|
PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE
|
Professional
|
Both
|
$616.76
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
z49591
|
| Min. Negotiated Rate |
$303.35 |
| Max. Negotiated Rate |
$423.33 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$303.35
|
| Rate for Payer: Cash Price |
$382.39
|
| Rate for Payer: Humana ChoiceCare |
$311.44
|
| Rate for Payer: Managed Health Services Medicaid |
$303.35
|
| Rate for Payer: MDWise Medicaid |
$303.35
|
| Rate for Payer: United Healthcare Commercial |
$423.33
|
| Rate for Payer: United Healthcare Medicare |
$303.84
|
|
|
PR RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
CPT 49616
|
| Hospital Charge Code |
z49616
|
| Min. Negotiated Rate |
$759.78 |
| Max. Negotiated Rate |
$1,063.03 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$759.78
|
| Rate for Payer: Cash Price |
$957.90
|
| Rate for Payer: Humana ChoiceCare |
$781.66
|
| Rate for Payer: Managed Health Services Medicaid |
$759.78
|
| Rate for Payer: MDWise Medicaid |
$759.78
|
| Rate for Payer: United Healthcare Commercial |
$1,063.03
|
| Rate for Payer: United Healthcare Medicare |
$762.60
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
z49615
|
| Min. Negotiated Rate |
$566.01 |
| Max. Negotiated Rate |
$791.76 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$566.01
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Humana ChoiceCare |
$582.35
|
| Rate for Payer: Managed Health Services Medicaid |
$566.01
|
| Rate for Payer: MDWise Medicaid |
$566.01
|
| Rate for Payer: United Healthcare Commercial |
$791.76
|
| Rate for Payer: United Healthcare Medicare |
$568.15
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
z49614
|
| Min. Negotiated Rate |
$506.09 |
| Max. Negotiated Rate |
$707.86 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$506.09
|
| Rate for Payer: Cash Price |
$637.98
|
| Rate for Payer: Humana ChoiceCare |
$520.63
|
| Rate for Payer: Managed Health Services Medicaid |
$506.09
|
| Rate for Payer: MDWise Medicaid |
$506.09
|
| Rate for Payer: United Healthcare Commercial |
$707.86
|
| Rate for Payer: United Healthcare Medicare |
$507.77
|
|
|
PR RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$760.84
|
|
|
Service Code
|
CPT 49613
|
| Hospital Charge Code |
z49613
|
| Min. Negotiated Rate |
$374.21 |
| Max. Negotiated Rate |
$522.20 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$374.21
|
| Rate for Payer: Cash Price |
$471.72
|
| Rate for Payer: Humana ChoiceCare |
$384.28
|
| Rate for Payer: Managed Health Services Medicaid |
$374.21
|
| Rate for Payer: MDWise Medicaid |
$374.21
|
| Rate for Payer: United Healthcare Commercial |
$522.20
|
| Rate for Payer: United Healthcare Medicare |
$374.91
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$555.54
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
z33215
|
| Min. Negotiated Rate |
$273.24 |
| Max. Negotiated Rate |
$42,300.00 |
| Rate for Payer: Aetna Commercial |
$285.77
|
| Rate for Payer: Aetna Commercial |
$285.77
|
| Rate for Payer: Aetna Medicare |
$285.77
|
| Rate for Payer: Aetna Medicare |
$285.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$559.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$273.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$273.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.35
|
| Rate for Payer: Cash Price |
$344.43
|
| Rate for Payer: Cash Price |
$340.95
|
| Rate for Payer: Centivo All Commercial |
$442.94
|
| Rate for Payer: Centivo All Commercial |
$442.94
|
| Rate for Payer: Cigna All Commercial |
$285.77
|
| Rate for Payer: Cigna All Commercial |
$285.77
|
| Rate for Payer: CORVEL All Commercial |
$285.77
|
| Rate for Payer: CORVEL All Commercial |
$285.77
|
| Rate for Payer: Coventry All Commercial |
$342.92
|
| Rate for Payer: Coventry All Commercial |
$342.92
|
| Rate for Payer: Encore All Commercial |
$285.77
|
| Rate for Payer: Encore All Commercial |
$285.77
|
| Rate for Payer: Frontpath All Commercial |
$405.03
|
| Rate for Payer: Frontpath All Commercial |
$405.03
|
| Rate for Payer: Humana ChoiceCare |
$385.84
|
| Rate for Payer: Humana ChoiceCare |
$385.84
|
| Rate for Payer: Humana Medicare |
$285.77
|
| Rate for Payer: Humana Medicare |
$285.77
|
| Rate for Payer: Lucent All Commercial |
$400.08
|
| Rate for Payer: Lucent All Commercial |
$400.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$451.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$451.00
|
| Rate for Payer: Managed Health Services Medicaid |
$273.24
|
| Rate for Payer: Managed Health Services Medicaid |
$273.24
|
| Rate for Payer: MDWise Medicaid |
$273.24
|
| Rate for Payer: MDWise Medicaid |
$273.24
|
| Rate for Payer: PHCS All Commercial |
$285.77
|
| Rate for Payer: PHCS All Commercial |
$285.77
|
| Rate for Payer: PHP All Commercial |
$384.95
|
| Rate for Payer: PHP All Commercial |
$384.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.77
|
| Rate for Payer: Sagamore Health Network All Products |
$285.77
|
| Rate for Payer: Sagamore Health Network All Products |
$285.77
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42,300.00
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Medicare |
$274.96
|
| Rate for Payer: United Healthcare Medicare |
$274.96
|
|
|
PR RX ECTOP PREG BY LAPAROSCOPE
|
Professional
|
Both
|
$1,405.86
|
|
|
Service Code
|
CPT 59150
|
| Hospital Charge Code |
z59150
|
| Min. Negotiated Rate |
$693.79 |
| Max. Negotiated Rate |
$93,700.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,000.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$702.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$702.75
|
| Rate for Payer: Cash Price |
$885.87
|
| Rate for Payer: Cash Price |
$871.63
|
| Rate for Payer: Frontpath All Commercial |
$1,030.99
|
| Rate for Payer: Frontpath All Commercial |
$1,030.99
|
| Rate for Payer: Humana ChoiceCare |
$693.79
|
| Rate for Payer: Humana ChoiceCare |
$693.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.00
|
| Rate for Payer: Managed Health Services Medicaid |
$702.75
|
| Rate for Payer: Managed Health Services Medicaid |
$702.75
|
| Rate for Payer: MDWise Medicaid |
$702.75
|
| Rate for Payer: MDWise Medicaid |
$702.75
|
| Rate for Payer: PHP All Commercial |
$927.87
|
| Rate for Payer: PHP All Commercial |
$927.87
|
| Rate for Payer: Signature Care EPO |
$869.55
|
| Rate for Payer: Signature Care EPO |
$869.55
|
| Rate for Payer: Signature Care PPO |
$869.55
|
| Rate for Payer: Signature Care PPO |
$869.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93,700.00
|
| Rate for Payer: United Healthcare Commercial |
$855.01
|
| Rate for Payer: United Healthcare Commercial |
$855.01
|
| Rate for Payer: United Healthcare Medicare |
$702.93
|
| Rate for Payer: United Healthcare Medicare |
$702.93
|
|
|
PR RX ECTOP PREG BY SCOPE,RMV TUBE/OVRY
|
Professional
|
Both
|
$1,397.42
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
z59151
|
| Min. Negotiated Rate |
$687.31 |
| Max. Negotiated Rate |
$91,700.00 |
| Rate for Payer: Aetna Commercial |
$709.29
|
| Rate for Payer: Aetna Commercial |
$709.29
|
| Rate for Payer: Aetna Medicare |
$709.29
|
| Rate for Payer: Aetna Medicare |
$709.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$687.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$687.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$815.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$815.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$780.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$780.22
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$852.98
|
| Rate for Payer: Centivo All Commercial |
$1,099.40
|
| Rate for Payer: Centivo All Commercial |
$1,099.40
|
| Rate for Payer: Cigna All Commercial |
$709.29
|
| Rate for Payer: Cigna All Commercial |
$709.29
|
| Rate for Payer: CORVEL All Commercial |
$709.29
|
| Rate for Payer: CORVEL All Commercial |
$709.29
|
| Rate for Payer: Coventry All Commercial |
$851.15
|
| Rate for Payer: Coventry All Commercial |
$851.15
|
| Rate for Payer: Encore All Commercial |
$709.29
|
| Rate for Payer: Encore All Commercial |
$709.29
|
| Rate for Payer: Frontpath All Commercial |
$1,008.63
|
| Rate for Payer: Frontpath All Commercial |
$1,008.63
|
| Rate for Payer: Humana ChoiceCare |
$688.21
|
| Rate for Payer: Humana ChoiceCare |
$688.21
|
| Rate for Payer: Humana Medicare |
$709.29
|
| Rate for Payer: Humana Medicare |
$709.29
|
| Rate for Payer: Lucent All Commercial |
$993.01
|
| Rate for Payer: Lucent All Commercial |
$993.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$987.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$987.00
|
| Rate for Payer: Managed Health Services Medicaid |
$687.31
|
| Rate for Payer: Managed Health Services Medicaid |
$687.31
|
| Rate for Payer: MDWise Medicaid |
$687.31
|
| Rate for Payer: MDWise Medicaid |
$687.31
|
| Rate for Payer: PHCS All Commercial |
$709.29
|
| Rate for Payer: PHCS All Commercial |
$709.29
|
| Rate for Payer: PHP All Commercial |
$908.02
|
| Rate for Payer: PHP All Commercial |
$908.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$709.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$709.29
|
| Rate for Payer: Sagamore Health Network All Products |
$709.29
|
| Rate for Payer: Sagamore Health Network All Products |
$709.29
|
| Rate for Payer: Signature Care EPO |
$867.85
|
| Rate for Payer: Signature Care EPO |
$867.85
|
| Rate for Payer: Signature Care PPO |
$867.85
|
| Rate for Payer: Signature Care PPO |
$867.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: United Healthcare Commercial |
$835.63
|
| Rate for Payer: United Healthcare Commercial |
$835.63
|
| Rate for Payer: United Healthcare Medicare |
$687.89
|
| Rate for Payer: United Healthcare Medicare |
$687.89
|
|
|
PR RX ECTOP PREG,UTER WALL,PART HYSTREC
|
Professional
|
Both
|
$1,620.14
|
|
|
Service Code
|
CPT 59136
|
| Hospital Charge Code |
z59136
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$106,200.00 |
| Rate for Payer: Aetna Commercial |
$822.30
|
| Rate for Payer: Aetna Commercial |
$822.30
|
| Rate for Payer: Aetna Medicare |
$822.30
|
| Rate for Payer: Aetna Medicare |
$822.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,121.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$796.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$796.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$945.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$945.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$904.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$904.53
|
| Rate for Payer: Cash Price |
$1,004.49
|
| Rate for Payer: Cash Price |
$988.30
|
| Rate for Payer: Centivo All Commercial |
$1,274.57
|
| Rate for Payer: Centivo All Commercial |
$1,274.57
|
| Rate for Payer: Cigna All Commercial |
$822.30
|
| Rate for Payer: Cigna All Commercial |
$822.30
|
| Rate for Payer: CORVEL All Commercial |
$822.30
|
| Rate for Payer: CORVEL All Commercial |
$822.30
|
| Rate for Payer: Coventry All Commercial |
$986.76
|
| Rate for Payer: Coventry All Commercial |
$986.76
|
| Rate for Payer: Encore All Commercial |
$822.30
|
| Rate for Payer: Encore All Commercial |
$822.30
|
| Rate for Payer: Frontpath All Commercial |
$1,171.64
|
| Rate for Payer: Frontpath All Commercial |
$1,171.64
|
| Rate for Payer: Humana ChoiceCare |
$777.75
|
| Rate for Payer: Humana ChoiceCare |
$777.75
|
| Rate for Payer: Humana Medicare |
$822.30
|
| Rate for Payer: Humana Medicare |
$822.30
|
| Rate for Payer: Lucent All Commercial |
$1,151.22
|
| Rate for Payer: Lucent All Commercial |
$1,151.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,144.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$796.85
|
| Rate for Payer: Managed Health Services Medicaid |
$796.85
|
| Rate for Payer: MDWise Medicaid |
$796.85
|
| Rate for Payer: MDWise Medicaid |
$796.85
|
| Rate for Payer: PHCS All Commercial |
$822.30
|
| Rate for Payer: PHCS All Commercial |
$822.30
|
| Rate for Payer: PHP All Commercial |
$1,052.06
|
| Rate for Payer: PHP All Commercial |
$1,052.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$822.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$822.30
|
| Rate for Payer: Sagamore Health Network All Products |
$822.30
|
| Rate for Payer: Sagamore Health Network All Products |
$822.30
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106,200.00
|
| Rate for Payer: United Healthcare Commercial |
$976.01
|
| Rate for Payer: United Healthcare Commercial |
$976.01
|
| Rate for Payer: United Healthcare Medicare |
$797.02
|
| Rate for Payer: United Healthcare Medicare |
$797.02
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$223.30
|
|
|
Service Code
|
CPT 99233
|
| Hospital Charge Code |
z99233
|
| Min. Negotiated Rate |
$76.07 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: Aetna Medicare |
$97.00
|
| Rate for Payer: Aetna Medicare |
$97.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$109.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$109.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.70
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Centivo All Commercial |
$150.35
|
| Rate for Payer: Centivo All Commercial |
$150.35
|
| Rate for Payer: Cigna All Commercial |
$97.00
|
| Rate for Payer: Cigna All Commercial |
$97.00
|
| Rate for Payer: CORVEL All Commercial |
$97.00
|
| Rate for Payer: CORVEL All Commercial |
$97.00
|
| Rate for Payer: Coventry All Commercial |
$116.40
|
| Rate for Payer: Coventry All Commercial |
$116.40
|
| Rate for Payer: Encore All Commercial |
$97.00
|
| Rate for Payer: Encore All Commercial |
$97.00
|
| Rate for Payer: Frontpath All Commercial |
$104.44
|
| Rate for Payer: Frontpath All Commercial |
$104.44
|
| Rate for Payer: Humana ChoiceCare |
$76.07
|
| Rate for Payer: Humana ChoiceCare |
$76.07
|
| Rate for Payer: Humana Medicare |
$97.00
|
| Rate for Payer: Humana Medicare |
$97.00
|
| Rate for Payer: Lucent All Commercial |
$135.80
|
| Rate for Payer: Lucent All Commercial |
$135.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.00
|
| Rate for Payer: Managed Health Services Medicaid |
$109.82
|
| Rate for Payer: Managed Health Services Medicaid |
$109.82
|
| Rate for Payer: MDWise Medicaid |
$109.82
|
| Rate for Payer: MDWise Medicaid |
$109.82
|
| Rate for Payer: PHCS All Commercial |
$97.00
|
| Rate for Payer: PHCS All Commercial |
$97.00
|
| Rate for Payer: PHP All Commercial |
$113.80
|
| Rate for Payer: PHP All Commercial |
$113.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.00
|
| Rate for Payer: Sagamore Health Network All Products |
$97.00
|
| Rate for Payer: Sagamore Health Network All Products |
$97.00
|
| Rate for Payer: Signature Care EPO |
$85.80
|
| Rate for Payer: Signature Care EPO |
$85.80
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,700.00
|
| Rate for Payer: United Healthcare Commercial |
$97.61
|
| Rate for Payer: United Healthcare Commercial |
$97.61
|
| Rate for Payer: United Healthcare Medicare |
$110.48
|
| Rate for Payer: United Healthcare Medicare |
$110.48
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$148.40
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
z99232
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$7,800.00 |
| Rate for Payer: Aetna Commercial |
$67.46
|
| Rate for Payer: Aetna Commercial |
$67.46
|
| Rate for Payer: Aetna Medicare |
$67.46
|
| Rate for Payer: Aetna Medicare |
$67.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$72.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.21
|
| Rate for Payer: Cash Price |
$92.01
|
| Rate for Payer: Cash Price |
$91.05
|
| Rate for Payer: Centivo All Commercial |
$104.56
|
| Rate for Payer: Centivo All Commercial |
$104.56
|
| Rate for Payer: Cigna All Commercial |
$67.46
|
| Rate for Payer: Cigna All Commercial |
$67.46
|
| Rate for Payer: CORVEL All Commercial |
$67.46
|
| Rate for Payer: CORVEL All Commercial |
$67.46
|
| Rate for Payer: Coventry All Commercial |
$80.95
|
| Rate for Payer: Coventry All Commercial |
$80.95
|
| Rate for Payer: Encore All Commercial |
$67.46
|
| Rate for Payer: Encore All Commercial |
$67.46
|
| Rate for Payer: Frontpath All Commercial |
$72.70
|
| Rate for Payer: Frontpath All Commercial |
$72.70
|
| Rate for Payer: Humana ChoiceCare |
$53.54
|
| Rate for Payer: Humana ChoiceCare |
$53.54
|
| Rate for Payer: Humana Medicare |
$67.46
|
| Rate for Payer: Humana Medicare |
$67.46
|
| Rate for Payer: Lucent All Commercial |
$94.44
|
| Rate for Payer: Lucent All Commercial |
$94.44
|
| 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 |
$72.99
|
| Rate for Payer: Managed Health Services Medicaid |
$72.99
|
| Rate for Payer: MDWise Medicaid |
$72.99
|
| Rate for Payer: MDWise Medicaid |
$72.99
|
| Rate for Payer: PHCS All Commercial |
$67.46
|
| Rate for Payer: PHCS All Commercial |
$67.46
|
| Rate for Payer: PHP All Commercial |
$75.63
|
| Rate for Payer: PHP All Commercial |
$75.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.46
|
| Rate for Payer: Sagamore Health Network All Products |
$67.46
|
| Rate for Payer: Sagamore Health Network All Products |
$67.46
|
| Rate for Payer: Signature Care EPO |
$59.61
|
| Rate for Payer: Signature Care EPO |
$59.61
|
| Rate for Payer: Signature Care PPO |
$59.61
|
| Rate for Payer: Signature Care PPO |
$59.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,800.00
|
| Rate for Payer: United Healthcare Commercial |
$68.15
|
| Rate for Payer: United Healthcare Commercial |
$68.15
|
| Rate for Payer: United Healthcare Medicare |
$73.43
|
| Rate for Payer: United Healthcare Medicare |
$73.43
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$92.80
|
|
|
Service Code
|
CPT 99231
|
| Hospital Charge Code |
z99231
|
| Min. Negotiated Rate |
$32.65 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$36.46
|
| Rate for Payer: Aetna Commercial |
$36.46
|
| Rate for Payer: Aetna Medicare |
$36.46
|
| Rate for Payer: Aetna Medicare |
$36.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.11
|
| Rate for Payer: Cash Price |
$57.54
|
| Rate for Payer: Cash Price |
$56.75
|
| Rate for Payer: Centivo All Commercial |
$56.51
|
| Rate for Payer: Centivo All Commercial |
$56.51
|
| Rate for Payer: Cigna All Commercial |
$36.46
|
| Rate for Payer: Cigna All Commercial |
$36.46
|
| Rate for Payer: CORVEL All Commercial |
$36.46
|
| Rate for Payer: CORVEL All Commercial |
$36.46
|
| Rate for Payer: Coventry All Commercial |
$43.75
|
| Rate for Payer: Coventry All Commercial |
$43.75
|
| Rate for Payer: Encore All Commercial |
$36.46
|
| Rate for Payer: Encore All Commercial |
$36.46
|
| Rate for Payer: Frontpath All Commercial |
$39.63
|
| Rate for Payer: Frontpath All Commercial |
$39.63
|
| Rate for Payer: Humana ChoiceCare |
$32.65
|
| Rate for Payer: Humana ChoiceCare |
$32.65
|
| Rate for Payer: Humana Medicare |
$36.46
|
| Rate for Payer: Humana Medicare |
$36.46
|
| Rate for Payer: Lucent All Commercial |
$51.04
|
| Rate for Payer: Lucent All Commercial |
$51.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Managed Health Services Medicaid |
$45.65
|
| Rate for Payer: Managed Health Services Medicaid |
$45.65
|
| Rate for Payer: MDWise Medicaid |
$45.65
|
| Rate for Payer: MDWise Medicaid |
$45.65
|
| Rate for Payer: PHCS All Commercial |
$36.46
|
| Rate for Payer: PHCS All Commercial |
$36.46
|
| Rate for Payer: PHP All Commercial |
$47.15
|
| Rate for Payer: PHP All Commercial |
$47.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.46
|
| Rate for Payer: Sagamore Health Network All Products |
$36.46
|
| Rate for Payer: Sagamore Health Network All Products |
$36.46
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare Commercial |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$37.80
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$289.86
|
|
|
Service Code
|
CPT 99310
|
| Hospital Charge Code |
z99310
|
| Min. Negotiated Rate |
$99.95 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Aetna Commercial |
$126.25
|
| Rate for Payer: Aetna Commercial |
$126.25
|
| Rate for Payer: Aetna Medicare |
$126.25
|
| Rate for Payer: Aetna Medicare |
$126.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$142.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$142.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.88
|
| Rate for Payer: Cash Price |
$179.71
|
| Rate for Payer: Cash Price |
$176.01
|
| Rate for Payer: Centivo All Commercial |
$195.69
|
| Rate for Payer: Centivo All Commercial |
$195.69
|
| Rate for Payer: Cigna All Commercial |
$126.25
|
| Rate for Payer: Cigna All Commercial |
$126.25
|
| Rate for Payer: CORVEL All Commercial |
$126.25
|
| Rate for Payer: CORVEL All Commercial |
$126.25
|
| Rate for Payer: Coventry All Commercial |
$151.50
|
| Rate for Payer: Coventry All Commercial |
$151.50
|
| Rate for Payer: Encore All Commercial |
$126.25
|
| Rate for Payer: Encore All Commercial |
$126.25
|
| Rate for Payer: Frontpath All Commercial |
$135.11
|
| Rate for Payer: Frontpath All Commercial |
$135.11
|
| Rate for Payer: Humana ChoiceCare |
$101.27
|
| Rate for Payer: Humana ChoiceCare |
$101.27
|
| Rate for Payer: Humana Medicare |
$126.25
|
| Rate for Payer: Humana Medicare |
$126.25
|
| Rate for Payer: Lucent All Commercial |
$176.75
|
| Rate for Payer: Lucent All Commercial |
$176.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.00
|
| Rate for Payer: Managed Health Services Medicaid |
$142.56
|
| Rate for Payer: Managed Health Services Medicaid |
$142.56
|
| Rate for Payer: MDWise Medicaid |
$142.56
|
| Rate for Payer: MDWise Medicaid |
$142.56
|
| Rate for Payer: PHCS All Commercial |
$126.25
|
| Rate for Payer: PHCS All Commercial |
$126.25
|
| Rate for Payer: PHP All Commercial |
$146.19
|
| Rate for Payer: PHP All Commercial |
$146.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.25
|
| Rate for Payer: Sagamore Health Network All Products |
$126.25
|
| Rate for Payer: Sagamore Health Network All Products |
$126.25
|
| Rate for Payer: Signature Care EPO |
$110.90
|
| Rate for Payer: Signature Care EPO |
$110.90
|
| Rate for Payer: Signature Care PPO |
$110.90
|
| Rate for Payer: Signature Care PPO |
$110.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,000.00
|
| Rate for Payer: United Healthcare Commercial |
$120.71
|
| Rate for Payer: United Healthcare Commercial |
$120.71
|
| Rate for Payer: United Healthcare Medicare |
$141.94
|
| Rate for Payer: United Healthcare Medicare |
$141.94
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$140.40
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
z99308
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Aetna Commercial |
$64.64
|
| Rate for Payer: Aetna Commercial |
$64.64
|
| Rate for Payer: Aetna Medicare |
$64.64
|
| Rate for Payer: Aetna Medicare |
$64.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.10
|
| Rate for Payer: Cash Price |
$87.05
|
| Rate for Payer: Cash Price |
$85.11
|
| Rate for Payer: Centivo All Commercial |
$100.19
|
| Rate for Payer: Centivo All Commercial |
$100.19
|
| Rate for Payer: Cigna All Commercial |
$64.64
|
| Rate for Payer: Cigna All Commercial |
$64.64
|
| Rate for Payer: CORVEL All Commercial |
$64.64
|
| Rate for Payer: CORVEL All Commercial |
$64.64
|
| Rate for Payer: Coventry All Commercial |
$77.57
|
| Rate for Payer: Coventry All Commercial |
$77.57
|
| Rate for Payer: Encore All Commercial |
$64.64
|
| Rate for Payer: Encore All Commercial |
$64.64
|
| Rate for Payer: Frontpath All Commercial |
$69.61
|
| Rate for Payer: Frontpath All Commercial |
$69.61
|
| Rate for Payer: Humana ChoiceCare |
$57.47
|
| Rate for Payer: Humana ChoiceCare |
$57.47
|
| Rate for Payer: Humana Medicare |
$64.64
|
| Rate for Payer: Humana Medicare |
$64.64
|
| Rate for Payer: Lucent All Commercial |
$90.50
|
| Rate for Payer: Lucent All Commercial |
$90.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: Managed Health Services Medicaid |
$69.05
|
| Rate for Payer: Managed Health Services Medicaid |
$69.05
|
| Rate for Payer: MDWise Medicaid |
$69.05
|
| Rate for Payer: MDWise Medicaid |
$69.05
|
| Rate for Payer: PHCS All Commercial |
$64.64
|
| Rate for Payer: PHCS All Commercial |
$64.64
|
| Rate for Payer: PHP All Commercial |
$70.70
|
| Rate for Payer: PHP All Commercial |
$70.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.64
|
| Rate for Payer: Sagamore Health Network All Products |
$64.64
|
| Rate for Payer: Sagamore Health Network All Products |
$64.64
|
| Rate for Payer: Signature Care EPO |
$56.25
|
| Rate for Payer: Signature Care EPO |
$56.25
|
| Rate for Payer: Signature Care PPO |
$56.25
|
| Rate for Payer: Signature Care PPO |
$56.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: United Healthcare Commercial |
$61.52
|
| Rate for Payer: United Healthcare Commercial |
$61.52
|
| Rate for Payer: United Healthcare Medicare |
$68.64
|
| Rate for Payer: United Healthcare Medicare |
$68.64
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$203.22
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
z99309
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$10,400.00 |
| Rate for Payer: Aetna Commercial |
$85.46
|
| Rate for Payer: Aetna Commercial |
$85.46
|
| Rate for Payer: Aetna Medicare |
$85.46
|
| Rate for Payer: Aetna Medicare |
$85.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$99.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$99.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.01
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Centivo All Commercial |
$132.46
|
| Rate for Payer: Centivo All Commercial |
$132.46
|
| Rate for Payer: Cigna All Commercial |
$85.46
|
| Rate for Payer: Cigna All Commercial |
$85.46
|
| Rate for Payer: CORVEL All Commercial |
$85.46
|
| Rate for Payer: CORVEL All Commercial |
$85.46
|
| Rate for Payer: Coventry All Commercial |
$102.55
|
| Rate for Payer: Coventry All Commercial |
$102.55
|
| Rate for Payer: Encore All Commercial |
$85.46
|
| Rate for Payer: Encore All Commercial |
$85.46
|
| Rate for Payer: Frontpath All Commercial |
$91.59
|
| Rate for Payer: Frontpath All Commercial |
$91.59
|
| Rate for Payer: Humana ChoiceCare |
$80.96
|
| Rate for Payer: Humana ChoiceCare |
$80.96
|
| Rate for Payer: Humana Medicare |
$85.46
|
| Rate for Payer: Humana Medicare |
$85.46
|
| Rate for Payer: Lucent All Commercial |
$119.64
|
| Rate for Payer: Lucent All Commercial |
$119.64
|
| 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 |
$99.95
|
| Rate for Payer: Managed Health Services Medicaid |
$99.95
|
| Rate for Payer: MDWise Medicaid |
$99.95
|
| Rate for Payer: MDWise Medicaid |
$99.95
|
| Rate for Payer: PHCS All Commercial |
$85.46
|
| Rate for Payer: PHCS All Commercial |
$85.46
|
| Rate for Payer: PHP All Commercial |
$101.76
|
| Rate for Payer: PHP All Commercial |
$101.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.46
|
| Rate for Payer: Sagamore Health Network All Products |
$85.46
|
| Rate for Payer: Sagamore Health Network All Products |
$85.46
|
| Rate for Payer: Signature Care EPO |
$74.80
|
| Rate for Payer: Signature Care EPO |
$74.80
|
| Rate for Payer: Signature Care PPO |
$74.80
|
| Rate for Payer: Signature Care PPO |
$74.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,400.00
|
| Rate for Payer: United Healthcare Commercial |
$81.62
|
| Rate for Payer: United Healthcare Commercial |
$81.62
|
| Rate for Payer: United Healthcare Medicare |
$98.79
|
| Rate for Payer: United Healthcare Medicare |
$98.79
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$75.84
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
z99307
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.23
|
| Rate for Payer: Cash Price |
$47.02
|
| Rate for Payer: Cash Price |
$45.53
|
| Rate for Payer: Centivo All Commercial |
$63.74
|
| Rate for Payer: Centivo All Commercial |
$63.74
|
| Rate for Payer: Cigna All Commercial |
$41.12
|
| Rate for Payer: Cigna All Commercial |
$41.12
|
| Rate for Payer: CORVEL All Commercial |
$41.12
|
| Rate for Payer: CORVEL All Commercial |
$41.12
|
| Rate for Payer: Coventry All Commercial |
$49.34
|
| Rate for Payer: Coventry All Commercial |
$49.34
|
| Rate for Payer: Encore All Commercial |
$41.12
|
| Rate for Payer: Encore All Commercial |
$41.12
|
| Rate for Payer: Frontpath All Commercial |
$44.11
|
| Rate for Payer: Frontpath All Commercial |
$44.11
|
| Rate for Payer: Humana ChoiceCare |
$34.58
|
| Rate for Payer: Humana ChoiceCare |
$34.58
|
| Rate for Payer: Humana Medicare |
$41.12
|
| Rate for Payer: Humana Medicare |
$41.12
|
| Rate for Payer: Lucent All Commercial |
$57.57
|
| Rate for Payer: Lucent All Commercial |
$57.57
|
| 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 |
$37.30
|
| Rate for Payer: Managed Health Services Medicaid |
$37.30
|
| Rate for Payer: MDWise Medicaid |
$37.30
|
| Rate for Payer: MDWise Medicaid |
$37.30
|
| Rate for Payer: PHCS All Commercial |
$41.12
|
| Rate for Payer: PHCS All Commercial |
$41.12
|
| Rate for Payer: PHP All Commercial |
$37.82
|
| Rate for Payer: PHP All Commercial |
$37.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.12
|
| Rate for Payer: Sagamore Health Network All Products |
$41.12
|
| Rate for Payer: Sagamore Health Network All Products |
$41.12
|
| Rate for Payer: Signature Care EPO |
$36.44
|
| Rate for Payer: Signature Care EPO |
$36.44
|
| Rate for Payer: Signature Care PPO |
$36.44
|
| Rate for Payer: Signature Care PPO |
$36.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare Commercial |
$40.24
|
| Rate for Payer: United Healthcare Commercial |
$40.24
|
| Rate for Payer: United Healthcare Medicare |
$36.72
|
| Rate for Payer: United Healthcare Medicare |
$36.72
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$1,468.72
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
z13160
|
| Min. Negotiated Rate |
$668.38 |
| Max. Negotiated Rate |
$88,700.00 |
| Rate for Payer: Aetna Commercial |
$743.99
|
| Rate for Payer: Aetna Commercial |
$743.99
|
| Rate for Payer: Aetna Medicare |
$743.99
|
| Rate for Payer: Aetna Medicare |
$743.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$772.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$722.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$722.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$855.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$855.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$818.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$818.39
|
| Rate for Payer: Cash Price |
$910.61
|
| Rate for Payer: Cash Price |
$894.28
|
| Rate for Payer: Centivo All Commercial |
$1,153.18
|
| Rate for Payer: Centivo All Commercial |
$1,153.18
|
| Rate for Payer: Cigna All Commercial |
$743.99
|
| Rate for Payer: Cigna All Commercial |
$743.99
|
| Rate for Payer: CORVEL All Commercial |
$743.99
|
| Rate for Payer: CORVEL All Commercial |
$743.99
|
| Rate for Payer: Coventry All Commercial |
$892.79
|
| Rate for Payer: Coventry All Commercial |
$892.79
|
| Rate for Payer: Encore All Commercial |
$743.99
|
| Rate for Payer: Encore All Commercial |
$743.99
|
| Rate for Payer: Frontpath All Commercial |
$1,031.85
|
| Rate for Payer: Frontpath All Commercial |
$1,031.85
|
| Rate for Payer: Humana ChoiceCare |
$668.38
|
| Rate for Payer: Humana ChoiceCare |
$668.38
|
| Rate for Payer: Humana Medicare |
$743.99
|
| Rate for Payer: Humana Medicare |
$743.99
|
| Rate for Payer: Lucent All Commercial |
$1,041.59
|
| Rate for Payer: Lucent All Commercial |
$1,041.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$961.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$961.00
|
| Rate for Payer: Managed Health Services Medicaid |
$722.37
|
| Rate for Payer: Managed Health Services Medicaid |
$722.37
|
| Rate for Payer: MDWise Medicaid |
$722.37
|
| Rate for Payer: MDWise Medicaid |
$722.37
|
| Rate for Payer: PHCS All Commercial |
$743.99
|
| Rate for Payer: PHCS All Commercial |
$743.99
|
| Rate for Payer: PHP All Commercial |
$1,009.66
|
| Rate for Payer: PHP All Commercial |
$1,009.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$743.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$743.99
|
| Rate for Payer: Sagamore Health Network All Products |
$743.99
|
| Rate for Payer: Sagamore Health Network All Products |
$743.99
|
| Rate for Payer: Signature Care EPO |
$742.05
|
| Rate for Payer: Signature Care EPO |
$742.05
|
| Rate for Payer: Signature Care PPO |
$742.05
|
| Rate for Payer: Signature Care PPO |
$742.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88,700.00
|
| Rate for Payer: United Healthcare Commercial |
$872.94
|
| Rate for Payer: United Healthcare Commercial |
$872.94
|
| Rate for Payer: United Healthcare Medicare |
$721.19
|
| Rate for Payer: United Healthcare Medicare |
$721.19
|
|
|
PR SELF-MEAS BP 2 READG 1 MIN APART BID 30 DAY PD
|
Professional
|
Both
|
$34.34
|
|
|
Service Code
|
CPT 99474
|
| Hospital Charge Code |
z99474
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$8.57
|
| Rate for Payer: Aetna Medicare |
$8.57
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$6.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$6.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.43
|
| Rate for Payer: Cash Price |
$19.43
|
| Rate for Payer: Cash Price |
$21.29
|
| Rate for Payer: Centivo All Commercial |
$13.28
|
| Rate for Payer: Centivo All Commercial |
$13.28
|
| Rate for Payer: Cigna All Commercial |
$8.57
|
| Rate for Payer: Cigna All Commercial |
$8.57
|
| Rate for Payer: CORVEL All Commercial |
$8.57
|
| Rate for Payer: CORVEL All Commercial |
$8.57
|
| Rate for Payer: Coventry All Commercial |
$10.28
|
| Rate for Payer: Coventry All Commercial |
$10.28
|
| Rate for Payer: Encore All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.57
|
| Rate for Payer: Frontpath All Commercial |
$9.17
|
| Rate for Payer: Frontpath All Commercial |
$9.17
|
| Rate for Payer: Humana ChoiceCare |
$13.10
|
| Rate for Payer: Humana ChoiceCare |
$13.10
|
| Rate for Payer: Humana Medicare |
$8.57
|
| Rate for Payer: Humana Medicare |
$8.57
|
| Rate for Payer: Lucent All Commercial |
$12.00
|
| Rate for Payer: Lucent All Commercial |
$12.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.41
|
| Rate for Payer: Managed Health Services Medicaid |
$15.41
|
| Rate for Payer: MDWise Medicaid |
$15.41
|
| Rate for Payer: MDWise Medicaid |
$15.41
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$6.73
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$6.73
|
| Rate for Payer: PHCS All Commercial |
$8.57
|
| Rate for Payer: PHCS All Commercial |
$8.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.57
|
| Rate for Payer: Sagamore Health Network All Products |
$8.57
|
| Rate for Payer: Sagamore Health Network All Products |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$9.12
|
| Rate for Payer: United Healthcare Commercial |
$9.12
|
| Rate for Payer: United Healthcare Medicare |
$13.94
|
| Rate for Payer: United Healthcare Medicare |
$13.94
|
|
|
PR SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION
|
Professional
|
Both
|
$26.10
|
|
|
Service Code
|
CPT 99473
|
| Hospital Charge Code |
z99473
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$10.44
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.48
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Centivo All Commercial |
$16.18
|
| Rate for Payer: Cigna All Commercial |
$10.44
|
| Rate for Payer: CORVEL All Commercial |
$10.44
|
| Rate for Payer: Coventry All Commercial |
$12.53
|
| Rate for Payer: Encore All Commercial |
$10.44
|
| Rate for Payer: Frontpath All Commercial |
$11.24
|
| Rate for Payer: Humana ChoiceCare |
$15.20
|
| Rate for Payer: Humana Medicare |
$10.44
|
| Rate for Payer: Lucent All Commercial |
$14.62
|
| Rate for Payer: Managed Health Services Medicaid |
$12.84
|
| Rate for Payer: MDWise Medicaid |
$12.84
|
| Rate for Payer: PHCS All Commercial |
$10.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.44
|
| Rate for Payer: Sagamore Health Network All Products |
$10.44
|
| Rate for Payer: United Healthcare Commercial |
$10.66
|
| Rate for Payer: United Healthcare Medicare |
$11.30
|
|
|
PR SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN
|
Professional
|
Both
|
$51.82
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
z98960
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$29.20 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.49
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Frontpath All Commercial |
$27.36
|
| Rate for Payer: Frontpath All Commercial |
$27.36
|
| Rate for Payer: Humana ChoiceCare |
$29.20
|
| Rate for Payer: Humana ChoiceCare |
$29.20
|
| Rate for Payer: Managed Health Services Medicaid |
$27.49
|
| Rate for Payer: Managed Health Services Medicaid |
$27.49
|
| Rate for Payer: MDWise Medicaid |
$27.49
|
| Rate for Payer: MDWise Medicaid |
$27.49
|
| Rate for Payer: United Healthcare Commercial |
$27.18
|
| Rate for Payer: United Healthcare Commercial |
$27.18
|
| Rate for Payer: United Healthcare Medicare |
$25.91
|
| Rate for Payer: United Healthcare Medicare |
$25.91
|
|
|
PR SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN
|
Professional
|
Both
|
$25.02
|
|
|
Service Code
|
CPT 98961
|
| Hospital Charge Code |
z98961
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.14
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cash Price |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$12.82
|
| Rate for Payer: Frontpath All Commercial |
$12.82
|
| Rate for Payer: Humana ChoiceCare |
$34.95
|
| Rate for Payer: Humana ChoiceCare |
$34.95
|
| Rate for Payer: Managed Health Services Medicaid |
$13.14
|
| Rate for Payer: Managed Health Services Medicaid |
$13.14
|
| Rate for Payer: MDWise Medicaid |
$13.14
|
| Rate for Payer: MDWise Medicaid |
$13.14
|
| Rate for Payer: United Healthcare Commercial |
$13.10
|
| Rate for Payer: United Healthcare Commercial |
$13.10
|
| Rate for Payer: United Healthcare Medicare |
$12.51
|
| Rate for Payer: United Healthcare Medicare |
$12.51
|
|
|
PR SELF-MGMT EDUC/TRAIN, 5-8 PT, EA 30 MIN
|
Professional
|
Both
|
$19.96
|
|
|
Service Code
|
CPT 98962
|
| Hospital Charge Code |
z98962
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.82
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Frontpath All Commercial |
$9.63
|
| Rate for Payer: Frontpath All Commercial |
$9.63
|
| Rate for Payer: Humana ChoiceCare |
$37.94
|
| Rate for Payer: Humana ChoiceCare |
$37.94
|
| Rate for Payer: Managed Health Services Medicaid |
$9.82
|
| Rate for Payer: Managed Health Services Medicaid |
$9.82
|
| Rate for Payer: MDWise Medicaid |
$9.82
|
| Rate for Payer: MDWise Medicaid |
$9.82
|
| Rate for Payer: United Healthcare Commercial |
$9.79
|
| Rate for Payer: United Healthcare Commercial |
$9.79
|
| Rate for Payer: United Healthcare Medicare |
$9.19
|
| Rate for Payer: United Healthcare Medicare |
$9.19
|
|
|
PR SENSORINEURAL ACUITY TEST
|
Professional
|
Both
|
$135.68
|
|
|
Service Code
|
CPT 92575
|
| Hospital Charge Code |
z92575
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$8,200.00 |
| Rate for Payer: Aetna Commercial |
$63.87
|
| Rate for Payer: Aetna Commercial |
$63.87
|
| Rate for Payer: Aetna Medicare |
$63.87
|
| Rate for Payer: Aetna Medicare |
$63.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$66.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$66.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.26
|
| Rate for Payer: Cash Price |
$84.12
|
| Rate for Payer: Cash Price |
$82.93
|
| Rate for Payer: Centivo All Commercial |
$99.00
|
| Rate for Payer: Centivo All Commercial |
$99.00
|
| Rate for Payer: Cigna All Commercial |
$63.87
|
| Rate for Payer: Cigna All Commercial |
$63.87
|
| Rate for Payer: CORVEL All Commercial |
$63.87
|
| Rate for Payer: CORVEL All Commercial |
$63.87
|
| Rate for Payer: Coventry All Commercial |
$76.64
|
| Rate for Payer: Coventry All Commercial |
$76.64
|
| Rate for Payer: Encore All Commercial |
$63.87
|
| Rate for Payer: Encore All Commercial |
$63.87
|
| Rate for Payer: Frontpath All Commercial |
$72.22
|
| Rate for Payer: Frontpath All Commercial |
$72.22
|
| Rate for Payer: Humana ChoiceCare |
$12.44
|
| Rate for Payer: Humana ChoiceCare |
$12.44
|
| Rate for Payer: Humana Medicare |
$63.87
|
| Rate for Payer: Humana Medicare |
$63.87
|
| Rate for Payer: Lucent All Commercial |
$89.42
|
| Rate for Payer: Lucent All Commercial |
$89.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: Managed Health Services Medicaid |
$66.74
|
| Rate for Payer: Managed Health Services Medicaid |
$66.74
|
| Rate for Payer: MDWise Medicaid |
$66.74
|
| Rate for Payer: MDWise Medicaid |
$66.74
|
| Rate for Payer: PHCS All Commercial |
$63.87
|
| Rate for Payer: PHCS All Commercial |
$63.87
|
| Rate for Payer: PHP All Commercial |
$96.97
|
| Rate for Payer: PHP All Commercial |
$96.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.87
|
| Rate for Payer: Sagamore Health Network All Products |
$63.87
|
| Rate for Payer: Sagamore Health Network All Products |
$63.87
|
| Rate for Payer: Signature Care EPO |
$55.89
|
| Rate for Payer: Signature Care EPO |
$55.89
|
| Rate for Payer: Signature Care PPO |
$55.89
|
| Rate for Payer: Signature Care PPO |
$55.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,200.00
|
| Rate for Payer: United Healthcare Commercial |
$39.03
|
| Rate for Payer: United Healthcare Commercial |
$39.03
|
| Rate for Payer: United Healthcare Medicare |
$66.88
|
| Rate for Payer: United Healthcare Medicare |
$66.88
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$535.96
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
z45335
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$266.08 |
| Rate for Payer: Aetna Commercial |
$61.90
|
| Rate for Payer: Aetna Commercial |
$61.90
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$66.79
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$66.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$263.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$263.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.09
|
| Rate for Payer: Cash Price |
$329.94
|
| Rate for Payer: Cash Price |
$332.30
|
| Rate for Payer: Centivo All Commercial |
$95.94
|
| Rate for Payer: Centivo All Commercial |
$95.94
|
| Rate for Payer: Cigna All Commercial |
$61.90
|
| Rate for Payer: Cigna All Commercial |
$61.90
|
| Rate for Payer: CORVEL All Commercial |
$61.90
|
| Rate for Payer: CORVEL All Commercial |
$61.90
|
| Rate for Payer: Coventry All Commercial |
$74.28
|
| Rate for Payer: Coventry All Commercial |
$74.28
|
| Rate for Payer: Encore All Commercial |
$61.90
|
| Rate for Payer: Encore All Commercial |
$61.90
|
| Rate for Payer: Frontpath All Commercial |
$84.32
|
| Rate for Payer: Frontpath All Commercial |
$84.32
|
| Rate for Payer: Humana ChoiceCare |
$96.77
|
| Rate for Payer: Humana ChoiceCare |
$96.77
|
| Rate for Payer: Humana Medicare |
$61.90
|
| Rate for Payer: Humana Medicare |
$61.90
|
| Rate for Payer: Lucent All Commercial |
$86.66
|
| Rate for Payer: Lucent All Commercial |
$86.66
|
| Rate for Payer: Managed Health Services Medicaid |
$263.61
|
| Rate for Payer: Managed Health Services Medicaid |
$263.61
|
| Rate for Payer: MDWise Medicaid |
$263.61
|
| Rate for Payer: MDWise Medicaid |
$263.61
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$66.79
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$66.79
|
| Rate for Payer: PHCS All Commercial |
$61.90
|
| Rate for Payer: PHCS All Commercial |
$61.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.90
|
| Rate for Payer: Sagamore Health Network All Products |
$61.90
|
| Rate for Payer: Sagamore Health Network All Products |
$61.90
|
| Rate for Payer: United Healthcare Commercial |
$103.98
|
| Rate for Payer: United Healthcare Commercial |
$103.98
|
| Rate for Payer: United Healthcare Medicare |
$266.08
|
| Rate for Payer: United Healthcare Medicare |
$266.08
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Professional
|
Both
|
$553.68
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
z45338
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$273.35 |
| Rate for Payer: Aetna Commercial |
$112.96
|
| Rate for Payer: Aetna Commercial |
$112.96
|
| Rate for Payer: Aetna Medicare |
$112.96
|
| Rate for Payer: Aetna Medicare |
$112.96
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$120.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$120.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$272.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$272.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$129.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$129.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.26
|
| Rate for Payer: Cash Price |
$338.95
|
| Rate for Payer: Cash Price |
$343.28
|
| Rate for Payer: Centivo All Commercial |
$175.09
|
| Rate for Payer: Centivo All Commercial |
$175.09
|
| Rate for Payer: Cigna All Commercial |
$112.96
|
| Rate for Payer: Cigna All Commercial |
$112.96
|
| Rate for Payer: CORVEL All Commercial |
$112.96
|
| Rate for Payer: CORVEL All Commercial |
$112.96
|
| Rate for Payer: Coventry All Commercial |
$135.55
|
| Rate for Payer: Coventry All Commercial |
$135.55
|
| Rate for Payer: Encore All Commercial |
$112.96
|
| Rate for Payer: Encore All Commercial |
$112.96
|
| Rate for Payer: Frontpath All Commercial |
$154.64
|
| Rate for Payer: Frontpath All Commercial |
$154.64
|
| Rate for Payer: Humana ChoiceCare |
$151.00
|
| Rate for Payer: Humana ChoiceCare |
$151.00
|
| Rate for Payer: Humana Medicare |
$112.96
|
| Rate for Payer: Humana Medicare |
$112.96
|
| Rate for Payer: Lucent All Commercial |
$158.14
|
| Rate for Payer: Lucent All Commercial |
$158.14
|
| Rate for Payer: Managed Health Services Medicaid |
$272.32
|
| Rate for Payer: Managed Health Services Medicaid |
$272.32
|
| Rate for Payer: MDWise Medicaid |
$272.32
|
| Rate for Payer: MDWise Medicaid |
$272.32
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$120.87
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$120.87
|
| Rate for Payer: PHCS All Commercial |
$112.96
|
| Rate for Payer: PHCS All Commercial |
$112.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.96
|
| Rate for Payer: Sagamore Health Network All Products |
$112.96
|
| Rate for Payer: Sagamore Health Network All Products |
$112.96
|
| Rate for Payer: United Healthcare Commercial |
$161.95
|
| Rate for Payer: United Healthcare Commercial |
$161.95
|
| Rate for Payer: United Healthcare Medicare |
$273.35
|
| Rate for Payer: United Healthcare Medicare |
$273.35
|
|
