|
PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
z45330
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$7,300.00 |
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Medicare |
$52.33
|
| Rate for Payer: Aetna Medicare |
$52.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$169.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$169.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.56
|
| Rate for Payer: Cash Price |
$203.28
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Centivo All Commercial |
$81.11
|
| Rate for Payer: Centivo All Commercial |
$81.11
|
| Rate for Payer: Cigna All Commercial |
$52.33
|
| Rate for Payer: Cigna All Commercial |
$52.33
|
| Rate for Payer: CORVEL All Commercial |
$52.33
|
| Rate for Payer: CORVEL All Commercial |
$52.33
|
| Rate for Payer: Coventry All Commercial |
$62.80
|
| Rate for Payer: Coventry All Commercial |
$62.80
|
| Rate for Payer: Encore All Commercial |
$52.33
|
| Rate for Payer: Encore All Commercial |
$52.33
|
| Rate for Payer: Frontpath All Commercial |
$71.54
|
| Rate for Payer: Frontpath All Commercial |
$71.54
|
| Rate for Payer: Humana ChoiceCare |
$65.68
|
| Rate for Payer: Humana ChoiceCare |
$65.68
|
| Rate for Payer: Humana Medicare |
$52.33
|
| Rate for Payer: Humana Medicare |
$52.33
|
| Rate for Payer: Lucent All Commercial |
$73.26
|
| Rate for Payer: Lucent All Commercial |
$73.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.00
|
| Rate for Payer: Managed Health Services Medicaid |
$169.19
|
| Rate for Payer: Managed Health Services Medicaid |
$169.19
|
| Rate for Payer: MDWise Medicaid |
$169.19
|
| Rate for Payer: MDWise Medicaid |
$169.19
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$52.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$52.42
|
| Rate for Payer: PHCS All Commercial |
$52.33
|
| Rate for Payer: PHCS All Commercial |
$52.33
|
| Rate for Payer: PHP All Commercial |
$88.79
|
| Rate for Payer: PHP All Commercial |
$88.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.33
|
| Rate for Payer: Sagamore Health Network All Products |
$52.33
|
| Rate for Payer: Sagamore Health Network All Products |
$52.33
|
| Rate for Payer: Signature Care EPO |
$172.55
|
| Rate for Payer: Signature Care EPO |
$172.55
|
| Rate for Payer: Signature Care PPO |
$172.55
|
| Rate for Payer: Signature Care PPO |
$172.55
|
| 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 |
$70.28
|
| Rate for Payer: United Healthcare Commercial |
$70.28
|
| Rate for Payer: United Healthcare Medicare |
$169.40
|
| Rate for Payer: United Healthcare Medicare |
$169.40
|
|
|
PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT
|
Professional
|
Both
|
$836.66
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
z45340
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$10,100.00 |
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Medicare |
$72.94
|
| Rate for Payer: Aetna Medicare |
$72.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.38
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$79.25
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$79.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$411.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$411.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.23
|
| Rate for Payer: Cash Price |
$500.78
|
| Rate for Payer: Cash Price |
$502.00
|
| Rate for Payer: Centivo All Commercial |
$113.06
|
| Rate for Payer: Centivo All Commercial |
$113.06
|
| Rate for Payer: Cigna All Commercial |
$72.94
|
| Rate for Payer: Cigna All Commercial |
$72.94
|
| Rate for Payer: CORVEL All Commercial |
$72.94
|
| Rate for Payer: CORVEL All Commercial |
$72.94
|
| Rate for Payer: Coventry All Commercial |
$87.53
|
| Rate for Payer: Coventry All Commercial |
$87.53
|
| Rate for Payer: Encore All Commercial |
$72.94
|
| Rate for Payer: Encore All Commercial |
$72.94
|
| Rate for Payer: Frontpath All Commercial |
$100.41
|
| Rate for Payer: Frontpath All Commercial |
$100.41
|
| Rate for Payer: Humana ChoiceCare |
$122.81
|
| Rate for Payer: Humana ChoiceCare |
$122.81
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$102.12
|
| Rate for Payer: Lucent All Commercial |
$102.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.00
|
| Rate for Payer: Managed Health Services Medicaid |
$411.50
|
| Rate for Payer: Managed Health Services Medicaid |
$411.50
|
| Rate for Payer: MDWise Medicaid |
$411.50
|
| Rate for Payer: MDWise Medicaid |
$411.50
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$79.25
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$79.25
|
| Rate for Payer: PHCS All Commercial |
$72.94
|
| Rate for Payer: PHCS All Commercial |
$72.94
|
| Rate for Payer: PHP All Commercial |
$123.65
|
| Rate for Payer: PHP All Commercial |
$123.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.94
|
| Rate for Payer: Sagamore Health Network All Products |
$72.94
|
| Rate for Payer: Sagamore Health Network All Products |
$72.94
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,100.00
|
| Rate for Payer: United Healthcare Commercial |
$131.06
|
| Rate for Payer: United Healthcare Commercial |
$131.06
|
| Rate for Payer: United Healthcare Medicare |
$417.32
|
| Rate for Payer: United Healthcare Medicare |
$417.32
|
|
|
PR SLING OPER STRES INCONTINENCE
|
Professional
|
Both
|
$1,346.82
|
|
|
Service Code
|
CPT 57288
|
| Hospital Charge Code |
z57288
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$1,089.46 |
| Rate for Payer: Aetna Commercial |
$702.88
|
| Rate for Payer: Aetna Medicare |
$702.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$681.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$808.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$773.17
|
| Rate for Payer: Cash Price |
$808.09
|
| Rate for Payer: Centivo All Commercial |
$1,089.46
|
| Rate for Payer: Cigna All Commercial |
$702.88
|
| Rate for Payer: CORVEL All Commercial |
$702.88
|
| Rate for Payer: Coventry All Commercial |
$843.46
|
| Rate for Payer: Encore All Commercial |
$702.88
|
| Rate for Payer: Frontpath All Commercial |
$968.89
|
| Rate for Payer: Humana ChoiceCare |
$835.89
|
| Rate for Payer: Humana Medicare |
$702.88
|
| Rate for Payer: Lucent All Commercial |
$984.03
|
| Rate for Payer: Managed Health Services Medicaid |
$681.37
|
| Rate for Payer: MDWise Medicaid |
$681.37
|
| Rate for Payer: PHCS All Commercial |
$702.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$702.88
|
| Rate for Payer: Sagamore Health Network All Products |
$702.88
|
| Rate for Payer: United Healthcare Commercial |
$836.54
|
| Rate for Payer: United Healthcare Medicare |
$680.02
|
|
|
PR SPEECH AUDIOMETRY, COMPLETE
|
Professional
|
Both
|
$82.58
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
z92556
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.26
|
| Rate for Payer: Cash Price |
$49.55
|
| Rate for Payer: Cash Price |
$45.73
|
| Rate for Payer: Centivo All Commercial |
$56.73
|
| Rate for Payer: Centivo All Commercial |
$56.73
|
| Rate for Payer: Cigna All Commercial |
$36.60
|
| Rate for Payer: Cigna All Commercial |
$36.60
|
| Rate for Payer: CORVEL All Commercial |
$36.60
|
| Rate for Payer: CORVEL All Commercial |
$36.60
|
| Rate for Payer: Coventry All Commercial |
$43.92
|
| Rate for Payer: Coventry All Commercial |
$43.92
|
| Rate for Payer: Encore All Commercial |
$36.60
|
| Rate for Payer: Encore All Commercial |
$36.60
|
| Rate for Payer: Frontpath All Commercial |
$41.09
|
| Rate for Payer: Frontpath All Commercial |
$41.09
|
| Rate for Payer: Humana ChoiceCare |
$24.06
|
| Rate for Payer: Humana ChoiceCare |
$24.06
|
| Rate for Payer: Humana Medicare |
$36.60
|
| Rate for Payer: Humana Medicare |
$36.60
|
| Rate for Payer: Lucent All Commercial |
$51.24
|
| Rate for Payer: Lucent All Commercial |
$51.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.00
|
| Rate for Payer: Managed Health Services Medicaid |
$40.61
|
| Rate for Payer: Managed Health Services Medicaid |
$40.61
|
| Rate for Payer: MDWise Medicaid |
$40.61
|
| Rate for Payer: MDWise Medicaid |
$40.61
|
| Rate for Payer: PHCS All Commercial |
$36.60
|
| Rate for Payer: PHCS All Commercial |
$36.60
|
| Rate for Payer: PHP All Commercial |
$55.25
|
| Rate for Payer: PHP All Commercial |
$55.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.60
|
| Rate for Payer: Sagamore Health Network All Products |
$36.60
|
| Rate for Payer: Sagamore Health Network All Products |
$36.60
|
| Rate for Payer: Signature Care EPO |
$31.11
|
| Rate for Payer: Signature Care EPO |
$31.11
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| 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 |
$27.28
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
|
|
PR SPEECH THRESHOLD AUDIOMETRY
|
Professional
|
Both
|
$53.12
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
z92555
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Medicare |
$23.21
|
| Rate for Payer: Aetna Medicare |
$23.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.53
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Centivo All Commercial |
$35.98
|
| Rate for Payer: Centivo All Commercial |
$35.98
|
| Rate for Payer: Cigna All Commercial |
$23.21
|
| Rate for Payer: Cigna All Commercial |
$23.21
|
| Rate for Payer: CORVEL All Commercial |
$23.21
|
| Rate for Payer: CORVEL All Commercial |
$23.21
|
| Rate for Payer: Coventry All Commercial |
$27.85
|
| Rate for Payer: Coventry All Commercial |
$27.85
|
| Rate for Payer: Encore All Commercial |
$23.21
|
| Rate for Payer: Encore All Commercial |
$23.21
|
| Rate for Payer: Frontpath All Commercial |
$26.14
|
| Rate for Payer: Frontpath All Commercial |
$26.14
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana Medicare |
$23.21
|
| Rate for Payer: Humana Medicare |
$23.21
|
| Rate for Payer: Lucent All Commercial |
$32.49
|
| Rate for Payer: Lucent All Commercial |
$32.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: Managed Health Services Medicaid |
$26.12
|
| Rate for Payer: Managed Health Services Medicaid |
$26.12
|
| Rate for Payer: MDWise Medicaid |
$26.12
|
| Rate for Payer: MDWise Medicaid |
$26.12
|
| Rate for Payer: PHCS All Commercial |
$23.21
|
| Rate for Payer: PHCS All Commercial |
$23.21
|
| Rate for Payer: PHP All Commercial |
$35.60
|
| Rate for Payer: PHP All Commercial |
$35.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.21
|
| Rate for Payer: Sagamore Health Network All Products |
$23.21
|
| Rate for Payer: Sagamore Health Network All Products |
$23.21
|
| Rate for Payer: Signature Care EPO |
$19.73
|
| Rate for Payer: Signature Care EPO |
$19.73
|
| Rate for Payer: Signature Care PPO |
$19.73
|
| Rate for Payer: Signature Care PPO |
$19.73
|
| 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 |
$17.64
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
| Rate for Payer: United Healthcare Medicare |
$24.55
|
| Rate for Payer: United Healthcare Medicare |
$24.55
|
|
|
PR SPLINT FINGER FOAM 3 INCH
|
Professional
|
Both
|
$4.77
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927A
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$33.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.97
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Centivo All Commercial |
$52.10
|
| Rate for Payer: Cigna All Commercial |
$33.61
|
| Rate for Payer: CORVEL All Commercial |
$33.61
|
| Rate for Payer: Coventry All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$33.61
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: Humana Medicare |
$33.61
|
| Rate for Payer: Lucent All Commercial |
$47.05
|
| Rate for Payer: Managed Health Services Medicaid |
$37.48
|
| Rate for Payer: MDWise Medicaid |
$37.48
|
| Rate for Payer: PHCS All Commercial |
$33.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.61
|
| Rate for Payer: Sagamore Health Network All Products |
$33.61
|
| Rate for Payer: Signature Care EPO |
$4.77
|
| Rate for Payer: Signature Care PPO |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM 6 INCH
|
Professional
|
Both
|
$2.41
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927B
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$33.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.97
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Centivo All Commercial |
$52.10
|
| Rate for Payer: Cigna All Commercial |
$33.61
|
| Rate for Payer: CORVEL All Commercial |
$33.61
|
| Rate for Payer: Coventry All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$33.61
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: Humana Medicare |
$33.61
|
| Rate for Payer: Lucent All Commercial |
$47.05
|
| Rate for Payer: Managed Health Services Medicaid |
$37.48
|
| Rate for Payer: MDWise Medicaid |
$37.48
|
| Rate for Payer: PHCS All Commercial |
$33.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.61
|
| Rate for Payer: Sagamore Health Network All Products |
$33.61
|
| Rate for Payer: Signature Care EPO |
$2.41
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM MED
|
Professional
|
Both
|
$4.20
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927C
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$33.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.97
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Centivo All Commercial |
$52.10
|
| Rate for Payer: Cigna All Commercial |
$33.61
|
| Rate for Payer: CORVEL All Commercial |
$33.61
|
| Rate for Payer: Coventry All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$33.61
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: Humana Medicare |
$33.61
|
| Rate for Payer: Lucent All Commercial |
$47.05
|
| Rate for Payer: Managed Health Services Medicaid |
$37.48
|
| Rate for Payer: MDWise Medicaid |
$37.48
|
| Rate for Payer: PHCS All Commercial |
$33.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.61
|
| Rate for Payer: Sagamore Health Network All Products |
$33.61
|
| Rate for Payer: Signature Care EPO |
$4.20
|
| Rate for Payer: Signature Care PPO |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM XLG
|
Professional
|
Both
|
$2.59
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927D
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$33.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.97
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Centivo All Commercial |
$52.10
|
| Rate for Payer: Cigna All Commercial |
$33.61
|
| Rate for Payer: CORVEL All Commercial |
$33.61
|
| Rate for Payer: Coventry All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$33.61
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: Humana Medicare |
$33.61
|
| Rate for Payer: Lucent All Commercial |
$47.05
|
| Rate for Payer: Managed Health Services Medicaid |
$37.48
|
| Rate for Payer: MDWise Medicaid |
$37.48
|
| Rate for Payer: PHCS All Commercial |
$33.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.61
|
| Rate for Payer: Sagamore Health Network All Products |
$33.61
|
| Rate for Payer: Signature Care EPO |
$2.59
|
| Rate for Payer: Signature Care PPO |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER STAX #2
|
Professional
|
Both
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049A
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.57
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: Managed Health Services Medicaid |
$2.57
|
| Rate for Payer: MDWise Medicaid |
$2.57
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #3
|
Professional
|
Both
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049B
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.57
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: Managed Health Services Medicaid |
$2.57
|
| Rate for Payer: MDWise Medicaid |
$2.57
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #4
|
Professional
|
Both
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049C
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.57
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: Managed Health Services Medicaid |
$2.57
|
| Rate for Payer: MDWise Medicaid |
$2.57
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #5
|
Professional
|
Both
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049D
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.57
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: Managed Health Services Medicaid |
$2.57
|
| Rate for Payer: MDWise Medicaid |
$2.57
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX # 5 1/2
|
Professional
|
Both
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049G
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.57
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: Managed Health Services Medicaid |
$2.57
|
| Rate for Payer: MDWise Medicaid |
$2.57
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #6
|
Professional
|
Both
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049E
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.57
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: Managed Health Services Medicaid |
$2.57
|
| Rate for Payer: MDWise Medicaid |
$2.57
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #7
|
Professional
|
Both
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049F
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.57
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: Managed Health Services Medicaid |
$2.57
|
| Rate for Payer: MDWise Medicaid |
$2.57
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM
|
Professional
|
Both
|
$1,566.92
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
z15120
|
| Min. Negotiated Rate |
$351.26 |
| Max. Negotiated Rate |
$76,900.00 |
| Rate for Payer: Aetna Commercial |
$642.69
|
| Rate for Payer: Aetna Commercial |
$642.69
|
| Rate for Payer: Aetna Medicare |
$642.69
|
| Rate for Payer: Aetna Medicare |
$642.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$949.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$351.26
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$351.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$770.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$770.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$739.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$739.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$706.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$706.96
|
| Rate for Payer: Cash Price |
$923.12
|
| Rate for Payer: Cash Price |
$940.15
|
| Rate for Payer: Centivo All Commercial |
$996.17
|
| Rate for Payer: Centivo All Commercial |
$996.17
|
| Rate for Payer: Cigna All Commercial |
$642.69
|
| Rate for Payer: Cigna All Commercial |
$642.69
|
| Rate for Payer: CORVEL All Commercial |
$642.69
|
| Rate for Payer: CORVEL All Commercial |
$642.69
|
| Rate for Payer: Coventry All Commercial |
$771.23
|
| Rate for Payer: Coventry All Commercial |
$771.23
|
| Rate for Payer: Encore All Commercial |
$642.69
|
| Rate for Payer: Encore All Commercial |
$642.69
|
| Rate for Payer: Frontpath All Commercial |
$886.89
|
| Rate for Payer: Frontpath All Commercial |
$886.89
|
| Rate for Payer: Humana ChoiceCare |
$659.13
|
| Rate for Payer: Humana ChoiceCare |
$659.13
|
| Rate for Payer: Humana Medicare |
$642.69
|
| Rate for Payer: Humana Medicare |
$642.69
|
| Rate for Payer: Lucent All Commercial |
$899.77
|
| Rate for Payer: Lucent All Commercial |
$899.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$834.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$834.00
|
| Rate for Payer: Managed Health Services Medicaid |
$770.67
|
| Rate for Payer: Managed Health Services Medicaid |
$770.67
|
| Rate for Payer: MDWise Medicaid |
$770.67
|
| Rate for Payer: MDWise Medicaid |
$770.67
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$351.26
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$351.26
|
| Rate for Payer: PHCS All Commercial |
$642.69
|
| Rate for Payer: PHCS All Commercial |
$642.69
|
| Rate for Payer: PHP All Commercial |
$875.84
|
| Rate for Payer: PHP All Commercial |
$875.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$642.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$642.69
|
| Rate for Payer: Sagamore Health Network All Products |
$642.69
|
| Rate for Payer: Sagamore Health Network All Products |
$642.69
|
| Rate for Payer: Signature Care EPO |
$848.30
|
| Rate for Payer: Signature Care EPO |
$848.30
|
| Rate for Payer: Signature Care PPO |
$848.30
|
| Rate for Payer: Signature Care PPO |
$848.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76,900.00
|
| Rate for Payer: United Healthcare Commercial |
$841.21
|
| Rate for Payer: United Healthcare Commercial |
$841.21
|
| Rate for Payer: United Healthcare Medicare |
$769.27
|
| Rate for Payer: United Healthcare Medicare |
$769.27
|
|
|
PR SPLIT GRFT TRUNK,ARM,LEG <100 SQCM
|
Professional
|
Both
|
$1,599.18
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
z15100
|
| Min. Negotiated Rate |
$365.96 |
| Max. Negotiated Rate |
$79,400.00 |
| Rate for Payer: Aetna Commercial |
$663.94
|
| Rate for Payer: Aetna Commercial |
$663.94
|
| Rate for Payer: Aetna Medicare |
$663.94
|
| Rate for Payer: Aetna Medicare |
$663.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$872.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$365.96
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$365.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$786.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$786.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$763.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$763.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$730.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$730.33
|
| Rate for Payer: Cash Price |
$944.32
|
| Rate for Payer: Cash Price |
$959.51
|
| Rate for Payer: Centivo All Commercial |
$1,029.11
|
| Rate for Payer: Centivo All Commercial |
$1,029.11
|
| Rate for Payer: Cigna All Commercial |
$663.94
|
| Rate for Payer: Cigna All Commercial |
$663.94
|
| Rate for Payer: CORVEL All Commercial |
$663.94
|
| Rate for Payer: CORVEL All Commercial |
$663.94
|
| Rate for Payer: Coventry All Commercial |
$796.73
|
| Rate for Payer: Coventry All Commercial |
$796.73
|
| Rate for Payer: Encore All Commercial |
$663.94
|
| Rate for Payer: Encore All Commercial |
$663.94
|
| Rate for Payer: Frontpath All Commercial |
$923.18
|
| Rate for Payer: Frontpath All Commercial |
$923.18
|
| Rate for Payer: Humana ChoiceCare |
$632.93
|
| Rate for Payer: Humana ChoiceCare |
$632.93
|
| Rate for Payer: Humana Medicare |
$663.94
|
| Rate for Payer: Humana Medicare |
$663.94
|
| Rate for Payer: Lucent All Commercial |
$929.52
|
| Rate for Payer: Lucent All Commercial |
$929.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$860.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$860.00
|
| Rate for Payer: Managed Health Services Medicaid |
$786.54
|
| Rate for Payer: Managed Health Services Medicaid |
$786.54
|
| Rate for Payer: MDWise Medicaid |
$786.54
|
| Rate for Payer: MDWise Medicaid |
$786.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$365.96
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$365.96
|
| Rate for Payer: PHCS All Commercial |
$663.94
|
| Rate for Payer: PHCS All Commercial |
$663.94
|
| Rate for Payer: PHP All Commercial |
$903.94
|
| Rate for Payer: PHP All Commercial |
$903.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$663.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$663.94
|
| Rate for Payer: Sagamore Health Network All Products |
$663.94
|
| Rate for Payer: Sagamore Health Network All Products |
$663.94
|
| Rate for Payer: Signature Care EPO |
$888.25
|
| Rate for Payer: Signature Care EPO |
$888.25
|
| Rate for Payer: Signature Care PPO |
$888.25
|
| Rate for Payer: Signature Care PPO |
$888.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79,400.00
|
| Rate for Payer: United Healthcare Commercial |
$766.28
|
| Rate for Payer: United Healthcare Commercial |
$766.28
|
| Rate for Payer: United Healthcare Medicare |
$786.93
|
| Rate for Payer: United Healthcare Medicare |
$786.93
|
|
|
PR STAGGERED SPONDAIC WORD TEST
|
Professional
|
Both
|
$97.92
|
|
|
Service Code
|
CPT 92572
|
| Hospital Charge Code |
z92572
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$5,200.00 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Medicare |
$37.54
|
| Rate for Payer: Aetna Medicare |
$37.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.29
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$50.78
|
| Rate for Payer: Centivo All Commercial |
$58.19
|
| Rate for Payer: Centivo All Commercial |
$58.19
|
| Rate for Payer: Cigna All Commercial |
$37.54
|
| Rate for Payer: Cigna All Commercial |
$37.54
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: Coventry All Commercial |
$45.05
|
| Rate for Payer: Coventry All Commercial |
$45.05
|
| Rate for Payer: Encore All Commercial |
$37.54
|
| Rate for Payer: Encore All Commercial |
$37.54
|
| Rate for Payer: Frontpath All Commercial |
$42.12
|
| Rate for Payer: Frontpath All Commercial |
$42.12
|
| Rate for Payer: Humana ChoiceCare |
$3.81
|
| Rate for Payer: Humana ChoiceCare |
$3.81
|
| Rate for Payer: Humana Medicare |
$37.54
|
| Rate for Payer: Humana Medicare |
$37.54
|
| Rate for Payer: Lucent All Commercial |
$52.56
|
| Rate for Payer: Lucent All Commercial |
$52.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: Managed Health Services Medicaid |
$48.16
|
| Rate for Payer: Managed Health Services Medicaid |
$48.16
|
| Rate for Payer: MDWise Medicaid |
$48.16
|
| Rate for Payer: MDWise Medicaid |
$48.16
|
| Rate for Payer: PHCS All Commercial |
$37.54
|
| Rate for Payer: PHCS All Commercial |
$37.54
|
| Rate for Payer: PHP All Commercial |
$61.37
|
| Rate for Payer: PHP All Commercial |
$61.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.54
|
| Rate for Payer: Sagamore Health Network All Products |
$37.54
|
| Rate for Payer: Sagamore Health Network All Products |
$37.54
|
| Rate for Payer: Signature Care EPO |
$31.91
|
| Rate for Payer: Signature Care EPO |
$31.91
|
| Rate for Payer: Signature Care PPO |
$31.91
|
| Rate for Payer: Signature Care PPO |
$31.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,200.00
|
| Rate for Payer: United Healthcare Commercial |
$19.31
|
| Rate for Payer: United Healthcare Commercial |
$19.31
|
| Rate for Payer: United Healthcare Medicare |
$42.32
|
| Rate for Payer: United Healthcare Medicare |
$42.32
|
|
|
PR STENGER TEST, PURE TONE
|
Professional
|
Both
|
$38.38
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
z92565
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$17.29
|
| Rate for Payer: Aetna Commercial |
$17.29
|
| Rate for Payer: Aetna Medicare |
$17.29
|
| Rate for Payer: Aetna Medicare |
$17.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.02
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Centivo All Commercial |
$26.80
|
| Rate for Payer: Centivo All Commercial |
$26.80
|
| Rate for Payer: Cigna All Commercial |
$17.29
|
| Rate for Payer: Cigna All Commercial |
$17.29
|
| Rate for Payer: CORVEL All Commercial |
$17.29
|
| Rate for Payer: CORVEL All Commercial |
$17.29
|
| Rate for Payer: Coventry All Commercial |
$20.75
|
| Rate for Payer: Coventry All Commercial |
$20.75
|
| Rate for Payer: Encore All Commercial |
$17.29
|
| Rate for Payer: Encore All Commercial |
$17.29
|
| Rate for Payer: Frontpath All Commercial |
$19.54
|
| Rate for Payer: Frontpath All Commercial |
$19.54
|
| Rate for Payer: Humana ChoiceCare |
$16.84
|
| Rate for Payer: Humana ChoiceCare |
$16.84
|
| Rate for Payer: Humana Medicare |
$17.29
|
| Rate for Payer: Humana Medicare |
$17.29
|
| Rate for Payer: Lucent All Commercial |
$24.21
|
| Rate for Payer: Lucent All Commercial |
$24.21
|
| 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 |
$18.88
|
| Rate for Payer: Managed Health Services Medicaid |
$18.88
|
| Rate for Payer: MDWise Medicaid |
$18.88
|
| Rate for Payer: MDWise Medicaid |
$18.88
|
| Rate for Payer: PHCS All Commercial |
$17.29
|
| Rate for Payer: PHCS All Commercial |
$17.29
|
| Rate for Payer: PHP All Commercial |
$25.99
|
| Rate for Payer: PHP All Commercial |
$25.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.29
|
| Rate for Payer: Sagamore Health Network All Products |
$17.29
|
| Rate for Payer: Sagamore Health Network All Products |
$17.29
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,200.00
|
| Rate for Payer: United Healthcare Commercial |
$13.91
|
| Rate for Payer: United Healthcare Commercial |
$13.91
|
| Rate for Payer: United Healthcare Medicare |
$17.93
|
| Rate for Payer: United Healthcare Medicare |
$17.93
|
|
|
PR STENGER TEST, SPEECH
|
Professional
|
Both
|
$40.22
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
z92577
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$16.98
|
| Rate for Payer: Aetna Medicare |
$16.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.68
|
| Rate for Payer: Cash Price |
$24.13
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Centivo All Commercial |
$26.32
|
| Rate for Payer: Centivo All Commercial |
$26.32
|
| Rate for Payer: Cigna All Commercial |
$16.98
|
| Rate for Payer: Cigna All Commercial |
$16.98
|
| Rate for Payer: CORVEL All Commercial |
$16.98
|
| Rate for Payer: CORVEL All Commercial |
$16.98
|
| Rate for Payer: Coventry All Commercial |
$20.38
|
| Rate for Payer: Coventry All Commercial |
$20.38
|
| Rate for Payer: Encore All Commercial |
$16.98
|
| Rate for Payer: Encore All Commercial |
$16.98
|
| Rate for Payer: Frontpath All Commercial |
$19.18
|
| Rate for Payer: Frontpath All Commercial |
$19.18
|
| Rate for Payer: Humana ChoiceCare |
$30.28
|
| Rate for Payer: Humana ChoiceCare |
$30.28
|
| Rate for Payer: Humana Medicare |
$16.98
|
| Rate for Payer: Humana Medicare |
$16.98
|
| Rate for Payer: Lucent All Commercial |
$23.77
|
| Rate for Payer: Lucent All Commercial |
$23.77
|
| 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 |
$19.78
|
| Rate for Payer: Managed Health Services Medicaid |
$19.78
|
| Rate for Payer: MDWise Medicaid |
$19.78
|
| Rate for Payer: MDWise Medicaid |
$19.78
|
| Rate for Payer: PHCS All Commercial |
$16.98
|
| Rate for Payer: PHCS All Commercial |
$16.98
|
| Rate for Payer: PHP All Commercial |
$26.43
|
| Rate for Payer: PHP All Commercial |
$26.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.98
|
| Rate for Payer: Sagamore Health Network All Products |
$16.98
|
| Rate for Payer: Sagamore Health Network All Products |
$16.98
|
| Rate for Payer: Signature Care EPO |
$14.66
|
| Rate for Payer: Signature Care EPO |
$14.66
|
| Rate for Payer: Signature Care PPO |
$14.66
|
| Rate for Payer: Signature Care PPO |
$14.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,200.00
|
| Rate for Payer: United Healthcare Commercial |
$18.86
|
| Rate for Payer: United Healthcare Commercial |
$18.86
|
| Rate for Payer: United Healthcare Medicare |
$18.23
|
| Rate for Payer: United Healthcare Medicare |
$18.23
|
|
|
PR STRAPPING OF TOES
|
Professional
|
Both
|
$36.32
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
z29550
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$10.84
|
| Rate for Payer: Aetna Commercial |
$10.84
|
| Rate for Payer: Aetna Medicare |
$10.84
|
| Rate for Payer: Aetna Medicare |
$10.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.15
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$11.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$11.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.92
|
| Rate for Payer: Cash Price |
$21.13
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Centivo All Commercial |
$16.80
|
| Rate for Payer: Centivo All Commercial |
$16.80
|
| Rate for Payer: Cigna All Commercial |
$10.84
|
| Rate for Payer: Cigna All Commercial |
$10.84
|
| Rate for Payer: CORVEL All Commercial |
$10.84
|
| Rate for Payer: CORVEL All Commercial |
$10.84
|
| Rate for Payer: Coventry All Commercial |
$13.01
|
| Rate for Payer: Coventry All Commercial |
$13.01
|
| Rate for Payer: Encore All Commercial |
$10.84
|
| Rate for Payer: Encore All Commercial |
$10.84
|
| Rate for Payer: Frontpath All Commercial |
$14.69
|
| Rate for Payer: Frontpath All Commercial |
$14.69
|
| Rate for Payer: Humana ChoiceCare |
$32.74
|
| Rate for Payer: Humana ChoiceCare |
$32.74
|
| Rate for Payer: Humana Medicare |
$10.84
|
| Rate for Payer: Humana Medicare |
$10.84
|
| Rate for Payer: Lucent All Commercial |
$15.18
|
| Rate for Payer: Lucent All Commercial |
$15.18
|
| 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 |
$17.86
|
| Rate for Payer: Managed Health Services Medicaid |
$17.86
|
| Rate for Payer: MDWise Medicaid |
$17.86
|
| Rate for Payer: MDWise Medicaid |
$17.86
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$11.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$11.42
|
| Rate for Payer: PHCS All Commercial |
$10.84
|
| Rate for Payer: PHCS All Commercial |
$10.84
|
| Rate for Payer: PHP All Commercial |
$18.07
|
| Rate for Payer: PHP All Commercial |
$18.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.84
|
| Rate for Payer: Sagamore Health Network All Products |
$10.84
|
| Rate for Payer: Sagamore Health Network All Products |
$10.84
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$30.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,600.00
|
| Rate for Payer: United Healthcare Commercial |
$34.81
|
| Rate for Payer: United Healthcare Commercial |
$34.81
|
| Rate for Payer: United Healthcare Medicare |
$17.61
|
| Rate for Payer: United Healthcare Medicare |
$17.61
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$118.68
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
z29580
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare |
$25.30
|
| Rate for Payer: Aetna Medicare |
$25.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.05
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.68
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.83
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$71.21
|
| Rate for Payer: Centivo All Commercial |
$39.22
|
| Rate for Payer: Centivo All Commercial |
$39.22
|
| Rate for Payer: Cigna All Commercial |
$25.30
|
| Rate for Payer: Cigna All Commercial |
$25.30
|
| Rate for Payer: CORVEL All Commercial |
$25.30
|
| Rate for Payer: CORVEL All Commercial |
$25.30
|
| Rate for Payer: Coventry All Commercial |
$30.36
|
| Rate for Payer: Coventry All Commercial |
$30.36
|
| Rate for Payer: Encore All Commercial |
$25.30
|
| Rate for Payer: Encore All Commercial |
$25.30
|
| Rate for Payer: Frontpath All Commercial |
$35.26
|
| Rate for Payer: Frontpath All Commercial |
$35.26
|
| Rate for Payer: Humana ChoiceCare |
$40.07
|
| Rate for Payer: Humana ChoiceCare |
$40.07
|
| Rate for Payer: Humana Medicare |
$25.30
|
| Rate for Payer: Humana Medicare |
$25.30
|
| Rate for Payer: Lucent All Commercial |
$35.42
|
| Rate for Payer: Lucent All Commercial |
$35.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: Managed Health Services Medicaid |
$58.37
|
| Rate for Payer: Managed Health Services Medicaid |
$58.37
|
| Rate for Payer: MDWise Medicaid |
$58.37
|
| Rate for Payer: MDWise Medicaid |
$58.37
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$21.68
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$21.68
|
| Rate for Payer: PHCS All Commercial |
$25.30
|
| Rate for Payer: PHCS All Commercial |
$25.30
|
| Rate for Payer: PHP All Commercial |
$41.94
|
| Rate for Payer: PHP All Commercial |
$41.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.30
|
| Rate for Payer: Sagamore Health Network All Products |
$25.30
|
| Rate for Payer: Sagamore Health Network All Products |
$25.30
|
| 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 |
$3,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,700.00
|
| Rate for Payer: United Healthcare Commercial |
$40.76
|
| Rate for Payer: United Healthcare Commercial |
$40.76
|
| Rate for Payer: United Healthcare Medicare |
$57.53
|
| Rate for Payer: United Healthcare Medicare |
$57.53
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM
|
Professional
|
Both
|
$627.14
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
z15277
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$324.49 |
| Rate for Payer: Aetna Commercial |
$209.35
|
| Rate for Payer: Aetna Commercial |
$209.35
|
| Rate for Payer: Aetna Medicare |
$209.35
|
| Rate for Payer: Aetna Medicare |
$209.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$114.72
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$114.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$308.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$308.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$240.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$240.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.28
|
| Rate for Payer: Cash Price |
$375.37
|
| Rate for Payer: Cash Price |
$376.28
|
| Rate for Payer: Centivo All Commercial |
$324.49
|
| Rate for Payer: Centivo All Commercial |
$324.49
|
| Rate for Payer: Cigna All Commercial |
$209.35
|
| Rate for Payer: Cigna All Commercial |
$209.35
|
| Rate for Payer: CORVEL All Commercial |
$209.35
|
| Rate for Payer: CORVEL All Commercial |
$209.35
|
| Rate for Payer: Coventry All Commercial |
$251.22
|
| Rate for Payer: Coventry All Commercial |
$251.22
|
| Rate for Payer: Encore All Commercial |
$209.35
|
| Rate for Payer: Encore All Commercial |
$209.35
|
| Rate for Payer: Frontpath All Commercial |
$293.92
|
| Rate for Payer: Frontpath All Commercial |
$293.92
|
| Rate for Payer: Humana ChoiceCare |
$203.75
|
| Rate for Payer: Humana ChoiceCare |
$203.75
|
| Rate for Payer: Humana Medicare |
$209.35
|
| Rate for Payer: Humana Medicare |
$209.35
|
| Rate for Payer: Lucent All Commercial |
$293.09
|
| Rate for Payer: Lucent All Commercial |
$293.09
|
| Rate for Payer: Managed Health Services Medicaid |
$308.46
|
| Rate for Payer: Managed Health Services Medicaid |
$308.46
|
| Rate for Payer: MDWise Medicaid |
$308.46
|
| Rate for Payer: MDWise Medicaid |
$308.46
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$114.72
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$114.72
|
| Rate for Payer: PHCS All Commercial |
$209.35
|
| Rate for Payer: PHCS All Commercial |
$209.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$209.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$209.35
|
| Rate for Payer: Sagamore Health Network All Products |
$209.35
|
| Rate for Payer: Sagamore Health Network All Products |
$209.35
|
| Rate for Payer: United Healthcare Commercial |
$269.10
|
| Rate for Payer: United Healthcare Commercial |
$269.10
|
| Rate for Payer: United Healthcare Medicare |
$312.81
|
| Rate for Payer: United Healthcare Medicare |
$312.81
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM
|
Professional
|
Both
|
$296.76
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
z15275
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$88.66
|
| Rate for Payer: Aetna Commercial |
$88.66
|
| Rate for Payer: Aetna Medicare |
$88.66
|
| Rate for Payer: Aetna Medicare |
$88.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$47.41
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$47.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$145.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$145.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.53
|
| Rate for Payer: Cash Price |
$174.49
|
| Rate for Payer: Cash Price |
$178.06
|
| Rate for Payer: Centivo All Commercial |
$137.42
|
| Rate for Payer: Centivo All Commercial |
$137.42
|
| Rate for Payer: Cigna All Commercial |
$88.66
|
| Rate for Payer: Cigna All Commercial |
$88.66
|
| Rate for Payer: CORVEL All Commercial |
$88.66
|
| Rate for Payer: CORVEL All Commercial |
$88.66
|
| Rate for Payer: Coventry All Commercial |
$106.39
|
| Rate for Payer: Coventry All Commercial |
$106.39
|
| Rate for Payer: Encore All Commercial |
$88.66
|
| Rate for Payer: Encore All Commercial |
$88.66
|
| Rate for Payer: Frontpath All Commercial |
$121.33
|
| Rate for Payer: Frontpath All Commercial |
$121.33
|
| Rate for Payer: Humana ChoiceCare |
$95.46
|
| Rate for Payer: Humana ChoiceCare |
$95.46
|
| Rate for Payer: Humana Medicare |
$88.66
|
| Rate for Payer: Humana Medicare |
$88.66
|
| Rate for Payer: Lucent All Commercial |
$124.12
|
| Rate for Payer: Lucent All Commercial |
$124.12
|
| Rate for Payer: Managed Health Services Medicaid |
$145.96
|
| Rate for Payer: Managed Health Services Medicaid |
$145.96
|
| Rate for Payer: MDWise Medicaid |
$145.96
|
| Rate for Payer: MDWise Medicaid |
$145.96
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$47.41
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$47.41
|
| Rate for Payer: PHCS All Commercial |
$88.66
|
| Rate for Payer: PHCS All Commercial |
$88.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.66
|
| Rate for Payer: Sagamore Health Network All Products |
$88.66
|
| Rate for Payer: Sagamore Health Network All Products |
$88.66
|
| Rate for Payer: United Healthcare Commercial |
$126.05
|
| Rate for Payer: United Healthcare Commercial |
$126.05
|
| Rate for Payer: United Healthcare Medicare |
$145.41
|
| Rate for Payer: United Healthcare Medicare |
$145.41
|
|
