|
PR PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB
|
Professional
|
Both
|
$907.82
|
|
|
Service Code
|
CPT 26650
|
| Hospital Charge Code |
z26650
|
| Min. Negotiated Rate |
$443.75 |
| Max. Negotiated Rate |
$68,200.00 |
| Rate for Payer: Aetna Commercial |
$452.12
|
| Rate for Payer: Aetna Commercial |
$452.12
|
| Rate for Payer: Aetna Medicare |
$452.12
|
| Rate for Payer: Aetna Medicare |
$452.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$446.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$446.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$519.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$519.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$497.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$497.33
|
| Rate for Payer: Cash Price |
$544.69
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Centivo All Commercial |
$700.79
|
| Rate for Payer: Centivo All Commercial |
$700.79
|
| Rate for Payer: Cigna All Commercial |
$452.12
|
| Rate for Payer: Cigna All Commercial |
$452.12
|
| Rate for Payer: CORVEL All Commercial |
$452.12
|
| Rate for Payer: CORVEL All Commercial |
$452.12
|
| Rate for Payer: Coventry All Commercial |
$542.54
|
| Rate for Payer: Coventry All Commercial |
$542.54
|
| Rate for Payer: Encore All Commercial |
$452.12
|
| Rate for Payer: Encore All Commercial |
$452.12
|
| Rate for Payer: Frontpath All Commercial |
$621.04
|
| Rate for Payer: Frontpath All Commercial |
$621.04
|
| Rate for Payer: Humana ChoiceCare |
$532.59
|
| Rate for Payer: Humana ChoiceCare |
$532.59
|
| Rate for Payer: Humana Medicare |
$452.12
|
| Rate for Payer: Humana Medicare |
$452.12
|
| Rate for Payer: Lucent All Commercial |
$632.97
|
| Rate for Payer: Lucent All Commercial |
$632.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$728.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$728.00
|
| Rate for Payer: Managed Health Services Medicaid |
$446.50
|
| Rate for Payer: Managed Health Services Medicaid |
$446.50
|
| Rate for Payer: MDWise Medicaid |
$446.50
|
| Rate for Payer: MDWise Medicaid |
$446.50
|
| Rate for Payer: PHCS All Commercial |
$452.12
|
| Rate for Payer: PHCS All Commercial |
$452.12
|
| Rate for Payer: PHP All Commercial |
$772.13
|
| Rate for Payer: PHP All Commercial |
$772.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$452.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$452.12
|
| Rate for Payer: Sagamore Health Network All Products |
$452.12
|
| Rate for Payer: Sagamore Health Network All Products |
$452.12
|
| Rate for Payer: Signature Care EPO |
$718.25
|
| Rate for Payer: Signature Care EPO |
$718.25
|
| Rate for Payer: Signature Care PPO |
$718.25
|
| Rate for Payer: Signature Care PPO |
$718.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68,200.00
|
| Rate for Payer: United Healthcare Commercial |
$497.75
|
| Rate for Payer: United Healthcare Commercial |
$497.75
|
| Rate for Payer: United Healthcare Medicare |
$443.75
|
| Rate for Payer: United Healthcare Medicare |
$443.75
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$334.38
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
z90791
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$17,700.00 |
| Rate for Payer: Aetna Commercial |
$150.08
|
| Rate for Payer: Aetna Commercial |
$150.08
|
| Rate for Payer: Aetna Medicare |
$150.08
|
| Rate for Payer: Aetna Medicare |
$150.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$155.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$77.14
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$77.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$164.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$164.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.09
|
| Rate for Payer: Cash Price |
$198.32
|
| Rate for Payer: Cash Price |
$200.63
|
| Rate for Payer: Centivo All Commercial |
$232.62
|
| Rate for Payer: Centivo All Commercial |
$232.62
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$150.08
|
| Rate for Payer: Coventry All Commercial |
$180.10
|
| Rate for Payer: Coventry All Commercial |
$180.10
|
| Rate for Payer: Encore All Commercial |
$150.08
|
| Rate for Payer: Encore All Commercial |
$150.08
|
| Rate for Payer: Frontpath All Commercial |
$168.20
|
| Rate for Payer: Frontpath All Commercial |
$168.20
|
| Rate for Payer: Humana ChoiceCare |
$92.50
|
| Rate for Payer: Humana ChoiceCare |
$92.50
|
| Rate for Payer: Humana Medicare |
$150.08
|
| Rate for Payer: Humana Medicare |
$150.08
|
| Rate for Payer: Lucent All Commercial |
$210.11
|
| Rate for Payer: Lucent All Commercial |
$210.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Managed Health Services Medicaid |
$164.46
|
| Rate for Payer: Managed Health Services Medicaid |
$164.46
|
| Rate for Payer: MDWise Medicaid |
$164.46
|
| Rate for Payer: MDWise Medicaid |
$164.46
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$77.14
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$77.14
|
| Rate for Payer: PHCS All Commercial |
$150.08
|
| Rate for Payer: PHCS All Commercial |
$150.08
|
| Rate for Payer: PHP All Commercial |
$156.83
|
| Rate for Payer: PHP All Commercial |
$156.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.08
|
| Rate for Payer: Sagamore Health Network All Products |
$150.08
|
| Rate for Payer: Sagamore Health Network All Products |
$150.08
|
| Rate for Payer: Signature Care EPO |
$166.72
|
| Rate for Payer: Signature Care EPO |
$166.72
|
| Rate for Payer: Signature Care PPO |
$166.72
|
| Rate for Payer: Signature Care PPO |
$166.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,700.00
|
| Rate for Payer: United Healthcare Commercial |
$151.14
|
| Rate for Payer: United Healthcare Commercial |
$151.14
|
| Rate for Payer: United Healthcare Medicare |
$165.27
|
| Rate for Payer: United Healthcare Medicare |
$165.27
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
Both
|
$373.90
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
z90792
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Aetna Commercial |
$170.06
|
| Rate for Payer: Aetna Commercial |
$170.06
|
| Rate for Payer: Aetna Medicare |
$170.06
|
| Rate for Payer: Aetna Medicare |
$170.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$87.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$87.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$183.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$183.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$195.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$195.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.07
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cash Price |
$224.34
|
| Rate for Payer: Centivo All Commercial |
$263.59
|
| Rate for Payer: Centivo All Commercial |
$263.59
|
| Rate for Payer: Cigna All Commercial |
$170.06
|
| Rate for Payer: Cigna All Commercial |
$170.06
|
| Rate for Payer: CORVEL All Commercial |
$170.06
|
| Rate for Payer: CORVEL All Commercial |
$170.06
|
| Rate for Payer: Coventry All Commercial |
$204.07
|
| Rate for Payer: Coventry All Commercial |
$204.07
|
| Rate for Payer: Encore All Commercial |
$170.06
|
| Rate for Payer: Encore All Commercial |
$170.06
|
| Rate for Payer: Frontpath All Commercial |
$191.50
|
| Rate for Payer: Frontpath All Commercial |
$191.50
|
| Rate for Payer: Humana ChoiceCare |
$95.64
|
| Rate for Payer: Humana ChoiceCare |
$95.64
|
| Rate for Payer: Humana Medicare |
$170.06
|
| Rate for Payer: Humana Medicare |
$170.06
|
| Rate for Payer: Lucent All Commercial |
$238.08
|
| Rate for Payer: Lucent All Commercial |
$238.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: Managed Health Services Medicaid |
$183.90
|
| Rate for Payer: Managed Health Services Medicaid |
$183.90
|
| Rate for Payer: MDWise Medicaid |
$183.90
|
| Rate for Payer: MDWise Medicaid |
$183.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$87.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$87.90
|
| Rate for Payer: PHCS All Commercial |
$170.06
|
| Rate for Payer: PHCS All Commercial |
$170.06
|
| Rate for Payer: PHP All Commercial |
$177.28
|
| Rate for Payer: PHP All Commercial |
$177.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.06
|
| Rate for Payer: Sagamore Health Network All Products |
$170.06
|
| Rate for Payer: Sagamore Health Network All Products |
$170.06
|
| Rate for Payer: Signature Care EPO |
$163.34
|
| Rate for Payer: Signature Care EPO |
$163.34
|
| Rate for Payer: Signature Care PPO |
$163.34
|
| Rate for Payer: Signature Care PPO |
$163.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,000.00
|
| Rate for Payer: United Healthcare Commercial |
$156.29
|
| Rate for Payer: United Healthcare Commercial |
$156.29
|
| Rate for Payer: United Healthcare Medicare |
$184.33
|
| Rate for Payer: United Healthcare Medicare |
$184.33
|
|
|
PR PSYCHOANALYSIS
|
Professional
|
Both
|
$189.86
|
|
|
Service Code
|
CPT 90845
|
| Hospital Charge Code |
z90845
|
| Min. Negotiated Rate |
$53.03 |
| Max. Negotiated Rate |
$9,800.00 |
| Rate for Payer: Aetna Commercial |
$83.78
|
| Rate for Payer: Aetna Commercial |
$83.78
|
| Rate for Payer: Aetna Medicare |
$83.78
|
| Rate for Payer: Aetna Medicare |
$83.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$53.03
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$53.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$93.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$93.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.16
|
| Rate for Payer: Cash Price |
$107.21
|
| Rate for Payer: Cash Price |
$113.92
|
| Rate for Payer: Centivo All Commercial |
$129.86
|
| Rate for Payer: Centivo All Commercial |
$129.86
|
| Rate for Payer: Cigna All Commercial |
$83.78
|
| Rate for Payer: Cigna All Commercial |
$83.78
|
| Rate for Payer: CORVEL All Commercial |
$83.78
|
| Rate for Payer: CORVEL All Commercial |
$83.78
|
| Rate for Payer: Coventry All Commercial |
$100.54
|
| Rate for Payer: Coventry All Commercial |
$100.54
|
| Rate for Payer: Encore All Commercial |
$83.78
|
| Rate for Payer: Encore All Commercial |
$83.78
|
| Rate for Payer: Frontpath All Commercial |
$94.46
|
| Rate for Payer: Frontpath All Commercial |
$94.46
|
| Rate for Payer: Humana ChoiceCare |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$70.78
|
| Rate for Payer: Humana Medicare |
$83.78
|
| Rate for Payer: Humana Medicare |
$83.78
|
| Rate for Payer: Lucent All Commercial |
$117.29
|
| Rate for Payer: Lucent All Commercial |
$117.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.00
|
| Rate for Payer: Managed Health Services Medicaid |
$93.38
|
| Rate for Payer: Managed Health Services Medicaid |
$93.38
|
| Rate for Payer: MDWise Medicaid |
$93.38
|
| Rate for Payer: MDWise Medicaid |
$93.38
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$53.03
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$53.03
|
| Rate for Payer: PHCS All Commercial |
$83.78
|
| Rate for Payer: PHCS All Commercial |
$83.78
|
| Rate for Payer: PHP All Commercial |
$86.88
|
| Rate for Payer: PHP All Commercial |
$86.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.78
|
| Rate for Payer: Sagamore Health Network All Products |
$83.78
|
| Rate for Payer: Sagamore Health Network All Products |
$83.78
|
| Rate for Payer: 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 |
$9,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,800.00
|
| Rate for Payer: United Healthcare Commercial |
$97.93
|
| Rate for Payer: United Healthcare Commercial |
$97.93
|
| Rate for Payer: United Healthcare Medicare |
$89.34
|
| Rate for Payer: United Healthcare Medicare |
$89.34
|
|
|
PR PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Professional
|
Both
|
$28.44
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
z90785
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$12.83
|
| Rate for Payer: Aetna Commercial |
$12.83
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.11
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Centivo All Commercial |
$19.89
|
| Rate for Payer: Centivo All Commercial |
$19.89
|
| Rate for Payer: Cigna All Commercial |
$12.83
|
| Rate for Payer: Cigna All Commercial |
$12.83
|
| Rate for Payer: CORVEL All Commercial |
$12.83
|
| Rate for Payer: CORVEL All Commercial |
$12.83
|
| Rate for Payer: Coventry All Commercial |
$15.40
|
| Rate for Payer: Coventry All Commercial |
$15.40
|
| Rate for Payer: Encore All Commercial |
$12.83
|
| Rate for Payer: Encore All Commercial |
$12.83
|
| Rate for Payer: Frontpath All Commercial |
$14.37
|
| Rate for Payer: Frontpath All Commercial |
$14.37
|
| Rate for Payer: Humana ChoiceCare |
$3.71
|
| Rate for Payer: Humana ChoiceCare |
$3.71
|
| Rate for Payer: Humana Medicare |
$12.83
|
| Rate for Payer: Humana Medicare |
$12.83
|
| Rate for Payer: Lucent All Commercial |
$17.96
|
| Rate for Payer: Lucent All Commercial |
$17.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.98
|
| Rate for Payer: Managed Health Services Medicaid |
$13.98
|
| Rate for Payer: MDWise Medicaid |
$13.98
|
| Rate for Payer: MDWise Medicaid |
$13.98
|
| Rate for Payer: PHCS All Commercial |
$12.83
|
| Rate for Payer: PHCS All Commercial |
$12.83
|
| Rate for Payer: PHP All Commercial |
$13.70
|
| Rate for Payer: PHP All Commercial |
$13.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.83
|
| Rate for Payer: Sagamore Health Network All Products |
$12.83
|
| Rate for Payer: Sagamore Health Network All Products |
$12.83
|
| 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 |
$1,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Commercial |
$6.06
|
| Rate for Payer: United Healthcare Commercial |
$6.06
|
| Rate for Payer: United Healthcare Medicare |
$14.08
|
| Rate for Payer: United Healthcare Medicare |
$14.08
|
|
|
PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Professional
|
Both
|
$139.64
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
z90840
|
| Min. Negotiated Rate |
$46.85 |
| Max. Negotiated Rate |
$7,300.00 |
| Rate for Payer: Aetna Commercial |
$61.47
|
| Rate for Payer: Aetna Commercial |
$61.47
|
| Rate for Payer: Aetna Medicare |
$61.47
|
| Rate for Payer: Aetna Medicare |
$61.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$46.85
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$46.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.62
|
| Rate for Payer: Cash Price |
$78.73
|
| Rate for Payer: Cash Price |
$83.78
|
| Rate for Payer: Centivo All Commercial |
$95.28
|
| Rate for Payer: Centivo All Commercial |
$95.28
|
| Rate for Payer: Cigna All Commercial |
$61.47
|
| Rate for Payer: Cigna All Commercial |
$61.47
|
| Rate for Payer: CORVEL All Commercial |
$61.47
|
| Rate for Payer: CORVEL All Commercial |
$61.47
|
| Rate for Payer: Coventry All Commercial |
$73.76
|
| Rate for Payer: Coventry All Commercial |
$73.76
|
| Rate for Payer: Encore All Commercial |
$61.47
|
| Rate for Payer: Encore All Commercial |
$61.47
|
| Rate for Payer: Frontpath All Commercial |
$70.37
|
| Rate for Payer: Frontpath All Commercial |
$70.37
|
| Rate for Payer: Humana ChoiceCare |
$50.75
|
| Rate for Payer: Humana ChoiceCare |
$50.75
|
| Rate for Payer: Humana Medicare |
$61.47
|
| Rate for Payer: Humana Medicare |
$61.47
|
| Rate for Payer: Lucent All Commercial |
$86.06
|
| Rate for Payer: Lucent All Commercial |
$86.06
|
| 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 |
$68.68
|
| Rate for Payer: Managed Health Services Medicaid |
$68.68
|
| Rate for Payer: MDWise Medicaid |
$68.68
|
| Rate for Payer: MDWise Medicaid |
$68.68
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$46.85
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$46.85
|
| Rate for Payer: PHCS All Commercial |
$61.47
|
| Rate for Payer: PHCS All Commercial |
$61.47
|
| Rate for Payer: PHP All Commercial |
$64.29
|
| Rate for Payer: PHP All Commercial |
$64.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.47
|
| Rate for Payer: Sagamore Health Network All Products |
$61.47
|
| Rate for Payer: Sagamore Health Network All Products |
$61.47
|
| Rate for Payer: Signature Care EPO |
$58.07
|
| Rate for Payer: Signature Care EPO |
$58.07
|
| Rate for Payer: Signature Care PPO |
$58.07
|
| Rate for Payer: Signature Care PPO |
$58.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,300.00
|
| Rate for Payer: United Healthcare Commercial |
$114.65
|
| Rate for Payer: United Healthcare Commercial |
$114.65
|
| Rate for Payer: United Healthcare Medicare |
$65.61
|
| Rate for Payer: United Healthcare Medicare |
$65.61
|
|
|
PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
|
Professional
|
Both
|
$284.20
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
z90839
|
| Min. Negotiated Rate |
$97.31 |
| Max. Negotiated Rate |
$14,600.00 |
| Rate for Payer: Aetna Commercial |
$123.95
|
| Rate for Payer: Aetna Commercial |
$123.95
|
| Rate for Payer: Aetna Medicare |
$123.95
|
| Rate for Payer: Aetna Medicare |
$123.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.95
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$97.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$97.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$139.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$139.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.34
|
| Rate for Payer: Cash Price |
$160.03
|
| Rate for Payer: Cash Price |
$170.52
|
| Rate for Payer: Centivo All Commercial |
$192.12
|
| Rate for Payer: Centivo All Commercial |
$192.12
|
| Rate for Payer: Cigna All Commercial |
$123.95
|
| Rate for Payer: Cigna All Commercial |
$123.95
|
| Rate for Payer: CORVEL All Commercial |
$123.95
|
| Rate for Payer: CORVEL All Commercial |
$123.95
|
| Rate for Payer: Coventry All Commercial |
$148.74
|
| Rate for Payer: Coventry All Commercial |
$148.74
|
| Rate for Payer: Encore All Commercial |
$123.95
|
| Rate for Payer: Encore All Commercial |
$123.95
|
| Rate for Payer: Frontpath All Commercial |
$139.44
|
| Rate for Payer: Frontpath All Commercial |
$139.44
|
| Rate for Payer: Humana ChoiceCare |
$105.62
|
| Rate for Payer: Humana ChoiceCare |
$105.62
|
| Rate for Payer: Humana Medicare |
$123.95
|
| Rate for Payer: Humana Medicare |
$123.95
|
| Rate for Payer: Lucent All Commercial |
$173.53
|
| Rate for Payer: Lucent All Commercial |
$173.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.00
|
| Rate for Payer: Managed Health Services Medicaid |
$139.78
|
| Rate for Payer: Managed Health Services Medicaid |
$139.78
|
| Rate for Payer: MDWise Medicaid |
$139.78
|
| Rate for Payer: MDWise Medicaid |
$139.78
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$97.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$97.31
|
| Rate for Payer: PHCS All Commercial |
$123.95
|
| Rate for Payer: PHCS All Commercial |
$123.95
|
| Rate for Payer: PHP All Commercial |
$129.61
|
| Rate for Payer: PHP All Commercial |
$129.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.95
|
| Rate for Payer: Sagamore Health Network All Products |
$123.95
|
| Rate for Payer: Sagamore Health Network All Products |
$123.95
|
| Rate for Payer: Signature Care EPO |
$151.11
|
| Rate for Payer: Signature Care EPO |
$151.11
|
| Rate for Payer: Signature Care PPO |
$151.11
|
| Rate for Payer: Signature Care PPO |
$151.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,600.00
|
| Rate for Payer: United Healthcare Commercial |
$221.39
|
| Rate for Payer: United Healthcare Commercial |
$221.39
|
| Rate for Payer: United Healthcare Medicare |
$133.36
|
| Rate for Payer: United Healthcare Medicare |
$133.36
|
|
|
PR PSYCHOTHERAPY W/PATIENT 30 MINUTES
|
Professional
|
Both
|
$152.04
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
z90832
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$7,800.00 |
| Rate for Payer: Aetna Commercial |
$66.81
|
| Rate for Payer: Aetna Commercial |
$66.81
|
| Rate for Payer: Aetna Medicare |
$66.81
|
| Rate for Payer: Aetna Medicare |
$66.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.72
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.58
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.49
|
| Rate for Payer: Cash Price |
$85.91
|
| Rate for Payer: Cash Price |
$91.22
|
| Rate for Payer: Centivo All Commercial |
$103.56
|
| Rate for Payer: Centivo All Commercial |
$103.56
|
| Rate for Payer: Cigna All Commercial |
$66.81
|
| Rate for Payer: Cigna All Commercial |
$66.81
|
| Rate for Payer: CORVEL All Commercial |
$66.81
|
| Rate for Payer: CORVEL All Commercial |
$66.81
|
| Rate for Payer: Coventry All Commercial |
$80.17
|
| Rate for Payer: Coventry All Commercial |
$80.17
|
| Rate for Payer: Encore All Commercial |
$66.81
|
| Rate for Payer: Encore All Commercial |
$66.81
|
| Rate for Payer: Frontpath All Commercial |
$75.27
|
| Rate for Payer: Frontpath All Commercial |
$75.27
|
| Rate for Payer: Humana ChoiceCare |
$38.86
|
| Rate for Payer: Humana ChoiceCare |
$38.86
|
| Rate for Payer: Humana Medicare |
$66.81
|
| Rate for Payer: Humana Medicare |
$66.81
|
| Rate for Payer: Lucent All Commercial |
$93.53
|
| Rate for Payer: Lucent All Commercial |
$93.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: Managed Health Services Medicaid |
$74.78
|
| Rate for Payer: Managed Health Services Medicaid |
$74.78
|
| Rate for Payer: MDWise Medicaid |
$74.78
|
| Rate for Payer: MDWise Medicaid |
$74.78
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.58
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.58
|
| Rate for Payer: PHCS All Commercial |
$66.81
|
| Rate for Payer: PHCS All Commercial |
$66.81
|
| Rate for Payer: PHP All Commercial |
$69.17
|
| Rate for Payer: PHP All Commercial |
$69.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.81
|
| Rate for Payer: Sagamore Health Network All Products |
$66.81
|
| Rate for Payer: Sagamore Health Network All Products |
$66.81
|
| Rate for Payer: Signature Care EPO |
$69.45
|
| Rate for Payer: Signature Care EPO |
$69.45
|
| Rate for Payer: Signature Care PPO |
$69.45
|
| Rate for Payer: Signature Care PPO |
$69.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,800.00
|
| Rate for Payer: United Healthcare Commercial |
$63.50
|
| Rate for Payer: United Healthcare Commercial |
$63.50
|
| Rate for Payer: United Healthcare Medicare |
$71.59
|
| Rate for Payer: United Healthcare Medicare |
$71.59
|
|
|
PR PSYCHOTHERAPY W/PATIENT 45 MINUTES
|
Professional
|
Both
|
$200.74
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
z90834
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$10,300.00 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.84
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$49.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$49.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.80
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$120.44
|
| Rate for Payer: Centivo All Commercial |
$136.40
|
| Rate for Payer: Centivo All Commercial |
$136.40
|
| Rate for Payer: Cigna All Commercial |
$88.00
|
| Rate for Payer: Cigna All Commercial |
$88.00
|
| Rate for Payer: CORVEL All Commercial |
$88.00
|
| Rate for Payer: CORVEL All Commercial |
$88.00
|
| Rate for Payer: Coventry All Commercial |
$105.60
|
| Rate for Payer: Coventry All Commercial |
$105.60
|
| Rate for Payer: Encore All Commercial |
$88.00
|
| Rate for Payer: Encore All Commercial |
$88.00
|
| Rate for Payer: Frontpath All Commercial |
$99.10
|
| Rate for Payer: Frontpath All Commercial |
$99.10
|
| Rate for Payer: Humana ChoiceCare |
$58.35
|
| Rate for Payer: Humana ChoiceCare |
$58.35
|
| Rate for Payer: Humana Medicare |
$88.00
|
| Rate for Payer: Humana Medicare |
$88.00
|
| Rate for Payer: Lucent All Commercial |
$123.20
|
| Rate for Payer: Lucent All Commercial |
$123.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.00
|
| Rate for Payer: Managed Health Services Medicaid |
$98.73
|
| Rate for Payer: Managed Health Services Medicaid |
$98.73
|
| Rate for Payer: MDWise Medicaid |
$98.73
|
| Rate for Payer: MDWise Medicaid |
$98.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$49.43
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$49.43
|
| Rate for Payer: PHCS All Commercial |
$88.00
|
| Rate for Payer: PHCS All Commercial |
$88.00
|
| Rate for Payer: PHP All Commercial |
$91.60
|
| Rate for Payer: PHP All Commercial |
$91.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$88.00
|
| Rate for Payer: Signature Care EPO |
$90.24
|
| Rate for Payer: Signature Care EPO |
$90.24
|
| Rate for Payer: Signature Care PPO |
$90.24
|
| Rate for Payer: Signature Care PPO |
$90.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,300.00
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Medicare |
$94.58
|
| Rate for Payer: United Healthcare Medicare |
$94.58
|
|
|
PR PSYCHOTHERAPY W/PATIENT 60 MINUTES
|
Professional
|
Both
|
$295.92
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
z90837
|
| Min. Negotiated Rate |
$75.77 |
| Max. Negotiated Rate |
$15,200.00 |
| Rate for Payer: Aetna Commercial |
$129.40
|
| Rate for Payer: Aetna Commercial |
$129.40
|
| Rate for Payer: Aetna Medicare |
$129.40
|
| Rate for Payer: Aetna Medicare |
$129.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.86
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$75.77
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$75.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$145.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$145.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.34
|
| Rate for Payer: Cash Price |
$167.16
|
| Rate for Payer: Cash Price |
$177.55
|
| Rate for Payer: Centivo All Commercial |
$200.57
|
| Rate for Payer: Centivo All Commercial |
$200.57
|
| Rate for Payer: Cigna All Commercial |
$129.40
|
| Rate for Payer: Cigna All Commercial |
$129.40
|
| Rate for Payer: CORVEL All Commercial |
$129.40
|
| Rate for Payer: CORVEL All Commercial |
$129.40
|
| Rate for Payer: Coventry All Commercial |
$155.28
|
| Rate for Payer: Coventry All Commercial |
$155.28
|
| Rate for Payer: Encore All Commercial |
$129.40
|
| Rate for Payer: Encore All Commercial |
$129.40
|
| Rate for Payer: Frontpath All Commercial |
$145.18
|
| Rate for Payer: Frontpath All Commercial |
$145.18
|
| Rate for Payer: Humana ChoiceCare |
$87.99
|
| Rate for Payer: Humana ChoiceCare |
$87.99
|
| Rate for Payer: Humana Medicare |
$129.40
|
| Rate for Payer: Humana Medicare |
$129.40
|
| Rate for Payer: Lucent All Commercial |
$181.16
|
| Rate for Payer: Lucent All Commercial |
$181.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: Managed Health Services Medicaid |
$145.54
|
| Rate for Payer: Managed Health Services Medicaid |
$145.54
|
| Rate for Payer: MDWise Medicaid |
$145.54
|
| Rate for Payer: MDWise Medicaid |
$145.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$75.77
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$75.77
|
| Rate for Payer: PHCS All Commercial |
$129.40
|
| Rate for Payer: PHCS All Commercial |
$129.40
|
| Rate for Payer: PHP All Commercial |
$134.77
|
| Rate for Payer: PHP All Commercial |
$134.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.40
|
| Rate for Payer: Sagamore Health Network All Products |
$129.40
|
| Rate for Payer: Sagamore Health Network All Products |
$129.40
|
| Rate for Payer: Signature Care EPO |
$132.22
|
| Rate for Payer: Signature Care EPO |
$132.22
|
| Rate for Payer: Signature Care PPO |
$132.22
|
| Rate for Payer: Signature Care PPO |
$132.22
|
| 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 |
$143.80
|
| Rate for Payer: United Healthcare Commercial |
$143.80
|
| Rate for Payer: United Healthcare Medicare |
$139.30
|
| Rate for Payer: United Healthcare Medicare |
$139.30
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN
|
Professional
|
Both
|
$138.70
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
z90833
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Aetna Commercial |
$61.45
|
| Rate for Payer: Aetna Commercial |
$61.45
|
| Rate for Payer: Aetna Medicare |
$61.45
|
| Rate for Payer: Aetna Medicare |
$61.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$36.85
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$36.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.59
|
| Rate for Payer: Cash Price |
$78.35
|
| Rate for Payer: Cash Price |
$83.22
|
| Rate for Payer: Centivo All Commercial |
$95.25
|
| Rate for Payer: Centivo All Commercial |
$95.25
|
| Rate for Payer: Cigna All Commercial |
$61.45
|
| Rate for Payer: Cigna All Commercial |
$61.45
|
| Rate for Payer: CORVEL All Commercial |
$61.45
|
| Rate for Payer: CORVEL All Commercial |
$61.45
|
| Rate for Payer: Coventry All Commercial |
$73.74
|
| Rate for Payer: Coventry All Commercial |
$73.74
|
| Rate for Payer: Encore All Commercial |
$61.45
|
| Rate for Payer: Encore All Commercial |
$61.45
|
| Rate for Payer: Frontpath All Commercial |
$69.40
|
| Rate for Payer: Frontpath All Commercial |
$69.40
|
| Rate for Payer: Humana ChoiceCare |
$32.51
|
| Rate for Payer: Humana ChoiceCare |
$32.51
|
| Rate for Payer: Humana Medicare |
$61.45
|
| Rate for Payer: Humana Medicare |
$61.45
|
| Rate for Payer: Lucent All Commercial |
$86.03
|
| Rate for Payer: Lucent All Commercial |
$86.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.00
|
| Rate for Payer: Managed Health Services Medicaid |
$68.22
|
| Rate for Payer: Managed Health Services Medicaid |
$68.22
|
| Rate for Payer: MDWise Medicaid |
$68.22
|
| Rate for Payer: MDWise Medicaid |
$68.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$36.85
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$36.85
|
| Rate for Payer: PHCS All Commercial |
$61.45
|
| Rate for Payer: PHCS All Commercial |
$61.45
|
| Rate for Payer: PHP All Commercial |
$63.95
|
| Rate for Payer: PHP All Commercial |
$63.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.45
|
| Rate for Payer: Sagamore Health Network All Products |
$61.45
|
| Rate for Payer: Sagamore Health Network All Products |
$61.45
|
| Rate for Payer: Signature Care EPO |
$58.06
|
| Rate for Payer: Signature Care EPO |
$58.06
|
| Rate for Payer: Signature Care PPO |
$58.06
|
| Rate for Payer: Signature Care PPO |
$58.06
|
| 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 |
$53.13
|
| Rate for Payer: United Healthcare Commercial |
$53.13
|
| Rate for Payer: United Healthcare Medicare |
$65.29
|
| Rate for Payer: United Healthcare Medicare |
$65.29
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN
|
Professional
|
Both
|
$175.58
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
z90836
|
| Min. Negotiated Rate |
$27.89 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna Commercial |
$77.63
|
| Rate for Payer: Aetna Commercial |
$77.63
|
| Rate for Payer: Aetna Medicare |
$77.63
|
| Rate for Payer: Aetna Medicare |
$77.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.89
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$47.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$47.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$86.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$86.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.39
|
| Rate for Payer: Cash Price |
$99.29
|
| Rate for Payer: Cash Price |
$105.35
|
| Rate for Payer: Centivo All Commercial |
$120.33
|
| Rate for Payer: Centivo All Commercial |
$120.33
|
| Rate for Payer: Cigna All Commercial |
$77.63
|
| Rate for Payer: Cigna All Commercial |
$77.63
|
| Rate for Payer: CORVEL All Commercial |
$77.63
|
| Rate for Payer: CORVEL All Commercial |
$77.63
|
| Rate for Payer: Coventry All Commercial |
$93.16
|
| Rate for Payer: Coventry All Commercial |
$93.16
|
| Rate for Payer: Encore All Commercial |
$77.63
|
| Rate for Payer: Encore All Commercial |
$77.63
|
| Rate for Payer: Frontpath All Commercial |
$87.47
|
| Rate for Payer: Frontpath All Commercial |
$87.47
|
| Rate for Payer: Humana ChoiceCare |
$53.25
|
| Rate for Payer: Humana ChoiceCare |
$53.25
|
| Rate for Payer: Humana Medicare |
$77.63
|
| Rate for Payer: Humana Medicare |
$77.63
|
| Rate for Payer: Lucent All Commercial |
$108.68
|
| Rate for Payer: Lucent All Commercial |
$108.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.00
|
| Rate for Payer: Managed Health Services Medicaid |
$86.36
|
| Rate for Payer: Managed Health Services Medicaid |
$86.36
|
| Rate for Payer: MDWise Medicaid |
$86.36
|
| Rate for Payer: MDWise Medicaid |
$86.36
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$47.45
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$47.45
|
| Rate for Payer: PHCS All Commercial |
$77.63
|
| Rate for Payer: PHCS All Commercial |
$77.63
|
| Rate for Payer: PHP All Commercial |
$81.00
|
| Rate for Payer: PHP All Commercial |
$81.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.63
|
| Rate for Payer: Sagamore Health Network All Products |
$77.63
|
| Rate for Payer: Sagamore Health Network All Products |
$77.63
|
| Rate for Payer: Signature Care EPO |
$75.44
|
| Rate for Payer: Signature Care EPO |
$75.44
|
| Rate for Payer: Signature Care PPO |
$75.44
|
| Rate for Payer: Signature Care PPO |
$75.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,100.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$82.74
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN
|
Professional
|
Both
|
$232.60
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
z90838
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$12,100.00 |
| Rate for Payer: Aetna Commercial |
$102.76
|
| Rate for Payer: Aetna Commercial |
$102.76
|
| Rate for Payer: Aetna Medicare |
$102.76
|
| Rate for Payer: Aetna Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.37
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.91
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.04
|
| Rate for Payer: Cash Price |
$131.26
|
| Rate for Payer: Cash Price |
$139.56
|
| Rate for Payer: Centivo All Commercial |
$159.28
|
| Rate for Payer: Centivo All Commercial |
$159.28
|
| Rate for Payer: Cigna All Commercial |
$102.76
|
| Rate for Payer: Cigna All Commercial |
$102.76
|
| Rate for Payer: CORVEL All Commercial |
$102.76
|
| Rate for Payer: CORVEL All Commercial |
$102.76
|
| Rate for Payer: Coventry All Commercial |
$123.31
|
| Rate for Payer: Coventry All Commercial |
$123.31
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$115.67
|
| Rate for Payer: Frontpath All Commercial |
$115.67
|
| Rate for Payer: Humana ChoiceCare |
$85.46
|
| Rate for Payer: Humana ChoiceCare |
$85.46
|
| Rate for Payer: Humana Medicare |
$102.76
|
| Rate for Payer: Humana Medicare |
$102.76
|
| Rate for Payer: Lucent All Commercial |
$143.86
|
| Rate for Payer: Lucent All Commercial |
$143.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.00
|
| Rate for Payer: Managed Health Services Medicaid |
$114.41
|
| Rate for Payer: Managed Health Services Medicaid |
$114.41
|
| Rate for Payer: MDWise Medicaid |
$114.41
|
| Rate for Payer: MDWise Medicaid |
$114.41
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.91
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.91
|
| Rate for Payer: PHCS All Commercial |
$102.76
|
| Rate for Payer: PHCS All Commercial |
$102.76
|
| Rate for Payer: PHP All Commercial |
$107.40
|
| Rate for Payer: PHP All Commercial |
$107.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.76
|
| Rate for Payer: Sagamore Health Network All Products |
$102.76
|
| Rate for Payer: Sagamore Health Network All Products |
$102.76
|
| Rate for Payer: Signature Care EPO |
$121.80
|
| Rate for Payer: Signature Care EPO |
$121.80
|
| Rate for Payer: Signature Care PPO |
$121.80
|
| Rate for Payer: Signature Care PPO |
$121.80
|
| 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 |
$139.64
|
| Rate for Payer: United Healthcare Commercial |
$139.64
|
| Rate for Payer: United Healthcare Medicare |
$109.38
|
| Rate for Payer: United Healthcare Medicare |
$109.38
|
|
|
PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$110.46
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
z11105
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$57.61 |
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Medicare |
$24.16
|
| Rate for Payer: Aetna Medicare |
$24.16
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$12.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$12.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.58
|
| Rate for Payer: Cash Price |
$64.88
|
| Rate for Payer: Cash Price |
$66.28
|
| Rate for Payer: Centivo All Commercial |
$37.45
|
| Rate for Payer: Centivo All Commercial |
$37.45
|
| Rate for Payer: Cigna All Commercial |
$24.16
|
| Rate for Payer: Cigna All Commercial |
$24.16
|
| Rate for Payer: CORVEL All Commercial |
$24.16
|
| Rate for Payer: CORVEL All Commercial |
$24.16
|
| Rate for Payer: Coventry All Commercial |
$28.99
|
| Rate for Payer: Coventry All Commercial |
$28.99
|
| Rate for Payer: Encore All Commercial |
$24.16
|
| Rate for Payer: Encore All Commercial |
$24.16
|
| Rate for Payer: Frontpath All Commercial |
$32.97
|
| Rate for Payer: Frontpath All Commercial |
$32.97
|
| Rate for Payer: Humana ChoiceCare |
$25.98
|
| Rate for Payer: Humana ChoiceCare |
$25.98
|
| Rate for Payer: Humana Medicare |
$24.16
|
| Rate for Payer: Humana Medicare |
$24.16
|
| Rate for Payer: Lucent All Commercial |
$33.82
|
| Rate for Payer: Lucent All Commercial |
$33.82
|
| Rate for Payer: Managed Health Services Medicaid |
$54.33
|
| Rate for Payer: Managed Health Services Medicaid |
$54.33
|
| Rate for Payer: MDWise Medicaid |
$54.33
|
| Rate for Payer: MDWise Medicaid |
$54.33
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$12.98
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$12.98
|
| Rate for Payer: PHCS All Commercial |
$24.16
|
| Rate for Payer: PHCS All Commercial |
$24.16
|
| Rate for Payer: PHP All Commercial |
$32.69
|
| Rate for Payer: PHP All Commercial |
$32.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.16
|
| Rate for Payer: Sagamore Health Network All Products |
$24.16
|
| Rate for Payer: Sagamore Health Network All Products |
$24.16
|
| Rate for Payer: Signature Care EPO |
$57.61
|
| Rate for Payer: Signature Care EPO |
$57.61
|
| Rate for Payer: Signature Care PPO |
$57.61
|
| Rate for Payer: Signature Care PPO |
$57.61
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Medicare |
$54.07
|
| Rate for Payer: United Healthcare Medicare |
$54.07
|
|
|
PR PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$232.20
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
z11104
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$117.21 |
| Rate for Payer: Aetna Commercial |
$44.19
|
| Rate for Payer: Aetna Commercial |
$44.19
|
| Rate for Payer: Aetna Medicare |
$44.19
|
| Rate for Payer: Aetna Medicare |
$44.19
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$31.09
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$31.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.61
|
| Rate for Payer: Cash Price |
$137.82
|
| Rate for Payer: Cash Price |
$139.32
|
| Rate for Payer: Centivo All Commercial |
$68.49
|
| Rate for Payer: Centivo All Commercial |
$68.49
|
| Rate for Payer: Cigna All Commercial |
$44.19
|
| Rate for Payer: Cigna All Commercial |
$44.19
|
| Rate for Payer: CORVEL All Commercial |
$44.19
|
| Rate for Payer: CORVEL All Commercial |
$44.19
|
| Rate for Payer: Coventry All Commercial |
$53.03
|
| Rate for Payer: Coventry All Commercial |
$53.03
|
| Rate for Payer: Encore All Commercial |
$44.19
|
| Rate for Payer: Encore All Commercial |
$44.19
|
| Rate for Payer: Frontpath All Commercial |
$60.26
|
| Rate for Payer: Frontpath All Commercial |
$60.26
|
| Rate for Payer: Humana ChoiceCare |
$47.64
|
| Rate for Payer: Humana ChoiceCare |
$47.64
|
| Rate for Payer: Humana Medicare |
$44.19
|
| Rate for Payer: Humana Medicare |
$44.19
|
| Rate for Payer: Lucent All Commercial |
$61.87
|
| Rate for Payer: Lucent All Commercial |
$61.87
|
| Rate for Payer: Managed Health Services Medicaid |
$114.20
|
| Rate for Payer: Managed Health Services Medicaid |
$114.20
|
| Rate for Payer: MDWise Medicaid |
$114.20
|
| Rate for Payer: MDWise Medicaid |
$114.20
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$31.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$31.09
|
| Rate for Payer: PHCS All Commercial |
$44.19
|
| Rate for Payer: PHCS All Commercial |
$44.19
|
| Rate for Payer: PHP All Commercial |
$60.01
|
| Rate for Payer: PHP All Commercial |
$60.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.19
|
| Rate for Payer: Sagamore Health Network All Products |
$44.19
|
| Rate for Payer: Sagamore Health Network All Products |
$44.19
|
| Rate for Payer: Signature Care EPO |
$117.21
|
| Rate for Payer: Signature Care EPO |
$117.21
|
| Rate for Payer: Signature Care PPO |
$117.21
|
| Rate for Payer: Signature Care PPO |
$117.21
|
| Rate for Payer: United Healthcare Commercial |
$60.68
|
| Rate for Payer: United Healthcare Commercial |
$60.68
|
| Rate for Payer: United Healthcare Medicare |
$114.85
|
| Rate for Payer: United Healthcare Medicare |
$114.85
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$241.84
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
z10160
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$10,800.00 |
| Rate for Payer: Aetna Commercial |
$89.11
|
| Rate for Payer: Aetna Commercial |
$89.11
|
| Rate for Payer: Aetna Medicare |
$89.11
|
| Rate for Payer: Aetna Medicare |
$89.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.94
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$48.28
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$48.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$118.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$118.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.02
|
| Rate for Payer: Cash Price |
$142.43
|
| Rate for Payer: Cash Price |
$145.10
|
| Rate for Payer: Centivo All Commercial |
$138.12
|
| Rate for Payer: Centivo All Commercial |
$138.12
|
| Rate for Payer: Cigna All Commercial |
$89.11
|
| Rate for Payer: Cigna All Commercial |
$89.11
|
| Rate for Payer: CORVEL All Commercial |
$89.11
|
| Rate for Payer: CORVEL All Commercial |
$89.11
|
| Rate for Payer: Coventry All Commercial |
$106.93
|
| Rate for Payer: Coventry All Commercial |
$106.93
|
| Rate for Payer: Encore All Commercial |
$89.11
|
| Rate for Payer: Encore All Commercial |
$89.11
|
| Rate for Payer: Frontpath All Commercial |
$120.63
|
| Rate for Payer: Frontpath All Commercial |
$120.63
|
| Rate for Payer: Humana ChoiceCare |
$84.87
|
| Rate for Payer: Humana ChoiceCare |
$84.87
|
| Rate for Payer: Humana Medicare |
$89.11
|
| Rate for Payer: Humana Medicare |
$89.11
|
| Rate for Payer: Lucent All Commercial |
$124.75
|
| Rate for Payer: Lucent All Commercial |
$124.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.00
|
| Rate for Payer: Managed Health Services Medicaid |
$118.95
|
| Rate for Payer: Managed Health Services Medicaid |
$118.95
|
| Rate for Payer: MDWise Medicaid |
$118.95
|
| Rate for Payer: MDWise Medicaid |
$118.95
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$48.28
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$48.28
|
| Rate for Payer: PHCS All Commercial |
$89.11
|
| Rate for Payer: PHCS All Commercial |
$89.11
|
| Rate for Payer: PHP All Commercial |
$123.16
|
| Rate for Payer: PHP All Commercial |
$123.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.11
|
| Rate for Payer: Sagamore Health Network All Products |
$89.11
|
| Rate for Payer: Sagamore Health Network All Products |
$89.11
|
| Rate for Payer: Signature Care EPO |
$104.81
|
| Rate for Payer: Signature Care EPO |
$104.81
|
| Rate for Payer: Signature Care PPO |
$104.81
|
| Rate for Payer: Signature Care PPO |
$104.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,800.00
|
| Rate for Payer: United Healthcare Commercial |
$103.06
|
| Rate for Payer: United Healthcare Commercial |
$103.06
|
| Rate for Payer: United Healthcare Medicare |
$118.69
|
| Rate for Payer: United Healthcare Medicare |
$118.69
|
|
|
PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST
|
Professional
|
Both
|
$49.22
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
z19001
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$20.01
|
| Rate for Payer: Aetna Commercial |
$20.01
|
| Rate for Payer: Aetna Medicare |
$20.01
|
| Rate for Payer: Aetna Medicare |
$20.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.93
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.21
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.01
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$29.53
|
| Rate for Payer: Centivo All Commercial |
$31.02
|
| Rate for Payer: Centivo All Commercial |
$31.02
|
| Rate for Payer: Cigna All Commercial |
$20.01
|
| Rate for Payer: Cigna All Commercial |
$20.01
|
| Rate for Payer: CORVEL All Commercial |
$20.01
|
| Rate for Payer: CORVEL All Commercial |
$20.01
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$20.01
|
| Rate for Payer: Encore All Commercial |
$20.01
|
| Rate for Payer: Frontpath All Commercial |
$27.52
|
| Rate for Payer: Frontpath All Commercial |
$27.52
|
| Rate for Payer: Humana ChoiceCare |
$21.38
|
| Rate for Payer: Humana ChoiceCare |
$21.38
|
| Rate for Payer: Humana Medicare |
$20.01
|
| Rate for Payer: Humana Medicare |
$20.01
|
| Rate for Payer: Lucent All Commercial |
$28.01
|
| Rate for Payer: Lucent All Commercial |
$28.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.00
|
| Rate for Payer: Managed Health Services Medicaid |
$24.21
|
| Rate for Payer: Managed Health Services Medicaid |
$24.21
|
| Rate for Payer: MDWise Medicaid |
$24.21
|
| Rate for Payer: MDWise Medicaid |
$24.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.21
|
| Rate for Payer: PHCS All Commercial |
$20.01
|
| Rate for Payer: PHCS All Commercial |
$20.01
|
| Rate for Payer: PHP All Commercial |
$26.64
|
| Rate for Payer: PHP All Commercial |
$26.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.01
|
| Rate for Payer: Sagamore Health Network All Products |
$20.01
|
| Rate for Payer: Sagamore Health Network All Products |
$20.01
|
| Rate for Payer: Signature Care EPO |
$43.03
|
| Rate for Payer: Signature Care EPO |
$43.03
|
| Rate for Payer: Signature Care PPO |
$43.03
|
| Rate for Payer: Signature Care PPO |
$43.03
|
| 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 |
$26.23
|
| Rate for Payer: United Healthcare Commercial |
$26.23
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
|
|
PR PUNCTURE ASPIRATION CYST OF BREAST
|
Professional
|
Both
|
$186.10
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
z19000
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$40.33
|
| Rate for Payer: Aetna Commercial |
$40.33
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$29.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$29.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.36
|
| Rate for Payer: Cash Price |
$111.55
|
| Rate for Payer: Cash Price |
$111.66
|
| Rate for Payer: Centivo All Commercial |
$62.51
|
| Rate for Payer: Centivo All Commercial |
$62.51
|
| Rate for Payer: Cigna All Commercial |
$40.33
|
| Rate for Payer: Cigna All Commercial |
$40.33
|
| Rate for Payer: CORVEL All Commercial |
$40.33
|
| Rate for Payer: CORVEL All Commercial |
$40.33
|
| Rate for Payer: Coventry All Commercial |
$48.40
|
| Rate for Payer: Coventry All Commercial |
$48.40
|
| Rate for Payer: Encore All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$40.33
|
| Rate for Payer: Frontpath All Commercial |
$55.44
|
| Rate for Payer: Frontpath All Commercial |
$55.44
|
| Rate for Payer: Humana ChoiceCare |
$43.80
|
| Rate for Payer: Humana ChoiceCare |
$43.80
|
| Rate for Payer: Humana Medicare |
$40.33
|
| Rate for Payer: Humana Medicare |
$40.33
|
| Rate for Payer: Lucent All Commercial |
$56.46
|
| Rate for Payer: Lucent All Commercial |
$56.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: Managed Health Services Medicaid |
$91.44
|
| Rate for Payer: Managed Health Services Medicaid |
$91.44
|
| Rate for Payer: MDWise Medicaid |
$91.44
|
| Rate for Payer: MDWise Medicaid |
$91.44
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$29.35
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$29.35
|
| Rate for Payer: PHCS All Commercial |
$40.33
|
| Rate for Payer: PHCS All Commercial |
$40.33
|
| Rate for Payer: PHP All Commercial |
$54.37
|
| Rate for Payer: PHP All Commercial |
$54.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.33
|
| Rate for Payer: Sagamore Health Network All Products |
$40.33
|
| Rate for Payer: Sagamore Health Network All Products |
$40.33
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare Commercial |
$52.45
|
| Rate for Payer: United Healthcare Commercial |
$52.45
|
| Rate for Payer: United Healthcare Medicare |
$93.05
|
| Rate for Payer: United Healthcare Medicare |
$93.05
|
|
|
PR PURE TONE AUDIOMETRY, AIR
|
Professional
|
Both
|
$69.68
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
z92552
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$30.68
|
| Rate for Payer: Aetna Commercial |
$30.68
|
| Rate for Payer: Aetna Medicare |
$30.68
|
| Rate for Payer: Aetna Medicare |
$30.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.75
|
| Rate for Payer: Cash Price |
$41.81
|
| Rate for Payer: Cash Price |
$38.14
|
| Rate for Payer: Centivo All Commercial |
$47.55
|
| Rate for Payer: Centivo All Commercial |
$47.55
|
| Rate for Payer: Cigna All Commercial |
$30.68
|
| Rate for Payer: Cigna All Commercial |
$30.68
|
| Rate for Payer: CORVEL All Commercial |
$30.68
|
| Rate for Payer: CORVEL All Commercial |
$30.68
|
| Rate for Payer: Coventry All Commercial |
$36.82
|
| Rate for Payer: Coventry All Commercial |
$36.82
|
| Rate for Payer: Encore All Commercial |
$30.68
|
| Rate for Payer: Encore All Commercial |
$30.68
|
| Rate for Payer: Frontpath All Commercial |
$34.47
|
| Rate for Payer: Frontpath All Commercial |
$34.47
|
| Rate for Payer: Humana ChoiceCare |
$18.45
|
| Rate for Payer: Humana ChoiceCare |
$18.45
|
| Rate for Payer: Humana Medicare |
$30.68
|
| Rate for Payer: Humana Medicare |
$30.68
|
| Rate for Payer: Lucent All Commercial |
$42.95
|
| Rate for Payer: Lucent All Commercial |
$42.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: Managed Health Services Medicaid |
$34.27
|
| Rate for Payer: Managed Health Services Medicaid |
$34.27
|
| Rate for Payer: MDWise Medicaid |
$34.27
|
| Rate for Payer: MDWise Medicaid |
$34.27
|
| Rate for Payer: PHCS All Commercial |
$30.68
|
| Rate for Payer: PHCS All Commercial |
$30.68
|
| Rate for Payer: PHP All Commercial |
$46.08
|
| Rate for Payer: PHP All Commercial |
$46.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.68
|
| Rate for Payer: Sagamore Health Network All Products |
$30.68
|
| Rate for Payer: Sagamore Health Network All Products |
$30.68
|
| Rate for Payer: Signature Care EPO |
$26.08
|
| Rate for Payer: Signature Care EPO |
$26.08
|
| Rate for Payer: Signature Care PPO |
$26.08
|
| Rate for Payer: Signature Care PPO |
$26.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare Commercial |
$23.84
|
| Rate for Payer: United Healthcare Commercial |
$23.84
|
| Rate for Payer: United Healthcare Medicare |
$31.78
|
| Rate for Payer: United Healthcare Medicare |
$31.78
|
|
|
PR PURE TONE HEARING TEST, AIR
|
Professional
|
Both
|
$21.40
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
z92551
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.33
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$11.84
|
| Rate for Payer: Humana ChoiceCare |
$11.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: Managed Health Services Medicaid |
$11.33
|
| Rate for Payer: Managed Health Services Medicaid |
$11.33
|
| Rate for Payer: MDWise Medicaid |
$11.33
|
| Rate for Payer: MDWise Medicaid |
$11.33
|
| Rate for Payer: PHP All Commercial |
$15.51
|
| Rate for Payer: PHP All Commercial |
$15.51
|
| Rate for Payer: Signature Care EPO |
$18.70
|
| Rate for Payer: Signature Care EPO |
$18.70
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.00
|
| Rate for Payer: United Healthcare Commercial |
$11.86
|
| Rate for Payer: United Healthcare Commercial |
$11.86
|
| Rate for Payer: United Healthcare Medicare |
$10.70
|
| Rate for Payer: United Healthcare Medicare |
$10.70
|
|
|
PR RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Professional
|
Both
|
$721.08
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
z13131
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$356.11 |
| Rate for Payer: Aetna Commercial |
$226.47
|
| Rate for Payer: Aetna Commercial |
$226.47
|
| Rate for Payer: Aetna Medicare |
$226.47
|
| Rate for Payer: Aetna Medicare |
$226.47
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$122.16
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$122.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$354.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$354.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$260.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$260.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$249.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$249.12
|
| Rate for Payer: Cash Price |
$427.33
|
| Rate for Payer: Cash Price |
$432.65
|
| Rate for Payer: Centivo All Commercial |
$351.03
|
| Rate for Payer: Centivo All Commercial |
$351.03
|
| Rate for Payer: Cigna All Commercial |
$226.47
|
| Rate for Payer: Cigna All Commercial |
$226.47
|
| Rate for Payer: CORVEL All Commercial |
$226.47
|
| Rate for Payer: CORVEL All Commercial |
$226.47
|
| Rate for Payer: Coventry All Commercial |
$271.76
|
| Rate for Payer: Coventry All Commercial |
$271.76
|
| Rate for Payer: Encore All Commercial |
$226.47
|
| Rate for Payer: Encore All Commercial |
$226.47
|
| Rate for Payer: Frontpath All Commercial |
$308.00
|
| Rate for Payer: Frontpath All Commercial |
$308.00
|
| Rate for Payer: Humana ChoiceCare |
$239.91
|
| Rate for Payer: Humana ChoiceCare |
$239.91
|
| Rate for Payer: Humana Medicare |
$226.47
|
| Rate for Payer: Humana Medicare |
$226.47
|
| Rate for Payer: Lucent All Commercial |
$317.06
|
| Rate for Payer: Lucent All Commercial |
$317.06
|
| Rate for Payer: Managed Health Services Medicaid |
$354.66
|
| Rate for Payer: Managed Health Services Medicaid |
$354.66
|
| Rate for Payer: MDWise Medicaid |
$354.66
|
| Rate for Payer: MDWise Medicaid |
$354.66
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$122.16
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$122.16
|
| Rate for Payer: PHCS All Commercial |
$226.47
|
| Rate for Payer: PHCS All Commercial |
$226.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.47
|
| Rate for Payer: Sagamore Health Network All Products |
$226.47
|
| Rate for Payer: Sagamore Health Network All Products |
$226.47
|
| Rate for Payer: United Healthcare Commercial |
$298.36
|
| Rate for Payer: United Healthcare Commercial |
$298.36
|
| Rate for Payer: United Healthcare Medicare |
$356.11
|
| Rate for Payer: United Healthcare Medicare |
$356.11
|
|
|
PR RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM
|
Professional
|
Both
|
$875.54
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
z13132
|
| Min. Negotiated Rate |
$152.79 |
| Max. Negotiated Rate |
$34,000.00 |
| Rate for Payer: Aetna Commercial |
$283.73
|
| Rate for Payer: Aetna Commercial |
$283.73
|
| Rate for Payer: Aetna Medicare |
$283.73
|
| Rate for Payer: Aetna Medicare |
$283.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$152.79
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$152.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$430.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$430.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.10
|
| Rate for Payer: Cash Price |
$519.13
|
| Rate for Payer: Cash Price |
$525.32
|
| Rate for Payer: Centivo All Commercial |
$439.78
|
| Rate for Payer: Centivo All Commercial |
$439.78
|
| Rate for Payer: Cigna All Commercial |
$283.73
|
| Rate for Payer: Cigna All Commercial |
$283.73
|
| Rate for Payer: CORVEL All Commercial |
$283.73
|
| Rate for Payer: CORVEL All Commercial |
$283.73
|
| Rate for Payer: Coventry All Commercial |
$340.48
|
| Rate for Payer: Coventry All Commercial |
$340.48
|
| Rate for Payer: Encore All Commercial |
$283.73
|
| Rate for Payer: Encore All Commercial |
$283.73
|
| Rate for Payer: Frontpath All Commercial |
$385.63
|
| Rate for Payer: Frontpath All Commercial |
$385.63
|
| Rate for Payer: Humana ChoiceCare |
$373.58
|
| Rate for Payer: Humana ChoiceCare |
$373.58
|
| Rate for Payer: Humana Medicare |
$283.73
|
| Rate for Payer: Humana Medicare |
$283.73
|
| Rate for Payer: Lucent All Commercial |
$397.22
|
| Rate for Payer: Lucent All Commercial |
$397.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.00
|
| Rate for Payer: Managed Health Services Medicaid |
$430.62
|
| Rate for Payer: Managed Health Services Medicaid |
$430.62
|
| Rate for Payer: MDWise Medicaid |
$430.62
|
| Rate for Payer: MDWise Medicaid |
$430.62
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$152.79
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$152.79
|
| Rate for Payer: PHCS All Commercial |
$283.73
|
| Rate for Payer: PHCS All Commercial |
$283.73
|
| Rate for Payer: PHP All Commercial |
$386.82
|
| Rate for Payer: PHP All Commercial |
$386.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.73
|
| Rate for Payer: Sagamore Health Network All Products |
$283.73
|
| Rate for Payer: Sagamore Health Network All Products |
$283.73
|
| Rate for Payer: Signature Care EPO |
$436.90
|
| Rate for Payer: Signature Care EPO |
$436.90
|
| Rate for Payer: Signature Care PPO |
$436.90
|
| Rate for Payer: Signature Care PPO |
$436.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,000.00
|
| Rate for Payer: United Healthcare Commercial |
$503.16
|
| Rate for Payer: United Healthcare Commercial |
$503.16
|
| Rate for Payer: United Healthcare Medicare |
$432.61
|
| Rate for Payer: United Healthcare Medicare |
$432.61
|
|
|
PR RECMPL WND LID,NOS,EAR 2.5-7.5 CM
|
Professional
|
Both
|
$923.12
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
z13152
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$37,600.00 |
| Rate for Payer: Aetna Commercial |
$314.21
|
| Rate for Payer: Aetna Commercial |
$314.21
|
| Rate for Payer: Aetna Medicare |
$314.21
|
| Rate for Payer: Aetna Medicare |
$314.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$169.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$169.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$454.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$454.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$361.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$361.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$345.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$345.63
|
| Rate for Payer: Cash Price |
$547.21
|
| Rate for Payer: Cash Price |
$553.87
|
| Rate for Payer: Centivo All Commercial |
$487.03
|
| Rate for Payer: Centivo All Commercial |
$487.03
|
| Rate for Payer: Cigna All Commercial |
$314.21
|
| Rate for Payer: Cigna All Commercial |
$314.21
|
| Rate for Payer: CORVEL All Commercial |
$314.21
|
| Rate for Payer: CORVEL All Commercial |
$314.21
|
| Rate for Payer: Coventry All Commercial |
$377.05
|
| Rate for Payer: Coventry All Commercial |
$377.05
|
| Rate for Payer: Encore All Commercial |
$314.21
|
| Rate for Payer: Encore All Commercial |
$314.21
|
| Rate for Payer: Frontpath All Commercial |
$427.99
|
| Rate for Payer: Frontpath All Commercial |
$427.99
|
| Rate for Payer: Humana ChoiceCare |
$385.18
|
| Rate for Payer: Humana ChoiceCare |
$385.18
|
| Rate for Payer: Humana Medicare |
$314.21
|
| Rate for Payer: Humana Medicare |
$314.21
|
| Rate for Payer: Lucent All Commercial |
$439.89
|
| Rate for Payer: Lucent All Commercial |
$439.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$407.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$407.00
|
| Rate for Payer: Managed Health Services Medicaid |
$454.03
|
| Rate for Payer: Managed Health Services Medicaid |
$454.03
|
| Rate for Payer: MDWise Medicaid |
$454.03
|
| Rate for Payer: MDWise Medicaid |
$454.03
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$169.40
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$169.40
|
| Rate for Payer: PHCS All Commercial |
$314.21
|
| Rate for Payer: PHCS All Commercial |
$314.21
|
| Rate for Payer: PHP All Commercial |
$428.01
|
| Rate for Payer: PHP All Commercial |
$428.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$314.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$314.21
|
| Rate for Payer: Sagamore Health Network All Products |
$314.21
|
| Rate for Payer: Sagamore Health Network All Products |
$314.21
|
| Rate for Payer: Signature Care EPO |
$508.30
|
| Rate for Payer: Signature Care EPO |
$508.30
|
| Rate for Payer: Signature Care PPO |
$508.30
|
| Rate for Payer: Signature Care PPO |
$508.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37,600.00
|
| Rate for Payer: United Healthcare Commercial |
$465.90
|
| Rate for Payer: United Healthcare Commercial |
$465.90
|
| Rate for Payer: United Healthcare Medicare |
$456.01
|
| Rate for Payer: United Healthcare Medicare |
$456.01
|
|
|
PR RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Professional
|
Both
|
$790.34
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
z13121
|
| Min. Negotiated Rate |
$129.78 |
| Max. Negotiated Rate |
$28,900.00 |
| Rate for Payer: Aetna Commercial |
$241.11
|
| Rate for Payer: Aetna Commercial |
$241.11
|
| Rate for Payer: Aetna Medicare |
$241.11
|
| Rate for Payer: Aetna Medicare |
$241.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$129.78
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$129.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$388.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$388.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$277.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$277.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$265.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$265.22
|
| Rate for Payer: Cash Price |
$468.41
|
| Rate for Payer: Cash Price |
$474.20
|
| Rate for Payer: Centivo All Commercial |
$373.72
|
| Rate for Payer: Centivo All Commercial |
$373.72
|
| Rate for Payer: Cigna All Commercial |
$241.11
|
| Rate for Payer: Cigna All Commercial |
$241.11
|
| Rate for Payer: CORVEL All Commercial |
$241.11
|
| Rate for Payer: CORVEL All Commercial |
$241.11
|
| Rate for Payer: Coventry All Commercial |
$289.33
|
| Rate for Payer: Coventry All Commercial |
$289.33
|
| Rate for Payer: Encore All Commercial |
$241.11
|
| Rate for Payer: Encore All Commercial |
$241.11
|
| Rate for Payer: Frontpath All Commercial |
$327.13
|
| Rate for Payer: Frontpath All Commercial |
$327.13
|
| Rate for Payer: Humana ChoiceCare |
$263.99
|
| Rate for Payer: Humana ChoiceCare |
$263.99
|
| Rate for Payer: Humana Medicare |
$241.11
|
| Rate for Payer: Humana Medicare |
$241.11
|
| Rate for Payer: Lucent All Commercial |
$337.55
|
| Rate for Payer: Lucent All Commercial |
$337.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.00
|
| Rate for Payer: Managed Health Services Medicaid |
$388.72
|
| Rate for Payer: Managed Health Services Medicaid |
$388.72
|
| Rate for Payer: MDWise Medicaid |
$388.72
|
| Rate for Payer: MDWise Medicaid |
$388.72
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$129.78
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$129.78
|
| Rate for Payer: PHCS All Commercial |
$241.11
|
| Rate for Payer: PHCS All Commercial |
$241.11
|
| Rate for Payer: PHP All Commercial |
$328.90
|
| Rate for Payer: PHP All Commercial |
$328.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$241.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$241.11
|
| Rate for Payer: Sagamore Health Network All Products |
$241.11
|
| Rate for Payer: Sagamore Health Network All Products |
$241.11
|
| Rate for Payer: Signature Care EPO |
$342.87
|
| Rate for Payer: Signature Care EPO |
$342.87
|
| Rate for Payer: Signature Care PPO |
$342.87
|
| Rate for Payer: Signature Care PPO |
$342.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28,900.00
|
| Rate for Payer: United Healthcare Commercial |
$348.58
|
| Rate for Payer: United Healthcare Commercial |
$348.58
|
| Rate for Payer: United Healthcare Medicare |
$390.34
|
| Rate for Payer: United Healthcare Medicare |
$390.34
|
|
|
PR RECMPL WND TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$737.02
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
z13101
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$231.90
|
| Rate for Payer: Aetna Commercial |
$231.90
|
| Rate for Payer: Aetna Medicare |
$231.90
|
| Rate for Payer: Aetna Medicare |
$231.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$125.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$125.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$362.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$362.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.09
|
| Rate for Payer: Cash Price |
$437.16
|
| Rate for Payer: Cash Price |
$442.21
|
| Rate for Payer: Centivo All Commercial |
$359.44
|
| Rate for Payer: Centivo All Commercial |
$359.44
|
| Rate for Payer: Cigna All Commercial |
$231.90
|
| Rate for Payer: Cigna All Commercial |
$231.90
|
| Rate for Payer: CORVEL All Commercial |
$231.90
|
| Rate for Payer: CORVEL All Commercial |
$231.90
|
| Rate for Payer: Coventry All Commercial |
$278.28
|
| Rate for Payer: Coventry All Commercial |
$278.28
|
| Rate for Payer: Encore All Commercial |
$231.90
|
| Rate for Payer: Encore All Commercial |
$231.90
|
| Rate for Payer: Frontpath All Commercial |
$314.74
|
| Rate for Payer: Frontpath All Commercial |
$314.74
|
| Rate for Payer: Humana ChoiceCare |
$244.84
|
| Rate for Payer: Humana ChoiceCare |
$244.84
|
| Rate for Payer: Humana Medicare |
$231.90
|
| Rate for Payer: Humana Medicare |
$231.90
|
| Rate for Payer: Lucent All Commercial |
$324.66
|
| Rate for Payer: Lucent All Commercial |
$324.66
|
| Rate for Payer: Managed Health Services Medicaid |
$362.49
|
| Rate for Payer: Managed Health Services Medicaid |
$362.49
|
| Rate for Payer: MDWise Medicaid |
$362.49
|
| Rate for Payer: MDWise Medicaid |
$362.49
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$125.45
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$125.45
|
| Rate for Payer: PHCS All Commercial |
$231.90
|
| Rate for Payer: PHCS All Commercial |
$231.90
|
| Rate for Payer: PHP All Commercial |
$315.64
|
| Rate for Payer: PHP All Commercial |
$315.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$231.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$231.90
|
| Rate for Payer: Sagamore Health Network All Products |
$231.90
|
| Rate for Payer: Sagamore Health Network All Products |
$231.90
|
| Rate for Payer: Signature Care EPO |
$320.21
|
| Rate for Payer: Signature Care EPO |
$320.21
|
| Rate for Payer: Signature Care PPO |
$320.21
|
| Rate for Payer: Signature Care PPO |
$320.21
|
| Rate for Payer: United Healthcare Commercial |
$307.53
|
| Rate for Payer: United Healthcare Commercial |
$307.53
|
| Rate for Payer: United Healthcare Medicare |
$364.30
|
| Rate for Payer: United Healthcare Medicare |
$364.30
|
|
