|
PROPRANOLOL 80 MG ORAL CS24
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.92
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Centivo All Commercial |
$2.97
|
| Rate for Payer: Cigna All Commercial |
$4.71
|
| Rate for Payer: CORVEL All Commercial |
$5.07
|
| Rate for Payer: Coventry All Commercial |
$4.80
|
| Rate for Payer: Encore All Commercial |
$5.02
|
| Rate for Payer: Frontpath All Commercial |
$5.02
|
| Rate for Payer: Humana ChoiceCare |
$4.71
|
| Rate for Payer: Humana Medicare |
$1.74
|
| Rate for Payer: Lucent All Commercial |
$2.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.91
|
| Rate for Payer: PHCS All Commercial |
$4.09
|
| Rate for Payer: PHP All Commercial |
$4.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4.21
|
| Rate for Payer: Signature Care EPO |
$4.53
|
| Rate for Payer: Signature Care PPO |
$4.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$4.30
|
| Rate for Payer: United Healthcare Medicare |
$1.74
|
|
|
PROPYLENE GLYCOL-GLYCERIN 1-0.3 % OPHT DROP
|
Facility
|
IP
|
$41.69
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.26 |
| Max. Negotiated Rate |
$38.77 |
| Rate for Payer: Aetna Commercial |
$36.02
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cigna All Commercial |
$35.97
|
| Rate for Payer: CORVEL All Commercial |
$38.77
|
| Rate for Payer: Coventry All Commercial |
$36.68
|
| Rate for Payer: Encore All Commercial |
$38.37
|
| Rate for Payer: Frontpath All Commercial |
$38.35
|
| Rate for Payer: Humana ChoiceCare |
$36.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.52
|
| Rate for Payer: PHCS All Commercial |
$31.26
|
| Rate for Payer: PHP All Commercial |
$31.61
|
| Rate for Payer: Sagamore Health Network All Products |
$32.18
|
| Rate for Payer: Signature Care EPO |
$34.60
|
| Rate for Payer: Signature Care PPO |
$36.68
|
| Rate for Payer: United Healthcare Commercial |
$32.85
|
|
|
PROPYLENE GLYCOL-GLYCERIN 1-0.3 % OPHT DROP
|
Facility
|
OP
|
$41.69
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$38.77 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.67
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Centivo All Commercial |
$22.68
|
| Rate for Payer: Cigna All Commercial |
$35.97
|
| Rate for Payer: CORVEL All Commercial |
$38.77
|
| Rate for Payer: Coventry All Commercial |
$36.68
|
| Rate for Payer: Encore All Commercial |
$38.37
|
| Rate for Payer: Frontpath All Commercial |
$38.35
|
| Rate for Payer: Humana ChoiceCare |
$36.00
|
| Rate for Payer: Humana Medicare |
$13.34
|
| Rate for Payer: Lucent All Commercial |
$22.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.52
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$31.26
|
| Rate for Payer: PHP All Commercial |
$31.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.26
|
| Rate for Payer: Sagamore Health Network All Products |
$32.18
|
| Rate for Payer: Signature Care EPO |
$34.60
|
| Rate for Payer: Signature Care PPO |
$36.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.43
|
| Rate for Payer: United Healthcare Commercial |
$32.85
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
|
OP
|
$15.56
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.48
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Centivo All Commercial |
$8.47
|
| Rate for Payer: Cigna All Commercial |
$13.43
|
| Rate for Payer: CORVEL All Commercial |
$14.47
|
| Rate for Payer: Coventry All Commercial |
$13.69
|
| Rate for Payer: Encore All Commercial |
$14.32
|
| Rate for Payer: Frontpath All Commercial |
$14.32
|
| Rate for Payer: Humana ChoiceCare |
$13.44
|
| Rate for Payer: Humana Medicare |
$4.98
|
| Rate for Payer: Lucent All Commercial |
$8.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$11.67
|
| Rate for Payer: PHP All Commercial |
$11.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.07
|
| Rate for Payer: Sagamore Health Network All Products |
$12.01
|
| Rate for Payer: Signature Care EPO |
$12.92
|
| Rate for Payer: Signature Care PPO |
$13.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.23
|
| Rate for Payer: United Healthcare Commercial |
$12.26
|
| Rate for Payer: United Healthcare Medicare |
$4.98
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
|
IP
|
$15.56
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Aetna Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cigna All Commercial |
$13.43
|
| Rate for Payer: CORVEL All Commercial |
$14.47
|
| Rate for Payer: Coventry All Commercial |
$13.69
|
| Rate for Payer: Encore All Commercial |
$14.32
|
| Rate for Payer: Frontpath All Commercial |
$14.32
|
| Rate for Payer: Humana ChoiceCare |
$13.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$11.67
|
| Rate for Payer: PHP All Commercial |
$11.80
|
| Rate for Payer: Sagamore Health Network All Products |
$12.01
|
| Rate for Payer: Signature Care EPO |
$12.92
|
| Rate for Payer: Signature Care PPO |
$13.69
|
| Rate for Payer: United Healthcare Commercial |
$12.26
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
|
IP
|
$15.56
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Aetna Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cigna All Commercial |
$13.43
|
| Rate for Payer: CORVEL All Commercial |
$14.47
|
| Rate for Payer: Coventry All Commercial |
$13.69
|
| Rate for Payer: Encore All Commercial |
$14.32
|
| Rate for Payer: Frontpath All Commercial |
$14.32
|
| Rate for Payer: Humana ChoiceCare |
$13.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$11.67
|
| Rate for Payer: PHP All Commercial |
$11.80
|
| Rate for Payer: Sagamore Health Network All Products |
$12.01
|
| Rate for Payer: Signature Care EPO |
$12.92
|
| Rate for Payer: Signature Care PPO |
$13.69
|
| Rate for Payer: United Healthcare Commercial |
$12.26
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
|
OP
|
$15.56
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.48
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Centivo All Commercial |
$8.47
|
| Rate for Payer: Cigna All Commercial |
$13.43
|
| Rate for Payer: CORVEL All Commercial |
$14.47
|
| Rate for Payer: Coventry All Commercial |
$13.69
|
| Rate for Payer: Encore All Commercial |
$14.32
|
| Rate for Payer: Frontpath All Commercial |
$14.32
|
| Rate for Payer: Humana ChoiceCare |
$13.44
|
| Rate for Payer: Humana Medicare |
$4.98
|
| Rate for Payer: Lucent All Commercial |
$8.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$11.67
|
| Rate for Payer: PHP All Commercial |
$11.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.07
|
| Rate for Payer: Sagamore Health Network All Products |
$12.01
|
| Rate for Payer: Signature Care EPO |
$12.92
|
| Rate for Payer: Signature Care PPO |
$13.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.23
|
| Rate for Payer: United Healthcare Commercial |
$12.26
|
| Rate for Payer: United Healthcare Medicare |
$4.98
|
|
|
PR OSTEOCHONDRAL KNEE ALLOGRAFT
|
Professional
|
Both
|
$2,524.92
|
|
|
Service Code
|
CPT 27415
|
| Hospital Charge Code |
z27415
|
| Min. Negotiated Rate |
$1,238.32 |
| Max. Negotiated Rate |
$2,154.67 |
| Rate for Payer: Aetna Commercial |
$1,273.57
|
| Rate for Payer: Aetna Commercial |
$1,273.57
|
| Rate for Payer: Aetna Medicare |
$1,273.57
|
| Rate for Payer: Aetna Medicare |
$1,273.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,241.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,241.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,464.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,464.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,400.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,400.93
|
| Rate for Payer: Cash Price |
$1,514.95
|
| Rate for Payer: Cash Price |
$1,485.98
|
| Rate for Payer: Centivo All Commercial |
$1,974.03
|
| Rate for Payer: Centivo All Commercial |
$1,974.03
|
| Rate for Payer: Cigna All Commercial |
$1,273.57
|
| Rate for Payer: Cigna All Commercial |
$1,273.57
|
| Rate for Payer: CORVEL All Commercial |
$1,273.57
|
| Rate for Payer: CORVEL All Commercial |
$1,273.57
|
| Rate for Payer: Coventry All Commercial |
$1,528.28
|
| Rate for Payer: Coventry All Commercial |
$1,528.28
|
| Rate for Payer: Encore All Commercial |
$1,273.57
|
| Rate for Payer: Encore All Commercial |
$1,273.57
|
| Rate for Payer: Frontpath All Commercial |
$1,781.90
|
| Rate for Payer: Frontpath All Commercial |
$1,781.90
|
| Rate for Payer: Humana ChoiceCare |
$1,388.02
|
| Rate for Payer: Humana ChoiceCare |
$1,388.02
|
| Rate for Payer: Humana Medicare |
$1,273.57
|
| Rate for Payer: Humana Medicare |
$1,273.57
|
| Rate for Payer: Lucent All Commercial |
$1,783.00
|
| Rate for Payer: Lucent All Commercial |
$1,783.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,241.86
|
| Rate for Payer: Managed Health Services Medicaid |
$1,241.86
|
| Rate for Payer: MDWise Medicaid |
$1,241.86
|
| Rate for Payer: MDWise Medicaid |
$1,241.86
|
| Rate for Payer: PHCS All Commercial |
$1,273.57
|
| Rate for Payer: PHCS All Commercial |
$1,273.57
|
| Rate for Payer: PHP All Commercial |
$2,154.67
|
| Rate for Payer: PHP All Commercial |
$2,154.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,273.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,273.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,273.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,273.57
|
| Rate for Payer: Signature Care EPO |
$1,877.65
|
| Rate for Payer: Signature Care EPO |
$1,877.65
|
| Rate for Payer: Signature Care PPO |
$1,877.65
|
| Rate for Payer: Signature Care PPO |
$1,877.65
|
| Rate for Payer: United Healthcare Commercial |
$1,521.06
|
| Rate for Payer: United Healthcare Commercial |
$1,521.06
|
| Rate for Payer: United Healthcare Medicare |
$1,238.32
|
| Rate for Payer: United Healthcare Medicare |
$1,238.32
|
|
|
PR OSTEOCHONDRAL KNEE AUTOGRAFT
|
Professional
|
Both
|
$1,808.86
|
|
|
Service Code
|
CPT 27416
|
| Hospital Charge Code |
z27416
|
| Min. Negotiated Rate |
$886.81 |
| Max. Negotiated Rate |
$136,400.00 |
| Rate for Payer: Aetna Commercial |
$911.85
|
| Rate for Payer: Aetna Commercial |
$911.85
|
| Rate for Payer: Aetna Medicare |
$911.85
|
| Rate for Payer: Aetna Medicare |
$911.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,322.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,322.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,322.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,322.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,322.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,322.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,322.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,322.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$889.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$889.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,048.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,048.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,003.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,003.03
|
| Rate for Payer: Cash Price |
$1,085.32
|
| Rate for Payer: Cash Price |
$1,064.17
|
| Rate for Payer: Centivo All Commercial |
$1,413.37
|
| Rate for Payer: Centivo All Commercial |
$1,413.37
|
| Rate for Payer: Cigna All Commercial |
$911.85
|
| Rate for Payer: Cigna All Commercial |
$911.85
|
| Rate for Payer: CORVEL All Commercial |
$911.85
|
| Rate for Payer: CORVEL All Commercial |
$911.85
|
| Rate for Payer: Coventry All Commercial |
$1,094.22
|
| Rate for Payer: Coventry All Commercial |
$1,094.22
|
| Rate for Payer: Encore All Commercial |
$911.85
|
| Rate for Payer: Encore All Commercial |
$911.85
|
| Rate for Payer: Frontpath All Commercial |
$1,275.35
|
| Rate for Payer: Frontpath All Commercial |
$1,275.35
|
| Rate for Payer: Humana ChoiceCare |
$929.04
|
| Rate for Payer: Humana ChoiceCare |
$929.04
|
| Rate for Payer: Humana Medicare |
$911.85
|
| Rate for Payer: Humana Medicare |
$911.85
|
| Rate for Payer: Lucent All Commercial |
$1,276.59
|
| Rate for Payer: Lucent All Commercial |
$1,276.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,455.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,455.00
|
| Rate for Payer: Managed Health Services Medicaid |
$889.66
|
| Rate for Payer: Managed Health Services Medicaid |
$889.66
|
| Rate for Payer: MDWise Medicaid |
$889.66
|
| Rate for Payer: MDWise Medicaid |
$889.66
|
| Rate for Payer: PHCS All Commercial |
$911.85
|
| Rate for Payer: PHCS All Commercial |
$911.85
|
| Rate for Payer: PHP All Commercial |
$1,543.05
|
| Rate for Payer: PHP All Commercial |
$1,543.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$911.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$911.85
|
| Rate for Payer: Sagamore Health Network All Products |
$911.85
|
| Rate for Payer: Sagamore Health Network All Products |
$911.85
|
| Rate for Payer: Signature Care EPO |
$1,261.31
|
| Rate for Payer: Signature Care EPO |
$1,261.31
|
| Rate for Payer: Signature Care PPO |
$1,261.31
|
| Rate for Payer: Signature Care PPO |
$1,261.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136,400.00
|
| Rate for Payer: United Healthcare Commercial |
$1,052.64
|
| Rate for Payer: United Healthcare Commercial |
$1,052.64
|
| Rate for Payer: United Healthcare Medicare |
$886.81
|
| Rate for Payer: United Healthcare Medicare |
$886.81
|
|
|
PR OSTEOPATHIC MANIP,1-2 BODY REGN
|
Professional
|
Both
|
$59.22
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
z98925
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$22.48
|
| Rate for Payer: Aetna Commercial |
$22.48
|
| Rate for Payer: Aetna Medicare |
$22.48
|
| Rate for Payer: Aetna Medicare |
$22.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.13
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$11.94
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$11.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.73
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$35.53
|
| Rate for Payer: Centivo All Commercial |
$34.84
|
| Rate for Payer: Centivo All Commercial |
$34.84
|
| Rate for Payer: Cigna All Commercial |
$22.48
|
| Rate for Payer: Cigna All Commercial |
$22.48
|
| Rate for Payer: CORVEL All Commercial |
$22.48
|
| Rate for Payer: CORVEL All Commercial |
$22.48
|
| Rate for Payer: Coventry All Commercial |
$26.98
|
| Rate for Payer: Coventry All Commercial |
$26.98
|
| Rate for Payer: Encore All Commercial |
$22.48
|
| Rate for Payer: Encore All Commercial |
$22.48
|
| Rate for Payer: Frontpath All Commercial |
$24.38
|
| Rate for Payer: Frontpath All Commercial |
$24.38
|
| Rate for Payer: Humana ChoiceCare |
$22.97
|
| Rate for Payer: Humana ChoiceCare |
$22.97
|
| Rate for Payer: Humana Medicare |
$22.48
|
| Rate for Payer: Humana Medicare |
$22.48
|
| Rate for Payer: Lucent All Commercial |
$31.47
|
| Rate for Payer: Lucent All Commercial |
$31.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.00
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$11.94
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$11.94
|
| Rate for Payer: PHCS All Commercial |
$22.48
|
| Rate for Payer: PHCS All Commercial |
$22.48
|
| Rate for Payer: PHP All Commercial |
$21.56
|
| Rate for Payer: PHP All Commercial |
$21.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.48
|
| Rate for Payer: Sagamore Health Network All Products |
$22.48
|
| Rate for Payer: Sagamore Health Network All Products |
$22.48
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare Commercial |
$26.21
|
| Rate for Payer: United Healthcare Commercial |
$26.21
|
| Rate for Payer: United Healthcare Medicare |
$28.79
|
| Rate for Payer: United Healthcare Medicare |
$28.79
|
|
|
PR OSTEOPATHIC MANIP,3-4 BODY REGN
|
Professional
|
Both
|
$85.38
|
|
|
Service Code
|
CPT 98926
|
| Hospital Charge Code |
z98926
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$52.59 |
| Rate for Payer: Aetna Commercial |
$33.93
|
| Rate for Payer: Aetna Commercial |
$33.93
|
| Rate for Payer: Aetna Medicare |
$33.93
|
| Rate for Payer: Aetna Medicare |
$33.93
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$17.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$17.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.32
|
| Rate for Payer: Cash Price |
$49.88
|
| Rate for Payer: Cash Price |
$51.23
|
| Rate for Payer: Centivo All Commercial |
$52.59
|
| Rate for Payer: Centivo All Commercial |
$52.59
|
| Rate for Payer: Cigna All Commercial |
$33.93
|
| Rate for Payer: Cigna All Commercial |
$33.93
|
| Rate for Payer: CORVEL All Commercial |
$33.93
|
| Rate for Payer: CORVEL All Commercial |
$33.93
|
| Rate for Payer: Coventry All Commercial |
$40.72
|
| Rate for Payer: Coventry All Commercial |
$40.72
|
| Rate for Payer: Encore All Commercial |
$33.93
|
| Rate for Payer: Encore All Commercial |
$33.93
|
| Rate for Payer: Frontpath All Commercial |
$36.33
|
| Rate for Payer: Frontpath All Commercial |
$36.33
|
| Rate for Payer: Humana ChoiceCare |
$34.89
|
| Rate for Payer: Humana ChoiceCare |
$34.89
|
| Rate for Payer: Humana Medicare |
$33.93
|
| Rate for Payer: Humana Medicare |
$33.93
|
| Rate for Payer: Lucent All Commercial |
$47.50
|
| Rate for Payer: Lucent All Commercial |
$47.50
|
| Rate for Payer: Managed Health Services Medicaid |
$42.00
|
| Rate for Payer: Managed Health Services Medicaid |
$42.00
|
| Rate for Payer: MDWise Medicaid |
$42.00
|
| Rate for Payer: MDWise Medicaid |
$42.00
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$17.82
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$17.82
|
| Rate for Payer: PHCS All Commercial |
$33.93
|
| Rate for Payer: PHCS All Commercial |
$33.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.93
|
| Rate for Payer: Sagamore Health Network All Products |
$33.93
|
| Rate for Payer: Sagamore Health Network All Products |
$33.93
|
| Rate for Payer: United Healthcare Commercial |
$38.39
|
| Rate for Payer: United Healthcare Commercial |
$38.39
|
| Rate for Payer: United Healthcare Medicare |
$41.57
|
| Rate for Payer: United Healthcare Medicare |
$41.57
|
|
|
PR OSTEOPATHIC MANIP,5-6 BODY REGN
|
Professional
|
Both
|
$111.56
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
z98927
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$69.64 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Medicare |
$44.93
|
| Rate for Payer: Aetna Medicare |
$44.93
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$23.53
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$23.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.42
|
| Rate for Payer: Cash Price |
$64.86
|
| Rate for Payer: Cash Price |
$66.94
|
| Rate for Payer: Centivo All Commercial |
$69.64
|
| Rate for Payer: Centivo All Commercial |
$69.64
|
| Rate for Payer: Cigna All Commercial |
$44.93
|
| Rate for Payer: Cigna All Commercial |
$44.93
|
| Rate for Payer: CORVEL All Commercial |
$44.93
|
| Rate for Payer: CORVEL All Commercial |
$44.93
|
| Rate for Payer: Coventry All Commercial |
$53.92
|
| Rate for Payer: Coventry All Commercial |
$53.92
|
| Rate for Payer: Encore All Commercial |
$44.93
|
| Rate for Payer: Encore All Commercial |
$44.93
|
| Rate for Payer: Frontpath All Commercial |
$48.02
|
| Rate for Payer: Frontpath All Commercial |
$48.02
|
| Rate for Payer: Humana ChoiceCare |
$44.94
|
| Rate for Payer: Humana ChoiceCare |
$44.94
|
| Rate for Payer: Humana Medicare |
$44.93
|
| Rate for Payer: Humana Medicare |
$44.93
|
| Rate for Payer: Lucent All Commercial |
$62.90
|
| Rate for Payer: Lucent All Commercial |
$62.90
|
| Rate for Payer: Managed Health Services Medicaid |
$54.87
|
| Rate for Payer: Managed Health Services Medicaid |
$54.87
|
| Rate for Payer: MDWise Medicaid |
$54.87
|
| Rate for Payer: MDWise Medicaid |
$54.87
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$23.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$23.53
|
| Rate for Payer: PHCS All Commercial |
$44.93
|
| Rate for Payer: PHCS All Commercial |
$44.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.93
|
| Rate for Payer: Sagamore Health Network All Products |
$44.93
|
| Rate for Payer: Sagamore Health Network All Products |
$44.93
|
| Rate for Payer: United Healthcare Commercial |
$50.38
|
| Rate for Payer: United Healthcare Commercial |
$50.38
|
| Rate for Payer: United Healthcare Medicare |
$54.05
|
| Rate for Payer: United Healthcare Medicare |
$54.05
|
|
|
PR OSTEOTOMY HUMERUS
|
Professional
|
Both
|
$1,534.46
|
|
|
Service Code
|
CPT 24400
|
| Hospital Charge Code |
z24400
|
| Min. Negotiated Rate |
$751.77 |
| Max. Negotiated Rate |
$1,193.22 |
| Rate for Payer: Aetna Commercial |
$769.82
|
| Rate for Payer: Aetna Medicare |
$769.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$754.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$885.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$846.80
|
| Rate for Payer: Cash Price |
$920.68
|
| Rate for Payer: Centivo All Commercial |
$1,193.22
|
| Rate for Payer: Cigna All Commercial |
$769.82
|
| Rate for Payer: CORVEL All Commercial |
$769.82
|
| Rate for Payer: Coventry All Commercial |
$923.78
|
| Rate for Payer: Encore All Commercial |
$769.82
|
| Rate for Payer: Frontpath All Commercial |
$1,071.69
|
| Rate for Payer: Humana ChoiceCare |
$869.77
|
| Rate for Payer: Humana Medicare |
$769.82
|
| Rate for Payer: Lucent All Commercial |
$1,077.75
|
| Rate for Payer: Managed Health Services Medicaid |
$754.70
|
| Rate for Payer: MDWise Medicaid |
$754.70
|
| Rate for Payer: PHCS All Commercial |
$769.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$769.82
|
| Rate for Payer: Sagamore Health Network All Products |
$769.82
|
| Rate for Payer: United Healthcare Commercial |
$891.00
|
| Rate for Payer: United Healthcare Medicare |
$751.77
|
|
|
PR OSTEOTOMY TIBIA
|
Professional
|
Both
|
$1,392.16
|
|
|
Service Code
|
CPT 27705
|
| Hospital Charge Code |
z27705
|
| Min. Negotiated Rate |
$684.72 |
| Max. Negotiated Rate |
$1,193.43 |
| Rate for Payer: Aetna Commercial |
$708.90
|
| Rate for Payer: Aetna Commercial |
$708.90
|
| Rate for Payer: Aetna Medicare |
$708.90
|
| Rate for Payer: Aetna Medicare |
$708.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$684.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$684.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$815.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$815.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$779.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$779.79
|
| Rate for Payer: Cash Price |
$835.30
|
| Rate for Payer: Cash Price |
$823.06
|
| Rate for Payer: Centivo All Commercial |
$1,098.80
|
| Rate for Payer: Centivo All Commercial |
$1,098.80
|
| Rate for Payer: Cigna All Commercial |
$708.90
|
| Rate for Payer: Cigna All Commercial |
$708.90
|
| Rate for Payer: CORVEL All Commercial |
$708.90
|
| Rate for Payer: CORVEL All Commercial |
$708.90
|
| Rate for Payer: Coventry All Commercial |
$850.68
|
| Rate for Payer: Coventry All Commercial |
$850.68
|
| Rate for Payer: Encore All Commercial |
$708.90
|
| Rate for Payer: Encore All Commercial |
$708.90
|
| Rate for Payer: Frontpath All Commercial |
$985.50
|
| Rate for Payer: Frontpath All Commercial |
$985.50
|
| Rate for Payer: Humana ChoiceCare |
$810.50
|
| Rate for Payer: Humana ChoiceCare |
$810.50
|
| Rate for Payer: Humana Medicare |
$708.90
|
| Rate for Payer: Humana Medicare |
$708.90
|
| Rate for Payer: Lucent All Commercial |
$992.46
|
| Rate for Payer: Lucent All Commercial |
$992.46
|
| Rate for Payer: Managed Health Services Medicaid |
$684.72
|
| Rate for Payer: Managed Health Services Medicaid |
$684.72
|
| Rate for Payer: MDWise Medicaid |
$684.72
|
| Rate for Payer: MDWise Medicaid |
$684.72
|
| Rate for Payer: PHCS All Commercial |
$708.90
|
| Rate for Payer: PHCS All Commercial |
$708.90
|
| Rate for Payer: PHP All Commercial |
$1,193.43
|
| Rate for Payer: PHP All Commercial |
$1,193.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$708.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$708.90
|
| Rate for Payer: Sagamore Health Network All Products |
$708.90
|
| Rate for Payer: Sagamore Health Network All Products |
$708.90
|
| Rate for Payer: Signature Care EPO |
$1,088.85
|
| Rate for Payer: Signature Care EPO |
$1,088.85
|
| Rate for Payer: Signature Care PPO |
$1,088.85
|
| Rate for Payer: Signature Care PPO |
$1,088.85
|
| Rate for Payer: United Healthcare Commercial |
$838.09
|
| Rate for Payer: United Healthcare Commercial |
$838.09
|
| Rate for Payer: United Healthcare Medicare |
$685.88
|
| Rate for Payer: United Healthcare Medicare |
$685.88
|
|
|
PROTAMINE 10 MG/ML IV SOLN
|
Facility
|
IP
|
$347.20
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$322.90 |
| Rate for Payer: Aetna Commercial |
$299.98
|
| Rate for Payer: Cash Price |
$208.32
|
| Rate for Payer: Cigna All Commercial |
$299.63
|
| Rate for Payer: CORVEL All Commercial |
$322.90
|
| Rate for Payer: Coventry All Commercial |
$305.54
|
| Rate for Payer: Encore All Commercial |
$319.60
|
| Rate for Payer: Frontpath All Commercial |
$319.42
|
| Rate for Payer: Humana ChoiceCare |
$299.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$312.48
|
| Rate for Payer: PHCS All Commercial |
$260.40
|
| Rate for Payer: PHP All Commercial |
$263.32
|
| Rate for Payer: Sagamore Health Network All Products |
$268.04
|
| Rate for Payer: Signature Care EPO |
$288.18
|
| Rate for Payer: Signature Care PPO |
$305.54
|
| Rate for Payer: United Healthcare Commercial |
$273.59
|
|
|
PROTAMINE 10 MG/ML IV SOLN
|
Facility
|
OP
|
$347.20
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.63 |
| Max. Negotiated Rate |
$322.90 |
| Rate for Payer: Aetna Commercial |
$293.04
|
| Rate for Payer: Aetna Medicare |
$111.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$199.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$217.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.21
|
| Rate for Payer: Cash Price |
$208.32
|
| Rate for Payer: Centivo All Commercial |
$188.88
|
| Rate for Payer: Cigna All Commercial |
$299.63
|
| Rate for Payer: CORVEL All Commercial |
$322.90
|
| Rate for Payer: Coventry All Commercial |
$305.54
|
| Rate for Payer: Encore All Commercial |
$319.60
|
| Rate for Payer: Frontpath All Commercial |
$319.42
|
| Rate for Payer: Humana ChoiceCare |
$299.88
|
| Rate for Payer: Humana Medicare |
$111.10
|
| Rate for Payer: Lucent All Commercial |
$188.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$312.48
|
| Rate for Payer: PHCS All Commercial |
$260.40
|
| Rate for Payer: PHP All Commercial |
$263.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.41
|
| Rate for Payer: Sagamore Health Network All Products |
$268.04
|
| Rate for Payer: Signature Care EPO |
$288.18
|
| Rate for Payer: Signature Care PPO |
$305.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$295.12
|
| Rate for Payer: United Healthcare Commercial |
$273.59
|
| Rate for Payer: United Healthcare Medicare |
$111.10
|
|
|
PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1
|
Professional
|
Both
|
$132.30
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
z11055
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: Aetna Medicare |
$15.25
|
| Rate for Payer: Aetna Medicare |
$15.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$64.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$64.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.99
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$9.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$9.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.77
|
| Rate for Payer: Cash Price |
$78.25
|
| Rate for Payer: Cash Price |
$79.38
|
| Rate for Payer: Centivo All Commercial |
$23.64
|
| Rate for Payer: Centivo All Commercial |
$23.64
|
| Rate for Payer: Cigna All Commercial |
$15.25
|
| Rate for Payer: Cigna All Commercial |
$15.25
|
| Rate for Payer: CORVEL All Commercial |
$15.25
|
| Rate for Payer: CORVEL All Commercial |
$15.25
|
| Rate for Payer: Coventry All Commercial |
$18.30
|
| Rate for Payer: Coventry All Commercial |
$18.30
|
| Rate for Payer: Encore All Commercial |
$15.25
|
| Rate for Payer: Encore All Commercial |
$15.25
|
| Rate for Payer: Frontpath All Commercial |
$20.99
|
| Rate for Payer: Frontpath All Commercial |
$20.99
|
| Rate for Payer: Humana ChoiceCare |
$22.96
|
| Rate for Payer: Humana ChoiceCare |
$22.96
|
| Rate for Payer: Humana Medicare |
$15.25
|
| Rate for Payer: Humana Medicare |
$15.25
|
| Rate for Payer: Lucent All Commercial |
$21.35
|
| Rate for Payer: Lucent All Commercial |
$21.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.00
|
| Rate for Payer: Managed Health Services Medicaid |
$65.07
|
| Rate for Payer: Managed Health Services Medicaid |
$65.07
|
| Rate for Payer: MDWise Medicaid |
$65.07
|
| Rate for Payer: MDWise Medicaid |
$65.07
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$9.82
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$9.82
|
| Rate for Payer: PHCS All Commercial |
$15.25
|
| Rate for Payer: PHCS All Commercial |
$15.25
|
| Rate for Payer: PHP All Commercial |
$20.45
|
| Rate for Payer: PHP All Commercial |
$20.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.25
|
| Rate for Payer: Sagamore Health Network All Products |
$15.25
|
| Rate for Payer: Sagamore Health Network All Products |
$15.25
|
| Rate for Payer: Signature Care EPO |
$57.70
|
| Rate for Payer: Signature Care EPO |
$57.70
|
| Rate for Payer: Signature Care PPO |
$57.70
|
| Rate for Payer: Signature Care PPO |
$57.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare Commercial |
$26.11
|
| Rate for Payer: United Healthcare Commercial |
$26.11
|
| Rate for Payer: United Healthcare Medicare |
$65.21
|
| Rate for Payer: United Healthcare Medicare |
$65.21
|
|
|
PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4
|
Professional
|
Both
|
$153.66
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
z11056
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$75.58 |
| Rate for Payer: Aetna Commercial |
$21.37
|
| Rate for Payer: Aetna Commercial |
$21.37
|
| Rate for Payer: Aetna Medicare |
$21.37
|
| Rate for Payer: Aetna Medicare |
$21.37
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.51
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$92.20
|
| Rate for Payer: Centivo All Commercial |
$33.12
|
| Rate for Payer: Centivo All Commercial |
$33.12
|
| Rate for Payer: Cigna All Commercial |
$21.37
|
| Rate for Payer: Cigna All Commercial |
$21.37
|
| Rate for Payer: CORVEL All Commercial |
$21.37
|
| Rate for Payer: CORVEL All Commercial |
$21.37
|
| Rate for Payer: Coventry All Commercial |
$25.64
|
| Rate for Payer: Coventry All Commercial |
$25.64
|
| Rate for Payer: Encore All Commercial |
$21.37
|
| Rate for Payer: Encore All Commercial |
$21.37
|
| Rate for Payer: Frontpath All Commercial |
$28.98
|
| Rate for Payer: Frontpath All Commercial |
$28.98
|
| Rate for Payer: Humana ChoiceCare |
$32.17
|
| Rate for Payer: Humana ChoiceCare |
$32.17
|
| Rate for Payer: Humana Medicare |
$21.37
|
| Rate for Payer: Humana Medicare |
$21.37
|
| Rate for Payer: Lucent All Commercial |
$29.92
|
| Rate for Payer: Lucent All Commercial |
$29.92
|
| Rate for Payer: Managed Health Services Medicaid |
$75.58
|
| Rate for Payer: Managed Health Services Medicaid |
$75.58
|
| Rate for Payer: MDWise Medicaid |
$75.58
|
| Rate for Payer: MDWise Medicaid |
$75.58
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.45
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.45
|
| Rate for Payer: PHCS All Commercial |
$21.37
|
| Rate for Payer: PHCS All Commercial |
$21.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.37
|
| Rate for Payer: Sagamore Health Network All Products |
$21.37
|
| Rate for Payer: Sagamore Health Network All Products |
$21.37
|
| Rate for Payer: United Healthcare Commercial |
$36.84
|
| Rate for Payer: United Healthcare Commercial |
$36.84
|
| Rate for Payer: United Healthcare Medicare |
$75.29
|
| Rate for Payer: United Healthcare Medicare |
$75.29
|
|
|
PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4
|
Professional
|
Both
|
$168.26
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
z11057
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$82.76 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Medicare |
$27.66
|
| Rate for Payer: Aetna Medicare |
$27.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$82.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$82.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.43
|
| Rate for Payer: Cash Price |
$98.82
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Centivo All Commercial |
$42.87
|
| Rate for Payer: Centivo All Commercial |
$42.87
|
| Rate for Payer: Cigna All Commercial |
$27.66
|
| Rate for Payer: Cigna All Commercial |
$27.66
|
| Rate for Payer: CORVEL All Commercial |
$27.66
|
| Rate for Payer: CORVEL All Commercial |
$27.66
|
| Rate for Payer: Coventry All Commercial |
$33.19
|
| Rate for Payer: Coventry All Commercial |
$33.19
|
| Rate for Payer: Encore All Commercial |
$27.66
|
| Rate for Payer: Encore All Commercial |
$27.66
|
| Rate for Payer: Frontpath All Commercial |
$37.45
|
| Rate for Payer: Frontpath All Commercial |
$37.45
|
| Rate for Payer: Humana ChoiceCare |
$41.89
|
| Rate for Payer: Humana ChoiceCare |
$41.89
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Lucent All Commercial |
$38.72
|
| Rate for Payer: Lucent All Commercial |
$38.72
|
| Rate for Payer: Managed Health Services Medicaid |
$82.76
|
| Rate for Payer: Managed Health Services Medicaid |
$82.76
|
| Rate for Payer: MDWise Medicaid |
$82.76
|
| Rate for Payer: MDWise Medicaid |
$82.76
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$21.43
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$21.43
|
| Rate for Payer: PHCS All Commercial |
$27.66
|
| Rate for Payer: PHCS All Commercial |
$27.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.66
|
| Rate for Payer: Sagamore Health Network All Products |
$27.66
|
| Rate for Payer: Sagamore Health Network All Products |
$27.66
|
| Rate for Payer: United Healthcare Commercial |
$47.84
|
| Rate for Payer: United Healthcare Commercial |
$47.84
|
| Rate for Payer: United Healthcare Medicare |
$82.35
|
| Rate for Payer: United Healthcare Medicare |
$82.35
|
|
|
PR PART EXCIS 5TH METATARSAL HEAD
|
Professional
|
Both
|
$835.26
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
z28110
|
| Min. Negotiated Rate |
$147.77 |
| Max. Negotiated Rate |
$425.10 |
| Rate for Payer: Aetna Commercial |
$274.26
|
| Rate for Payer: Aetna Commercial |
$274.26
|
| Rate for Payer: Aetna Medicare |
$274.26
|
| Rate for Payer: Aetna Medicare |
$274.26
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$147.77
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$147.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$424.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$424.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.69
|
| Rate for Payer: Cash Price |
$517.39
|
| Rate for Payer: Cash Price |
$501.16
|
| Rate for Payer: Centivo All Commercial |
$425.10
|
| Rate for Payer: Centivo All Commercial |
$425.10
|
| Rate for Payer: Cigna All Commercial |
$274.26
|
| Rate for Payer: Cigna All Commercial |
$274.26
|
| Rate for Payer: CORVEL All Commercial |
$274.26
|
| Rate for Payer: CORVEL All Commercial |
$274.26
|
| Rate for Payer: Coventry All Commercial |
$329.11
|
| Rate for Payer: Coventry All Commercial |
$329.11
|
| Rate for Payer: Encore All Commercial |
$274.26
|
| Rate for Payer: Encore All Commercial |
$274.26
|
| Rate for Payer: Frontpath All Commercial |
$370.71
|
| Rate for Payer: Frontpath All Commercial |
$370.71
|
| Rate for Payer: Humana ChoiceCare |
$315.73
|
| Rate for Payer: Humana ChoiceCare |
$315.73
|
| Rate for Payer: Humana Medicare |
$274.26
|
| Rate for Payer: Humana Medicare |
$274.26
|
| Rate for Payer: Lucent All Commercial |
$383.96
|
| Rate for Payer: Lucent All Commercial |
$383.96
|
| Rate for Payer: Managed Health Services Medicaid |
$424.13
|
| Rate for Payer: Managed Health Services Medicaid |
$424.13
|
| Rate for Payer: MDWise Medicaid |
$424.13
|
| Rate for Payer: MDWise Medicaid |
$424.13
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$147.77
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$147.77
|
| Rate for Payer: PHCS All Commercial |
$274.26
|
| Rate for Payer: PHCS All Commercial |
$274.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.26
|
| Rate for Payer: Sagamore Health Network All Products |
$274.26
|
| Rate for Payer: Sagamore Health Network All Products |
$274.26
|
| Rate for Payer: United Healthcare Commercial |
$327.84
|
| Rate for Payer: United Healthcare Commercial |
$327.84
|
| Rate for Payer: United Healthcare Medicare |
$417.63
|
| Rate for Payer: United Healthcare Medicare |
$417.63
|
|
|
PR PART/FULL REMOVAL OF KNEECAP
|
Professional
|
Both
|
$1,219.54
|
|
|
Service Code
|
CPT 27350
|
| Hospital Charge Code |
z27350
|
| Min. Negotiated Rate |
$596.43 |
| Max. Negotiated Rate |
$91,700.00 |
| Rate for Payer: Aetna Commercial |
$611.44
|
| Rate for Payer: Aetna Commercial |
$611.44
|
| Rate for Payer: Aetna Medicare |
$611.44
|
| Rate for Payer: Aetna Medicare |
$611.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$838.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$838.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$838.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$838.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$838.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$838.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$838.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$838.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$599.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$599.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$703.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$703.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$672.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$672.58
|
| Rate for Payer: Cash Price |
$731.72
|
| Rate for Payer: Cash Price |
$715.72
|
| Rate for Payer: Centivo All Commercial |
$947.73
|
| Rate for Payer: Centivo All Commercial |
$947.73
|
| Rate for Payer: Cigna All Commercial |
$611.44
|
| Rate for Payer: Cigna All Commercial |
$611.44
|
| Rate for Payer: CORVEL All Commercial |
$611.44
|
| Rate for Payer: CORVEL All Commercial |
$611.44
|
| Rate for Payer: Coventry All Commercial |
$733.73
|
| Rate for Payer: Coventry All Commercial |
$733.73
|
| Rate for Payer: Encore All Commercial |
$611.44
|
| Rate for Payer: Encore All Commercial |
$611.44
|
| Rate for Payer: Frontpath All Commercial |
$849.99
|
| Rate for Payer: Frontpath All Commercial |
$849.99
|
| Rate for Payer: Humana ChoiceCare |
$670.25
|
| Rate for Payer: Humana ChoiceCare |
$670.25
|
| Rate for Payer: Humana Medicare |
$611.44
|
| Rate for Payer: Humana Medicare |
$611.44
|
| Rate for Payer: Lucent All Commercial |
$856.02
|
| Rate for Payer: Lucent All Commercial |
$856.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$978.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$978.00
|
| Rate for Payer: Managed Health Services Medicaid |
$599.82
|
| Rate for Payer: Managed Health Services Medicaid |
$599.82
|
| Rate for Payer: MDWise Medicaid |
$599.82
|
| Rate for Payer: MDWise Medicaid |
$599.82
|
| Rate for Payer: PHCS All Commercial |
$611.44
|
| Rate for Payer: PHCS All Commercial |
$611.44
|
| Rate for Payer: PHP All Commercial |
$1,037.79
|
| Rate for Payer: PHP All Commercial |
$1,037.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$611.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$611.44
|
| Rate for Payer: Sagamore Health Network All Products |
$611.44
|
| Rate for Payer: Sagamore Health Network All Products |
$611.44
|
| Rate for Payer: Signature Care EPO |
$895.90
|
| Rate for Payer: Signature Care EPO |
$895.90
|
| Rate for Payer: Signature Care PPO |
$895.90
|
| Rate for Payer: Signature Care PPO |
$895.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: United Healthcare Commercial |
$697.89
|
| Rate for Payer: United Healthcare Commercial |
$697.89
|
| Rate for Payer: United Healthcare Medicare |
$596.43
|
| Rate for Payer: United Healthcare Medicare |
$596.43
|
|
|
PR PARTIAL EXCISION DEEP PELVIS
|
Professional
|
Both
|
$1,795.72
|
|
|
Service Code
|
CPT 27071
|
| Hospital Charge Code |
z27071
|
| Min. Negotiated Rate |
$883.21 |
| Max. Negotiated Rate |
$136,100.00 |
| Rate for Payer: Aetna Commercial |
$910.83
|
| Rate for Payer: Aetna Commercial |
$910.83
|
| Rate for Payer: Aetna Medicare |
$910.83
|
| Rate for Payer: Aetna Medicare |
$910.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,185.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$883.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$883.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,047.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,047.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,001.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,001.91
|
| Rate for Payer: Cash Price |
$1,077.43
|
| Rate for Payer: Cash Price |
$1,062.34
|
| Rate for Payer: Centivo All Commercial |
$1,411.79
|
| Rate for Payer: Centivo All Commercial |
$1,411.79
|
| Rate for Payer: Cigna All Commercial |
$910.83
|
| Rate for Payer: Cigna All Commercial |
$910.83
|
| Rate for Payer: CORVEL All Commercial |
$910.83
|
| Rate for Payer: CORVEL All Commercial |
$910.83
|
| Rate for Payer: Coventry All Commercial |
$1,093.00
|
| Rate for Payer: Coventry All Commercial |
$1,093.00
|
| Rate for Payer: Encore All Commercial |
$910.83
|
| Rate for Payer: Encore All Commercial |
$910.83
|
| Rate for Payer: Frontpath All Commercial |
$1,264.51
|
| Rate for Payer: Frontpath All Commercial |
$1,264.51
|
| Rate for Payer: Humana ChoiceCare |
$937.46
|
| Rate for Payer: Humana ChoiceCare |
$937.46
|
| Rate for Payer: Humana Medicare |
$910.83
|
| Rate for Payer: Humana Medicare |
$910.83
|
| Rate for Payer: Lucent All Commercial |
$1,275.16
|
| Rate for Payer: Lucent All Commercial |
$1,275.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,452.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$883.21
|
| Rate for Payer: Managed Health Services Medicaid |
$883.21
|
| Rate for Payer: MDWise Medicaid |
$883.21
|
| Rate for Payer: MDWise Medicaid |
$883.21
|
| Rate for Payer: PHCS All Commercial |
$910.83
|
| Rate for Payer: PHCS All Commercial |
$910.83
|
| Rate for Payer: PHP All Commercial |
$1,540.39
|
| Rate for Payer: PHP All Commercial |
$1,540.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.83
|
| Rate for Payer: Sagamore Health Network All Products |
$910.83
|
| Rate for Payer: Sagamore Health Network All Products |
$910.83
|
| Rate for Payer: Signature Care EPO |
$1,288.60
|
| Rate for Payer: Signature Care EPO |
$1,288.60
|
| Rate for Payer: Signature Care PPO |
$1,288.60
|
| Rate for Payer: Signature Care PPO |
$1,288.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136,100.00
|
| Rate for Payer: United Healthcare Commercial |
$981.84
|
| Rate for Payer: United Healthcare Commercial |
$981.84
|
| Rate for Payer: United Healthcare Medicare |
$885.28
|
| Rate for Payer: United Healthcare Medicare |
$885.28
|
|
|
PR PARTIAL HIP REPLACEMENT
|
Professional
|
Both
|
$2,082.18
|
|
|
Service Code
|
CPT 27125
|
| Hospital Charge Code |
z27125
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$157,100.00 |
| Rate for Payer: Aetna Commercial |
$1,050.87
|
| Rate for Payer: Aetna Commercial |
$1,050.87
|
| Rate for Payer: Aetna Medicare |
$1,050.87
|
| Rate for Payer: Aetna Medicare |
$1,050.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,461.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,461.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,461.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,461.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,461.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,461.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,024.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,024.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,208.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,208.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,155.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,155.96
|
| Rate for Payer: Cash Price |
$1,249.31
|
| Rate for Payer: Cash Price |
$1,225.99
|
| Rate for Payer: Centivo All Commercial |
$1,628.85
|
| Rate for Payer: Centivo All Commercial |
$1,628.85
|
| Rate for Payer: Cigna All Commercial |
$1,050.87
|
| Rate for Payer: Cigna All Commercial |
$1,050.87
|
| Rate for Payer: CORVEL All Commercial |
$1,050.87
|
| Rate for Payer: CORVEL All Commercial |
$1,050.87
|
| Rate for Payer: Coventry All Commercial |
$1,261.04
|
| Rate for Payer: Coventry All Commercial |
$1,261.04
|
| Rate for Payer: Encore All Commercial |
$1,050.87
|
| Rate for Payer: Encore All Commercial |
$1,050.87
|
| Rate for Payer: Frontpath All Commercial |
$1,470.52
|
| Rate for Payer: Frontpath All Commercial |
$1,470.52
|
| Rate for Payer: Humana ChoiceCare |
$1,110.06
|
| Rate for Payer: Humana ChoiceCare |
$1,110.06
|
| Rate for Payer: Humana Medicare |
$1,050.87
|
| Rate for Payer: Humana Medicare |
$1,050.87
|
| Rate for Payer: Lucent All Commercial |
$1,471.22
|
| Rate for Payer: Lucent All Commercial |
$1,471.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,676.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,676.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,024.09
|
| Rate for Payer: Managed Health Services Medicaid |
$1,024.09
|
| Rate for Payer: MDWise Medicaid |
$1,024.09
|
| Rate for Payer: MDWise Medicaid |
$1,024.09
|
| Rate for Payer: PHCS All Commercial |
$1,050.87
|
| Rate for Payer: PHCS All Commercial |
$1,050.87
|
| Rate for Payer: PHP All Commercial |
$1,777.68
|
| Rate for Payer: PHP All Commercial |
$1,777.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,050.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,050.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,050.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,050.87
|
| Rate for Payer: Signature Care EPO |
$1,479.85
|
| Rate for Payer: Signature Care EPO |
$1,479.85
|
| Rate for Payer: Signature Care PPO |
$1,479.85
|
| Rate for Payer: Signature Care PPO |
$1,479.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157,100.00
|
| Rate for Payer: United Healthcare Commercial |
$1,231.43
|
| Rate for Payer: United Healthcare Commercial |
$1,231.43
|
| Rate for Payer: United Healthcare Medicare |
$1,021.66
|
| Rate for Payer: United Healthcare Medicare |
$1,021.66
|
|
|
PR PARTIAL REMOVAL, CLAVICLE
|
Professional
|
Both
|
$1,099.32
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
z23120
|
| Min. Negotiated Rate |
$535.91 |
| Max. Negotiated Rate |
$82,400.00 |
| Rate for Payer: Aetna Commercial |
$548.50
|
| Rate for Payer: Aetna Commercial |
$548.50
|
| Rate for Payer: Aetna Medicare |
$548.50
|
| Rate for Payer: Aetna Medicare |
$548.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$688.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$688.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$688.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$688.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$688.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$688.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$688.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$688.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$540.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$540.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$630.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$630.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$603.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$603.35
|
| Rate for Payer: Cash Price |
$659.59
|
| Rate for Payer: Cash Price |
$643.09
|
| Rate for Payer: Centivo All Commercial |
$850.17
|
| Rate for Payer: Centivo All Commercial |
$850.17
|
| Rate for Payer: Cigna All Commercial |
$548.50
|
| Rate for Payer: Cigna All Commercial |
$548.50
|
| Rate for Payer: CORVEL All Commercial |
$548.50
|
| Rate for Payer: CORVEL All Commercial |
$548.50
|
| Rate for Payer: Coventry All Commercial |
$658.20
|
| Rate for Payer: Coventry All Commercial |
$658.20
|
| Rate for Payer: Encore All Commercial |
$548.50
|
| Rate for Payer: Encore All Commercial |
$548.50
|
| Rate for Payer: Frontpath All Commercial |
$760.27
|
| Rate for Payer: Frontpath All Commercial |
$760.27
|
| Rate for Payer: Humana ChoiceCare |
$589.70
|
| Rate for Payer: Humana ChoiceCare |
$589.70
|
| Rate for Payer: Humana Medicare |
$548.50
|
| Rate for Payer: Humana Medicare |
$548.50
|
| Rate for Payer: Lucent All Commercial |
$767.90
|
| Rate for Payer: Lucent All Commercial |
$767.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$879.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$879.00
|
| Rate for Payer: Managed Health Services Medicaid |
$540.69
|
| Rate for Payer: Managed Health Services Medicaid |
$540.69
|
| Rate for Payer: MDWise Medicaid |
$540.69
|
| Rate for Payer: MDWise Medicaid |
$540.69
|
| Rate for Payer: PHCS All Commercial |
$548.50
|
| Rate for Payer: PHCS All Commercial |
$548.50
|
| Rate for Payer: PHP All Commercial |
$932.49
|
| Rate for Payer: PHP All Commercial |
$932.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$548.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$548.50
|
| Rate for Payer: Sagamore Health Network All Products |
$548.50
|
| Rate for Payer: Sagamore Health Network All Products |
$548.50
|
| Rate for Payer: Signature Care EPO |
$791.35
|
| Rate for Payer: Signature Care EPO |
$791.35
|
| Rate for Payer: Signature Care PPO |
$791.35
|
| Rate for Payer: Signature Care PPO |
$791.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,400.00
|
| Rate for Payer: United Healthcare Commercial |
$614.11
|
| Rate for Payer: United Healthcare Commercial |
$614.11
|
| Rate for Payer: United Healthcare Medicare |
$535.91
|
| Rate for Payer: United Healthcare Medicare |
$535.91
|
|
|
PR PARTIAL REMOVAL OF HYMEN
|
Professional
|
Both
|
$378.58
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
z56700
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$24,800.00 |
| Rate for Payer: Aetna Commercial |
$192.11
|
| Rate for Payer: Aetna Commercial |
$192.11
|
| Rate for Payer: Aetna Medicare |
$192.11
|
| Rate for Payer: Aetna Medicare |
$192.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$228.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$228.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$228.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$228.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$228.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$228.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$186.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$186.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.32
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$223.62
|
| Rate for Payer: Centivo All Commercial |
$297.77
|
| Rate for Payer: Centivo All Commercial |
$297.77
|
| Rate for Payer: Cigna All Commercial |
$192.11
|
| Rate for Payer: Cigna All Commercial |
$192.11
|
| Rate for Payer: CORVEL All Commercial |
$192.11
|
| Rate for Payer: CORVEL All Commercial |
$192.11
|
| Rate for Payer: Coventry All Commercial |
$230.53
|
| Rate for Payer: Coventry All Commercial |
$230.53
|
| Rate for Payer: Encore All Commercial |
$192.11
|
| Rate for Payer: Encore All Commercial |
$192.11
|
| Rate for Payer: Frontpath All Commercial |
$264.10
|
| Rate for Payer: Frontpath All Commercial |
$264.10
|
| Rate for Payer: Humana ChoiceCare |
$191.46
|
| Rate for Payer: Humana ChoiceCare |
$191.46
|
| Rate for Payer: Humana Medicare |
$192.11
|
| Rate for Payer: Humana Medicare |
$192.11
|
| Rate for Payer: Lucent All Commercial |
$268.95
|
| Rate for Payer: Lucent All Commercial |
$268.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.00
|
| Rate for Payer: Managed Health Services Medicaid |
$186.20
|
| Rate for Payer: Managed Health Services Medicaid |
$186.20
|
| Rate for Payer: MDWise Medicaid |
$186.20
|
| Rate for Payer: MDWise Medicaid |
$186.20
|
| Rate for Payer: PHCS All Commercial |
$192.11
|
| Rate for Payer: PHCS All Commercial |
$192.11
|
| Rate for Payer: PHP All Commercial |
$245.98
|
| Rate for Payer: PHP All Commercial |
$245.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.11
|
| Rate for Payer: Sagamore Health Network All Products |
$192.11
|
| Rate for Payer: Sagamore Health Network All Products |
$192.11
|
| Rate for Payer: Signature Care EPO |
$209.95
|
| Rate for Payer: Signature Care EPO |
$209.95
|
| Rate for Payer: Signature Care PPO |
$209.95
|
| Rate for Payer: Signature Care PPO |
$209.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,800.00
|
| Rate for Payer: United Healthcare Commercial |
$207.96
|
| Rate for Payer: United Healthcare Commercial |
$207.96
|
| Rate for Payer: United Healthcare Medicare |
$186.35
|
| Rate for Payer: United Healthcare Medicare |
$186.35
|
|
