: Signature Care PPO |
$514.25
|
| Rate for Payer: Signature Care PPO |
$514.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,900.00
|
| Rate for Payer: United Healthcare Commercial |
$395.39
|
| Rate for Payer: United Healthcare Commercial |
$395.39
|
| Rate for Payer: United Healthcare Medicare |
$312.65
|
| Rate for Payer: United Healthcare Medicare |
$312.65
|
|
|
PROMETHAZINE 12.5 MG RECT SUPP
|
Facility
|
OP
|
$35.74
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: Aetna Commercial |
$30.16
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.58
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Centivo All Commercial |
$19.44
|
| Rate for Payer: Cigna All Commercial |
$30.84
|
| Rate for Payer: CORVEL All Commercial |
$33.23
|
| Rate for Payer: Coventry All Commercial |
$31.45
|
| Rate for Payer: Encore All Commercial |
$32.89
|
| Rate for Payer: Frontpath All Commercial |
$32.88
|
| Rate for Payer: Humana ChoiceCare |
$30.86
|
| Rate for Payer: Humana Medicare |
$11.44
|
| Rate for Payer: Lucent All Commercial |
$19.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.16
|
| Rate for Payer: PHCS All Commercial |
$26.80
|
| Rate for Payer: PHP All Commercial |
$27.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.94
|
| Rate for Payer: Sagamore Health Network All Products |
$27.59
|
| Rate for Payer: Signature Care EPO |
$29.66
|
| Rate for Payer: Signature Care PPO |
$31.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.37
|
| Rate for Payer: United Healthcare Commercial |
$28.16
|
| Rate for Payer: United Healthcare Medicare |
$11.44
|
|
|
PROMETHAZINE 12.5 MG RECT SUPP
|
Facility
|
IP
|
$35.74
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: Aetna Commercial |
$30.88
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cigna All Commercial |
$30.84
|
| Rate for Payer: CORVEL All Commercial |
$33.23
|
| Rate for Payer: Coventry All Commercial |
$31.45
|
| Rate for Payer: Encore All Commercial |
$32.89
|
| Rate for Payer: Frontpath All Commercial |
$32.88
|
| Rate for Payer: Humana ChoiceCare |
$30.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.16
|
| Rate for Payer: PHCS All Commercial |
$26.80
|
| Rate for Payer: PHP All Commercial |
$27.10
|
| Rate for Payer: Sagamore Health Network All Products |
$27.59
|
| Rate for Payer: Signature Care EPO |
$29.66
|
| Rate for Payer: Signature Care PPO |
$31.45
|
| Rate for Payer: United Healthcare Commercial |
$28.16
|
|
|
PROMETHAZINE 25 MG/ML INJ SOLN - FOR IM USE
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
800115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
PROMETHAZINE 25 MG/ML INJ SOLN - FOR IM USE
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
800115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
PROMETHAZINE 25 MG/ML INJ SOLN - FOR IV USE
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
PROMETHAZINE 25 MG/ML INJ SOLN - FOR IV USE
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
PROMETHAZINE 25 MG ORAL TAB
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
HCPCS Q0169
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna All Commercial |
$0.92
|
| Rate for Payer: CORVEL All Commercial |
$0.99
|
| Rate for Payer: Coventry All Commercial |
$0.94
|
| Rate for Payer: Encore All Commercial |
$0.98
|
| Rate for Payer: Frontpath All Commercial |
$0.98
|
| Rate for Payer: Humana ChoiceCare |
$0.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.96
|
| Rate for Payer: PHCS All Commercial |
$0.80
|
| Rate for Payer: PHP All Commercial |
$0.81
|
| Rate for Payer: Sagamore Health Network All Products |
$0.82
|
| Rate for Payer: Signature Care EPO |
$0.88
|
| Rate for Payer: Signature Care PPO |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
|
|
PROMETHAZINE 25 MG ORAL TAB
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
HCPCS Q0169
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Centivo All Commercial |
$0.58
|
| Rate for Payer: Cigna All Commercial |
$0.92
|
| Rate for Payer: CORVEL All Commercial |
$0.99
|
| Rate for Payer: Coventry All Commercial |
$0.94
|
| Rate for Payer: Encore All Commercial |
$0.98
|
| Rate for Payer: Frontpath All Commercial |
$0.98
|
| Rate for Payer: Humana ChoiceCare |
$0.92
|
| Rate for Payer: Humana Medicare |
$0.34
|
| Rate for Payer: Lucent All Commercial |
$0.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.96
|
| Rate for Payer: PHCS All Commercial |
$0.80
|
| Rate for Payer: PHP All Commercial |
$0.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.41
|
| Rate for Payer: Sagamore Health Network All Products |
$0.82
|
| Rate for Payer: Signature Care EPO |
$0.88
|
| Rate for Payer: Signature Care PPO |
$0.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
|
|
PROMETHAZINE 25 MG RECT SUPP
|
Facility
|
OP
|
$23.09
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.13
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Centivo All Commercial |
$12.56
|
| Rate for Payer: Cigna All Commercial |
$19.92
|
| Rate for Payer: CORVEL All Commercial |
$21.47
|
| Rate for Payer: Coventry All Commercial |
$20.32
|
| Rate for Payer: Encore All Commercial |
$21.25
|
| Rate for Payer: Frontpath All Commercial |
$21.24
|
| Rate for Payer: Humana ChoiceCare |
$19.94
|
| Rate for Payer: Humana Medicare |
$7.39
|
| Rate for Payer: Lucent All Commercial |
$12.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.78
|
| Rate for Payer: PHCS All Commercial |
$17.31
|
| Rate for Payer: PHP All Commercial |
$17.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.00
|
| Rate for Payer: Sagamore Health Network All Products |
$17.82
|
| Rate for Payer: Signature Care EPO |
$19.16
|
| Rate for Payer: Signature Care PPO |
$20.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.62
|
| Rate for Payer: United Healthcare Commercial |
$18.19
|
| Rate for Payer: United Healthcare Medicare |
$7.39
|
|
|
PROMETHAZINE 25 MG RECT SUPP
|
Facility
|
IP
|
$23.09
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cigna All Commercial |
$19.92
|
| Rate for Payer: CORVEL All Commercial |
$21.47
|
| Rate for Payer: Coventry All Commercial |
$20.32
|
| Rate for Payer: Encore All Commercial |
$21.25
|
| Rate for Payer: Frontpath All Commercial |
$21.24
|
| Rate for Payer: Humana ChoiceCare |
$19.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.78
|
| Rate for Payer: PHCS All Commercial |
$17.31
|
| Rate for Payer: PHP All Commercial |
$17.51
|
| Rate for Payer: Sagamore Health Network All Products |
$17.82
|
| Rate for Payer: Signature Care EPO |
$19.16
|
| Rate for Payer: Signature Care PPO |
$20.32
|
| Rate for Payer: United Healthcare Commercial |
$18.19
|
|
|
PROPARACAINE 0.5 % OPHT DROP
|
Facility
|
OP
|
$209.37
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Aetna Commercial |
$176.71
|
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.70
|
| Rate for Payer: Cash Price |
$129.81
|
| Rate for Payer: Cash Price |
$129.81
|
| Rate for Payer: Centivo All Commercial |
$113.90
|
| Rate for Payer: Cigna All Commercial |
$180.69
|
| Rate for Payer: CORVEL All Commercial |
$194.71
|
| Rate for Payer: Coventry All Commercial |
$184.25
|
| Rate for Payer: Encore All Commercial |
$192.73
|
| Rate for Payer: Frontpath All Commercial |
$192.62
|
| Rate for Payer: Humana ChoiceCare |
$180.83
|
| Rate for Payer: Humana Medicare |
$67.00
|
| Rate for Payer: Lucent All Commercial |
$113.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.43
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$157.03
|
| Rate for Payer: PHP All Commercial |
$158.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.65
|
| Rate for Payer: Sagamore Health Network All Products |
$161.63
|
| Rate for Payer: Signature Care EPO |
$173.78
|
| Rate for Payer: Signature Care PPO |
$184.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.96
|
| Rate for Payer: United Healthcare Commercial |
$164.98
|
| Rate for Payer: United Healthcare Medicare |
$67.00
|
|
|
PROPARACAINE 0.5 % OPHT DROP
|
Facility
|
IP
|
$209.37
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.03 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Cash Price |
$129.81
|
| Rate for Payer: Cigna All Commercial |
$180.69
|
| Rate for Payer: CORVEL All Commercial |
$194.71
|
| Rate for Payer: Coventry All Commercial |
$184.25
|
| Rate for Payer: Encore All Commercial |
$192.73
|
| Rate for Payer: Frontpath All Commercial |
$192.62
|
| Rate for Payer: Humana ChoiceCare |
$180.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.43
|
| Rate for Payer: PHCS All Commercial |
$157.03
|
| Rate for Payer: PHP All Commercial |
$158.79
|
| Rate for Payer: Sagamore Health Network All Products |
$161.63
|
| Rate for Payer: Signature Care EPO |
$173.78
|
| Rate for Payer: Signature Care PPO |
$184.25
|
| Rate for Payer: United Healthcare Commercial |
$164.98
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$799.38
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
z38531
|
| Min. Negotiated Rate |
$401.09 |
| Max. Negotiated Rate |
$641.58 |
| Rate for Payer: Aetna Commercial |
$413.92
|
| Rate for Payer: Aetna Medicare |
$413.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$402.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.31
|
| Rate for Payer: Cash Price |
$495.62
|
| Rate for Payer: Centivo All Commercial |
$641.58
|
| Rate for Payer: Cigna All Commercial |
$413.92
|
| Rate for Payer: CORVEL All Commercial |
$413.92
|
| Rate for Payer: Coventry All Commercial |
$496.70
|
| Rate for Payer: Encore All Commercial |
$413.92
|
| Rate for Payer: Frontpath All Commercial |
$584.87
|
| Rate for Payer: Humana ChoiceCare |
$538.27
|
| Rate for Payer: Humana Medicare |
$413.92
|
| Rate for Payer: Lucent All Commercial |
$579.49
|
| Rate for Payer: Managed Health Services Medicaid |
$402.20
|
| Rate for Payer: MDWise Medicaid |
$402.20
|
| Rate for Payer: PHCS All Commercial |
$413.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$413.92
|
| Rate for Payer: Sagamore Health Network All Products |
$413.92
|
| Rate for Payer: United Healthcare Commercial |
$528.26
|
| Rate for Payer: United Healthcare Medicare |
$401.09
|
|
|
PR OPEN FIXATN MID HUMERUS FRACTURE
|
Professional
|
Both
|
$1,632.08
|
|
|
Service Code
|
CPT 24515
|
| Hospital Charge Code |
z24515
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$123,000.00 |
| Rate for Payer: Aetna Commercial |
$821.39
|
| Rate for Payer: Aetna Commercial |
$821.39
|
| Rate for Payer: Aetna Medicare |
$821.39
|
| Rate for Payer: Aetna Medicare |
$821.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,085.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$802.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$802.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$944.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$944.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$903.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$903.53
|
| Rate for Payer: Cash Price |
$1,011.89
|
| Rate for Payer: Cash Price |
$991.75
|
| Rate for Payer: Centivo All Commercial |
$1,273.15
|
| Rate for Payer: Centivo All Commercial |
$1,273.15
|
| Rate for Payer: Cigna All Commercial |
$821.39
|
| Rate for Payer: Cigna All Commercial |
$821.39
|
| Rate for Payer: CORVEL All Commercial |
$821.39
|
| Rate for Payer: CORVEL All Commercial |
$821.39
|
| Rate for Payer: Coventry All Commercial |
$985.67
|
| Rate for Payer: Coventry All Commercial |
$985.67
|
| Rate for Payer: Encore All Commercial |
$821.39
|
| Rate for Payer: Encore All Commercial |
$821.39
|
| Rate for Payer: Frontpath All Commercial |
$1,143.94
|
| Rate for Payer: Frontpath All Commercial |
$1,143.94
|
| Rate for Payer: Humana ChoiceCare |
$918.40
|
| Rate for Payer: Humana ChoiceCare |
$918.40
|
| Rate for Payer: Humana Medicare |
$821.39
|
| Rate for Payer: Humana Medicare |
$821.39
|
| Rate for Payer: Lucent All Commercial |
$1,149.95
|
| Rate for Payer: Lucent All Commercial |
$1,149.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,312.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,312.00
|
| Rate for Payer: Managed Health Services Medicaid |
$802.72
|
| Rate for Payer: Managed Health Services Medicaid |
$802.72
|
| Rate for Payer: MDWise Medicaid |
$802.72
|
| Rate for Payer: MDWise Medicaid |
$802.72
|
| Rate for Payer: PHCS All Commercial |
$821.39
|
| Rate for Payer: PHCS All Commercial |
$821.39
|
| Rate for Payer: PHP All Commercial |
$1,391.66
|
| Rate for Payer: PHP All Commercial |
$1,391.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$821.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$821.39
|
| Rate for Payer: Sagamore Health Network All Products |
$821.39
|
| Rate for Payer: Sagamore Health Network All Products |
$821.39
|
| Rate for Payer: Signature Care EPO |
$1,228.25
|
| Rate for Payer: Signature Care EPO |
$1,228.25
|
| Rate for Payer: Signature Care PPO |
$1,228.25
|
| Rate for Payer: Signature Care PPO |
$1,228.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123,000.00
|
| Rate for Payer: United Healthcare Commercial |
$949.15
|
| Rate for Payer: United Healthcare Commercial |
$949.15
|
| Rate for Payer: United Healthcare Medicare |
$799.80
|
| Rate for Payer: United Healthcare Medicare |
$799.80
|
|
