|
PR TYMPANOMETRY
|
Professional
|
Both
|
$30.82
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
z92567
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$9.55
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$9.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.22
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Centivo All Commercial |
$15.81
|
| Rate for Payer: Centivo All Commercial |
$15.81
|
| Rate for Payer: Cigna All Commercial |
$10.20
|
| Rate for Payer: Cigna All Commercial |
$10.20
|
| Rate for Payer: CORVEL All Commercial |
$10.20
|
| Rate for Payer: CORVEL All Commercial |
$10.20
|
| Rate for Payer: Coventry All Commercial |
$12.24
|
| Rate for Payer: Coventry All Commercial |
$12.24
|
| Rate for Payer: Encore All Commercial |
$10.20
|
| Rate for Payer: Encore All Commercial |
$10.20
|
| Rate for Payer: Frontpath All Commercial |
$11.51
|
| Rate for Payer: Frontpath All Commercial |
$11.51
|
| Rate for Payer: Humana ChoiceCare |
$22.05
|
| Rate for Payer: Humana ChoiceCare |
$22.05
|
| Rate for Payer: Humana Medicare |
$10.20
|
| Rate for Payer: Humana Medicare |
$10.20
|
| Rate for Payer: Lucent All Commercial |
$14.28
|
| Rate for Payer: Lucent All Commercial |
$14.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.16
|
| Rate for Payer: Managed Health Services Medicaid |
$15.16
|
| Rate for Payer: MDWise Medicaid |
$15.16
|
| Rate for Payer: MDWise Medicaid |
$15.16
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$9.55
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$9.55
|
| Rate for Payer: PHCS All Commercial |
$10.20
|
| Rate for Payer: PHCS All Commercial |
$10.20
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.20
|
| Rate for Payer: Sagamore Health Network All Products |
$10.20
|
| Rate for Payer: Sagamore Health Network All Products |
$10.20
|
| Rate for Payer: Signature Care EPO |
$22.10
|
| Rate for Payer: Signature Care EPO |
$22.10
|
| Rate for Payer: Signature Care PPO |
$22.10
|
| Rate for Payer: Signature Care PPO |
$22.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Commercial |
$18.09
|
| Rate for Payer: United Healthcare Commercial |
$18.09
|
| Rate for Payer: United Healthcare Medicare |
$15.20
|
| Rate for Payer: United Healthcare Medicare |
$15.20
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$41.52
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
z92550
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$21.47
|
| Rate for Payer: Aetna Medicare |
$21.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.62
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Centivo All Commercial |
$33.28
|
| Rate for Payer: Centivo All Commercial |
$33.28
|
| Rate for Payer: Cigna All Commercial |
$21.47
|
| Rate for Payer: Cigna All Commercial |
$21.47
|
| Rate for Payer: CORVEL All Commercial |
$21.47
|
| Rate for Payer: CORVEL All Commercial |
$21.47
|
| Rate for Payer: Coventry All Commercial |
$25.76
|
| Rate for Payer: Coventry All Commercial |
$25.76
|
| Rate for Payer: Encore All Commercial |
$21.47
|
| Rate for Payer: Encore All Commercial |
$21.47
|
| Rate for Payer: Frontpath All Commercial |
$24.23
|
| Rate for Payer: Frontpath All Commercial |
$24.23
|
| Rate for Payer: Humana ChoiceCare |
$22.97
|
| Rate for Payer: Humana ChoiceCare |
$22.97
|
| Rate for Payer: Humana Medicare |
$21.47
|
| Rate for Payer: Humana Medicare |
$21.47
|
| Rate for Payer: Lucent All Commercial |
$30.06
|
| Rate for Payer: Lucent All Commercial |
$30.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.00
|
| Rate for Payer: Managed Health Services Medicaid |
$20.37
|
| Rate for Payer: Managed Health Services Medicaid |
$20.37
|
| Rate for Payer: MDWise Medicaid |
$20.37
|
| Rate for Payer: MDWise Medicaid |
$20.37
|
| Rate for Payer: PHCS All Commercial |
$21.47
|
| Rate for Payer: PHCS All Commercial |
$21.47
|
| Rate for Payer: PHP All Commercial |
$30.11
|
| Rate for Payer: PHP All Commercial |
$30.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.47
|
| Rate for Payer: Sagamore Health Network All Products |
$21.47
|
| Rate for Payer: Sagamore Health Network All Products |
$21.47
|
| Rate for Payer: Signature Care EPO |
$22.10
|
| Rate for Payer: Signature Care EPO |
$22.10
|
| Rate for Payer: Signature Care PPO |
$22.10
|
| Rate for Payer: Signature Care PPO |
$22.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,600.00
|
| Rate for Payer: United Healthcare Commercial |
$24.74
|
| Rate for Payer: United Healthcare Commercial |
$24.74
|
| Rate for Payer: United Healthcare Medicare |
$20.76
|
| Rate for Payer: United Healthcare Medicare |
$20.76
|
|
|
PR ULTRASOUND,PELVIC NON-OB
|
Professional
|
Both
|
$194.18
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
z76856
|
| Min. Negotiated Rate |
$96.59 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Medicare |
$100.99
|
| Rate for Payer: Aetna Medicare |
$100.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$96.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$96.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.09
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cash Price |
$116.51
|
| Rate for Payer: Centivo All Commercial |
$156.53
|
| Rate for Payer: Centivo All Commercial |
$156.53
|
| Rate for Payer: Cigna All Commercial |
$100.99
|
| Rate for Payer: Cigna All Commercial |
$100.99
|
| Rate for Payer: CORVEL All Commercial |
$100.99
|
| Rate for Payer: CORVEL All Commercial |
$100.99
|
| Rate for Payer: Coventry All Commercial |
$121.19
|
| Rate for Payer: Coventry All Commercial |
$121.19
|
| Rate for Payer: Encore All Commercial |
$100.99
|
| Rate for Payer: Encore All Commercial |
$100.99
|
| Rate for Payer: Frontpath All Commercial |
$175.41
|
| Rate for Payer: Frontpath All Commercial |
$175.41
|
| Rate for Payer: Humana ChoiceCare |
$115.73
|
| Rate for Payer: Humana ChoiceCare |
$115.73
|
| Rate for Payer: Humana Medicare |
$100.99
|
| Rate for Payer: Humana Medicare |
$100.99
|
| Rate for Payer: Lucent All Commercial |
$141.39
|
| Rate for Payer: Lucent All Commercial |
$141.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: Managed Health Services Medicaid |
$96.59
|
| Rate for Payer: Managed Health Services Medicaid |
$96.59
|
| Rate for Payer: MDWise Medicaid |
$96.59
|
| Rate for Payer: MDWise Medicaid |
$96.59
|
| Rate for Payer: PHCS All Commercial |
$100.99
|
| Rate for Payer: PHCS All Commercial |
$100.99
|
| Rate for Payer: PHP All Commercial |
$126.21
|
| Rate for Payer: PHP All Commercial |
$126.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.99
|
| Rate for Payer: Sagamore Health Network All Products |
$100.99
|
| Rate for Payer: Sagamore Health Network All Products |
$100.99
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare Commercial |
$110.80
|
| Rate for Payer: United Healthcare Commercial |
$110.80
|
|
|
PR ULTRASOUND,TRANSVAGINAL NON-OB
|
Professional
|
Both
|
$220.08
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
z76830
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$114.07
|
| Rate for Payer: Aetna Commercial |
$114.07
|
| Rate for Payer: Aetna Medicare |
$114.07
|
| Rate for Payer: Aetna Medicare |
$114.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$109.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$109.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.48
|
| Rate for Payer: Cash Price |
$95.77
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Centivo All Commercial |
$176.81
|
| Rate for Payer: Centivo All Commercial |
$176.81
|
| Rate for Payer: Cigna All Commercial |
$114.07
|
| Rate for Payer: Cigna All Commercial |
$114.07
|
| Rate for Payer: CORVEL All Commercial |
$114.07
|
| Rate for Payer: CORVEL All Commercial |
$114.07
|
| Rate for Payer: Coventry All Commercial |
$136.88
|
| Rate for Payer: Coventry All Commercial |
$136.88
|
| Rate for Payer: Encore All Commercial |
$114.07
|
| Rate for Payer: Encore All Commercial |
$114.07
|
| Rate for Payer: Frontpath All Commercial |
$197.96
|
| Rate for Payer: Frontpath All Commercial |
$197.96
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Humana Medicare |
$114.07
|
| Rate for Payer: Humana Medicare |
$114.07
|
| Rate for Payer: Lucent All Commercial |
$159.70
|
| Rate for Payer: Lucent All Commercial |
$159.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$175.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$175.00
|
| Rate for Payer: Managed Health Services Medicaid |
$109.13
|
| Rate for Payer: Managed Health Services Medicaid |
$109.13
|
| Rate for Payer: MDWise Medicaid |
$109.13
|
| Rate for Payer: MDWise Medicaid |
$109.13
|
| Rate for Payer: PHCS All Commercial |
$114.07
|
| Rate for Payer: PHCS All Commercial |
$114.07
|
| Rate for Payer: PHP All Commercial |
$143.05
|
| Rate for Payer: PHP All Commercial |
$143.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.07
|
| Rate for Payer: Sagamore Health Network All Products |
$114.07
|
| Rate for Payer: Sagamore Health Network All Products |
$114.07
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,400.00
|
| Rate for Payer: United Healthcare Commercial |
$110.14
|
| Rate for Payer: United Healthcare Commercial |
$110.14
|
|
|
PR UNLISTED LAPAROSCOPIC PROC, LIVER
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
z47379
|
| Rate for Payer: Cash Price |
$1,533.00
|
|
|
PR UNLISTED OTORHINOLARYNG SERVICE/PROC
|
Professional
|
Both
|
$52.93
|
|
|
Service Code
|
CPT 92700
|
| Hospital Charge Code |
z92700
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$44.99 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$31.76
|
| Rate for Payer: Cash Price |
$31.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.99
|
| Rate for Payer: Signature Care EPO |
$33.75
|
| Rate for Payer: Signature Care PPO |
$33.75
|
|
|
PR UNLISTED PROC, ARTHROSCOPY
|
Professional
|
Both
|
$508.53
|
|
|
Service Code
|
CPT 29999
|
| Hospital Charge Code |
z29999
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.25
|
| Rate for Payer: Signature Care EPO |
$324.19
|
| Rate for Payer: Signature Care PPO |
$324.19
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$857.28
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
z33214
|
| Min. Negotiated Rate |
$421.65 |
| Max. Negotiated Rate |
$65,500.00 |
| Rate for Payer: Aetna Commercial |
$442.33
|
| Rate for Payer: Aetna Commercial |
$442.33
|
| Rate for Payer: Aetna Medicare |
$442.33
|
| Rate for Payer: Aetna Medicare |
$442.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$695.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$695.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$695.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$695.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$695.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$695.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$695.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$695.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$421.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$421.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$508.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$508.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$486.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$486.56
|
| Rate for Payer: Cash Price |
$514.37
|
| Rate for Payer: Cash Price |
$510.94
|
| Rate for Payer: Centivo All Commercial |
$685.61
|
| Rate for Payer: Centivo All Commercial |
$685.61
|
| Rate for Payer: Cigna All Commercial |
$442.33
|
| Rate for Payer: Cigna All Commercial |
$442.33
|
| Rate for Payer: CORVEL All Commercial |
$442.33
|
| Rate for Payer: CORVEL All Commercial |
$442.33
|
| Rate for Payer: Coventry All Commercial |
$530.80
|
| Rate for Payer: Coventry All Commercial |
$530.80
|
| Rate for Payer: Encore All Commercial |
$442.33
|
| Rate for Payer: Encore All Commercial |
$442.33
|
| Rate for Payer: Frontpath All Commercial |
$626.55
|
| Rate for Payer: Frontpath All Commercial |
$626.55
|
| Rate for Payer: Humana ChoiceCare |
$614.85
|
| Rate for Payer: Humana ChoiceCare |
$614.85
|
| Rate for Payer: Humana Medicare |
$442.33
|
| Rate for Payer: Humana Medicare |
$442.33
|
| Rate for Payer: Lucent All Commercial |
$619.26
|
| Rate for Payer: Lucent All Commercial |
$619.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$698.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$698.00
|
| Rate for Payer: Managed Health Services Medicaid |
$421.65
|
| Rate for Payer: Managed Health Services Medicaid |
$421.65
|
| Rate for Payer: MDWise Medicaid |
$421.65
|
| Rate for Payer: MDWise Medicaid |
$421.65
|
| Rate for Payer: PHCS All Commercial |
$442.33
|
| Rate for Payer: PHCS All Commercial |
$442.33
|
| Rate for Payer: PHP All Commercial |
$596.10
|
| Rate for Payer: PHP All Commercial |
$596.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.33
|
| Rate for Payer: Sagamore Health Network All Products |
$442.33
|
| Rate for Payer: Sagamore Health Network All Products |
$442.33
|
| Rate for Payer: Signature Care EPO |
$713.15
|
| Rate for Payer: Signature Care EPO |
$713.15
|
| Rate for Payer: Signature Care PPO |
$713.15
|
| Rate for Payer: Signature Care PPO |
$713.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65,500.00
|
| Rate for Payer: United Healthcare Commercial |
$581.20
|
| Rate for Payer: United Healthcare Commercial |
$581.20
|
| Rate for Payer: United Healthcare Medicare |
$425.78
|
| Rate for Payer: United Healthcare Medicare |
$425.78
|
|
|
PR VAG DELIV ONLY,PREV C-SECTN
|
Professional
|
Both
|
$1,610.62
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
z59612
|
| Min. Negotiated Rate |
$792.17 |
| Max. Negotiated Rate |
$105,900.00 |
| Rate for Payer: Aetna Commercial |
$820.52
|
| Rate for Payer: Aetna Commercial |
$820.52
|
| Rate for Payer: Aetna Medicare |
$820.52
|
| Rate for Payer: Aetna Medicare |
$820.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$792.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$792.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$943.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$943.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$902.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$902.57
|
| Rate for Payer: Cash Price |
$966.37
|
| Rate for Payer: Cash Price |
$953.78
|
| Rate for Payer: Centivo All Commercial |
$1,271.81
|
| Rate for Payer: Centivo All Commercial |
$1,271.81
|
| Rate for Payer: Cigna All Commercial |
$820.52
|
| Rate for Payer: Cigna All Commercial |
$820.52
|
| Rate for Payer: CORVEL All Commercial |
$820.52
|
| Rate for Payer: CORVEL All Commercial |
$820.52
|
| Rate for Payer: Coventry All Commercial |
$984.62
|
| Rate for Payer: Coventry All Commercial |
$984.62
|
| Rate for Payer: Encore All Commercial |
$820.52
|
| Rate for Payer: Encore All Commercial |
$820.52
|
| Rate for Payer: Frontpath All Commercial |
$1,182.49
|
| Rate for Payer: Frontpath All Commercial |
$1,182.49
|
| Rate for Payer: Humana ChoiceCare |
$837.55
|
| Rate for Payer: Humana ChoiceCare |
$837.55
|
| Rate for Payer: Humana Medicare |
$820.52
|
| Rate for Payer: Humana Medicare |
$820.52
|
| Rate for Payer: Lucent All Commercial |
$1,148.73
|
| Rate for Payer: Lucent All Commercial |
$1,148.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,141.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,141.00
|
| Rate for Payer: Managed Health Services Medicaid |
$792.17
|
| Rate for Payer: Managed Health Services Medicaid |
$792.17
|
| Rate for Payer: MDWise Medicaid |
$792.17
|
| Rate for Payer: MDWise Medicaid |
$792.17
|
| Rate for Payer: PHCS All Commercial |
$820.52
|
| Rate for Payer: PHCS All Commercial |
$820.52
|
| Rate for Payer: PHP All Commercial |
$1,049.16
|
| Rate for Payer: PHP All Commercial |
$1,049.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$820.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$820.52
|
| Rate for Payer: Sagamore Health Network All Products |
$820.52
|
| Rate for Payer: Sagamore Health Network All Products |
$820.52
|
| Rate for Payer: Signature Care EPO |
$1,074.40
|
| Rate for Payer: Signature Care EPO |
$1,074.40
|
| Rate for Payer: Signature Care PPO |
$1,074.40
|
| Rate for Payer: Signature Care PPO |
$1,074.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105,900.00
|
| Rate for Payer: United Healthcare Commercial |
$976.96
|
| Rate for Payer: United Healthcare Commercial |
$976.96
|
| Rate for Payer: United Healthcare Medicare |
$794.82
|
| Rate for Payer: United Healthcare Medicare |
$794.82
|
|
|
PR VAG DELIV+POSTPARTUM CARE,PREV C-SEC
|
Professional
|
Both
|
$2,081.52
|
|
|
Service Code
|
CPT 59614
|
| Hospital Charge Code |
z59614
|
| Min. Negotiated Rate |
$921.23 |
| Max. Negotiated Rate |
$134,000.00 |
| Rate for Payer: Aetna Commercial |
$1,037.78
|
| Rate for Payer: Aetna Commercial |
$1,037.78
|
| Rate for Payer: Aetna Medicare |
$1,037.78
|
| Rate for Payer: Aetna Medicare |
$1,037.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,164.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,023.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,023.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,193.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,193.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,141.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,141.56
|
| Rate for Payer: Cash Price |
$1,248.91
|
| Rate for Payer: Cash Price |
$1,206.53
|
| Rate for Payer: Centivo All Commercial |
$1,608.56
|
| Rate for Payer: Centivo All Commercial |
$1,608.56
|
| Rate for Payer: Cigna All Commercial |
$1,037.78
|
| Rate for Payer: Cigna All Commercial |
$1,037.78
|
| Rate for Payer: CORVEL All Commercial |
$1,037.78
|
| Rate for Payer: CORVEL All Commercial |
$1,037.78
|
| Rate for Payer: Coventry All Commercial |
$1,245.34
|
| Rate for Payer: Coventry All Commercial |
$1,245.34
|
| Rate for Payer: Encore All Commercial |
$1,037.78
|
| Rate for Payer: Encore All Commercial |
$1,037.78
|
| Rate for Payer: Frontpath All Commercial |
$1,494.31
|
| Rate for Payer: Frontpath All Commercial |
$1,494.31
|
| Rate for Payer: Humana ChoiceCare |
$921.23
|
| Rate for Payer: Humana ChoiceCare |
$921.23
|
| Rate for Payer: Humana Medicare |
$1,037.78
|
| Rate for Payer: Humana Medicare |
$1,037.78
|
| Rate for Payer: Lucent All Commercial |
$1,452.89
|
| Rate for Payer: Lucent All Commercial |
$1,452.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,443.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,443.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,023.77
|
| Rate for Payer: Managed Health Services Medicaid |
$1,023.77
|
| Rate for Payer: MDWise Medicaid |
$1,023.77
|
| Rate for Payer: MDWise Medicaid |
$1,023.77
|
| Rate for Payer: PHCS All Commercial |
$1,037.78
|
| Rate for Payer: PHCS All Commercial |
$1,037.78
|
| Rate for Payer: PHP All Commercial |
$1,327.18
|
| Rate for Payer: PHP All Commercial |
$1,327.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,037.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,037.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,037.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,037.78
|
| Rate for Payer: Signature Care EPO |
$1,182.35
|
| Rate for Payer: Signature Care EPO |
$1,182.35
|
| Rate for Payer: Signature Care PPO |
$1,182.35
|
| Rate for Payer: Signature Care PPO |
$1,182.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134,000.00
|
| Rate for Payer: United Healthcare Commercial |
$1,093.85
|
| Rate for Payer: United Healthcare Commercial |
$1,093.85
|
| Rate for Payer: United Healthcare Medicare |
$1,005.44
|
| Rate for Payer: United Healthcare Medicare |
$1,005.44
|
|
|
PR VAG HYST,REV VAG/URETHR,FIX ENTEROCE
|
Professional
|
Both
|
$1,659.52
|
|
|
Service Code
|
CPT 58270
|
| Hospital Charge Code |
z58270
|
| Min. Negotiated Rate |
$816.21 |
| Max. Negotiated Rate |
$109,100.00 |
| Rate for Payer: Aetna Commercial |
$846.74
|
| Rate for Payer: Aetna Commercial |
$846.74
|
| Rate for Payer: Aetna Medicare |
$846.74
|
| Rate for Payer: Aetna Medicare |
$846.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,128.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,128.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,128.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,128.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,128.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,128.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,128.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,128.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$816.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$816.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$973.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$973.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$931.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$931.41
|
| Rate for Payer: Cash Price |
$995.71
|
| Rate for Payer: Cash Price |
$982.27
|
| Rate for Payer: Centivo All Commercial |
$1,312.45
|
| Rate for Payer: Centivo All Commercial |
$1,312.45
|
| Rate for Payer: Cigna All Commercial |
$846.74
|
| Rate for Payer: Cigna All Commercial |
$846.74
|
| Rate for Payer: CORVEL All Commercial |
$846.74
|
| Rate for Payer: CORVEL All Commercial |
$846.74
|
| Rate for Payer: Coventry All Commercial |
$1,016.09
|
| Rate for Payer: Coventry All Commercial |
$1,016.09
|
| Rate for Payer: Encore All Commercial |
$846.74
|
| Rate for Payer: Encore All Commercial |
$846.74
|
| Rate for Payer: Frontpath All Commercial |
$1,176.42
|
| Rate for Payer: Frontpath All Commercial |
$1,176.42
|
| Rate for Payer: Humana ChoiceCare |
$949.27
|
| Rate for Payer: Humana ChoiceCare |
$949.27
|
| Rate for Payer: Humana Medicare |
$846.74
|
| Rate for Payer: Humana Medicare |
$846.74
|
| Rate for Payer: Lucent All Commercial |
$1,185.44
|
| Rate for Payer: Lucent All Commercial |
$1,185.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,175.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,175.00
|
| Rate for Payer: Managed Health Services Medicaid |
$816.21
|
| Rate for Payer: Managed Health Services Medicaid |
$816.21
|
| Rate for Payer: MDWise Medicaid |
$816.21
|
| Rate for Payer: MDWise Medicaid |
$816.21
|
| Rate for Payer: PHCS All Commercial |
$846.74
|
| Rate for Payer: PHCS All Commercial |
$846.74
|
| Rate for Payer: PHP All Commercial |
$1,080.50
|
| Rate for Payer: PHP All Commercial |
$1,080.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$846.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$846.74
|
| Rate for Payer: Sagamore Health Network All Products |
$846.74
|
| Rate for Payer: Sagamore Health Network All Products |
$846.74
|
| Rate for Payer: Signature Care EPO |
$1,066.75
|
| Rate for Payer: Signature Care EPO |
$1,066.75
|
| Rate for Payer: Signature Care PPO |
$1,066.75
|
| Rate for Payer: Signature Care PPO |
$1,066.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,100.00
|
| Rate for Payer: United Healthcare Commercial |
$997.95
|
| Rate for Payer: United Healthcare Commercial |
$997.95
|
| Rate for Payer: United Healthcare Medicare |
$818.56
|
| Rate for Payer: United Healthcare Medicare |
$818.56
|
|
|
PR VAG HYST,RMV TUBE/OVARY
|
Professional
|
Both
|
$1,721.92
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
z58262
|
| Min. Negotiated Rate |
$846.91 |
| Max. Negotiated Rate |
$112,900.00 |
| Rate for Payer: Aetna Commercial |
$876.40
|
| Rate for Payer: Aetna Commercial |
$876.40
|
| Rate for Payer: Aetna Medicare |
$876.40
|
| Rate for Payer: Aetna Medicare |
$876.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,171.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,171.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,171.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,171.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,171.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,171.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,171.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,171.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$846.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$846.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,007.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,007.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$964.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$964.04
|
| Rate for Payer: Cash Price |
$1,033.15
|
| Rate for Payer: Cash Price |
$1,016.94
|
| Rate for Payer: Centivo All Commercial |
$1,358.42
|
| Rate for Payer: Centivo All Commercial |
$1,358.42
|
| Rate for Payer: Cigna All Commercial |
$876.40
|
| Rate for Payer: Cigna All Commercial |
$876.40
|
| Rate for Payer: CORVEL All Commercial |
$876.40
|
| Rate for Payer: CORVEL All Commercial |
$876.40
|
| Rate for Payer: Coventry All Commercial |
$1,051.68
|
| Rate for Payer: Coventry All Commercial |
$1,051.68
|
| Rate for Payer: Encore All Commercial |
$876.40
|
| Rate for Payer: Encore All Commercial |
$876.40
|
| Rate for Payer: Frontpath All Commercial |
$1,217.37
|
| Rate for Payer: Frontpath All Commercial |
$1,217.37
|
| Rate for Payer: Humana ChoiceCare |
$985.89
|
| Rate for Payer: Humana ChoiceCare |
$985.89
|
| Rate for Payer: Humana Medicare |
$876.40
|
| Rate for Payer: Humana Medicare |
$876.40
|
| Rate for Payer: Lucent All Commercial |
$1,226.96
|
| Rate for Payer: Lucent All Commercial |
$1,226.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,216.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,216.00
|
| Rate for Payer: Managed Health Services Medicaid |
$846.91
|
| Rate for Payer: Managed Health Services Medicaid |
$846.91
|
| Rate for Payer: MDWise Medicaid |
$846.91
|
| Rate for Payer: MDWise Medicaid |
$846.91
|
| Rate for Payer: PHCS All Commercial |
$876.40
|
| Rate for Payer: PHCS All Commercial |
$876.40
|
| Rate for Payer: PHP All Commercial |
$1,118.63
|
| Rate for Payer: PHP All Commercial |
$1,118.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$876.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$876.40
|
| Rate for Payer: Sagamore Health Network All Products |
$876.40
|
| Rate for Payer: Sagamore Health Network All Products |
$876.40
|
| Rate for Payer: Signature Care EPO |
$1,183.20
|
| Rate for Payer: Signature Care EPO |
$1,183.20
|
| Rate for Payer: Signature Care PPO |
$1,183.20
|
| Rate for Payer: Signature Care PPO |
$1,183.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112,900.00
|
| Rate for Payer: United Healthcare Commercial |
$1,040.74
|
| Rate for Payer: United Healthcare Commercial |
$1,040.74
|
| Rate for Payer: United Healthcare Medicare |
$847.45
|
| Rate for Payer: United Healthcare Medicare |
$847.45
|
|
|
PR VAG HYST,RMV TUBE/OVARY,FIX ENTEROCE
|
Professional
|
Both
|
$1,845.28
|
|
|
Service Code
|
CPT 58263
|
| Hospital Charge Code |
z58263
|
| Min. Negotiated Rate |
$907.58 |
| Max. Negotiated Rate |
$121,100.00 |
| Rate for Payer: Aetna Commercial |
$939.37
|
| Rate for Payer: Aetna Commercial |
$939.37
|
| Rate for Payer: Aetna Medicare |
$939.37
|
| Rate for Payer: Aetna Medicare |
$939.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,266.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,266.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,266.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,266.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,266.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,266.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,266.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,266.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$907.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$907.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,080.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,080.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,033.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,033.31
|
| Rate for Payer: Cash Price |
$1,107.17
|
| Rate for Payer: Cash Price |
$1,090.52
|
| Rate for Payer: Centivo All Commercial |
$1,456.02
|
| Rate for Payer: Centivo All Commercial |
$1,456.02
|
| Rate for Payer: Cigna All Commercial |
$939.37
|
| Rate for Payer: Cigna All Commercial |
$939.37
|
| Rate for Payer: CORVEL All Commercial |
$939.37
|
| Rate for Payer: CORVEL All Commercial |
$939.37
|
| Rate for Payer: Coventry All Commercial |
$1,127.24
|
| Rate for Payer: Coventry All Commercial |
$1,127.24
|
| Rate for Payer: Encore All Commercial |
$939.37
|
| Rate for Payer: Encore All Commercial |
$939.37
|
| Rate for Payer: Frontpath All Commercial |
$1,305.46
|
| Rate for Payer: Frontpath All Commercial |
$1,305.46
|
| Rate for Payer: Humana ChoiceCare |
$1,066.08
|
| Rate for Payer: Humana ChoiceCare |
$1,066.08
|
| Rate for Payer: Humana Medicare |
$939.37
|
| Rate for Payer: Humana Medicare |
$939.37
|
| Rate for Payer: Lucent All Commercial |
$1,315.12
|
| Rate for Payer: Lucent All Commercial |
$1,315.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,304.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,304.00
|
| Rate for Payer: Managed Health Services Medicaid |
$907.58
|
| Rate for Payer: Managed Health Services Medicaid |
$907.58
|
| Rate for Payer: MDWise Medicaid |
$907.58
|
| Rate for Payer: MDWise Medicaid |
$907.58
|
| Rate for Payer: PHCS All Commercial |
$939.37
|
| Rate for Payer: PHCS All Commercial |
$939.37
|
| Rate for Payer: PHP All Commercial |
$1,199.57
|
| Rate for Payer: PHP All Commercial |
$1,199.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$939.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$939.37
|
| Rate for Payer: Sagamore Health Network All Products |
$939.37
|
| Rate for Payer: Sagamore Health Network All Products |
$939.37
|
| Rate for Payer: Signature Care EPO |
$1,197.65
|
| Rate for Payer: Signature Care EPO |
$1,197.65
|
| Rate for Payer: Signature Care PPO |
$1,197.65
|
| Rate for Payer: Signature Care PPO |
$1,197.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121,100.00
|
| Rate for Payer: United Healthcare Commercial |
$1,121.56
|
| Rate for Payer: United Healthcare Commercial |
$1,121.56
|
| Rate for Payer: United Healthcare Medicare |
$908.77
|
| Rate for Payer: United Healthcare Medicare |
$908.77
|
|
|
PR VAG HYST,UTERUS >250 GMS
|
Professional
|
Both
|
$2,131.46
|
|
|
Service Code
|
CPT 58290
|
| Hospital Charge Code |
z58290
|
| Min. Negotiated Rate |
$1,048.33 |
| Max. Negotiated Rate |
$140,100.00 |
| Rate for Payer: Aetna Commercial |
$1,087.84
|
| Rate for Payer: Aetna Commercial |
$1,087.84
|
| Rate for Payer: Aetna Medicare |
$1,087.84
|
| Rate for Payer: Aetna Medicare |
$1,087.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,488.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,488.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,488.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,488.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,488.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,488.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,488.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,488.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,048.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,048.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,251.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,251.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,196.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,196.62
|
| Rate for Payer: Cash Price |
$1,278.88
|
| Rate for Payer: Cash Price |
$1,261.61
|
| Rate for Payer: Centivo All Commercial |
$1,686.15
|
| Rate for Payer: Centivo All Commercial |
$1,686.15
|
| Rate for Payer: Cigna All Commercial |
$1,087.84
|
| Rate for Payer: Cigna All Commercial |
$1,087.84
|
| Rate for Payer: CORVEL All Commercial |
$1,087.84
|
| Rate for Payer: CORVEL All Commercial |
$1,087.84
|
| Rate for Payer: Coventry All Commercial |
$1,305.41
|
| Rate for Payer: Coventry All Commercial |
$1,305.41
|
| Rate for Payer: Encore All Commercial |
$1,087.84
|
| Rate for Payer: Encore All Commercial |
$1,087.84
|
| Rate for Payer: Frontpath All Commercial |
$1,514.40
|
| Rate for Payer: Frontpath All Commercial |
$1,514.40
|
| Rate for Payer: Humana ChoiceCare |
$1,252.98
|
| Rate for Payer: Humana ChoiceCare |
$1,252.98
|
| Rate for Payer: Humana Medicare |
$1,087.84
|
| Rate for Payer: Humana Medicare |
$1,087.84
|
| Rate for Payer: Lucent All Commercial |
$1,522.98
|
| Rate for Payer: Lucent All Commercial |
$1,522.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,509.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,509.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,048.33
|
| Rate for Payer: Managed Health Services Medicaid |
$1,048.33
|
| Rate for Payer: MDWise Medicaid |
$1,048.33
|
| Rate for Payer: MDWise Medicaid |
$1,048.33
|
| Rate for Payer: PHCS All Commercial |
$1,087.84
|
| Rate for Payer: PHCS All Commercial |
$1,087.84
|
| Rate for Payer: PHP All Commercial |
$1,387.77
|
| Rate for Payer: PHP All Commercial |
$1,387.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,087.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,087.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,087.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,087.84
|
| Rate for Payer: Signature Care EPO |
$1,380.40
|
| Rate for Payer: Signature Care EPO |
$1,380.40
|
| Rate for Payer: Signature Care PPO |
$1,380.40
|
| Rate for Payer: Signature Care PPO |
$1,380.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140,100.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.84
|
| Rate for Payer: United Healthcare Commercial |
$1,305.84
|
| Rate for Payer: United Healthcare Medicare |
$1,051.34
|
| Rate for Payer: United Healthcare Medicare |
$1,051.34
|
|
|
PR VAG HYST,UTERUS >250 GMS,REM TUBE/OVARY
|
Professional
|
Both
|
$2,302.34
|
|
|
Service Code
|
CPT 58291
|
| Hospital Charge Code |
z58291
|
| Min. Negotiated Rate |
$1,132.38 |
| Max. Negotiated Rate |
$151,400.00 |
| Rate for Payer: Aetna Commercial |
$1,175.63
|
| Rate for Payer: Aetna Commercial |
$1,175.63
|
| Rate for Payer: Aetna Medicare |
$1,175.63
|
| Rate for Payer: Aetna Medicare |
$1,175.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,624.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,624.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,624.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,624.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,624.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,624.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,624.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,624.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,132.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,132.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,351.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,351.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,293.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,293.19
|
| Rate for Payer: Cash Price |
$1,381.40
|
| Rate for Payer: Cash Price |
$1,363.21
|
| Rate for Payer: Centivo All Commercial |
$1,822.23
|
| Rate for Payer: Centivo All Commercial |
$1,822.23
|
| Rate for Payer: Cigna All Commercial |
$1,175.63
|
| Rate for Payer: Cigna All Commercial |
$1,175.63
|
| Rate for Payer: CORVEL All Commercial |
$1,175.63
|
| Rate for Payer: CORVEL All Commercial |
$1,175.63
|
| Rate for Payer: Coventry All Commercial |
$1,410.76
|
| Rate for Payer: Coventry All Commercial |
$1,410.76
|
| Rate for Payer: Encore All Commercial |
$1,175.63
|
| Rate for Payer: Encore All Commercial |
$1,175.63
|
| Rate for Payer: Frontpath All Commercial |
$1,637.12
|
| Rate for Payer: Frontpath All Commercial |
$1,637.12
|
| Rate for Payer: Humana ChoiceCare |
$1,366.92
|
| Rate for Payer: Humana ChoiceCare |
$1,366.92
|
| Rate for Payer: Humana Medicare |
$1,175.63
|
| Rate for Payer: Humana Medicare |
$1,175.63
|
| Rate for Payer: Lucent All Commercial |
$1,645.88
|
| Rate for Payer: Lucent All Commercial |
$1,645.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,630.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,630.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,132.38
|
| Rate for Payer: Managed Health Services Medicaid |
$1,132.38
|
| Rate for Payer: MDWise Medicaid |
$1,132.38
|
| Rate for Payer: MDWise Medicaid |
$1,132.38
|
| Rate for Payer: PHCS All Commercial |
$1,175.63
|
| Rate for Payer: PHCS All Commercial |
$1,175.63
|
| Rate for Payer: PHP All Commercial |
$1,499.53
|
| Rate for Payer: PHP All Commercial |
$1,499.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,175.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,175.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,175.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,175.63
|
| Rate for Payer: Signature Care EPO |
$1,518.10
|
| Rate for Payer: Signature Care EPO |
$1,518.10
|
| Rate for Payer: Signature Care PPO |
$1,518.10
|
| Rate for Payer: Signature Care PPO |
$1,518.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151,400.00
|
| Rate for Payer: United Healthcare Commercial |
$1,419.24
|
| Rate for Payer: United Healthcare Commercial |
$1,419.24
|
| Rate for Payer: United Healthcare Medicare |
$1,136.01
|
| Rate for Payer: United Healthcare Medicare |
$1,136.01
|
|
|
PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/<
|
Professional
|
Both
|
$1,558.10
|
|
|
Service Code
|
CPT 58260
|
| Hospital Charge Code |
z58260
|
| Min. Negotiated Rate |
$766.34 |
| Max. Negotiated Rate |
$102,200.00 |
| Rate for Payer: Aetna Commercial |
$793.13
|
| Rate for Payer: Aetna Commercial |
$793.13
|
| Rate for Payer: Aetna Medicare |
$793.13
|
| Rate for Payer: Aetna Medicare |
$793.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,039.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,039.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,039.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,039.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,039.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,039.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,039.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,039.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$766.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$766.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$912.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$912.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$872.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$872.44
|
| Rate for Payer: Cash Price |
$934.86
|
| Rate for Payer: Cash Price |
$920.60
|
| Rate for Payer: Centivo All Commercial |
$1,229.35
|
| Rate for Payer: Centivo All Commercial |
$1,229.35
|
| Rate for Payer: Cigna All Commercial |
$793.13
|
| Rate for Payer: Cigna All Commercial |
$793.13
|
| Rate for Payer: CORVEL All Commercial |
$793.13
|
| Rate for Payer: CORVEL All Commercial |
$793.13
|
| Rate for Payer: Coventry All Commercial |
$951.76
|
| Rate for Payer: Coventry All Commercial |
$951.76
|
| Rate for Payer: Encore All Commercial |
$793.13
|
| Rate for Payer: Encore All Commercial |
$793.13
|
| Rate for Payer: Frontpath All Commercial |
$1,100.88
|
| Rate for Payer: Frontpath All Commercial |
$1,100.88
|
| Rate for Payer: Humana ChoiceCare |
$874.55
|
| Rate for Payer: Humana ChoiceCare |
$874.55
|
| Rate for Payer: Humana Medicare |
$793.13
|
| Rate for Payer: Humana Medicare |
$793.13
|
| Rate for Payer: Lucent All Commercial |
$1,110.38
|
| Rate for Payer: Lucent All Commercial |
$1,110.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,101.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,101.00
|
| Rate for Payer: Managed Health Services Medicaid |
$766.34
|
| Rate for Payer: Managed Health Services Medicaid |
$766.34
|
| Rate for Payer: MDWise Medicaid |
$766.34
|
| Rate for Payer: MDWise Medicaid |
$766.34
|
| Rate for Payer: PHCS All Commercial |
$793.13
|
| Rate for Payer: PHCS All Commercial |
$793.13
|
| Rate for Payer: PHP All Commercial |
$1,012.67
|
| Rate for Payer: PHP All Commercial |
$1,012.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$793.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$793.13
|
| Rate for Payer: Sagamore Health Network All Products |
$793.13
|
| Rate for Payer: Sagamore Health Network All Products |
$793.13
|
| Rate for Payer: Signature Care EPO |
$1,049.75
|
| Rate for Payer: Signature Care EPO |
$1,049.75
|
| Rate for Payer: Signature Care PPO |
$1,049.75
|
| Rate for Payer: Signature Care PPO |
$1,049.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102,200.00
|
| Rate for Payer: United Healthcare Commercial |
$931.06
|
| Rate for Payer: United Healthcare Commercial |
$931.06
|
| Rate for Payer: United Healthcare Medicare |
$767.17
|
| Rate for Payer: United Healthcare Medicare |
$767.17
|
|
|
PR VASCULAR SURGERY PROCEDURE UNLIST
|
Professional
|
Both
|
$708.53
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
z37799
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$602.25 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$425.12
|
| Rate for Payer: Cash Price |
$425.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$602.25
|
| Rate for Payer: Signature Care EPO |
$451.69
|
| Rate for Payer: Signature Care PPO |
$451.69
|
|
|
PR VENT TUBE REMVL REQ GEN ANESTHESIA
|
Professional
|
Both
|
$237.22
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
z69424
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.22
|
| Rate for Payer: Cash Price |
$281.57
|
| Rate for Payer: Cash Price |
$142.33
|
| Rate for Payer: Cash Price |
$284.66
|
| Rate for Payer: Cash Price |
$140.78
|
| Rate for Payer: Centivo All Commercial |
$87.67
|
| Rate for Payer: Centivo All Commercial |
$87.67
|
| Rate for Payer: Centivo All Commercial |
$87.67
|
| Rate for Payer: Centivo All Commercial |
$87.67
|
| Rate for Payer: Cigna All Commercial |
$56.56
|
| Rate for Payer: Cigna All Commercial |
$56.56
|
| Rate for Payer: Cigna All Commercial |
$56.56
|
| Rate for Payer: Cigna All Commercial |
$56.56
|
| Rate for Payer: CORVEL All Commercial |
$56.56
|
| Rate for Payer: CORVEL All Commercial |
$56.56
|
| Rate for Payer: CORVEL All Commercial |
$56.56
|
| Rate for Payer: CORVEL All Commercial |
$56.56
|
| Rate for Payer: Coventry All Commercial |
$67.87
|
| Rate for Payer: Coventry All Commercial |
$67.87
|
| Rate for Payer: Coventry All Commercial |
$67.87
|
| Rate for Payer: Coventry All Commercial |
$67.87
|
| Rate for Payer: Encore All Commercial |
$56.56
|
| Rate for Payer: Encore All Commercial |
$56.56
|
| Rate for Payer: Encore All Commercial |
$56.56
|
| Rate for Payer: Encore All Commercial |
$56.56
|
| Rate for Payer: Frontpath All Commercial |
$76.84
|
| Rate for Payer: Frontpath All Commercial |
$76.84
|
| Rate for Payer: Frontpath All Commercial |
$76.84
|
| Rate for Payer: Frontpath All Commercial |
$76.84
|
| Rate for Payer: Humana ChoiceCare |
$62.79
|
| Rate for Payer: Humana ChoiceCare |
$62.79
|
| Rate for Payer: Humana ChoiceCare |
$62.79
|
| Rate for Payer: Humana ChoiceCare |
$62.79
|
| Rate for Payer: Humana Medicare |
$56.56
|
| Rate for Payer: Humana Medicare |
$56.56
|
| Rate for Payer: Humana Medicare |
$56.56
|
| Rate for Payer: Humana Medicare |
$56.56
|
| Rate for Payer: Lucent All Commercial |
$79.18
|
| Rate for Payer: Lucent All Commercial |
$79.18
|
| Rate for Payer: Lucent All Commercial |
$79.18
|
| Rate for Payer: Lucent All Commercial |
$79.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: Managed Health Services Medicaid |
$116.67
|
| Rate for Payer: Managed Health Services Medicaid |
$116.67
|
| Rate for Payer: Managed Health Services Medicaid |
$116.67
|
| Rate for Payer: Managed Health Services Medicaid |
$116.67
|
| Rate for Payer: MDWise Medicaid |
$116.67
|
| Rate for Payer: MDWise Medicaid |
$116.67
|
| Rate for Payer: MDWise Medicaid |
$116.67
|
| Rate for Payer: MDWise Medicaid |
$116.67
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.42
|
| Rate for Payer: PHCS All Commercial |
$56.56
|
| Rate for Payer: PHCS All Commercial |
$56.56
|
| Rate for Payer: PHCS All Commercial |
$56.56
|
| Rate for Payer: PHCS All Commercial |
$56.56
|
| Rate for Payer: PHP All Commercial |
$71.85
|
| Rate for Payer: PHP All Commercial |
$71.85
|
| Rate for Payer: PHP All Commercial |
$71.85
|
| Rate for Payer: PHP All Commercial |
$71.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.56
|
| Rate for Payer: Sagamore Health Network All Products |
$56.56
|
| Rate for Payer: Sagamore Health Network All Products |
$56.56
|
| Rate for Payer: Sagamore Health Network All Products |
$56.56
|
| Rate for Payer: Sagamore Health Network All Products |
$56.56
|
| Rate for Payer: Signature Care EPO |
$140.25
|
| Rate for Payer: Signature Care EPO |
$140.25
|
| Rate for Payer: Signature Care EPO |
$140.25
|
| Rate for Payer: Signature Care EPO |
$140.25
|
| Rate for Payer: Signature Care PPO |
$140.25
|
| Rate for Payer: Signature Care PPO |
$140.25
|
| Rate for Payer: Signature Care PPO |
$140.25
|
| Rate for Payer: Signature Care PPO |
$140.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare Commercial |
$68.35
|
| Rate for Payer: United Healthcare Commercial |
$68.35
|
| Rate for Payer: United Healthcare Commercial |
$68.35
|
| Rate for Payer: United Healthcare Commercial |
$68.35
|
| Rate for Payer: United Healthcare Medicare |
$117.32
|
| Rate for Payer: United Healthcare Medicare |
$117.32
|
| Rate for Payer: United Healthcare Medicare |
$117.32
|
| Rate for Payer: United Healthcare Medicare |
$117.32
|
|
|
PR VISUAL AUDIOMETRY (VRA)
|
Professional
|
Both
|
$84.26
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
z92579
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$36.39
|
| Rate for Payer: Aetna Commercial |
$36.39
|
| Rate for Payer: Aetna Medicare |
$36.39
|
| Rate for Payer: Aetna Medicare |
$36.39
|
| 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: Buckeye Health Medicaid OOS |
$16.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.03
|
| Rate for Payer: Cash Price |
$50.45
|
| Rate for Payer: Cash Price |
$50.56
|
| Rate for Payer: Centivo All Commercial |
$56.40
|
| Rate for Payer: Centivo All Commercial |
$56.40
|
| Rate for Payer: Cigna All Commercial |
$36.39
|
| Rate for Payer: Cigna All Commercial |
$36.39
|
| Rate for Payer: CORVEL All Commercial |
$36.39
|
| Rate for Payer: CORVEL All Commercial |
$36.39
|
| Rate for Payer: Coventry All Commercial |
$43.67
|
| Rate for Payer: Coventry All Commercial |
$43.67
|
| Rate for Payer: Encore All Commercial |
$36.39
|
| Rate for Payer: Encore All Commercial |
$36.39
|
| Rate for Payer: Frontpath All Commercial |
$41.17
|
| Rate for Payer: Frontpath All Commercial |
$41.17
|
| Rate for Payer: Humana ChoiceCare |
$30.49
|
| Rate for Payer: Humana ChoiceCare |
$30.49
|
| Rate for Payer: Humana Medicare |
$36.39
|
| Rate for Payer: Humana Medicare |
$36.39
|
| Rate for Payer: Lucent All Commercial |
$50.95
|
| Rate for Payer: Lucent All Commercial |
$50.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.00
|
| Rate for Payer: Managed Health Services Medicaid |
$41.35
|
| Rate for Payer: Managed Health Services Medicaid |
$41.35
|
| Rate for Payer: MDWise Medicaid |
$41.35
|
| Rate for Payer: MDWise Medicaid |
$41.35
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.62
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.62
|
| Rate for Payer: PHCS All Commercial |
$36.39
|
| Rate for Payer: PHCS All Commercial |
$36.39
|
| Rate for Payer: PHP All Commercial |
$50.61
|
| Rate for Payer: PHP All Commercial |
$50.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.39
|
| Rate for Payer: Sagamore Health Network All Products |
$36.39
|
| Rate for Payer: Sagamore Health Network All Products |
$36.39
|
| Rate for Payer: Signature Care EPO |
$37.55
|
| Rate for Payer: Signature Care EPO |
$37.55
|
| Rate for Payer: Signature Care PPO |
$37.55
|
| Rate for Payer: Signature Care PPO |
$37.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,300.00
|
| Rate for Payer: United Healthcare Commercial |
$48.49
|
| Rate for Payer: United Healthcare Commercial |
$48.49
|
| Rate for Payer: United Healthcare Medicare |
$42.13
|
| Rate for Payer: United Healthcare Medicare |
$42.13
|
|
|
PR VISUAL SCREENING TEST, BILAT
|
Professional
|
Both
|
$5.14
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
z99173
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.88
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Frontpath All Commercial |
$2.93
|
| Rate for Payer: Frontpath All Commercial |
$2.93
|
| Rate for Payer: Humana ChoiceCare |
$13.09
|
| Rate for Payer: Humana ChoiceCare |
$13.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2.88
|
| Rate for Payer: Managed Health Services Medicaid |
$2.88
|
| Rate for Payer: MDWise Medicaid |
$2.88
|
| Rate for Payer: MDWise Medicaid |
$2.88
|
| Rate for Payer: PHP All Commercial |
$3.08
|
| Rate for Payer: PHP All Commercial |
$3.08
|
| Rate for Payer: Signature Care EPO |
$5.30
|
| Rate for Payer: Signature Care EPO |
$5.30
|
| Rate for Payer: Signature Care PPO |
$5.30
|
| Rate for Payer: Signature Care PPO |
$5.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$2.31
|
| Rate for Payer: United Healthcare Commercial |
$2.31
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
|
|
PR VOIDING PRESS STUDY INTRA-ABDOMINAL VOID
|
Professional
|
Both
|
$299.10
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
z51797
|
| Min. Negotiated Rate |
$172.08 |
| Max. Negotiated Rate |
$288.22 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$185.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$172.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.54
|
| Rate for Payer: Cash Price |
$179.46
|
| Rate for Payer: Centivo All Commercial |
$288.22
|
| Rate for Payer: Cigna All Commercial |
$185.95
|
| Rate for Payer: CORVEL All Commercial |
$185.95
|
| Rate for Payer: Coventry All Commercial |
$223.14
|
| Rate for Payer: Encore All Commercial |
$185.95
|
| Rate for Payer: Frontpath All Commercial |
$246.94
|
| Rate for Payer: Humana ChoiceCare |
$264.69
|
| Rate for Payer: Humana Medicare |
$185.95
|
| Rate for Payer: Lucent All Commercial |
$260.33
|
| Rate for Payer: Managed Health Services Medicaid |
$172.08
|
| Rate for Payer: MDWise Medicaid |
$172.08
|
| Rate for Payer: PHCS All Commercial |
$185.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.95
|
| Rate for Payer: Sagamore Health Network All Products |
$185.95
|
| Rate for Payer: United Healthcare Commercial |
$175.58
|
|
|
PR WEDGE BIOPSY OF LIVER
|
Professional
|
Both
|
$1,544.72
|
|
|
Service Code
|
CPT 47100
|
| Hospital Charge Code |
z47100
|
| Min. Negotiated Rate |
$586.30 |
| Max. Negotiated Rate |
$108,800.00 |
| Rate for Payer: Aetna Commercial |
$787.89
|
| Rate for Payer: Aetna Commercial |
$787.89
|
| Rate for Payer: Aetna Medicare |
$787.89
|
| Rate for Payer: Aetna Medicare |
$787.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$586.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$586.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$586.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$586.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$759.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$759.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$906.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$906.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$866.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$866.68
|
| Rate for Payer: Cash Price |
$926.83
|
| Rate for Payer: Cash Price |
$910.15
|
| Rate for Payer: Centivo All Commercial |
$1,221.23
|
| Rate for Payer: Centivo All Commercial |
$1,221.23
|
| Rate for Payer: Cigna All Commercial |
$787.89
|
| Rate for Payer: Cigna All Commercial |
$787.89
|
| Rate for Payer: CORVEL All Commercial |
$787.89
|
| Rate for Payer: CORVEL All Commercial |
$787.89
|
| Rate for Payer: Coventry All Commercial |
$945.47
|
| Rate for Payer: Coventry All Commercial |
$945.47
|
| Rate for Payer: Encore All Commercial |
$787.89
|
| Rate for Payer: Encore All Commercial |
$787.89
|
| Rate for Payer: Frontpath All Commercial |
$1,119.13
|
| Rate for Payer: Frontpath All Commercial |
$1,119.13
|
| Rate for Payer: Humana ChoiceCare |
$807.39
|
| Rate for Payer: Humana ChoiceCare |
$807.39
|
| Rate for Payer: Humana Medicare |
$787.89
|
| Rate for Payer: Humana Medicare |
$787.89
|
| Rate for Payer: Lucent All Commercial |
$1,103.05
|
| Rate for Payer: Lucent All Commercial |
$1,103.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,166.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,166.00
|
| Rate for Payer: Managed Health Services Medicaid |
$759.75
|
| Rate for Payer: Managed Health Services Medicaid |
$759.75
|
| Rate for Payer: MDWise Medicaid |
$759.75
|
| Rate for Payer: MDWise Medicaid |
$759.75
|
| Rate for Payer: PHCS All Commercial |
$787.89
|
| Rate for Payer: PHCS All Commercial |
$787.89
|
| Rate for Payer: PHP All Commercial |
$1,327.31
|
| Rate for Payer: PHP All Commercial |
$1,327.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$787.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$787.89
|
| Rate for Payer: Sagamore Health Network All Products |
$787.89
|
| Rate for Payer: Sagamore Health Network All Products |
$787.89
|
| Rate for Payer: Signature Care EPO |
$1,010.65
|
| Rate for Payer: Signature Care EPO |
$1,010.65
|
| Rate for Payer: Signature Care PPO |
$1,010.65
|
| Rate for Payer: Signature Care PPO |
$1,010.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108,800.00
|
| Rate for Payer: United Healthcare Commercial |
$881.53
|
| Rate for Payer: United Healthcare Commercial |
$881.53
|
| Rate for Payer: United Healthcare Medicare |
$758.46
|
| Rate for Payer: United Healthcare Medicare |
$758.46
|
|
|
PR WEDGING OF CAST
|
Professional
|
Both
|
$184.50
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
z29740
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$63.95
|
| Rate for Payer: Aetna Commercial |
$63.95
|
| Rate for Payer: Aetna Medicare |
$63.95
|
| Rate for Payer: Aetna Medicare |
$63.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.99
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.34
|
| Rate for Payer: Cash Price |
$107.12
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Centivo All Commercial |
$99.12
|
| Rate for Payer: Centivo All Commercial |
$99.12
|
| Rate for Payer: Cigna All Commercial |
$63.95
|
| Rate for Payer: Cigna All Commercial |
$63.95
|
| Rate for Payer: CORVEL All Commercial |
$63.95
|
| Rate for Payer: CORVEL All Commercial |
$63.95
|
| Rate for Payer: Coventry All Commercial |
$76.74
|
| Rate for Payer: Coventry All Commercial |
$76.74
|
| Rate for Payer: Encore All Commercial |
$63.95
|
| Rate for Payer: Encore All Commercial |
$63.95
|
| Rate for Payer: Frontpath All Commercial |
$90.05
|
| Rate for Payer: Frontpath All Commercial |
$90.05
|
| Rate for Payer: Humana ChoiceCare |
$71.70
|
| Rate for Payer: Humana ChoiceCare |
$71.70
|
| Rate for Payer: Humana Medicare |
$63.95
|
| Rate for Payer: Humana Medicare |
$63.95
|
| Rate for Payer: Lucent All Commercial |
$89.53
|
| Rate for Payer: Lucent All Commercial |
$89.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: Managed Health Services Medicaid |
$90.74
|
| Rate for Payer: Managed Health Services Medicaid |
$90.74
|
| Rate for Payer: MDWise Medicaid |
$90.74
|
| Rate for Payer: MDWise Medicaid |
$90.74
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.30
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.30
|
| Rate for Payer: PHCS All Commercial |
$63.95
|
| Rate for Payer: PHCS All Commercial |
$63.95
|
| Rate for Payer: PHP All Commercial |
$107.65
|
| Rate for Payer: PHP All Commercial |
$107.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.95
|
| Rate for Payer: Sagamore Health Network All Products |
$63.95
|
| Rate for Payer: Sagamore Health Network All Products |
$63.95
|
| Rate for Payer: Signature Care EPO |
$130.05
|
| Rate for Payer: Signature Care EPO |
$130.05
|
| Rate for Payer: Signature Care PPO |
$130.05
|
| Rate for Payer: Signature Care PPO |
$130.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,500.00
|
| Rate for Payer: United Healthcare Commercial |
$75.23
|
| Rate for Payer: United Healthcare Commercial |
$75.23
|
| Rate for Payer: United Healthcare Medicare |
$89.27
|
| Rate for Payer: United Healthcare Medicare |
$89.27
|
|
|
PR WINDOWING OF CAST
|
Professional
|
Both
|
$121.64
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
z29730
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$6,200.00 |
| Rate for Payer: Aetna Commercial |
$41.28
|
| Rate for Payer: Aetna Commercial |
$41.28
|
| Rate for Payer: Aetna Medicare |
$41.28
|
| Rate for Payer: Aetna Medicare |
$41.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$83.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$83.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.86
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$59.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$59.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.41
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$72.98
|
| Rate for Payer: Centivo All Commercial |
$63.98
|
| Rate for Payer: Centivo All Commercial |
$63.98
|
| Rate for Payer: Cigna All Commercial |
$41.28
|
| Rate for Payer: Cigna All Commercial |
$41.28
|
| Rate for Payer: CORVEL All Commercial |
$41.28
|
| Rate for Payer: CORVEL All Commercial |
$41.28
|
| Rate for Payer: Coventry All Commercial |
$49.54
|
| Rate for Payer: Coventry All Commercial |
$49.54
|
| Rate for Payer: Encore All Commercial |
$41.28
|
| Rate for Payer: Encore All Commercial |
$41.28
|
| Rate for Payer: Frontpath All Commercial |
$57.30
|
| Rate for Payer: Frontpath All Commercial |
$57.30
|
| Rate for Payer: Humana ChoiceCare |
$48.87
|
| Rate for Payer: Humana ChoiceCare |
$48.87
|
| Rate for Payer: Humana Medicare |
$41.28
|
| Rate for Payer: Humana Medicare |
$41.28
|
| Rate for Payer: Lucent All Commercial |
$57.79
|
| Rate for Payer: Lucent All Commercial |
$57.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Managed Health Services Medicaid |
$59.83
|
| Rate for Payer: Managed Health Services Medicaid |
$59.83
|
| Rate for Payer: MDWise Medicaid |
$59.83
|
| Rate for Payer: MDWise Medicaid |
$59.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.50
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.50
|
| Rate for Payer: PHCS All Commercial |
$41.28
|
| Rate for Payer: PHCS All Commercial |
$41.28
|
| Rate for Payer: PHP All Commercial |
$70.01
|
| Rate for Payer: PHP All Commercial |
$70.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.28
|
| Rate for Payer: Sagamore Health Network All Products |
$41.28
|
| Rate for Payer: Sagamore Health Network All Products |
$41.28
|
| Rate for Payer: Signature Care EPO |
$88.40
|
| Rate for Payer: Signature Care EPO |
$88.40
|
| Rate for Payer: Signature Care PPO |
$88.40
|
| Rate for Payer: Signature Care PPO |
$88.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,200.00
|
| Rate for Payer: United Healthcare Commercial |
$51.54
|
| Rate for Payer: United Healthcare Commercial |
$51.54
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
|
|
PR WND PREP PED, FACE/NCK/HND/FT/GEN 1ST 100 CM
|
Professional
|
Both
|
$727.60
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
z15004
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$29,100.00 |
| Rate for Payer: Aetna Commercial |
$244.95
|
| Rate for Payer: Aetna Commercial |
$244.95
|
| Rate for Payer: Aetna Medicare |
$244.95
|
| Rate for Payer: Aetna Medicare |
$244.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$436.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$436.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$436.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$436.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$436.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$436.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$436.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$436.07
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$132.72
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$132.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$357.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$357.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.44
|
| Rate for Payer: Cash Price |
$431.58
|
| Rate for Payer: Cash Price |
$436.56
|
| Rate for Payer: Centivo All Commercial |
$379.67
|
| Rate for Payer: Centivo All Commercial |
$379.67
|
| Rate for Payer: Cigna All Commercial |
$244.95
|
| Rate for Payer: Cigna All Commercial |
$244.95
|
| Rate for Payer: CORVEL All Commercial |
$244.95
|
| Rate for Payer: CORVEL All Commercial |
$244.95
|
| Rate for Payer: Coventry All Commercial |
$293.94
|
| Rate for Payer: Coventry All Commercial |
$293.94
|
| Rate for Payer: Encore All Commercial |
$244.95
|
| Rate for Payer: Encore All Commercial |
$244.95
|
| Rate for Payer: Frontpath All Commercial |
$338.26
|
| Rate for Payer: Frontpath All Commercial |
$338.26
|
| Rate for Payer: Humana ChoiceCare |
$234.01
|
| Rate for Payer: Humana ChoiceCare |
$234.01
|
| Rate for Payer: Humana Medicare |
$244.95
|
| Rate for Payer: Humana Medicare |
$244.95
|
| Rate for Payer: Lucent All Commercial |
$342.93
|
| Rate for Payer: Lucent All Commercial |
$342.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Managed Health Services Medicaid |
$357.86
|
| Rate for Payer: Managed Health Services Medicaid |
$357.86
|
| Rate for Payer: MDWise Medicaid |
$357.86
|
| Rate for Payer: MDWise Medicaid |
$357.86
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$132.72
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$132.72
|
| Rate for Payer: PHCS All Commercial |
$244.95
|
| Rate for Payer: PHCS All Commercial |
$244.95
|
| Rate for Payer: PHP All Commercial |
$331.05
|
| Rate for Payer: PHP All Commercial |
$331.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.95
|
| Rate for Payer: Sagamore Health Network All Products |
$244.95
|
| Rate for Payer: Sagamore Health Network All Products |
$244.95
|
| Rate for Payer: Signature Care EPO |
$368.05
|
| Rate for Payer: Signature Care EPO |
$368.05
|
| Rate for Payer: Signature Care PPO |
$368.05
|
| Rate for Payer: Signature Care PPO |
$368.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,100.00
|
| Rate for Payer: United Healthcare Commercial |
$311.79
|
| Rate for Payer: United Healthcare Commercial |
$311.79
|
| Rate for Payer: United Healthcare Medicare |
$359.65
|
| Rate for Payer: United Healthcare Medicare |
$359.65
|
|
