|
PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN
|
Professional
|
Both
|
$171.10
|
|
|
Service Code
|
CPT 99442
|
| Hospital Charge Code |
z99442
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$6,500.00 |
| Rate for Payer: Aetna Commercial |
$63.57
|
| Rate for Payer: Aetna Commercial |
$63.57
|
| Rate for Payer: Aetna Medicare |
$63.57
|
| Rate for Payer: Aetna Medicare |
$63.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.57
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.93
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Centivo All Commercial |
$98.53
|
| Rate for Payer: Centivo All Commercial |
$98.53
|
| Rate for Payer: Cigna All Commercial |
$63.57
|
| Rate for Payer: Cigna All Commercial |
$63.57
|
| Rate for Payer: CORVEL All Commercial |
$63.57
|
| Rate for Payer: CORVEL All Commercial |
$63.57
|
| Rate for Payer: Coventry All Commercial |
$76.28
|
| Rate for Payer: Coventry All Commercial |
$76.28
|
| Rate for Payer: Encore All Commercial |
$63.57
|
| Rate for Payer: Encore All Commercial |
$63.57
|
| Rate for Payer: Frontpath All Commercial |
$68.40
|
| Rate for Payer: Frontpath All Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$20.97
|
| Rate for Payer: Humana ChoiceCare |
$20.97
|
| Rate for Payer: Humana Medicare |
$63.57
|
| Rate for Payer: Humana Medicare |
$63.57
|
| Rate for Payer: Lucent All Commercial |
$89.00
|
| Rate for Payer: Lucent All Commercial |
$89.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.57
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.57
|
| Rate for Payer: PHCS All Commercial |
$63.57
|
| Rate for Payer: PHCS All Commercial |
$63.57
|
| Rate for Payer: PHP All Commercial |
$62.95
|
| Rate for Payer: PHP All Commercial |
$62.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.57
|
| Rate for Payer: Sagamore Health Network All Products |
$63.57
|
| Rate for Payer: Sagamore Health Network All Products |
$63.57
|
| Rate for Payer: Signature Care EPO |
$72.83
|
| Rate for Payer: Signature Care EPO |
$72.83
|
| Rate for Payer: Signature Care PPO |
$72.83
|
| Rate for Payer: Signature Care PPO |
$72.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: United Healthcare Commercial |
$25.29
|
| Rate for Payer: United Healthcare Commercial |
$25.29
|
| Rate for Payer: United Healthcare Medicare |
$83.10
|
| Rate for Payer: United Healthcare Medicare |
$83.10
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Professional
|
Both
|
$105.92
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
z99441
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: Aetna Medicare |
$34.06
|
| Rate for Payer: Aetna Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.47
|
| Rate for Payer: Cash Price |
$63.84
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Centivo All Commercial |
$52.79
|
| Rate for Payer: Centivo All Commercial |
$52.79
|
| Rate for Payer: Cigna All Commercial |
$34.06
|
| Rate for Payer: Cigna All Commercial |
$34.06
|
| Rate for Payer: CORVEL All Commercial |
$34.06
|
| Rate for Payer: CORVEL All Commercial |
$34.06
|
| Rate for Payer: Coventry All Commercial |
$40.87
|
| Rate for Payer: Coventry All Commercial |
$40.87
|
| Rate for Payer: Encore All Commercial |
$34.06
|
| Rate for Payer: Encore All Commercial |
$34.06
|
| Rate for Payer: Frontpath All Commercial |
$36.69
|
| Rate for Payer: Frontpath All Commercial |
$36.69
|
| Rate for Payer: Humana ChoiceCare |
$10.85
|
| Rate for Payer: Humana ChoiceCare |
$10.85
|
| Rate for Payer: Humana Medicare |
$34.06
|
| Rate for Payer: Humana Medicare |
$34.06
|
| Rate for Payer: Lucent All Commercial |
$47.68
|
| Rate for Payer: Lucent All Commercial |
$47.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$18.00
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$34.06
|
| Rate for Payer: PHCS All Commercial |
$34.06
|
| Rate for Payer: PHP All Commercial |
$33.48
|
| Rate for Payer: PHP All Commercial |
$33.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.06
|
| Rate for Payer: Sagamore Health Network All Products |
$34.06
|
| Rate for Payer: Sagamore Health Network All Products |
$34.06
|
| Rate for Payer: Signature Care EPO |
$44.84
|
| Rate for Payer: Signature Care EPO |
$44.84
|
| Rate for Payer: Signature Care PPO |
$44.84
|
| Rate for Payer: Signature Care PPO |
$44.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,400.00
|
| Rate for Payer: United Healthcare Commercial |
$12.71
|
| Rate for Payer: United Healthcare Commercial |
$12.71
|
| Rate for Payer: United Healthcare Medicare |
$51.48
|
| Rate for Payer: United Healthcare Medicare |
$51.48
|
|
|
PR PLACEMENT,SETON
|
Professional
|
Both
|
$209.88
|
|
|
Service Code
|
CPT 46020
|
| Hospital Charge Code |
z46020
|
| Min. Negotiated Rate |
$104.94 |
| Max. Negotiated Rate |
$15,100.00 |
| Rate for Payer: Aetna Commercial |
$107.84
|
| Rate for Payer: Aetna Commercial |
$107.84
|
| Rate for Payer: Aetna Medicare |
$107.84
|
| Rate for Payer: Aetna Medicare |
$107.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$291.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$118.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$118.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.62
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cash Price |
$130.13
|
| Rate for Payer: Centivo All Commercial |
$167.15
|
| Rate for Payer: Centivo All Commercial |
$167.15
|
| Rate for Payer: Cigna All Commercial |
$107.84
|
| Rate for Payer: Cigna All Commercial |
$107.84
|
| Rate for Payer: CORVEL All Commercial |
$107.84
|
| Rate for Payer: CORVEL All Commercial |
$107.84
|
| Rate for Payer: Coventry All Commercial |
$129.41
|
| Rate for Payer: Coventry All Commercial |
$129.41
|
| Rate for Payer: Encore All Commercial |
$107.84
|
| Rate for Payer: Encore All Commercial |
$107.84
|
| Rate for Payer: Frontpath All Commercial |
$150.53
|
| Rate for Payer: Frontpath All Commercial |
$150.53
|
| Rate for Payer: Humana ChoiceCare |
$214.13
|
| Rate for Payer: Humana ChoiceCare |
$214.13
|
| Rate for Payer: Humana Medicare |
$107.84
|
| Rate for Payer: Humana Medicare |
$107.84
|
| Rate for Payer: Lucent All Commercial |
$150.98
|
| Rate for Payer: Lucent All Commercial |
$150.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.00
|
| Rate for Payer: Managed Health Services Medicaid |
$105.41
|
| Rate for Payer: Managed Health Services Medicaid |
$105.41
|
| Rate for Payer: MDWise Medicaid |
$105.41
|
| Rate for Payer: MDWise Medicaid |
$105.41
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$118.35
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$118.35
|
| Rate for Payer: PHCS All Commercial |
$107.84
|
| Rate for Payer: PHCS All Commercial |
$107.84
|
| Rate for Payer: PHP All Commercial |
$183.64
|
| Rate for Payer: PHP All Commercial |
$183.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.84
|
| Rate for Payer: Sagamore Health Network All Products |
$107.84
|
| Rate for Payer: Sagamore Health Network All Products |
$107.84
|
| Rate for Payer: Signature Care EPO |
$183.33
|
| Rate for Payer: Signature Care EPO |
$183.33
|
| Rate for Payer: Signature Care PPO |
$183.33
|
| Rate for Payer: Signature Care PPO |
$183.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,100.00
|
| Rate for Payer: United Healthcare Commercial |
$231.96
|
| Rate for Payer: United Healthcare Commercial |
$231.96
|
| Rate for Payer: United Healthcare Medicare |
$104.94
|
| Rate for Payer: United Healthcare Medicare |
$104.94
|
|
|
PR PLASTY KNEE,MED OR LAT COMPARTMT
|
Professional
|
Both
|
$2,110.04
|
|
|
Service Code
|
CPT 27446
|
| Hospital Charge Code |
z27446
|
| Min. Negotiated Rate |
$1,035.21 |
| Max. Negotiated Rate |
$1,801.27 |
| Rate for Payer: Aetna Commercial |
$1,071.31
|
| Rate for Payer: Aetna Commercial |
$1,071.31
|
| Rate for Payer: Aetna Medicare |
$1,071.31
|
| Rate for Payer: Aetna Medicare |
$1,071.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,037.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,037.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,232.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,232.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,178.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,178.44
|
| Rate for Payer: Cash Price |
$1,308.22
|
| Rate for Payer: Cash Price |
$1,283.66
|
| Rate for Payer: Centivo All Commercial |
$1,660.53
|
| Rate for Payer: Centivo All Commercial |
$1,660.53
|
| Rate for Payer: Cigna All Commercial |
$1,071.31
|
| Rate for Payer: Cigna All Commercial |
$1,071.31
|
| Rate for Payer: CORVEL All Commercial |
$1,071.31
|
| Rate for Payer: CORVEL All Commercial |
$1,071.31
|
| Rate for Payer: Coventry All Commercial |
$1,285.57
|
| Rate for Payer: Coventry All Commercial |
$1,285.57
|
| Rate for Payer: Encore All Commercial |
$1,071.31
|
| Rate for Payer: Encore All Commercial |
$1,071.31
|
| Rate for Payer: Frontpath All Commercial |
$1,501.40
|
| Rate for Payer: Frontpath All Commercial |
$1,501.40
|
| Rate for Payer: Humana ChoiceCare |
$1,190.93
|
| Rate for Payer: Humana ChoiceCare |
$1,190.93
|
| Rate for Payer: Humana Medicare |
$1,071.31
|
| Rate for Payer: Humana Medicare |
$1,071.31
|
| Rate for Payer: Lucent All Commercial |
$1,499.83
|
| Rate for Payer: Lucent All Commercial |
$1,499.83
|
| Rate for Payer: Managed Health Services Medicaid |
$1,037.80
|
| Rate for Payer: Managed Health Services Medicaid |
$1,037.80
|
| Rate for Payer: MDWise Medicaid |
$1,037.80
|
| Rate for Payer: MDWise Medicaid |
$1,037.80
|
| Rate for Payer: PHCS All Commercial |
$1,071.31
|
| Rate for Payer: PHCS All Commercial |
$1,071.31
|
| Rate for Payer: PHP All Commercial |
$1,801.27
|
| Rate for Payer: PHP All Commercial |
$1,801.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,071.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,071.31
|
| Rate for Payer: Sagamore Health Network All Products |
$1,071.31
|
| Rate for Payer: Sagamore Health Network All Products |
$1,071.31
|
| Rate for Payer: Signature Care EPO |
$1,586.95
|
| Rate for Payer: Signature Care EPO |
$1,586.95
|
| Rate for Payer: Signature Care PPO |
$1,586.95
|
| Rate for Payer: Signature Care PPO |
$1,586.95
|
| Rate for Payer: United Healthcare Commercial |
$1,226.53
|
| Rate for Payer: United Healthcare Commercial |
$1,226.53
|
| Rate for Payer: United Healthcare Medicare |
$1,035.21
|
| Rate for Payer: United Healthcare Medicare |
$1,035.21
|
|
|
PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$1,565.06
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
z50432
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$832.45 |
| Rate for Payer: Aetna Commercial |
$192.64
|
| Rate for Payer: Aetna Medicare |
$192.64
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$178.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$811.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.90
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Centivo All Commercial |
$298.59
|
| Rate for Payer: Cigna All Commercial |
$192.64
|
| Rate for Payer: CORVEL All Commercial |
$192.64
|
| Rate for Payer: Coventry All Commercial |
$231.17
|
| Rate for Payer: Encore All Commercial |
$192.64
|
| Rate for Payer: Frontpath All Commercial |
$261.25
|
| Rate for Payer: Humana ChoiceCare |
$220.79
|
| Rate for Payer: Humana Medicare |
$192.64
|
| Rate for Payer: Lucent All Commercial |
$269.70
|
| Rate for Payer: Managed Health Services Medicaid |
$811.48
|
| Rate for Payer: MDWise Medicaid |
$811.48
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$178.65
|
| Rate for Payer: PHCS All Commercial |
$192.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.64
|
| Rate for Payer: Sagamore Health Network All Products |
$192.64
|
| Rate for Payer: United Healthcare Commercial |
$275.26
|
| Rate for Payer: United Healthcare Medicare |
$832.45
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,155.08
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
z95810
|
| Min. Negotiated Rate |
$565.33 |
| Max. Negotiated Rate |
$67,700.00 |
| Rate for Payer: Aetna Commercial |
$565.33
|
| Rate for Payer: Aetna Commercial |
$565.33
|
| Rate for Payer: Aetna Medicare |
$565.33
|
| Rate for Payer: Aetna Medicare |
$565.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$568.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$568.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$650.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$650.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$621.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$621.86
|
| Rate for Payer: Cash Price |
$682.67
|
| Rate for Payer: Cash Price |
$716.15
|
| Rate for Payer: Centivo All Commercial |
$876.26
|
| Rate for Payer: Centivo All Commercial |
$876.26
|
| Rate for Payer: Cigna All Commercial |
$565.33
|
| Rate for Payer: Cigna All Commercial |
$565.33
|
| Rate for Payer: CORVEL All Commercial |
$565.33
|
| Rate for Payer: CORVEL All Commercial |
$565.33
|
| Rate for Payer: Coventry All Commercial |
$678.40
|
| Rate for Payer: Coventry All Commercial |
$678.40
|
| Rate for Payer: Encore All Commercial |
$565.33
|
| Rate for Payer: Encore All Commercial |
$565.33
|
| Rate for Payer: Frontpath All Commercial |
$634.21
|
| Rate for Payer: Frontpath All Commercial |
$634.21
|
| Rate for Payer: Humana ChoiceCare |
$972.73
|
| Rate for Payer: Humana ChoiceCare |
$972.73
|
| Rate for Payer: Humana Medicare |
$565.33
|
| Rate for Payer: Humana Medicare |
$565.33
|
| Rate for Payer: Lucent All Commercial |
$791.46
|
| Rate for Payer: Lucent All Commercial |
$791.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.00
|
| Rate for Payer: Managed Health Services Medicaid |
$568.11
|
| Rate for Payer: Managed Health Services Medicaid |
$568.11
|
| Rate for Payer: MDWise Medicaid |
$568.11
|
| Rate for Payer: MDWise Medicaid |
$568.11
|
| Rate for Payer: PHCS All Commercial |
$565.33
|
| Rate for Payer: PHCS All Commercial |
$565.33
|
| Rate for Payer: PHP All Commercial |
$908.40
|
| Rate for Payer: PHP All Commercial |
$908.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.33
|
| Rate for Payer: Sagamore Health Network All Products |
$565.33
|
| Rate for Payer: Sagamore Health Network All Products |
$565.33
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67,700.00
|
| Rate for Payer: United Healthcare Commercial |
$885.23
|
| Rate for Payer: United Healthcare Commercial |
$885.23
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,207.18
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
z95811
|
| Min. Negotiated Rate |
$590.13 |
| Max. Negotiated Rate |
$70,800.00 |
| Rate for Payer: Aetna Commercial |
$590.13
|
| Rate for Payer: Aetna Commercial |
$590.13
|
| Rate for Payer: Aetna Medicare |
$590.13
|
| Rate for Payer: Aetna Medicare |
$590.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$593.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$593.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$678.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$678.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$649.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$649.14
|
| Rate for Payer: Cash Price |
$713.87
|
| Rate for Payer: Cash Price |
$748.45
|
| Rate for Payer: Centivo All Commercial |
$914.70
|
| Rate for Payer: Centivo All Commercial |
$914.70
|
| Rate for Payer: Cigna All Commercial |
$590.13
|
| Rate for Payer: Cigna All Commercial |
$590.13
|
| Rate for Payer: CORVEL All Commercial |
$590.13
|
| Rate for Payer: CORVEL All Commercial |
$590.13
|
| Rate for Payer: Coventry All Commercial |
$708.16
|
| Rate for Payer: Coventry All Commercial |
$708.16
|
| Rate for Payer: Encore All Commercial |
$590.13
|
| Rate for Payer: Encore All Commercial |
$590.13
|
| Rate for Payer: Frontpath All Commercial |
$662.06
|
| Rate for Payer: Frontpath All Commercial |
$662.06
|
| Rate for Payer: Humana ChoiceCare |
$1,062.69
|
| Rate for Payer: Humana ChoiceCare |
$1,062.69
|
| Rate for Payer: Humana Medicare |
$590.13
|
| Rate for Payer: Humana Medicare |
$590.13
|
| Rate for Payer: Lucent All Commercial |
$826.18
|
| Rate for Payer: Lucent All Commercial |
$826.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$767.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$767.00
|
| Rate for Payer: Managed Health Services Medicaid |
$593.74
|
| Rate for Payer: Managed Health Services Medicaid |
$593.74
|
| Rate for Payer: MDWise Medicaid |
$593.74
|
| Rate for Payer: MDWise Medicaid |
$593.74
|
| Rate for Payer: PHCS All Commercial |
$590.13
|
| Rate for Payer: PHCS All Commercial |
$590.13
|
| Rate for Payer: PHP All Commercial |
$949.91
|
| Rate for Payer: PHP All Commercial |
$949.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$590.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$590.13
|
| Rate for Payer: Sagamore Health Network All Products |
$590.13
|
| Rate for Payer: Sagamore Health Network All Products |
$590.13
|
| Rate for Payer: Signature Care EPO |
$784.24
|
| Rate for Payer: Signature Care EPO |
$784.24
|
| Rate for Payer: Signature Care PPO |
$784.24
|
| Rate for Payer: Signature Care PPO |
$784.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70,800.00
|
| Rate for Payer: United Healthcare Commercial |
$975.34
|
| Rate for Payer: United Healthcare Commercial |
$975.34
|
|
|
PR POST COLPORRHAPHY,RECTUM/VAGINA
|
Professional
|
Both
|
$1,146.02
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
z57250
|
| Min. Negotiated Rate |
$401.13 |
| Max. Negotiated Rate |
$75,100.00 |
| Rate for Payer: Aetna Commercial |
$583.09
|
| Rate for Payer: Aetna Commercial |
$583.09
|
| Rate for Payer: Aetna Medicare |
$583.09
|
| Rate for Payer: Aetna Medicare |
$583.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$477.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$563.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$563.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$670.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$670.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$641.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$641.40
|
| Rate for Payer: Cash Price |
$710.53
|
| Rate for Payer: Cash Price |
$699.09
|
| Rate for Payer: Centivo All Commercial |
$903.79
|
| Rate for Payer: Centivo All Commercial |
$903.79
|
| Rate for Payer: Cigna All Commercial |
$583.09
|
| Rate for Payer: Cigna All Commercial |
$583.09
|
| Rate for Payer: CORVEL All Commercial |
$583.09
|
| Rate for Payer: CORVEL All Commercial |
$583.09
|
| Rate for Payer: Coventry All Commercial |
$699.71
|
| Rate for Payer: Coventry All Commercial |
$699.71
|
| Rate for Payer: Encore All Commercial |
$583.09
|
| Rate for Payer: Encore All Commercial |
$583.09
|
| Rate for Payer: Frontpath All Commercial |
$806.94
|
| Rate for Payer: Frontpath All Commercial |
$806.94
|
| Rate for Payer: Humana ChoiceCare |
$401.13
|
| Rate for Payer: Humana ChoiceCare |
$401.13
|
| Rate for Payer: Humana Medicare |
$583.09
|
| Rate for Payer: Humana Medicare |
$583.09
|
| Rate for Payer: Lucent All Commercial |
$816.33
|
| Rate for Payer: Lucent All Commercial |
$816.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$809.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$809.00
|
| Rate for Payer: Managed Health Services Medicaid |
$563.66
|
| Rate for Payer: Managed Health Services Medicaid |
$563.66
|
| Rate for Payer: MDWise Medicaid |
$563.66
|
| Rate for Payer: MDWise Medicaid |
$563.66
|
| Rate for Payer: PHCS All Commercial |
$583.09
|
| Rate for Payer: PHCS All Commercial |
$583.09
|
| Rate for Payer: PHP All Commercial |
$744.20
|
| Rate for Payer: PHP All Commercial |
$744.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$583.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$583.09
|
| Rate for Payer: Sagamore Health Network All Products |
$583.09
|
| Rate for Payer: Sagamore Health Network All Products |
$583.09
|
| Rate for Payer: Signature Care EPO |
$552.76
|
| Rate for Payer: Signature Care EPO |
$552.76
|
| Rate for Payer: Signature Care PPO |
$552.76
|
| Rate for Payer: Signature Care PPO |
$552.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75,100.00
|
| Rate for Payer: United Healthcare Commercial |
$733.13
|
| Rate for Payer: United Healthcare Commercial |
$733.13
|
| Rate for Payer: United Healthcare Medicare |
$563.78
|
| Rate for Payer: United Healthcare Medicare |
$563.78
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT G0439
|
| Hospital Charge Code |
zG0439
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$192.63 |
| Rate for Payer: Aetna Commercial |
$124.28
|
| Rate for Payer: Aetna Medicare |
$124.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$145.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$145.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.71
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Centivo All Commercial |
$192.63
|
| Rate for Payer: Cigna All Commercial |
$124.28
|
| Rate for Payer: CORVEL All Commercial |
$124.28
|
| Rate for Payer: Coventry All Commercial |
$149.14
|
| Rate for Payer: Encore All Commercial |
$124.28
|
| Rate for Payer: Humana ChoiceCare |
$104.18
|
| Rate for Payer: Humana Medicare |
$124.28
|
| Rate for Payer: Lucent All Commercial |
$173.99
|
| Rate for Payer: PHCS All Commercial |
$124.28
|
| Rate for Payer: PHP All Commercial |
$123.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.28
|
| Rate for Payer: Sagamore Health Network All Products |
$124.28
|
| Rate for Payer: Signature Care EPO |
$105.64
|
| Rate for Payer: Signature Care PPO |
$105.64
|
| Rate for Payer: United Healthcare Commercial |
$114.16
|
|
|
PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Professional
|
Both
|
$15.98
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
z94640
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: Aetna Medicare |
$10.13
|
| Rate for Payer: Aetna Medicare |
$10.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.14
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$8.95
|
| Rate for Payer: Centivo All Commercial |
$15.70
|
| Rate for Payer: Centivo All Commercial |
$15.70
|
| Rate for Payer: Cigna All Commercial |
$10.13
|
| Rate for Payer: Cigna All Commercial |
$10.13
|
| Rate for Payer: CORVEL All Commercial |
$10.13
|
| Rate for Payer: CORVEL All Commercial |
$10.13
|
| Rate for Payer: Coventry All Commercial |
$12.16
|
| Rate for Payer: Coventry All Commercial |
$12.16
|
| Rate for Payer: Encore All Commercial |
$10.13
|
| Rate for Payer: Encore All Commercial |
$10.13
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$14.83
|
| Rate for Payer: Humana ChoiceCare |
$14.83
|
| Rate for Payer: Humana Medicare |
$10.13
|
| Rate for Payer: Humana Medicare |
$10.13
|
| Rate for Payer: Lucent All Commercial |
$14.18
|
| Rate for Payer: Lucent All Commercial |
$14.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.00
|
| Rate for Payer: Managed Health Services Medicaid |
$7.10
|
| Rate for Payer: Managed Health Services Medicaid |
$7.10
|
| Rate for Payer: MDWise Medicaid |
$7.10
|
| Rate for Payer: MDWise Medicaid |
$7.10
|
| Rate for Payer: PHCS All Commercial |
$10.13
|
| Rate for Payer: PHCS All Commercial |
$10.13
|
| Rate for Payer: PHP All Commercial |
$10.78
|
| Rate for Payer: PHP All Commercial |
$10.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.13
|
| Rate for Payer: Sagamore Health Network All Products |
$10.13
|
| Rate for Payer: Sagamore Health Network All Products |
$10.13
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$16.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,000.00
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$7.99
|
| Rate for Payer: United Healthcare Medicare |
$7.99
|
|
|
PR PREVENTIVE VISIT,EST,12-17
|
Professional
|
Both
|
$210.12
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
z99394
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$8,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.91
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.86
|
| Rate for Payer: Cash Price |
$130.27
|
| Rate for Payer: Cash Price |
$133.45
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$105.86
|
| Rate for Payer: Managed Health Services Medicaid |
$105.86
|
| Rate for Payer: MDWise Medicaid |
$105.86
|
| Rate for Payer: MDWise Medicaid |
$105.86
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.91
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.91
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: Signature Care EPO |
$85.00
|
| Rate for Payer: Signature Care EPO |
$85.00
|
| Rate for Payer: Signature Care PPO |
$85.00
|
| Rate for Payer: Signature Care PPO |
$85.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$105.06
|
| Rate for Payer: United Healthcare Medicare |
$105.06
|
|
|
PR PREVENTIVE VISIT,EST,18-39
|
Professional
|
Both
|
$214.94
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
z99395
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.76
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$44.13
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$44.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$108.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$108.26
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Cash Price |
$136.47
|
| Rate for Payer: Frontpath All Commercial |
$88.25
|
| Rate for Payer: Frontpath All Commercial |
$88.25
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.00
|
| Rate for Payer: Managed Health Services Medicaid |
$108.26
|
| Rate for Payer: Managed Health Services Medicaid |
$108.26
|
| Rate for Payer: MDWise Medicaid |
$108.26
|
| Rate for Payer: MDWise Medicaid |
$108.26
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$44.13
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$44.13
|
| Rate for Payer: PHP All Commercial |
$82.47
|
| Rate for Payer: PHP All Commercial |
$82.47
|
| Rate for Payer: Signature Care EPO |
$86.70
|
| Rate for Payer: Signature Care EPO |
$86.70
|
| Rate for Payer: Signature Care PPO |
$86.70
|
| Rate for Payer: Signature Care PPO |
$86.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$107.47
|
| Rate for Payer: United Healthcare Medicare |
$107.47
|
|
|
PR PREVENTIVE VISIT,EST,40-64
|
Professional
|
Both
|
$228.48
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
z99396
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$9,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$48.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$48.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$115.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$115.14
|
| Rate for Payer: Cash Price |
$141.66
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Frontpath All Commercial |
$97.08
|
| Rate for Payer: Frontpath All Commercial |
$97.08
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: Managed Health Services Medicaid |
$115.14
|
| Rate for Payer: Managed Health Services Medicaid |
$115.14
|
| Rate for Payer: MDWise Medicaid |
$115.14
|
| Rate for Payer: MDWise Medicaid |
$115.14
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$48.45
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$48.45
|
| Rate for Payer: PHP All Commercial |
$89.44
|
| Rate for Payer: PHP All Commercial |
$89.44
|
| Rate for Payer: Signature Care EPO |
$95.20
|
| Rate for Payer: Signature Care EPO |
$95.20
|
| Rate for Payer: Signature Care PPO |
$95.20
|
| Rate for Payer: Signature Care PPO |
$95.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Medicare |
$114.24
|
| Rate for Payer: United Healthcare Medicare |
$114.24
|
|
|
PR PREVENTIVE VISIT,EST,65 & OVER
|
Professional
|
Both
|
$246.24
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
z99397
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.65
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$51.05
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$51.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$123.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$123.85
|
| Rate for Payer: Cash Price |
$152.67
|
| Rate for Payer: Cash Price |
$156.12
|
| Rate for Payer: Frontpath All Commercial |
$102.28
|
| Rate for Payer: Frontpath All Commercial |
$102.28
|
| Rate for Payer: Humana ChoiceCare |
$88.46
|
| Rate for Payer: Humana ChoiceCare |
$88.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Managed Health Services Medicaid |
$123.85
|
| Rate for Payer: Managed Health Services Medicaid |
$123.85
|
| Rate for Payer: MDWise Medicaid |
$123.85
|
| Rate for Payer: MDWise Medicaid |
$123.85
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$51.05
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$51.05
|
| Rate for Payer: PHP All Commercial |
$93.93
|
| Rate for Payer: PHP All Commercial |
$93.93
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: United Healthcare Commercial |
$86.98
|
| Rate for Payer: United Healthcare Commercial |
$86.98
|
| Rate for Payer: United Healthcare Medicare |
$123.12
|
| Rate for Payer: United Healthcare Medicare |
$123.12
|
|
|
PR PREVENTIVE VISIT,EST,AGE 1-4
|
Professional
|
Both
|
$192.68
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
z99392
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$37.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$37.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.04
|
| Rate for Payer: Cash Price |
$119.46
|
| Rate for Payer: Cash Price |
$122.33
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Managed Health Services Medicaid |
$97.04
|
| Rate for Payer: Managed Health Services Medicaid |
$97.04
|
| Rate for Payer: MDWise Medicaid |
$97.04
|
| Rate for Payer: MDWise Medicaid |
$97.04
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$37.90
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$37.90
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: Signature Care EPO |
$78.20
|
| Rate for Payer: Signature Care EPO |
$78.20
|
| Rate for Payer: Signature Care PPO |
$78.20
|
| Rate for Payer: Signature Care PPO |
$78.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Medicare |
$96.34
|
| Rate for Payer: United Healthcare Medicare |
$96.34
|
|
|
PR PREVENTIVE VISIT,EST,AGE5-11
|
Professional
|
Both
|
$192.08
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
z99393
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$37.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$37.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$96.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$96.74
|
| Rate for Payer: Cash Price |
$119.09
|
| Rate for Payer: Cash Price |
$121.94
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Managed Health Services Medicaid |
$96.74
|
| Rate for Payer: Managed Health Services Medicaid |
$96.74
|
| Rate for Payer: MDWise Medicaid |
$96.74
|
| Rate for Payer: MDWise Medicaid |
$96.74
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$37.90
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$37.90
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: Signature Care EPO |
$77.35
|
| Rate for Payer: Signature Care EPO |
$77.35
|
| Rate for Payer: Signature Care PPO |
$77.35
|
| Rate for Payer: Signature Care PPO |
$77.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Medicare |
$96.04
|
| Rate for Payer: United Healthcare Medicare |
$96.04
|
|
|
PR PREVENTIVE VISIT,EST, INFANT < 1 YR
|
Professional
|
Both
|
$180.44
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
z99391
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$6,600.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.71
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$34.78
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$34.78
|
| Rate for Payer: Cash Price |
$114.86
|
| Rate for Payer: Cash Price |
$111.87
|
| Rate for Payer: Frontpath All Commercial |
$69.63
|
| Rate for Payer: Frontpath All Commercial |
$69.63
|
| Rate for Payer: Humana ChoiceCare |
$52.71
|
| Rate for Payer: Humana ChoiceCare |
$52.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$34.78
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$34.78
|
| Rate for Payer: PHP All Commercial |
$64.39
|
| Rate for Payer: PHP All Commercial |
$64.39
|
| Rate for Payer: Signature Care EPO |
$69.70
|
| Rate for Payer: Signature Care EPO |
$69.70
|
| Rate for Payer: Signature Care PPO |
$69.70
|
| Rate for Payer: Signature Care PPO |
$69.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,600.00
|
| Rate for Payer: United Healthcare Commercial |
$51.70
|
| Rate for Payer: United Healthcare Commercial |
$51.70
|
| Rate for Payer: United Healthcare Medicare |
$90.22
|
| Rate for Payer: United Healthcare Medicare |
$90.22
|
|
|
PR PREVENTIVE VISIT,NEW,12-17
|
Professional
|
Both
|
$245.64
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
z99384
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.89
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$51.05
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$51.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$123.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$123.55
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cash Price |
$155.74
|
| Rate for Payer: Frontpath All Commercial |
$102.28
|
| Rate for Payer: Frontpath All Commercial |
$102.28
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Managed Health Services Medicaid |
$123.55
|
| Rate for Payer: Managed Health Services Medicaid |
$123.55
|
| Rate for Payer: MDWise Medicaid |
$123.55
|
| Rate for Payer: MDWise Medicaid |
$123.55
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$51.05
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$51.05
|
| Rate for Payer: PHP All Commercial |
$93.93
|
| Rate for Payer: PHP All Commercial |
$93.93
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Medicare |
$122.82
|
| Rate for Payer: United Healthcare Medicare |
$122.82
|
|
|
PR PREVENTIVE VISIT,NEW,18-39
|
Professional
|
Both
|
$238.54
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
z99385
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$9,300.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$48.97
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$48.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$120.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$120.02
|
| Rate for Payer: Cash Price |
$147.89
|
| Rate for Payer: Cash Price |
$151.29
|
| Rate for Payer: Frontpath All Commercial |
$98.11
|
| Rate for Payer: Frontpath All Commercial |
$98.11
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.00
|
| Rate for Payer: Managed Health Services Medicaid |
$120.02
|
| Rate for Payer: Managed Health Services Medicaid |
$120.02
|
| Rate for Payer: MDWise Medicaid |
$120.02
|
| Rate for Payer: MDWise Medicaid |
$120.02
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$48.97
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$48.97
|
| Rate for Payer: PHP All Commercial |
$90.28
|
| Rate for Payer: PHP All Commercial |
$90.28
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,300.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Medicare |
$119.27
|
| Rate for Payer: United Healthcare Medicare |
$119.27
|
|
|
PR PREVENTIVE VISIT,NEW,40-64
|
Professional
|
Both
|
$275.32
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
z99386
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$11,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$62.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$62.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.60
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cash Price |
$174.72
|
| Rate for Payer: Frontpath All Commercial |
$118.88
|
| Rate for Payer: Frontpath All Commercial |
$118.88
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: Managed Health Services Medicaid |
$138.60
|
| Rate for Payer: Managed Health Services Medicaid |
$138.60
|
| Rate for Payer: MDWise Medicaid |
$138.60
|
| Rate for Payer: MDWise Medicaid |
$138.60
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$62.29
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$62.29
|
| Rate for Payer: PHP All Commercial |
$109.53
|
| Rate for Payer: PHP All Commercial |
$109.53
|
| Rate for Payer: Signature Care EPO |
$124.10
|
| Rate for Payer: Signature Care EPO |
$124.10
|
| Rate for Payer: Signature Care PPO |
$124.10
|
| Rate for Payer: Signature Care PPO |
$124.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,200.00
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Medicare |
$137.66
|
| Rate for Payer: United Healthcare Medicare |
$137.66
|
|
|
PR PREVENTIVE VISIT,NEW,65 & OVER
|
Professional
|
Both
|
$298.94
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
z99387
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$12,100.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$66.93
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$66.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$150.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$150.36
|
| Rate for Payer: Cash Price |
$185.34
|
| Rate for Payer: Cash Price |
$189.53
|
| Rate for Payer: Frontpath All Commercial |
$127.51
|
| Rate for Payer: Frontpath All Commercial |
$127.51
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.00
|
| Rate for Payer: Managed Health Services Medicaid |
$150.36
|
| Rate for Payer: Managed Health Services Medicaid |
$150.36
|
| Rate for Payer: MDWise Medicaid |
$150.36
|
| Rate for Payer: MDWise Medicaid |
$150.36
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$66.93
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$66.93
|
| Rate for Payer: PHP All Commercial |
$117.66
|
| Rate for Payer: PHP All Commercial |
$117.66
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,100.00
|
| Rate for Payer: United Healthcare Commercial |
$104.63
|
| Rate for Payer: United Healthcare Commercial |
$104.63
|
| Rate for Payer: United Healthcare Medicare |
$149.47
|
| Rate for Payer: United Healthcare Medicare |
$149.47
|
|
|
PR PREVENTIVE VISIT,NEW,AGE 1-4
|
Professional
|
Both
|
$215.32
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
z99382
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$7,700.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.74
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.91
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: Managed Health Services Medicaid |
$105.91
|
| Rate for Payer: Managed Health Services Medicaid |
$105.91
|
| Rate for Payer: MDWise Medicaid |
$105.91
|
| Rate for Payer: MDWise Medicaid |
$105.91
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.74
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.74
|
| Rate for Payer: PHP All Commercial |
$75.34
|
| Rate for Payer: PHP All Commercial |
$75.34
|
| Rate for Payer: Signature Care EPO |
$98.60
|
| Rate for Payer: Signature Care EPO |
$98.60
|
| Rate for Payer: Signature Care PPO |
$98.60
|
| Rate for Payer: Signature Care PPO |
$98.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$104.77
|
| Rate for Payer: United Healthcare Medicare |
$104.77
|
|
|
PR PREVENTIVE VISIT,NEW,AGE5-11
|
Professional
|
Both
|
$217.94
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
z99383
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$8,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$110.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$110.09
|
| Rate for Payer: Cash Price |
$135.12
|
| Rate for Payer: Cash Price |
$138.77
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$110.09
|
| Rate for Payer: Managed Health Services Medicaid |
$110.09
|
| Rate for Payer: MDWise Medicaid |
$110.09
|
| Rate for Payer: MDWise Medicaid |
$110.09
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.31
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.31
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: Signature Care EPO |
$96.90
|
| Rate for Payer: Signature Care EPO |
$96.90
|
| Rate for Payer: Signature Care PPO |
$96.90
|
| Rate for Payer: Signature Care PPO |
$96.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$108.97
|
| Rate for Payer: United Healthcare Medicare |
$108.97
|
|
|
PR PREVENTIVE VISIT,NEW,INFANT < 1 YR
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
z99381
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.99
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$38.57
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$38.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.27
|
| Rate for Payer: Cash Price |
$127.66
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Managed Health Services Medicaid |
$101.27
|
| Rate for Payer: Managed Health Services Medicaid |
$101.27
|
| Rate for Payer: MDWise Medicaid |
$101.27
|
| Rate for Payer: MDWise Medicaid |
$101.27
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$38.57
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$38.57
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: Signature Care EPO |
$91.80
|
| Rate for Payer: Signature Care EPO |
$91.80
|
| Rate for Payer: Signature Care PPO |
$91.80
|
| Rate for Payer: Signature Care PPO |
$91.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 15 MIN
|
Professional
|
Both
|
$70.94
|
|
|
Service Code
|
CPT 99401
|
| Hospital Charge Code |
z99401
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.52
|
| Rate for Payer: Cash Price |
$43.98
|
| Rate for Payer: Cash Price |
$44.76
|
| Rate for Payer: Frontpath All Commercial |
$24.59
|
| Rate for Payer: Frontpath All Commercial |
$24.59
|
| Rate for Payer: Humana ChoiceCare |
$24.88
|
| Rate for Payer: Humana ChoiceCare |
$24.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.00
|
| Rate for Payer: Managed Health Services Medicaid |
$35.52
|
| Rate for Payer: Managed Health Services Medicaid |
$35.52
|
| Rate for Payer: MDWise Medicaid |
$35.52
|
| Rate for Payer: MDWise Medicaid |
$35.52
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$18.75
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$18.75
|
| Rate for Payer: PHP All Commercial |
$22.89
|
| Rate for Payer: PHP All Commercial |
$22.89
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,300.00
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
| Rate for Payer: United Healthcare Medicare |
$35.47
|
| Rate for Payer: United Healthcare Medicare |
$35.47
|
|
