|
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 |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| 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 |
$2.60
|
| Rate for Payer: Cash Price |
$2.60
|
| 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 |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| 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 |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| 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 |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| 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 |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| 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 |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| 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 |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| 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 |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| 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 |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| 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 |
$953.89
|
| Rate for Payer: Cash Price |
$971.49
|
| 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 Medicare |
$351.26
|
| Rate for Payer: Molina Healthcare of OH 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 |
$975.79
|
| Rate for Payer: Cash Price |
$991.49
|
| 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 Medicare |
$365.96
|
| Rate for Payer: Molina Healthcare of OH 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 |
$60.71
|
| Rate for Payer: Cash Price |
$52.48
|
| 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 |
$23.80
|
| Rate for Payer: Cash Price |
$22.23
|
| 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 |
$24.94
|
| Rate for Payer: Cash Price |
$22.61
|
| 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 |
$21.84
|
| Rate for Payer: Cash Price |
$22.52
|
| 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 Medicare |
$11.42
|
| Rate for Payer: Molina Healthcare of OH 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 |
$71.34
|
| Rate for Payer: Cash Price |
$73.58
|
| 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 Medicare |
$21.68
|
| Rate for Payer: Molina Healthcare of OH 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 |
$387.88
|
| Rate for Payer: Cash Price |
$388.83
|
| 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 Medicare |
$114.72
|
| Rate for Payer: Molina Healthcare of OH 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 |
$180.31
|
| Rate for Payer: Cash Price |
$183.99
|
| 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 Medicare |
$47.41
|
| Rate for Payer: Molina Healthcare of OH 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
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM
|
Professional
|
Both
|
$173.70
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
z15278
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$86.34 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna Medicare |
$52.46
|
| Rate for Payer: Aetna Medicare |
$52.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.71
|
| Rate for Payer: Cash Price |
$107.06
|
| Rate for Payer: Cash Price |
$107.69
|
| Rate for Payer: Centivo All Commercial |
$81.31
|
| Rate for Payer: Centivo All Commercial |
$81.31
|
| Rate for Payer: Cigna All Commercial |
$52.46
|
| Rate for Payer: Cigna All Commercial |
$52.46
|
| Rate for Payer: CORVEL All Commercial |
$52.46
|
| Rate for Payer: CORVEL All Commercial |
$52.46
|
| Rate for Payer: Coventry All Commercial |
$62.95
|
| Rate for Payer: Coventry All Commercial |
$62.95
|
| Rate for Payer: Encore All Commercial |
$52.46
|
| Rate for Payer: Encore All Commercial |
$52.46
|
| Rate for Payer: Frontpath All Commercial |
$74.14
|
| Rate for Payer: Frontpath All Commercial |
$74.14
|
| Rate for Payer: Humana ChoiceCare |
$51.83
|
| Rate for Payer: Humana ChoiceCare |
$51.83
|
| Rate for Payer: Humana Medicare |
$52.46
|
| Rate for Payer: Humana Medicare |
$52.46
|
| Rate for Payer: Lucent All Commercial |
$73.44
|
| Rate for Payer: Lucent All Commercial |
$73.44
|
| Rate for Payer: Managed Health Services Medicaid |
$85.43
|
| Rate for Payer: Managed Health Services Medicaid |
$85.43
|
| Rate for Payer: MDWise Medicaid |
$85.43
|
| Rate for Payer: MDWise Medicaid |
$85.43
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$28.90
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$28.90
|
| Rate for Payer: PHCS All Commercial |
$52.46
|
| Rate for Payer: PHCS All Commercial |
$52.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.46
|
| Rate for Payer: Sagamore Health Network All Products |
$52.46
|
| Rate for Payer: Sagamore Health Network All Products |
$52.46
|
| Rate for Payer: United Healthcare Commercial |
$68.46
|
| Rate for Payer: United Healthcare Commercial |
$68.46
|
| Rate for Payer: United Healthcare Medicare |
$86.34
|
| Rate for Payer: United Healthcare Medicare |
$86.34
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM
|
Professional
|
Both
|
$60.10
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
z15276
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$37.03 |
| Rate for Payer: Aetna Commercial |
$23.89
|
| Rate for Payer: Aetna Commercial |
$23.89
|
| Rate for Payer: Aetna Medicare |
$23.89
|
| Rate for Payer: Aetna Medicare |
$23.89
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$12.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$12.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.28
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$37.26
|
| Rate for Payer: Centivo All Commercial |
$37.03
|
| Rate for Payer: Centivo All Commercial |
$37.03
|
| Rate for Payer: Cigna All Commercial |
$23.89
|
| Rate for Payer: Cigna All Commercial |
$23.89
|
| Rate for Payer: CORVEL All Commercial |
$23.89
|
| Rate for Payer: CORVEL All Commercial |
$23.89
|
| Rate for Payer: Coventry All Commercial |
$28.67
|
| Rate for Payer: Coventry All Commercial |
$28.67
|
| Rate for Payer: Encore All Commercial |
$23.89
|
| Rate for Payer: Encore All Commercial |
$23.89
|
| Rate for Payer: Frontpath All Commercial |
$33.41
|
| Rate for Payer: Frontpath All Commercial |
$33.41
|
| Rate for Payer: Humana ChoiceCare |
$23.61
|
| Rate for Payer: Humana ChoiceCare |
$23.61
|
| Rate for Payer: Humana Medicare |
$23.89
|
| Rate for Payer: Humana Medicare |
$23.89
|
| Rate for Payer: Lucent All Commercial |
$33.45
|
| Rate for Payer: Lucent All Commercial |
$33.45
|
| Rate for Payer: Managed Health Services Medicaid |
$29.56
|
| Rate for Payer: Managed Health Services Medicaid |
$29.56
|
| Rate for Payer: MDWise Medicaid |
$29.56
|
| Rate for Payer: MDWise Medicaid |
$29.56
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$12.98
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$12.98
|
| Rate for Payer: PHCS All Commercial |
$23.89
|
| Rate for Payer: PHCS All Commercial |
$23.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.89
|
| Rate for Payer: Sagamore Health Network All Products |
$23.89
|
| Rate for Payer: Sagamore Health Network All Products |
$23.89
|
| Rate for Payer: United Healthcare Commercial |
$31.20
|
| Rate for Payer: United Healthcare Commercial |
$31.20
|
| Rate for Payer: United Healthcare Medicare |
$29.68
|
| Rate for Payer: United Healthcare Medicare |
$29.68
|
|
|
PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN
|
Professional
|
Both
|
$76.88
|
|
|
Service Code
|
CPT 99462
|
| Hospital Charge Code |
z99462
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$14,500.00 |
| Rate for Payer: Aetna Commercial |
$39.85
|
| Rate for Payer: Aetna Commercial |
$39.85
|
| Rate for Payer: Aetna Medicare |
$39.85
|
| Rate for Payer: Aetna Medicare |
$39.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.84
|
| Rate for Payer: Cash Price |
$47.67
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Centivo All Commercial |
$61.77
|
| Rate for Payer: Centivo All Commercial |
$61.77
|
| Rate for Payer: Cigna All Commercial |
$39.85
|
| Rate for Payer: Cigna All Commercial |
$39.85
|
| Rate for Payer: CORVEL All Commercial |
$39.85
|
| Rate for Payer: CORVEL All Commercial |
$39.85
|
| Rate for Payer: Coventry All Commercial |
$47.82
|
| Rate for Payer: Coventry All Commercial |
$47.82
|
| Rate for Payer: Encore All Commercial |
$39.85
|
| Rate for Payer: Encore All Commercial |
$39.85
|
| Rate for Payer: Frontpath All Commercial |
$43.17
|
| Rate for Payer: Frontpath All Commercial |
$43.17
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Humana Medicare |
$39.85
|
| Rate for Payer: Humana Medicare |
$39.85
|
| Rate for Payer: Lucent All Commercial |
$55.79
|
| Rate for Payer: Lucent All Commercial |
$55.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.00
|
| Rate for Payer: Managed Health Services Medicaid |
$37.82
|
| Rate for Payer: Managed Health Services Medicaid |
$37.82
|
| Rate for Payer: MDWise Medicaid |
$37.82
|
| Rate for Payer: MDWise Medicaid |
$37.82
|
| Rate for Payer: PHCS All Commercial |
$39.85
|
| Rate for Payer: PHCS All Commercial |
$39.85
|
| Rate for Payer: PHP All Commercial |
$39.19
|
| Rate for Payer: PHP All Commercial |
$39.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.85
|
| Rate for Payer: Sagamore Health Network All Products |
$39.85
|
| Rate for Payer: Sagamore Health Network All Products |
$39.85
|
| Rate for Payer: Signature Care EPO |
$34.40
|
| Rate for Payer: Signature Care EPO |
$34.40
|
| Rate for Payer: Signature Care PPO |
$34.40
|
| Rate for Payer: Signature Care PPO |
$34.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,500.00
|
| Rate for Payer: United Healthcare Commercial |
$30.53
|
| Rate for Payer: United Healthcare Commercial |
$30.53
|
| Rate for Payer: United Healthcare Medicare |
$38.05
|
| Rate for Payer: United Healthcare Medicare |
$38.05
|
|
|
PR SUPRACERV ABD HYSTERECTOMY
|
Professional
|
Both
|
$1,781.78
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
z58180
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$116,500.00 |
| Rate for Payer: Aetna Commercial |
$904.46
|
| Rate for Payer: Aetna Commercial |
$904.46
|
| Rate for Payer: Aetna Medicare |
$904.46
|
| Rate for Payer: Aetna Medicare |
$904.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,193.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$876.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$876.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,040.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,040.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$994.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$994.91
|
| Rate for Payer: Cash Price |
$1,104.70
|
| Rate for Payer: Cash Price |
$1,084.38
|
| Rate for Payer: Centivo All Commercial |
$1,401.91
|
| Rate for Payer: Centivo All Commercial |
$1,401.91
|
| Rate for Payer: Cigna All Commercial |
$904.46
|
| Rate for Payer: Cigna All Commercial |
$904.46
|
| Rate for Payer: CORVEL All Commercial |
$904.46
|
| Rate for Payer: CORVEL All Commercial |
$904.46
|
| Rate for Payer: Coventry All Commercial |
$1,085.35
|
| Rate for Payer: Coventry All Commercial |
$1,085.35
|
| Rate for Payer: Encore All Commercial |
$904.46
|
| Rate for Payer: Encore All Commercial |
$904.46
|
| Rate for Payer: Frontpath All Commercial |
$1,258.14
|
| Rate for Payer: Frontpath All Commercial |
$1,258.14
|
| Rate for Payer: Humana ChoiceCare |
$1,008.87
|
| Rate for Payer: Humana ChoiceCare |
$1,008.87
|
| Rate for Payer: Humana Medicare |
$904.46
|
| Rate for Payer: Humana Medicare |
$904.46
|
| Rate for Payer: Lucent All Commercial |
$1,266.24
|
| Rate for Payer: Lucent All Commercial |
$1,266.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,255.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,255.00
|
| Rate for Payer: Managed Health Services Medicaid |
$876.35
|
| Rate for Payer: Managed Health Services Medicaid |
$876.35
|
| Rate for Payer: MDWise Medicaid |
$876.35
|
| Rate for Payer: MDWise Medicaid |
$876.35
|
| Rate for Payer: PHCS All Commercial |
$904.46
|
| Rate for Payer: PHCS All Commercial |
$904.46
|
| Rate for Payer: PHP All Commercial |
$1,154.34
|
| Rate for Payer: PHP All Commercial |
$1,154.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$904.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$904.46
|
| Rate for Payer: Sagamore Health Network All Products |
$904.46
|
| Rate for Payer: Sagamore Health Network All Products |
$904.46
|
| Rate for Payer: Signature Care EPO |
$1,211.25
|
| Rate for Payer: Signature Care EPO |
$1,211.25
|
| Rate for Payer: Signature Care PPO |
$1,211.25
|
| Rate for Payer: Signature Care PPO |
$1,211.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,071.66
|
| Rate for Payer: United Healthcare Commercial |
$1,071.66
|
| Rate for Payer: United Healthcare Medicare |
$874.50
|
| Rate for Payer: United Healthcare Medicare |
$874.50
|
|
|
PR SURG EXCISION OF ANAL LESION(S)
|
Professional
|
Both
|
$578.90
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
z46922
|
| Min. Negotiated Rate |
$100.92 |
| Max. Negotiated Rate |
$17,900.00 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$210.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$100.92
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$100.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$284.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$284.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.07
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cash Price |
$358.92
|
| Rate for Payer: Centivo All Commercial |
$198.79
|
| Rate for Payer: Centivo All Commercial |
$198.79
|
| Rate for Payer: Cigna All Commercial |
$128.25
|
| Rate for Payer: Cigna All Commercial |
$128.25
|
| Rate for Payer: CORVEL All Commercial |
$128.25
|
| Rate for Payer: CORVEL All Commercial |
$128.25
|
| Rate for Payer: Coventry All Commercial |
$153.90
|
| Rate for Payer: Coventry All Commercial |
$153.90
|
| Rate for Payer: Encore All Commercial |
$128.25
|
| Rate for Payer: Encore All Commercial |
$128.25
|
| Rate for Payer: Frontpath All Commercial |
$177.41
|
| Rate for Payer: Frontpath All Commercial |
$177.41
|
| Rate for Payer: Humana ChoiceCare |
$132.70
|
| Rate for Payer: Humana ChoiceCare |
$132.70
|
| Rate for Payer: Humana Medicare |
$128.25
|
| Rate for Payer: Humana Medicare |
$128.25
|
| Rate for Payer: Lucent All Commercial |
$179.55
|
| Rate for Payer: Lucent All Commercial |
$179.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Managed Health Services Medicaid |
$284.72
|
| Rate for Payer: Managed Health Services Medicaid |
$284.72
|
| Rate for Payer: MDWise Medicaid |
$284.72
|
| Rate for Payer: MDWise Medicaid |
$284.72
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$100.92
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$100.92
|
| Rate for Payer: PHCS All Commercial |
$128.25
|
| Rate for Payer: PHCS All Commercial |
$128.25
|
| Rate for Payer: PHP All Commercial |
$218.69
|
| Rate for Payer: PHP All Commercial |
$218.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.25
|
| Rate for Payer: Sagamore Health Network All Products |
$128.25
|
| Rate for Payer: Sagamore Health Network All Products |
$128.25
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: United Healthcare Commercial |
$139.54
|
| Rate for Payer: United Healthcare Commercial |
$139.54
|
| Rate for Payer: United Healthcare Medicare |
$286.40
|
| Rate for Payer: United Healthcare Medicare |
$286.40
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
Both
|
$985.82
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
z29822
|
| Min. Negotiated Rate |
$492.91 |
| Max. Negotiated Rate |
$75,800.00 |
| Rate for Payer: Aetna Commercial |
$505.32
|
| Rate for Payer: Aetna Commercial |
$505.32
|
| Rate for Payer: Aetna Medicare |
$505.32
|
| Rate for Payer: Aetna Medicare |
$505.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$798.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$496.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$496.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$581.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$581.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$555.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$555.85
|
| Rate for Payer: Cash Price |
$611.21
|
| Rate for Payer: Cash Price |
$625.32
|
| Rate for Payer: Centivo All Commercial |
$783.25
|
| Rate for Payer: Centivo All Commercial |
$783.25
|
| Rate for Payer: Cigna All Commercial |
$505.32
|
| Rate for Payer: Cigna All Commercial |
$505.32
|
| Rate for Payer: CORVEL All Commercial |
$505.32
|
| Rate for Payer: CORVEL All Commercial |
$505.32
|
| Rate for Payer: Coventry All Commercial |
$606.38
|
| Rate for Payer: Coventry All Commercial |
$606.38
|
| Rate for Payer: Encore All Commercial |
$505.32
|
| Rate for Payer: Encore All Commercial |
$505.32
|
| Rate for Payer: Frontpath All Commercial |
$701.02
|
| Rate for Payer: Frontpath All Commercial |
$701.02
|
| Rate for Payer: Humana ChoiceCare |
$613.72
|
| Rate for Payer: Humana ChoiceCare |
$613.72
|
| Rate for Payer: Humana Medicare |
$505.32
|
| Rate for Payer: Humana Medicare |
$505.32
|
| Rate for Payer: Lucent All Commercial |
$707.45
|
| Rate for Payer: Lucent All Commercial |
$707.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.00
|
| Rate for Payer: Managed Health Services Medicaid |
$496.06
|
| Rate for Payer: Managed Health Services Medicaid |
$496.06
|
| Rate for Payer: MDWise Medicaid |
$496.06
|
| Rate for Payer: MDWise Medicaid |
$496.06
|
| Rate for Payer: PHCS All Commercial |
$505.32
|
| Rate for Payer: PHCS All Commercial |
$505.32
|
| Rate for Payer: PHP All Commercial |
$857.67
|
| Rate for Payer: PHP All Commercial |
$857.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$505.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$505.32
|
| Rate for Payer: Sagamore Health Network All Products |
$505.32
|
| Rate for Payer: Sagamore Health Network All Products |
$505.32
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$846.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75,800.00
|
| Rate for Payer: United Healthcare Commercial |
$619.31
|
| Rate for Payer: United Healthcare Commercial |
$619.31
|
| Rate for Payer: United Healthcare Medicare |
$492.91
|
| Rate for Payer: United Healthcare Medicare |
$492.91
|
|
