|
PR PREVENTIVE VISIT,NEW,40-64
|
Professional
|
Both
|
$275.32
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
z99386
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$11,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$62.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$62.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.60
|
| Rate for Payer: Cash Price |
$165.19
|
| Rate for Payer: Cash Price |
$169.08
|
| Rate for Payer: Frontpath All Commercial |
$118.88
|
| Rate for Payer: Frontpath All Commercial |
$118.88
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: Managed Health Services Medicaid |
$138.60
|
| Rate for Payer: Managed Health Services Medicaid |
$138.60
|
| Rate for Payer: MDWise Medicaid |
$138.60
|
| Rate for Payer: MDWise Medicaid |
$138.60
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$62.29
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$62.29
|
| Rate for Payer: PHP All Commercial |
$109.53
|
| Rate for Payer: PHP All Commercial |
$109.53
|
| Rate for Payer: Signature Care EPO |
$124.10
|
| Rate for Payer: Signature Care EPO |
$124.10
|
| Rate for Payer: Signature Care PPO |
$124.10
|
| Rate for Payer: Signature Care PPO |
$124.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,200.00
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Medicare |
$137.66
|
| Rate for Payer: United Healthcare Medicare |
$137.66
|
|
|
PR PREVENTIVE VISIT,NEW,65 & OVER
|
Professional
|
Both
|
$298.94
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
z99387
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$12,100.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$66.93
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$66.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$150.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$150.36
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cash Price |
$183.42
|
| Rate for Payer: Frontpath All Commercial |
$127.51
|
| Rate for Payer: Frontpath All Commercial |
$127.51
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.00
|
| Rate for Payer: Managed Health Services Medicaid |
$150.36
|
| Rate for Payer: Managed Health Services Medicaid |
$150.36
|
| Rate for Payer: MDWise Medicaid |
$150.36
|
| Rate for Payer: MDWise Medicaid |
$150.36
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$66.93
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$66.93
|
| Rate for Payer: PHP All Commercial |
$117.66
|
| Rate for Payer: PHP All Commercial |
$117.66
|
| 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 |
$12,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,100.00
|
| Rate for Payer: United Healthcare Commercial |
$104.63
|
| Rate for Payer: United Healthcare Commercial |
$104.63
|
| Rate for Payer: United Healthcare Medicare |
$149.47
|
| Rate for Payer: United Healthcare Medicare |
$149.47
|
|
|
PR PREVENTIVE VISIT,NEW,AGE 1-4
|
Professional
|
Both
|
$215.32
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
z99382
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$7,700.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.74
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.91
|
| Rate for Payer: Cash Price |
$129.19
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: Managed Health Services Medicaid |
$105.91
|
| Rate for Payer: Managed Health Services Medicaid |
$105.91
|
| Rate for Payer: MDWise Medicaid |
$105.91
|
| Rate for Payer: MDWise Medicaid |
$105.91
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$42.74
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$42.74
|
| Rate for Payer: PHP All Commercial |
$75.34
|
| Rate for Payer: PHP All Commercial |
$75.34
|
| Rate for Payer: Signature Care EPO |
$98.60
|
| Rate for Payer: Signature Care EPO |
$98.60
|
| Rate for Payer: Signature Care PPO |
$98.60
|
| Rate for Payer: Signature Care PPO |
$98.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$104.77
|
| Rate for Payer: United Healthcare Medicare |
$104.77
|
|
|
PR PREVENTIVE VISIT,NEW,AGE5-11
|
Professional
|
Both
|
$217.94
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
z99383
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$8,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$110.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$110.09
|
| Rate for Payer: Cash Price |
$130.76
|
| Rate for Payer: Cash Price |
$134.29
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$110.09
|
| Rate for Payer: Managed Health Services Medicaid |
$110.09
|
| Rate for Payer: MDWise Medicaid |
$110.09
|
| Rate for Payer: MDWise Medicaid |
$110.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$42.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$42.31
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: Signature Care EPO |
$96.90
|
| Rate for Payer: Signature Care EPO |
$96.90
|
| Rate for Payer: Signature Care PPO |
$96.90
|
| Rate for Payer: Signature Care PPO |
$96.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$108.97
|
| Rate for Payer: United Healthcare Medicare |
$108.97
|
|
|
PR PREVENTIVE VISIT,NEW,INFANT < 1 YR
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
z99381
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.99
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$38.57
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$38.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.27
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Managed Health Services Medicaid |
$101.27
|
| Rate for Payer: Managed Health Services Medicaid |
$101.27
|
| Rate for Payer: MDWise Medicaid |
$101.27
|
| Rate for Payer: MDWise Medicaid |
$101.27
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$38.57
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$38.57
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: Signature Care EPO |
$91.80
|
| Rate for Payer: Signature Care EPO |
$91.80
|
| Rate for Payer: Signature Care PPO |
$91.80
|
| Rate for Payer: Signature Care PPO |
$91.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 15 MIN
|
Professional
|
Both
|
$70.94
|
|
|
Service Code
|
CPT 99401
|
| Hospital Charge Code |
z99401
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.52
|
| Rate for Payer: Cash Price |
$42.56
|
| Rate for Payer: Cash Price |
$43.32
|
| Rate for Payer: Frontpath All Commercial |
$24.59
|
| Rate for Payer: Frontpath All Commercial |
$24.59
|
| Rate for Payer: Humana ChoiceCare |
$24.88
|
| Rate for Payer: Humana ChoiceCare |
$24.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.00
|
| Rate for Payer: Managed Health Services Medicaid |
$35.52
|
| Rate for Payer: Managed Health Services Medicaid |
$35.52
|
| Rate for Payer: MDWise Medicaid |
$35.52
|
| Rate for Payer: MDWise Medicaid |
$35.52
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$18.75
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$18.75
|
| Rate for Payer: PHP All Commercial |
$22.89
|
| Rate for Payer: PHP All Commercial |
$22.89
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,300.00
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
| Rate for Payer: United Healthcare Medicare |
$35.47
|
| Rate for Payer: United Healthcare Medicare |
$35.47
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 30 MIN
|
Professional
|
Both
|
$116.08
|
|
|
Service Code
|
CPT 99402
|
| Hospital Charge Code |
z99402
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.10
|
| Rate for Payer: Cash Price |
$69.65
|
| Rate for Payer: Cash Price |
$70.87
|
| Rate for Payer: Frontpath All Commercial |
$50.27
|
| Rate for Payer: Frontpath All Commercial |
$50.27
|
| Rate for Payer: Humana ChoiceCare |
$50.17
|
| Rate for Payer: Humana ChoiceCare |
$50.17
|
| 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 |
$58.10
|
| Rate for Payer: Managed Health Services Medicaid |
$58.10
|
| Rate for Payer: MDWise Medicaid |
$58.10
|
| Rate for Payer: MDWise Medicaid |
$58.10
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.60
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.60
|
| Rate for Payer: PHP All Commercial |
$46.13
|
| Rate for Payer: PHP All Commercial |
$46.13
|
| Rate for Payer: Signature Care EPO |
$62.90
|
| Rate for Payer: Signature Care EPO |
$62.90
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| 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 |
$49.38
|
| Rate for Payer: United Healthcare Commercial |
$49.38
|
| Rate for Payer: United Healthcare Medicare |
$58.04
|
| Rate for Payer: United Healthcare Medicare |
$58.04
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$125.88
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
z93279
|
| Min. Negotiated Rate |
$61.91 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Aetna Commercial |
$65.65
|
| Rate for Payer: Aetna Commercial |
$65.65
|
| Rate for Payer: Aetna Medicare |
$65.65
|
| Rate for Payer: Aetna Medicare |
$65.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.22
|
| Rate for Payer: Cash Price |
$75.14
|
| Rate for Payer: Cash Price |
$75.53
|
| Rate for Payer: Centivo All Commercial |
$101.76
|
| Rate for Payer: Centivo All Commercial |
$101.76
|
| Rate for Payer: Cigna All Commercial |
$65.65
|
| Rate for Payer: Cigna All Commercial |
$65.65
|
| Rate for Payer: CORVEL All Commercial |
$65.65
|
| Rate for Payer: CORVEL All Commercial |
$65.65
|
| Rate for Payer: Coventry All Commercial |
$78.78
|
| Rate for Payer: Coventry All Commercial |
$78.78
|
| Rate for Payer: Encore All Commercial |
$65.65
|
| Rate for Payer: Encore All Commercial |
$65.65
|
| Rate for Payer: Frontpath All Commercial |
$73.61
|
| Rate for Payer: Frontpath All Commercial |
$73.61
|
| Rate for Payer: Humana ChoiceCare |
$71.42
|
| Rate for Payer: Humana ChoiceCare |
$71.42
|
| Rate for Payer: Humana Medicare |
$65.65
|
| Rate for Payer: Humana Medicare |
$65.65
|
| Rate for Payer: Lucent All Commercial |
$91.91
|
| Rate for Payer: Lucent All Commercial |
$91.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.00
|
| Rate for Payer: Managed Health Services Medicaid |
$61.91
|
| Rate for Payer: Managed Health Services Medicaid |
$61.91
|
| Rate for Payer: MDWise Medicaid |
$61.91
|
| Rate for Payer: MDWise Medicaid |
$61.91
|
| Rate for Payer: PHCS All Commercial |
$65.65
|
| Rate for Payer: PHCS All Commercial |
$65.65
|
| Rate for Payer: PHP All Commercial |
$92.05
|
| Rate for Payer: PHP All Commercial |
$92.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.65
|
| Rate for Payer: Sagamore Health Network All Products |
$65.65
|
| Rate for Payer: Sagamore Health Network All Products |
$65.65
|
| Rate for Payer: Signature Care EPO |
$80.40
|
| Rate for Payer: Signature Care EPO |
$80.40
|
| Rate for Payer: Signature Care PPO |
$80.40
|
| Rate for Payer: Signature Care PPO |
$80.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: United Healthcare Commercial |
$65.69
|
| Rate for Payer: United Healthcare Commercial |
$65.69
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$141.98
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
z93260
|
| Min. Negotiated Rate |
$69.83 |
| Max. Negotiated Rate |
$10,900.00 |
| Rate for Payer: Aetna Commercial |
$73.82
|
| Rate for Payer: Aetna Commercial |
$73.82
|
| Rate for Payer: Aetna Medicare |
$73.82
|
| Rate for Payer: Aetna Medicare |
$73.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.20
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$85.19
|
| Rate for Payer: Centivo All Commercial |
$114.42
|
| Rate for Payer: Centivo All Commercial |
$114.42
|
| Rate for Payer: Cigna All Commercial |
$73.82
|
| Rate for Payer: Cigna All Commercial |
$73.82
|
| Rate for Payer: CORVEL All Commercial |
$73.82
|
| Rate for Payer: CORVEL All Commercial |
$73.82
|
| Rate for Payer: Coventry All Commercial |
$88.58
|
| Rate for Payer: Coventry All Commercial |
$88.58
|
| Rate for Payer: Encore All Commercial |
$73.82
|
| Rate for Payer: Encore All Commercial |
$73.82
|
| Rate for Payer: Frontpath All Commercial |
$83.09
|
| Rate for Payer: Frontpath All Commercial |
$83.09
|
| Rate for Payer: Humana ChoiceCare |
$87.25
|
| Rate for Payer: Humana ChoiceCare |
$87.25
|
| Rate for Payer: Humana Medicare |
$73.82
|
| Rate for Payer: Humana Medicare |
$73.82
|
| Rate for Payer: Lucent All Commercial |
$103.35
|
| Rate for Payer: Lucent All Commercial |
$103.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.00
|
| Rate for Payer: Managed Health Services Medicaid |
$69.83
|
| Rate for Payer: Managed Health Services Medicaid |
$69.83
|
| Rate for Payer: MDWise Medicaid |
$69.83
|
| Rate for Payer: MDWise Medicaid |
$69.83
|
| Rate for Payer: PHCS All Commercial |
$73.82
|
| Rate for Payer: PHCS All Commercial |
$73.82
|
| Rate for Payer: PHP All Commercial |
$104.00
|
| Rate for Payer: PHP All Commercial |
$104.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.82
|
| Rate for Payer: Sagamore Health Network All Products |
$73.82
|
| Rate for Payer: Sagamore Health Network All Products |
$73.82
|
| Rate for Payer: Signature Care EPO |
$101.60
|
| Rate for Payer: Signature Care EPO |
$101.60
|
| Rate for Payer: Signature Care PPO |
$101.60
|
| Rate for Payer: Signature Care PPO |
$101.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,900.00
|
| Rate for Payer: United Healthcare Commercial |
$80.79
|
| Rate for Payer: United Healthcare Commercial |
$80.79
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$111.82
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
z93285
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$8,600.00 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Medicare |
$58.97
|
| Rate for Payer: Aetna Medicare |
$58.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.87
|
| Rate for Payer: Cash Price |
$67.02
|
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Centivo All Commercial |
$91.40
|
| Rate for Payer: Centivo All Commercial |
$91.40
|
| Rate for Payer: Cigna All Commercial |
$58.97
|
| Rate for Payer: Cigna All Commercial |
$58.97
|
| Rate for Payer: CORVEL All Commercial |
$58.97
|
| Rate for Payer: CORVEL All Commercial |
$58.97
|
| Rate for Payer: Coventry All Commercial |
$70.76
|
| Rate for Payer: Coventry All Commercial |
$70.76
|
| Rate for Payer: Encore All Commercial |
$58.97
|
| Rate for Payer: Encore All Commercial |
$58.97
|
| Rate for Payer: Frontpath All Commercial |
$66.23
|
| Rate for Payer: Frontpath All Commercial |
$66.23
|
| Rate for Payer: Humana ChoiceCare |
$61.44
|
| Rate for Payer: Humana ChoiceCare |
$61.44
|
| Rate for Payer: Humana Medicare |
$58.97
|
| Rate for Payer: Humana Medicare |
$58.97
|
| Rate for Payer: Lucent All Commercial |
$82.56
|
| Rate for Payer: Lucent All Commercial |
$82.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Managed Health Services Medicaid |
$54.94
|
| Rate for Payer: Managed Health Services Medicaid |
$54.94
|
| Rate for Payer: MDWise Medicaid |
$54.94
|
| Rate for Payer: MDWise Medicaid |
$54.94
|
| Rate for Payer: PHCS All Commercial |
$58.97
|
| Rate for Payer: PHCS All Commercial |
$58.97
|
| Rate for Payer: PHP All Commercial |
$82.19
|
| Rate for Payer: PHP All Commercial |
$82.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.97
|
| Rate for Payer: Sagamore Health Network All Products |
$58.97
|
| Rate for Payer: Sagamore Health Network All Products |
$58.97
|
| Rate for Payer: Signature Care EPO |
$68.56
|
| Rate for Payer: Signature Care EPO |
$68.56
|
| Rate for Payer: Signature Care PPO |
$68.56
|
| Rate for Payer: Signature Care PPO |
$68.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: United Healthcare Commercial |
$56.51
|
| Rate for Payer: United Healthcare Commercial |
$56.51
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$197.78
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
z93284
|
| Min. Negotiated Rate |
$97.27 |
| Max. Negotiated Rate |
$15,200.00 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$118.48
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Centivo All Commercial |
$160.50
|
| Rate for Payer: Centivo All Commercial |
$160.50
|
| Rate for Payer: Cigna All Commercial |
$103.55
|
| Rate for Payer: Cigna All Commercial |
$103.55
|
| Rate for Payer: CORVEL All Commercial |
$103.55
|
| Rate for Payer: CORVEL All Commercial |
$103.55
|
| Rate for Payer: Coventry All Commercial |
$124.26
|
| Rate for Payer: Coventry All Commercial |
$124.26
|
| Rate for Payer: Encore All Commercial |
$103.55
|
| Rate for Payer: Encore All Commercial |
$103.55
|
| Rate for Payer: Frontpath All Commercial |
$116.05
|
| Rate for Payer: Frontpath All Commercial |
$116.05
|
| Rate for Payer: Humana ChoiceCare |
$130.65
|
| Rate for Payer: Humana ChoiceCare |
$130.65
|
| Rate for Payer: Humana Medicare |
$103.55
|
| Rate for Payer: Humana Medicare |
$103.55
|
| Rate for Payer: Lucent All Commercial |
$144.97
|
| Rate for Payer: Lucent All Commercial |
$144.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: Managed Health Services Medicaid |
$97.27
|
| Rate for Payer: Managed Health Services Medicaid |
$97.27
|
| Rate for Payer: MDWise Medicaid |
$97.27
|
| Rate for Payer: MDWise Medicaid |
$97.27
|
| Rate for Payer: PHCS All Commercial |
$103.55
|
| Rate for Payer: PHCS All Commercial |
$103.55
|
| Rate for Payer: PHP All Commercial |
$145.14
|
| Rate for Payer: PHP All Commercial |
$145.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.55
|
| Rate for Payer: Sagamore Health Network All Products |
$103.55
|
| Rate for Payer: Sagamore Health Network All Products |
$103.55
|
| Rate for Payer: Signature Care EPO |
$146.71
|
| Rate for Payer: Signature Care EPO |
$146.71
|
| Rate for Payer: Signature Care PPO |
$146.71
|
| Rate for Payer: Signature Care PPO |
$146.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: United Healthcare Commercial |
$120.18
|
| Rate for Payer: United Healthcare Commercial |
$120.18
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$183.14
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
z93283
|
| Min. Negotiated Rate |
$90.08 |
| Max. Negotiated Rate |
$14,100.00 |
| Rate for Payer: Aetna Commercial |
$96.04
|
| Rate for Payer: Aetna Commercial |
$96.04
|
| Rate for Payer: Aetna Medicare |
$96.04
|
| Rate for Payer: Aetna Medicare |
$96.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.64
|
| Rate for Payer: Cash Price |
$109.81
|
| Rate for Payer: Cash Price |
$109.88
|
| Rate for Payer: Centivo All Commercial |
$148.86
|
| Rate for Payer: Centivo All Commercial |
$148.86
|
| Rate for Payer: Cigna All Commercial |
$96.04
|
| Rate for Payer: Cigna All Commercial |
$96.04
|
| Rate for Payer: CORVEL All Commercial |
$96.04
|
| Rate for Payer: CORVEL All Commercial |
$96.04
|
| Rate for Payer: Coventry All Commercial |
$115.25
|
| Rate for Payer: Coventry All Commercial |
$115.25
|
| Rate for Payer: Encore All Commercial |
$96.04
|
| Rate for Payer: Encore All Commercial |
$96.04
|
| Rate for Payer: Frontpath All Commercial |
$107.72
|
| Rate for Payer: Frontpath All Commercial |
$107.72
|
| Rate for Payer: Humana ChoiceCare |
$111.41
|
| Rate for Payer: Humana ChoiceCare |
$111.41
|
| Rate for Payer: Humana Medicare |
$96.04
|
| Rate for Payer: Humana Medicare |
$96.04
|
| Rate for Payer: Lucent All Commercial |
$134.46
|
| Rate for Payer: Lucent All Commercial |
$134.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.00
|
| Rate for Payer: Managed Health Services Medicaid |
$90.08
|
| Rate for Payer: Managed Health Services Medicaid |
$90.08
|
| Rate for Payer: MDWise Medicaid |
$90.08
|
| Rate for Payer: MDWise Medicaid |
$90.08
|
| Rate for Payer: PHCS All Commercial |
$96.04
|
| Rate for Payer: PHCS All Commercial |
$96.04
|
| Rate for Payer: PHP All Commercial |
$134.52
|
| Rate for Payer: PHP All Commercial |
$134.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.04
|
| Rate for Payer: Sagamore Health Network All Products |
$96.04
|
| Rate for Payer: Sagamore Health Network All Products |
$96.04
|
| Rate for Payer: Signature Care EPO |
$125.43
|
| Rate for Payer: Signature Care EPO |
$125.43
|
| Rate for Payer: Signature Care PPO |
$125.43
|
| Rate for Payer: Signature Care PPO |
$125.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
|
|
PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
|
Professional
|
Both
|
$149.34
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
z93282
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$11,500.00 |
| Rate for Payer: Aetna Commercial |
$78.50
|
| Rate for Payer: Aetna Commercial |
$78.50
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.35
|
| Rate for Payer: Cash Price |
$89.23
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Centivo All Commercial |
$121.67
|
| Rate for Payer: Centivo All Commercial |
$121.67
|
| Rate for Payer: Cigna All Commercial |
$78.50
|
| Rate for Payer: Cigna All Commercial |
$78.50
|
| Rate for Payer: CORVEL All Commercial |
$78.50
|
| Rate for Payer: CORVEL All Commercial |
$78.50
|
| Rate for Payer: Coventry All Commercial |
$94.20
|
| Rate for Payer: Coventry All Commercial |
$94.20
|
| Rate for Payer: Encore All Commercial |
$78.50
|
| Rate for Payer: Encore All Commercial |
$78.50
|
| Rate for Payer: Frontpath All Commercial |
$88.31
|
| Rate for Payer: Frontpath All Commercial |
$88.31
|
| Rate for Payer: Humana ChoiceCare |
$91.41
|
| Rate for Payer: Humana ChoiceCare |
$91.41
|
| Rate for Payer: Humana Medicare |
$78.50
|
| Rate for Payer: Humana Medicare |
$78.50
|
| Rate for Payer: Lucent All Commercial |
$109.90
|
| Rate for Payer: Lucent All Commercial |
$109.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: Managed Health Services Medicaid |
$73.15
|
| Rate for Payer: Managed Health Services Medicaid |
$73.15
|
| Rate for Payer: MDWise Medicaid |
$73.15
|
| Rate for Payer: MDWise Medicaid |
$73.15
|
| Rate for Payer: PHCS All Commercial |
$78.50
|
| Rate for Payer: PHCS All Commercial |
$78.50
|
| Rate for Payer: PHP All Commercial |
$109.76
|
| Rate for Payer: PHP All Commercial |
$109.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.50
|
| Rate for Payer: Sagamore Health Network All Products |
$78.50
|
| Rate for Payer: Sagamore Health Network All Products |
$78.50
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$102.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,500.00
|
| Rate for Payer: United Healthcare Commercial |
$84.08
|
| Rate for Payer: United Healthcare Commercial |
$84.08
|
|
|
PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS
|
Professional
|
Both
|
$236.70
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
z45300
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$6,300.00 |
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna Medicare |
$44.72
|
| Rate for Payer: Aetna Medicare |
$44.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$43.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$43.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.19
|
| Rate for Payer: Cash Price |
$140.62
|
| Rate for Payer: Cash Price |
$142.02
|
| Rate for Payer: Centivo All Commercial |
$69.32
|
| Rate for Payer: Centivo All Commercial |
$69.32
|
| Rate for Payer: Cigna All Commercial |
$44.72
|
| Rate for Payer: Cigna All Commercial |
$44.72
|
| Rate for Payer: CORVEL All Commercial |
$44.72
|
| Rate for Payer: CORVEL All Commercial |
$44.72
|
| Rate for Payer: Coventry All Commercial |
$53.66
|
| Rate for Payer: Coventry All Commercial |
$53.66
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Frontpath All Commercial |
$61.53
|
| Rate for Payer: Frontpath All Commercial |
$61.53
|
| Rate for Payer: Humana ChoiceCare |
$29.54
|
| Rate for Payer: Humana ChoiceCare |
$29.54
|
| Rate for Payer: Humana Medicare |
$44.72
|
| Rate for Payer: Humana Medicare |
$44.72
|
| Rate for Payer: Lucent All Commercial |
$62.61
|
| Rate for Payer: Lucent All Commercial |
$62.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: Managed Health Services Medicaid |
$116.42
|
| Rate for Payer: Managed Health Services Medicaid |
$116.42
|
| Rate for Payer: MDWise Medicaid |
$116.42
|
| Rate for Payer: MDWise Medicaid |
$116.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$43.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$43.22
|
| Rate for Payer: PHCS All Commercial |
$44.72
|
| Rate for Payer: PHCS All Commercial |
$44.72
|
| Rate for Payer: PHP All Commercial |
$76.46
|
| Rate for Payer: PHP All Commercial |
$76.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.72
|
| Rate for Payer: Sagamore Health Network All Products |
$44.72
|
| Rate for Payer: Sagamore Health Network All Products |
$44.72
|
| Rate for Payer: Signature Care EPO |
$103.93
|
| Rate for Payer: Signature Care EPO |
$103.93
|
| Rate for Payer: Signature Care PPO |
$103.93
|
| Rate for Payer: Signature Care PPO |
$103.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,300.00
|
| Rate for Payer: United Healthcare Commercial |
$54.53
|
| Rate for Payer: United Healthcare Commercial |
$54.53
|
| Rate for Payer: United Healthcare Medicare |
$117.18
|
| Rate for Payer: United Healthcare Medicare |
$117.18
|
|
|
PR PROFES SVC,IMMUNOTHER,SINGLE/MULT AGS
|
Professional
|
Both
|
$27.18
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: Cash Price |
$16.21
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$2.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$2.73
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
|
|
PR PROFES SVC, IMMUNOTHER, SUBLINGUAL 3 MON
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165A
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$2.73
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
|
|
PR PROFES SVC, IMMUNOTHER, SUBLINGUAL 6 MON
|
Professional
|
Both
|
$399.60
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165B
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: Cash Price |
$239.76
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$2.73
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$147.38
|
|
|
Service Code
|
CPT 93280
|
| Hospital Charge Code |
z93280
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$11,300.00 |
| Rate for Payer: Aetna Commercial |
$77.60
|
| Rate for Payer: Aetna Commercial |
$77.60
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.36
|
| Rate for Payer: Cash Price |
$88.21
|
| Rate for Payer: Cash Price |
$88.43
|
| Rate for Payer: Centivo All Commercial |
$120.28
|
| Rate for Payer: Centivo All Commercial |
$120.28
|
| Rate for Payer: Cigna All Commercial |
$77.60
|
| Rate for Payer: Cigna All Commercial |
$77.60
|
| Rate for Payer: CORVEL All Commercial |
$77.60
|
| Rate for Payer: CORVEL All Commercial |
$77.60
|
| Rate for Payer: Coventry All Commercial |
$93.12
|
| Rate for Payer: Coventry All Commercial |
$93.12
|
| Rate for Payer: Encore All Commercial |
$77.60
|
| Rate for Payer: Encore All Commercial |
$77.60
|
| Rate for Payer: Frontpath All Commercial |
$87.35
|
| Rate for Payer: Frontpath All Commercial |
$87.35
|
| Rate for Payer: Humana ChoiceCare |
$84.65
|
| Rate for Payer: Humana ChoiceCare |
$84.65
|
| Rate for Payer: Humana Medicare |
$77.60
|
| Rate for Payer: Humana Medicare |
$77.60
|
| Rate for Payer: Lucent All Commercial |
$108.64
|
| Rate for Payer: Lucent All Commercial |
$108.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: Managed Health Services Medicaid |
$72.48
|
| Rate for Payer: Managed Health Services Medicaid |
$72.48
|
| Rate for Payer: MDWise Medicaid |
$72.48
|
| Rate for Payer: MDWise Medicaid |
$72.48
|
| Rate for Payer: PHCS All Commercial |
$77.60
|
| Rate for Payer: PHCS All Commercial |
$77.60
|
| Rate for Payer: PHP All Commercial |
$108.07
|
| Rate for Payer: PHP All Commercial |
$108.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.60
|
| Rate for Payer: Sagamore Health Network All Products |
$77.60
|
| Rate for Payer: Sagamore Health Network All Products |
$77.60
|
| Rate for Payer: Signature Care EPO |
$95.31
|
| Rate for Payer: Signature Care EPO |
$95.31
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,300.00
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$156.70
|
|
|
Service Code
|
CPT 93281
|
| Hospital Charge Code |
z93281
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$12,000.00 |
| Rate for Payer: Aetna Commercial |
$82.23
|
| Rate for Payer: Aetna Commercial |
$82.23
|
| Rate for Payer: Aetna Medicare |
$82.23
|
| Rate for Payer: Aetna Medicare |
$82.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$77.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$77.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.45
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Centivo All Commercial |
$127.46
|
| Rate for Payer: Centivo All Commercial |
$127.46
|
| Rate for Payer: Cigna All Commercial |
$82.23
|
| Rate for Payer: Cigna All Commercial |
$82.23
|
| Rate for Payer: CORVEL All Commercial |
$82.23
|
| Rate for Payer: CORVEL All Commercial |
$82.23
|
| Rate for Payer: Coventry All Commercial |
$98.68
|
| Rate for Payer: Coventry All Commercial |
$98.68
|
| Rate for Payer: Encore All Commercial |
$82.23
|
| Rate for Payer: Encore All Commercial |
$82.23
|
| Rate for Payer: Frontpath All Commercial |
$92.48
|
| Rate for Payer: Frontpath All Commercial |
$92.48
|
| Rate for Payer: Humana ChoiceCare |
$98.96
|
| Rate for Payer: Humana ChoiceCare |
$98.96
|
| Rate for Payer: Humana Medicare |
$82.23
|
| Rate for Payer: Humana Medicare |
$82.23
|
| Rate for Payer: Lucent All Commercial |
$115.12
|
| Rate for Payer: Lucent All Commercial |
$115.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: Managed Health Services Medicaid |
$77.07
|
| Rate for Payer: Managed Health Services Medicaid |
$77.07
|
| Rate for Payer: MDWise Medicaid |
$77.07
|
| Rate for Payer: MDWise Medicaid |
$77.07
|
| Rate for Payer: PHCS All Commercial |
$82.23
|
| Rate for Payer: PHCS All Commercial |
$82.23
|
| Rate for Payer: PHP All Commercial |
$115.07
|
| Rate for Payer: PHP All Commercial |
$115.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.23
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$111.06
|
| Rate for Payer: Signature Care EPO |
$111.06
|
| Rate for Payer: Signature Care PPO |
$111.06
|
| Rate for Payer: Signature Care PPO |
$111.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,000.00
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$57.86
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
z99417
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.76
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Frontpath All Commercial |
$31.17
|
| Rate for Payer: Frontpath All Commercial |
$31.17
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.00
|
| Rate for Payer: Managed Health Services Medicaid |
$28.76
|
| Rate for Payer: Managed Health Services Medicaid |
$28.76
|
| Rate for Payer: MDWise Medicaid |
$28.76
|
| Rate for Payer: MDWise Medicaid |
$28.76
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.87
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.87
|
| Rate for Payer: PHP All Commercial |
$28.86
|
| Rate for Payer: PHP All Commercial |
$28.86
|
| Rate for Payer: Signature Care EPO |
$24.52
|
| Rate for Payer: Signature Care EPO |
$24.52
|
| Rate for Payer: Signature Care PPO |
$24.52
|
| Rate for Payer: Signature Care PPO |
$24.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
| Rate for Payer: United Healthcare Medicare |
$28.93
|
| Rate for Payer: United Healthcare Medicare |
$28.93
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$242.10
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
z99354
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$205.78 |
| Rate for Payer: Aetna Commercial |
$113.58
|
| Rate for Payer: Aetna Medicare |
$113.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$125.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$125.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.94
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Centivo All Commercial |
$176.05
|
| Rate for Payer: Cigna All Commercial |
$113.58
|
| Rate for Payer: CORVEL All Commercial |
$113.58
|
| Rate for Payer: Coventry All Commercial |
$136.30
|
| Rate for Payer: Encore All Commercial |
$113.58
|
| Rate for Payer: Frontpath All Commercial |
$122.43
|
| Rate for Payer: Humana ChoiceCare |
$96.89
|
| Rate for Payer: Humana Medicare |
$113.58
|
| Rate for Payer: Lucent All Commercial |
$159.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.78
|
| Rate for Payer: PHCS All Commercial |
$113.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.58
|
| Rate for Payer: Sagamore Health Network All Products |
$113.58
|
| Rate for Payer: Signature Care EPO |
$102.89
|
| Rate for Payer: Signature Care PPO |
$102.89
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$57.24
|
|
|
Service Code
|
CPT G0316
|
| Hospital Charge Code |
zG0316
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$23.29
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$23.29
|
| Rate for Payer: United Healthcare Commercial |
$32.70
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$61.24
|
|
|
Service Code
|
CPT G2212
|
| Hospital Charge Code |
zG2212
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$30.32
|
| Rate for Payer: Aetna Medicare |
$30.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.35
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Centivo All Commercial |
$47.00
|
| Rate for Payer: Cigna All Commercial |
$30.32
|
| Rate for Payer: CORVEL All Commercial |
$30.32
|
| Rate for Payer: Coventry All Commercial |
$36.38
|
| Rate for Payer: Encore All Commercial |
$30.32
|
| Rate for Payer: Humana ChoiceCare |
$25.20
|
| Rate for Payer: Humana Medicare |
$30.32
|
| Rate for Payer: Lucent All Commercial |
$42.45
|
| Rate for Payer: Managed Health Services Medicaid |
$30.13
|
| Rate for Payer: MDWise Medicaid |
$30.13
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.66
|
| Rate for Payer: PHCS All Commercial |
$30.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.32
|
| Rate for Payer: Sagamore Health Network All Products |
$30.32
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
CPT 23335
|
| Hospital Charge Code |
z23335
|
| Min. Negotiated Rate |
$1,144.49 |
| Max. Negotiated Rate |
$1,825.96 |
| Rate for Payer: Aetna Commercial |
$1,178.04
|
| Rate for Payer: Aetna Medicare |
$1,178.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,147.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,354.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,295.84
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Centivo All Commercial |
$1,825.96
|
| Rate for Payer: Cigna All Commercial |
$1,178.04
|
| Rate for Payer: CORVEL All Commercial |
$1,178.04
|
| Rate for Payer: Coventry All Commercial |
$1,413.65
|
| Rate for Payer: Encore All Commercial |
$1,178.04
|
| Rate for Payer: Frontpath All Commercial |
$1,646.49
|
| Rate for Payer: Humana ChoiceCare |
$1,409.54
|
| Rate for Payer: Humana Medicare |
$1,178.04
|
| Rate for Payer: Lucent All Commercial |
$1,649.26
|
| Rate for Payer: Managed Health Services Medicaid |
$1,147.08
|
| Rate for Payer: MDWise Medicaid |
$1,147.08
|
| Rate for Payer: PHCS All Commercial |
$1,178.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,178.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,178.04
|
| Rate for Payer: United Healthcare Commercial |
$1,534.75
|
| Rate for Payer: United Healthcare Medicare |
$1,144.49
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$1,284.14
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
z64561
|
| Min. Negotiated Rate |
$154.17 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Aetna Commercial |
$285.49
|
| Rate for Payer: Aetna Medicare |
$285.49
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$154.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$667.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.04
|
| Rate for Payer: Cash Price |
$770.48
|
| Rate for Payer: Centivo All Commercial |
$442.51
|
| Rate for Payer: Cigna All Commercial |
$285.49
|
| Rate for Payer: CORVEL All Commercial |
$285.49
|
| Rate for Payer: Coventry All Commercial |
$342.59
|
| Rate for Payer: Encore All Commercial |
$285.49
|
| Rate for Payer: Frontpath All Commercial |
$393.12
|
| Rate for Payer: Humana ChoiceCare |
$484.56
|
| Rate for Payer: Humana Medicare |
$285.49
|
| Rate for Payer: Lucent All Commercial |
$399.69
|
| Rate for Payer: Managed Health Services Medicaid |
$667.49
|
| Rate for Payer: MDWise Medicaid |
$667.49
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$154.17
|
| Rate for Payer: PHCS All Commercial |
$285.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.49
|
| Rate for Payer: Sagamore Health Network All Products |
$285.49
|
| Rate for Payer: United Healthcare Commercial |
$483.16
|
| Rate for Payer: United Healthcare Medicare |
$674.25
|
|
