|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 30 MIN
|
Professional
|
Both
|
$116.08
|
|
|
Service Code
|
CPT 99402
|
| Hospital Charge Code |
z99402
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.10
|
| Rate for Payer: Cash Price |
$71.97
|
| Rate for Payer: Cash Price |
$73.23
|
| Rate for Payer: Frontpath All Commercial |
$50.27
|
| Rate for Payer: Frontpath All Commercial |
$50.27
|
| Rate for Payer: Humana ChoiceCare |
$50.17
|
| Rate for Payer: Humana ChoiceCare |
$50.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: Managed Health Services Medicaid |
$58.10
|
| Rate for Payer: Managed Health Services Medicaid |
$58.10
|
| Rate for Payer: MDWise Medicaid |
$58.10
|
| Rate for Payer: MDWise Medicaid |
$58.10
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$30.60
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$30.60
|
| Rate for Payer: PHP All Commercial |
$46.13
|
| Rate for Payer: PHP All Commercial |
$46.13
|
| Rate for Payer: Signature Care EPO |
$62.90
|
| Rate for Payer: Signature Care EPO |
$62.90
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: United Healthcare Commercial |
$49.38
|
| Rate for Payer: United Healthcare Commercial |
$49.38
|
| Rate for Payer: United Healthcare Medicare |
$58.04
|
| Rate for Payer: United Healthcare Medicare |
$58.04
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$125.88
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
z93279
|
| Min. Negotiated Rate |
$61.91 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Aetna Commercial |
$65.65
|
| Rate for Payer: Aetna Commercial |
$65.65
|
| Rate for Payer: Aetna Medicare |
$65.65
|
| Rate for Payer: Aetna Medicare |
$65.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.22
|
| Rate for Payer: Cash Price |
$77.65
|
| Rate for Payer: Cash Price |
$78.05
|
| Rate for Payer: Centivo All Commercial |
$101.76
|
| Rate for Payer: Centivo All Commercial |
$101.76
|
| Rate for Payer: Cigna All Commercial |
$65.65
|
| Rate for Payer: Cigna All Commercial |
$65.65
|
| Rate for Payer: CORVEL All Commercial |
$65.65
|
| Rate for Payer: CORVEL All Commercial |
$65.65
|
| Rate for Payer: Coventry All Commercial |
$78.78
|
| Rate for Payer: Coventry All Commercial |
$78.78
|
| Rate for Payer: Encore All Commercial |
$65.65
|
| Rate for Payer: Encore All Commercial |
$65.65
|
| Rate for Payer: Frontpath All Commercial |
$73.61
|
| Rate for Payer: Frontpath All Commercial |
$73.61
|
| Rate for Payer: Humana ChoiceCare |
$71.42
|
| Rate for Payer: Humana ChoiceCare |
$71.42
|
| Rate for Payer: Humana Medicare |
$65.65
|
| Rate for Payer: Humana Medicare |
$65.65
|
| Rate for Payer: Lucent All Commercial |
$91.91
|
| Rate for Payer: Lucent All Commercial |
$91.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.00
|
| Rate for Payer: Managed Health Services Medicaid |
$61.91
|
| Rate for Payer: Managed Health Services Medicaid |
$61.91
|
| Rate for Payer: MDWise Medicaid |
$61.91
|
| Rate for Payer: MDWise Medicaid |
$61.91
|
| Rate for Payer: PHCS All Commercial |
$65.65
|
| Rate for Payer: PHCS All Commercial |
$65.65
|
| Rate for Payer: PHP All Commercial |
$92.05
|
| Rate for Payer: PHP All Commercial |
$92.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.65
|
| Rate for Payer: Sagamore Health Network All Products |
$65.65
|
| Rate for Payer: Sagamore Health Network All Products |
$65.65
|
| Rate for Payer: Signature Care EPO |
$80.40
|
| Rate for Payer: Signature Care EPO |
$80.40
|
| Rate for Payer: Signature Care PPO |
$80.40
|
| Rate for Payer: Signature Care PPO |
$80.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,600.00
|
| Rate for Payer: United Healthcare Commercial |
$65.69
|
| Rate for Payer: United Healthcare Commercial |
$65.69
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$141.98
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
z93260
|
| Min. Negotiated Rate |
$69.83 |
| Max. Negotiated Rate |
$10,900.00 |
| Rate for Payer: Aetna Commercial |
$73.82
|
| Rate for Payer: Aetna Commercial |
$73.82
|
| Rate for Payer: Aetna Medicare |
$73.82
|
| Rate for Payer: Aetna Medicare |
$73.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.20
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$88.03
|
| Rate for Payer: Centivo All Commercial |
$114.42
|
| Rate for Payer: Centivo All Commercial |
$114.42
|
| Rate for Payer: Cigna All Commercial |
$73.82
|
| Rate for Payer: Cigna All Commercial |
$73.82
|
| Rate for Payer: CORVEL All Commercial |
$73.82
|
| Rate for Payer: CORVEL All Commercial |
$73.82
|
| Rate for Payer: Coventry All Commercial |
$88.58
|
| Rate for Payer: Coventry All Commercial |
$88.58
|
| Rate for Payer: Encore All Commercial |
$73.82
|
| Rate for Payer: Encore All Commercial |
$73.82
|
| Rate for Payer: Frontpath All Commercial |
$83.09
|
| Rate for Payer: Frontpath All Commercial |
$83.09
|
| Rate for Payer: Humana ChoiceCare |
$87.25
|
| Rate for Payer: Humana ChoiceCare |
$87.25
|
| Rate for Payer: Humana Medicare |
$73.82
|
| Rate for Payer: Humana Medicare |
$73.82
|
| Rate for Payer: Lucent All Commercial |
$103.35
|
| Rate for Payer: Lucent All Commercial |
$103.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.00
|
| Rate for Payer: Managed Health Services Medicaid |
$69.83
|
| Rate for Payer: Managed Health Services Medicaid |
$69.83
|
| Rate for Payer: MDWise Medicaid |
$69.83
|
| Rate for Payer: MDWise Medicaid |
$69.83
|
| Rate for Payer: PHCS All Commercial |
$73.82
|
| Rate for Payer: PHCS All Commercial |
$73.82
|
| Rate for Payer: PHP All Commercial |
$104.00
|
| Rate for Payer: PHP All Commercial |
$104.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.82
|
| Rate for Payer: Sagamore Health Network All Products |
$73.82
|
| Rate for Payer: Sagamore Health Network All Products |
$73.82
|
| Rate for Payer: Signature Care EPO |
$101.60
|
| Rate for Payer: Signature Care EPO |
$101.60
|
| Rate for Payer: Signature Care PPO |
$101.60
|
| Rate for Payer: Signature Care PPO |
$101.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,900.00
|
| Rate for Payer: United Healthcare Commercial |
$80.79
|
| Rate for Payer: United Healthcare Commercial |
$80.79
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$111.82
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
z93285
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$8,600.00 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Medicare |
$58.97
|
| Rate for Payer: Aetna Medicare |
$58.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.87
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Centivo All Commercial |
$91.40
|
| Rate for Payer: Centivo All Commercial |
$91.40
|
| Rate for Payer: Cigna All Commercial |
$58.97
|
| Rate for Payer: Cigna All Commercial |
$58.97
|
| Rate for Payer: CORVEL All Commercial |
$58.97
|
| Rate for Payer: CORVEL All Commercial |
$58.97
|
| Rate for Payer: Coventry All Commercial |
$70.76
|
| Rate for Payer: Coventry All Commercial |
$70.76
|
| Rate for Payer: Encore All Commercial |
$58.97
|
| Rate for Payer: Encore All Commercial |
$58.97
|
| Rate for Payer: Frontpath All Commercial |
$66.23
|
| Rate for Payer: Frontpath All Commercial |
$66.23
|
| Rate for Payer: Humana ChoiceCare |
$61.44
|
| Rate for Payer: Humana ChoiceCare |
$61.44
|
| Rate for Payer: Humana Medicare |
$58.97
|
| Rate for Payer: Humana Medicare |
$58.97
|
| Rate for Payer: Lucent All Commercial |
$82.56
|
| Rate for Payer: Lucent All Commercial |
$82.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Managed Health Services Medicaid |
$54.94
|
| Rate for Payer: Managed Health Services Medicaid |
$54.94
|
| Rate for Payer: MDWise Medicaid |
$54.94
|
| Rate for Payer: MDWise Medicaid |
$54.94
|
| Rate for Payer: PHCS All Commercial |
$58.97
|
| Rate for Payer: PHCS All Commercial |
$58.97
|
| Rate for Payer: PHP All Commercial |
$82.19
|
| Rate for Payer: PHP All Commercial |
$82.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.97
|
| Rate for Payer: Sagamore Health Network All Products |
$58.97
|
| Rate for Payer: Sagamore Health Network All Products |
$58.97
|
| Rate for Payer: Signature Care EPO |
$68.56
|
| Rate for Payer: Signature Care EPO |
$68.56
|
| Rate for Payer: Signature Care PPO |
$68.56
|
| Rate for Payer: Signature Care PPO |
$68.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: United Healthcare Commercial |
$56.51
|
| Rate for Payer: United Healthcare Commercial |
$56.51
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$197.78
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
z93284
|
| Min. Negotiated Rate |
$97.27 |
| Max. Negotiated Rate |
$15,200.00 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cash Price |
$122.62
|
| Rate for Payer: Centivo All Commercial |
$160.50
|
| Rate for Payer: Centivo All Commercial |
$160.50
|
| Rate for Payer: Cigna All Commercial |
$103.55
|
| Rate for Payer: Cigna All Commercial |
$103.55
|
| Rate for Payer: CORVEL All Commercial |
$103.55
|
| Rate for Payer: CORVEL All Commercial |
$103.55
|
| Rate for Payer: Coventry All Commercial |
$124.26
|
| Rate for Payer: Coventry All Commercial |
$124.26
|
| Rate for Payer: Encore All Commercial |
$103.55
|
| Rate for Payer: Encore All Commercial |
$103.55
|
| Rate for Payer: Frontpath All Commercial |
$116.05
|
| Rate for Payer: Frontpath All Commercial |
$116.05
|
| Rate for Payer: Humana ChoiceCare |
$130.65
|
| Rate for Payer: Humana ChoiceCare |
$130.65
|
| Rate for Payer: Humana Medicare |
$103.55
|
| Rate for Payer: Humana Medicare |
$103.55
|
| Rate for Payer: Lucent All Commercial |
$144.97
|
| Rate for Payer: Lucent All Commercial |
$144.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: Managed Health Services Medicaid |
$97.27
|
| Rate for Payer: Managed Health Services Medicaid |
$97.27
|
| Rate for Payer: MDWise Medicaid |
$97.27
|
| Rate for Payer: MDWise Medicaid |
$97.27
|
| Rate for Payer: PHCS All Commercial |
$103.55
|
| Rate for Payer: PHCS All Commercial |
$103.55
|
| Rate for Payer: PHP All Commercial |
$145.14
|
| Rate for Payer: PHP All Commercial |
$145.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.55
|
| Rate for Payer: Sagamore Health Network All Products |
$103.55
|
| Rate for Payer: Sagamore Health Network All Products |
$103.55
|
| Rate for Payer: Signature Care EPO |
$146.71
|
| Rate for Payer: Signature Care EPO |
$146.71
|
| Rate for Payer: Signature Care PPO |
$146.71
|
| Rate for Payer: Signature Care PPO |
$146.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: United Healthcare Commercial |
$120.18
|
| Rate for Payer: United Healthcare Commercial |
$120.18
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$183.14
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
z93283
|
| Min. Negotiated Rate |
$90.08 |
| Max. Negotiated Rate |
$14,100.00 |
| Rate for Payer: Aetna Commercial |
$96.04
|
| Rate for Payer: Aetna Commercial |
$96.04
|
| Rate for Payer: Aetna Medicare |
$96.04
|
| Rate for Payer: Aetna Medicare |
$96.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.64
|
| Rate for Payer: Cash Price |
$113.47
|
| Rate for Payer: Cash Price |
$113.55
|
| Rate for Payer: Centivo All Commercial |
$148.86
|
| Rate for Payer: Centivo All Commercial |
$148.86
|
| Rate for Payer: Cigna All Commercial |
$96.04
|
| Rate for Payer: Cigna All Commercial |
$96.04
|
| Rate for Payer: CORVEL All Commercial |
$96.04
|
| Rate for Payer: CORVEL All Commercial |
$96.04
|
| Rate for Payer: Coventry All Commercial |
$115.25
|
| Rate for Payer: Coventry All Commercial |
$115.25
|
| Rate for Payer: Encore All Commercial |
$96.04
|
| Rate for Payer: Encore All Commercial |
$96.04
|
| Rate for Payer: Frontpath All Commercial |
$107.72
|
| Rate for Payer: Frontpath All Commercial |
$107.72
|
| Rate for Payer: Humana ChoiceCare |
$111.41
|
| Rate for Payer: Humana ChoiceCare |
$111.41
|
| Rate for Payer: Humana Medicare |
$96.04
|
| Rate for Payer: Humana Medicare |
$96.04
|
| Rate for Payer: Lucent All Commercial |
$134.46
|
| Rate for Payer: Lucent All Commercial |
$134.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.00
|
| Rate for Payer: Managed Health Services Medicaid |
$90.08
|
| Rate for Payer: Managed Health Services Medicaid |
$90.08
|
| Rate for Payer: MDWise Medicaid |
$90.08
|
| Rate for Payer: MDWise Medicaid |
$90.08
|
| Rate for Payer: PHCS All Commercial |
$96.04
|
| Rate for Payer: PHCS All Commercial |
$96.04
|
| Rate for Payer: PHP All Commercial |
$134.52
|
| Rate for Payer: PHP All Commercial |
$134.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.04
|
| Rate for Payer: Sagamore Health Network All Products |
$96.04
|
| Rate for Payer: Sagamore Health Network All Products |
$96.04
|
| Rate for Payer: Signature Care EPO |
$125.43
|
| Rate for Payer: Signature Care EPO |
$125.43
|
| Rate for Payer: Signature Care PPO |
$125.43
|
| Rate for Payer: Signature Care PPO |
$125.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
|
|
PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
|
Professional
|
Both
|
$149.34
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
z93282
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$11,500.00 |
| Rate for Payer: Aetna Commercial |
$78.50
|
| Rate for Payer: Aetna Commercial |
$78.50
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.35
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Centivo All Commercial |
$121.67
|
| Rate for Payer: Centivo All Commercial |
$121.67
|
| Rate for Payer: Cigna All Commercial |
$78.50
|
| Rate for Payer: Cigna All Commercial |
$78.50
|
| Rate for Payer: CORVEL All Commercial |
$78.50
|
| Rate for Payer: CORVEL All Commercial |
$78.50
|
| Rate for Payer: Coventry All Commercial |
$94.20
|
| Rate for Payer: Coventry All Commercial |
$94.20
|
| Rate for Payer: Encore All Commercial |
$78.50
|
| Rate for Payer: Encore All Commercial |
$78.50
|
| Rate for Payer: Frontpath All Commercial |
$88.31
|
| Rate for Payer: Frontpath All Commercial |
$88.31
|
| Rate for Payer: Humana ChoiceCare |
$91.41
|
| Rate for Payer: Humana ChoiceCare |
$91.41
|
| Rate for Payer: Humana Medicare |
$78.50
|
| Rate for Payer: Humana Medicare |
$78.50
|
| Rate for Payer: Lucent All Commercial |
$109.90
|
| Rate for Payer: Lucent All Commercial |
$109.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: Managed Health Services Medicaid |
$73.15
|
| Rate for Payer: Managed Health Services Medicaid |
$73.15
|
| Rate for Payer: MDWise Medicaid |
$73.15
|
| Rate for Payer: MDWise Medicaid |
$73.15
|
| Rate for Payer: PHCS All Commercial |
$78.50
|
| Rate for Payer: PHCS All Commercial |
$78.50
|
| Rate for Payer: PHP All Commercial |
$109.76
|
| Rate for Payer: PHP All Commercial |
$109.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.50
|
| Rate for Payer: Sagamore Health Network All Products |
$78.50
|
| Rate for Payer: Sagamore Health Network All Products |
$78.50
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$102.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,500.00
|
| Rate for Payer: United Healthcare Commercial |
$84.08
|
| Rate for Payer: United Healthcare Commercial |
$84.08
|
|
|
PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS
|
Professional
|
Both
|
$236.70
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
z45300
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$6,300.00 |
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna Medicare |
$44.72
|
| Rate for Payer: Aetna Medicare |
$44.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$43.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$43.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.19
|
| Rate for Payer: Cash Price |
$145.30
|
| Rate for Payer: Cash Price |
$146.75
|
| Rate for Payer: Centivo All Commercial |
$69.32
|
| Rate for Payer: Centivo All Commercial |
$69.32
|
| Rate for Payer: Cigna All Commercial |
$44.72
|
| Rate for Payer: Cigna All Commercial |
$44.72
|
| Rate for Payer: CORVEL All Commercial |
$44.72
|
| Rate for Payer: CORVEL All Commercial |
$44.72
|
| Rate for Payer: Coventry All Commercial |
$53.66
|
| Rate for Payer: Coventry All Commercial |
$53.66
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Frontpath All Commercial |
$61.53
|
| Rate for Payer: Frontpath All Commercial |
$61.53
|
| Rate for Payer: Humana ChoiceCare |
$29.54
|
| Rate for Payer: Humana ChoiceCare |
$29.54
|
| Rate for Payer: Humana Medicare |
$44.72
|
| Rate for Payer: Humana Medicare |
$44.72
|
| Rate for Payer: Lucent All Commercial |
$62.61
|
| Rate for Payer: Lucent All Commercial |
$62.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: Managed Health Services Medicaid |
$116.42
|
| Rate for Payer: Managed Health Services Medicaid |
$116.42
|
| Rate for Payer: MDWise Medicaid |
$116.42
|
| Rate for Payer: MDWise Medicaid |
$116.42
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$43.22
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$43.22
|
| Rate for Payer: PHCS All Commercial |
$44.72
|
| Rate for Payer: PHCS All Commercial |
$44.72
|
| Rate for Payer: PHP All Commercial |
$76.46
|
| Rate for Payer: PHP All Commercial |
$76.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.72
|
| Rate for Payer: Sagamore Health Network All Products |
$44.72
|
| Rate for Payer: Sagamore Health Network All Products |
$44.72
|
| Rate for Payer: Signature Care EPO |
$103.93
|
| Rate for Payer: Signature Care EPO |
$103.93
|
| Rate for Payer: Signature Care PPO |
$103.93
|
| Rate for Payer: Signature Care PPO |
$103.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,300.00
|
| Rate for Payer: United Healthcare Commercial |
$54.53
|
| Rate for Payer: United Healthcare Commercial |
$54.53
|
| Rate for Payer: United Healthcare Medicare |
$117.18
|
| Rate for Payer: United Healthcare Medicare |
$117.18
|
|
|
PR PROFES SVC,IMMUNOTHER,SINGLE/MULT AGS
|
Professional
|
Both
|
$27.18
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$2.73
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$2.73
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
|
|
PR PROFES SVC, IMMUNOTHER, SUBLINGUAL 3 MON
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165A
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: Cash Price |
$197.16
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$2.73
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
|
|
PR PROFES SVC, IMMUNOTHER, SUBLINGUAL 6 MON
|
Professional
|
Both
|
$399.60
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165B
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.15
|
| Rate for Payer: Cash Price |
$247.75
|
| Rate for Payer: Centivo All Commercial |
$4.43
|
| Rate for Payer: Cigna All Commercial |
$2.86
|
| Rate for Payer: CORVEL All Commercial |
$2.86
|
| Rate for Payer: Coventry All Commercial |
$3.43
|
| Rate for Payer: Encore All Commercial |
$2.86
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Lucent All Commercial |
$4.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$2.73
|
| Rate for Payer: PHCS All Commercial |
$2.86
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.86
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$147.38
|
|
|
Service Code
|
CPT 93280
|
| Hospital Charge Code |
z93280
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$11,300.00 |
| Rate for Payer: Aetna Commercial |
$77.60
|
| Rate for Payer: Aetna Commercial |
$77.60
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.36
|
| Rate for Payer: Cash Price |
$91.15
|
| Rate for Payer: Cash Price |
$91.38
|
| Rate for Payer: Centivo All Commercial |
$120.28
|
| Rate for Payer: Centivo All Commercial |
$120.28
|
| Rate for Payer: Cigna All Commercial |
$77.60
|
| Rate for Payer: Cigna All Commercial |
$77.60
|
| Rate for Payer: CORVEL All Commercial |
$77.60
|
| Rate for Payer: CORVEL All Commercial |
$77.60
|
| Rate for Payer: Coventry All Commercial |
$93.12
|
| Rate for Payer: Coventry All Commercial |
$93.12
|
| Rate for Payer: Encore All Commercial |
$77.60
|
| Rate for Payer: Encore All Commercial |
$77.60
|
| Rate for Payer: Frontpath All Commercial |
$87.35
|
| Rate for Payer: Frontpath All Commercial |
$87.35
|
| Rate for Payer: Humana ChoiceCare |
$84.65
|
| Rate for Payer: Humana ChoiceCare |
$84.65
|
| Rate for Payer: Humana Medicare |
$77.60
|
| Rate for Payer: Humana Medicare |
$77.60
|
| Rate for Payer: Lucent All Commercial |
$108.64
|
| Rate for Payer: Lucent All Commercial |
$108.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: Managed Health Services Medicaid |
$72.48
|
| Rate for Payer: Managed Health Services Medicaid |
$72.48
|
| Rate for Payer: MDWise Medicaid |
$72.48
|
| Rate for Payer: MDWise Medicaid |
$72.48
|
| Rate for Payer: PHCS All Commercial |
$77.60
|
| Rate for Payer: PHCS All Commercial |
$77.60
|
| Rate for Payer: PHP All Commercial |
$108.07
|
| Rate for Payer: PHP All Commercial |
$108.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.60
|
| Rate for Payer: Sagamore Health Network All Products |
$77.60
|
| Rate for Payer: Sagamore Health Network All Products |
$77.60
|
| Rate for Payer: Signature Care EPO |
$95.31
|
| Rate for Payer: Signature Care EPO |
$95.31
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,300.00
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$156.70
|
|
|
Service Code
|
CPT 93281
|
| Hospital Charge Code |
z93281
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$12,000.00 |
| Rate for Payer: Aetna Commercial |
$82.23
|
| Rate for Payer: Aetna Commercial |
$82.23
|
| Rate for Payer: Aetna Medicare |
$82.23
|
| Rate for Payer: Aetna Medicare |
$82.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$77.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$77.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.45
|
| Rate for Payer: Cash Price |
$97.07
|
| Rate for Payer: Cash Price |
$97.15
|
| Rate for Payer: Centivo All Commercial |
$127.46
|
| Rate for Payer: Centivo All Commercial |
$127.46
|
| Rate for Payer: Cigna All Commercial |
$82.23
|
| Rate for Payer: Cigna All Commercial |
$82.23
|
| Rate for Payer: CORVEL All Commercial |
$82.23
|
| Rate for Payer: CORVEL All Commercial |
$82.23
|
| Rate for Payer: Coventry All Commercial |
$98.68
|
| Rate for Payer: Coventry All Commercial |
$98.68
|
| Rate for Payer: Encore All Commercial |
$82.23
|
| Rate for Payer: Encore All Commercial |
$82.23
|
| Rate for Payer: Frontpath All Commercial |
$92.48
|
| Rate for Payer: Frontpath All Commercial |
$92.48
|
| Rate for Payer: Humana ChoiceCare |
$98.96
|
| Rate for Payer: Humana ChoiceCare |
$98.96
|
| Rate for Payer: Humana Medicare |
$82.23
|
| Rate for Payer: Humana Medicare |
$82.23
|
| Rate for Payer: Lucent All Commercial |
$115.12
|
| Rate for Payer: Lucent All Commercial |
$115.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: Managed Health Services Medicaid |
$77.07
|
| Rate for Payer: Managed Health Services Medicaid |
$77.07
|
| Rate for Payer: MDWise Medicaid |
$77.07
|
| Rate for Payer: MDWise Medicaid |
$77.07
|
| Rate for Payer: PHCS All Commercial |
$82.23
|
| Rate for Payer: PHCS All Commercial |
$82.23
|
| Rate for Payer: PHP All Commercial |
$115.07
|
| Rate for Payer: PHP All Commercial |
$115.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.23
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$111.06
|
| Rate for Payer: Signature Care EPO |
$111.06
|
| Rate for Payer: Signature Care PPO |
$111.06
|
| Rate for Payer: Signature Care PPO |
$111.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,000.00
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$57.86
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
z99417
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.76
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Cash Price |
$36.26
|
| Rate for Payer: Frontpath All Commercial |
$31.17
|
| Rate for Payer: Frontpath All Commercial |
$31.17
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.00
|
| Rate for Payer: Managed Health Services Medicaid |
$28.76
|
| Rate for Payer: Managed Health Services Medicaid |
$28.76
|
| Rate for Payer: MDWise Medicaid |
$28.76
|
| Rate for Payer: MDWise Medicaid |
$28.76
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$22.87
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$22.87
|
| Rate for Payer: PHP All Commercial |
$28.86
|
| Rate for Payer: PHP All Commercial |
$28.86
|
| Rate for Payer: Signature Care EPO |
$24.52
|
| Rate for Payer: Signature Care EPO |
$24.52
|
| Rate for Payer: Signature Care PPO |
$24.52
|
| Rate for Payer: Signature Care PPO |
$24.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
| Rate for Payer: United Healthcare Medicare |
$28.93
|
| Rate for Payer: United Healthcare Medicare |
$28.93
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$242.10
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
z99354
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$205.78 |
| Rate for Payer: Aetna Commercial |
$113.58
|
| Rate for Payer: Aetna Medicare |
$113.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$125.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$125.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.94
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Centivo All Commercial |
$176.05
|
| Rate for Payer: Cigna All Commercial |
$113.58
|
| Rate for Payer: CORVEL All Commercial |
$113.58
|
| Rate for Payer: Coventry All Commercial |
$136.30
|
| Rate for Payer: Encore All Commercial |
$113.58
|
| Rate for Payer: Frontpath All Commercial |
$122.43
|
| Rate for Payer: Humana ChoiceCare |
$96.89
|
| Rate for Payer: Humana Medicare |
$113.58
|
| Rate for Payer: Lucent All Commercial |
$159.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.78
|
| Rate for Payer: PHCS All Commercial |
$113.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.58
|
| Rate for Payer: Sagamore Health Network All Products |
$113.58
|
| Rate for Payer: Signature Care EPO |
$102.89
|
| Rate for Payer: Signature Care PPO |
$102.89
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$57.24
|
|
|
Service Code
|
CPT G0316
|
| Hospital Charge Code |
zG0316
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$23.29
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$23.29
|
| Rate for Payer: United Healthcare Commercial |
$32.70
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$61.24
|
|
|
Service Code
|
CPT G2212
|
| Hospital Charge Code |
zG2212
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$30.32
|
| Rate for Payer: Aetna Medicare |
$30.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.35
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Centivo All Commercial |
$47.00
|
| Rate for Payer: Cigna All Commercial |
$30.32
|
| Rate for Payer: CORVEL All Commercial |
$30.32
|
| Rate for Payer: Coventry All Commercial |
$36.38
|
| Rate for Payer: Encore All Commercial |
$30.32
|
| Rate for Payer: Humana ChoiceCare |
$25.20
|
| Rate for Payer: Humana Medicare |
$30.32
|
| Rate for Payer: Lucent All Commercial |
$42.45
|
| Rate for Payer: Managed Health Services Medicaid |
$30.13
|
| Rate for Payer: MDWise Medicaid |
$30.13
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$22.66
|
| Rate for Payer: PHCS All Commercial |
$30.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.32
|
| Rate for Payer: Sagamore Health Network All Products |
$30.32
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
CPT 23335
|
| Hospital Charge Code |
z23335
|
| Min. Negotiated Rate |
$1,144.49 |
| Max. Negotiated Rate |
$1,825.96 |
| Rate for Payer: Aetna Commercial |
$1,178.04
|
| Rate for Payer: Aetna Medicare |
$1,178.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,147.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,354.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,295.84
|
| Rate for Payer: Cash Price |
$1,445.84
|
| Rate for Payer: Centivo All Commercial |
$1,825.96
|
| Rate for Payer: Cigna All Commercial |
$1,178.04
|
| Rate for Payer: CORVEL All Commercial |
$1,178.04
|
| Rate for Payer: Coventry All Commercial |
$1,413.65
|
| Rate for Payer: Encore All Commercial |
$1,178.04
|
| Rate for Payer: Frontpath All Commercial |
$1,646.49
|
| Rate for Payer: Humana ChoiceCare |
$1,409.54
|
| Rate for Payer: Humana Medicare |
$1,178.04
|
| Rate for Payer: Lucent All Commercial |
$1,649.26
|
| Rate for Payer: Managed Health Services Medicaid |
$1,147.08
|
| Rate for Payer: MDWise Medicaid |
$1,147.08
|
| Rate for Payer: PHCS All Commercial |
$1,178.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,178.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,178.04
|
| Rate for Payer: United Healthcare Commercial |
$1,534.75
|
| Rate for Payer: United Healthcare Medicare |
$1,144.49
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$1,284.14
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
z64561
|
| Min. Negotiated Rate |
$154.17 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Aetna Commercial |
$285.49
|
| Rate for Payer: Aetna Medicare |
$285.49
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$154.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$667.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.04
|
| Rate for Payer: Cash Price |
$796.17
|
| Rate for Payer: Centivo All Commercial |
$442.51
|
| Rate for Payer: Cigna All Commercial |
$285.49
|
| Rate for Payer: CORVEL All Commercial |
$285.49
|
| Rate for Payer: Coventry All Commercial |
$342.59
|
| Rate for Payer: Encore All Commercial |
$285.49
|
| Rate for Payer: Frontpath All Commercial |
$393.12
|
| Rate for Payer: Humana ChoiceCare |
$484.56
|
| Rate for Payer: Humana Medicare |
$285.49
|
| Rate for Payer: Lucent All Commercial |
$399.69
|
| Rate for Payer: Managed Health Services Medicaid |
$667.49
|
| Rate for Payer: MDWise Medicaid |
$667.49
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$154.17
|
| Rate for Payer: PHCS All Commercial |
$285.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.49
|
| Rate for Payer: Sagamore Health Network All Products |
$285.49
|
| Rate for Payer: United Healthcare Commercial |
$483.16
|
| Rate for Payer: United Healthcare Medicare |
$674.25
|
|
|
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 |
$562.85
|
| Rate for Payer: Cash Price |
$550.25
|
| 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 |
$204.93
|
| Rate for Payer: Cash Price |
$207.32
|
| 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 Medicare |
$77.14
|
| Rate for Payer: Molina Healthcare of OH 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 |
$228.57
|
| Rate for Payer: Cash Price |
$231.82
|
| 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 Medicare |
$87.90
|
| Rate for Payer: Molina Healthcare of OH 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 |
$110.78
|
| Rate for Payer: Cash Price |
$117.71
|
| 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 Medicare |
$53.03
|
| Rate for Payer: Molina Healthcare of OH 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 |
$17.63
|
| Rate for Payer: Cash Price |
$17.46
|
| 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 |
$81.36
|
| Rate for Payer: Cash Price |
$86.58
|
| 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 Medicare |
$46.85
|
| Rate for Payer: Molina Healthcare of OH 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
|
|
