|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$27.68
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
z99406
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$7.72
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$7.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.57
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Centivo All Commercial |
$17.72
|
| Rate for Payer: Centivo All Commercial |
$17.72
|
| Rate for Payer: Cigna All Commercial |
$11.43
|
| Rate for Payer: Cigna All Commercial |
$11.43
|
| Rate for Payer: CORVEL All Commercial |
$11.43
|
| Rate for Payer: CORVEL All Commercial |
$11.43
|
| Rate for Payer: Coventry All Commercial |
$13.72
|
| Rate for Payer: Coventry All Commercial |
$13.72
|
| Rate for Payer: Encore All Commercial |
$11.43
|
| Rate for Payer: Encore All Commercial |
$11.43
|
| Rate for Payer: Frontpath All Commercial |
$12.51
|
| Rate for Payer: Frontpath All Commercial |
$12.51
|
| Rate for Payer: Humana ChoiceCare |
$10.97
|
| Rate for Payer: Humana ChoiceCare |
$10.97
|
| Rate for Payer: Humana Medicare |
$11.43
|
| Rate for Payer: Humana Medicare |
$11.43
|
| Rate for Payer: Lucent All Commercial |
$16.00
|
| Rate for Payer: Lucent All Commercial |
$16.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.61
|
| Rate for Payer: Managed Health Services Medicaid |
$13.61
|
| Rate for Payer: MDWise Medicaid |
$13.61
|
| Rate for Payer: MDWise Medicaid |
$13.61
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$7.72
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$7.72
|
| Rate for Payer: PHCS All Commercial |
$11.43
|
| Rate for Payer: PHCS All Commercial |
$11.43
|
| Rate for Payer: PHP All Commercial |
$11.29
|
| Rate for Payer: PHP All Commercial |
$11.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.43
|
| Rate for Payer: Sagamore Health Network All Products |
$11.43
|
| Rate for Payer: Sagamore Health Network All Products |
$11.43
|
| Rate for Payer: Signature Care EPO |
$12.36
|
| Rate for Payer: Signature Care EPO |
$12.36
|
| Rate for Payer: Signature Care PPO |
$12.36
|
| Rate for Payer: Signature Care PPO |
$12.36
|
| 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 |
$11.75
|
| Rate for Payer: United Healthcare Commercial |
$11.75
|
| Rate for Payer: United Healthcare Medicare |
$13.67
|
| Rate for Payer: United Healthcare Medicare |
$13.67
|
|
|
PR TONE DECAY HEARING TEST
|
Professional
|
Both
|
$63.54
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
z92563
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$29.13
|
| Rate for Payer: Aetna Commercial |
$29.13
|
| Rate for Payer: Aetna Medicare |
$29.13
|
| Rate for Payer: Aetna Medicare |
$29.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.04
|
| Rate for Payer: Cash Price |
$39.39
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Centivo All Commercial |
$45.15
|
| Rate for Payer: Centivo All Commercial |
$45.15
|
| Rate for Payer: Cigna All Commercial |
$29.13
|
| Rate for Payer: Cigna All Commercial |
$29.13
|
| Rate for Payer: CORVEL All Commercial |
$29.13
|
| Rate for Payer: CORVEL All Commercial |
$29.13
|
| Rate for Payer: Coventry All Commercial |
$34.96
|
| Rate for Payer: Coventry All Commercial |
$34.96
|
| Rate for Payer: Encore All Commercial |
$29.13
|
| Rate for Payer: Encore All Commercial |
$29.13
|
| Rate for Payer: Frontpath All Commercial |
$32.74
|
| Rate for Payer: Frontpath All Commercial |
$32.74
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana Medicare |
$29.13
|
| Rate for Payer: Humana Medicare |
$29.13
|
| Rate for Payer: Lucent All Commercial |
$40.78
|
| Rate for Payer: Lucent All Commercial |
$40.78
|
| 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 |
$31.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.25
|
| Rate for Payer: MDWise Medicaid |
$31.25
|
| Rate for Payer: MDWise Medicaid |
$31.25
|
| Rate for Payer: PHCS All Commercial |
$29.13
|
| Rate for Payer: PHCS All Commercial |
$29.13
|
| Rate for Payer: PHP All Commercial |
$43.03
|
| Rate for Payer: PHP All Commercial |
$43.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.13
|
| Rate for Payer: Sagamore Health Network All Products |
$29.13
|
| Rate for Payer: Sagamore Health Network All Products |
$29.13
|
| Rate for Payer: Signature Care EPO |
$24.76
|
| Rate for Payer: Signature Care EPO |
$24.76
|
| Rate for Payer: Signature Care PPO |
$24.76
|
| Rate for Payer: Signature Care PPO |
$24.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,600.00
|
| Rate for Payer: United Healthcare Commercial |
$22.60
|
| Rate for Payer: United Healthcare Commercial |
$22.60
|
| Rate for Payer: United Healthcare Medicare |
$29.67
|
| Rate for Payer: United Healthcare Medicare |
$29.67
|
|
|
PR TOTAL ABDOM HYSTERECTOMY
|
Professional
|
Both
|
$1,884.74
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
z58150
|
| Min. Negotiated Rate |
$923.79 |
| Max. Negotiated Rate |
$123,100.00 |
| Rate for Payer: Aetna Commercial |
$953.24
|
| Rate for Payer: Aetna Commercial |
$953.24
|
| Rate for Payer: Aetna Medicare |
$953.24
|
| Rate for Payer: Aetna Medicare |
$953.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,202.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$926.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$926.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,096.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,096.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.56
|
| Rate for Payer: Cash Price |
$1,168.54
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Centivo All Commercial |
$1,477.52
|
| Rate for Payer: Centivo All Commercial |
$1,477.52
|
| Rate for Payer: Cigna All Commercial |
$953.24
|
| Rate for Payer: Cigna All Commercial |
$953.24
|
| Rate for Payer: CORVEL All Commercial |
$953.24
|
| Rate for Payer: CORVEL All Commercial |
$953.24
|
| Rate for Payer: Coventry All Commercial |
$1,143.89
|
| Rate for Payer: Coventry All Commercial |
$1,143.89
|
| Rate for Payer: Encore All Commercial |
$953.24
|
| Rate for Payer: Encore All Commercial |
$953.24
|
| Rate for Payer: Frontpath All Commercial |
$1,325.65
|
| Rate for Payer: Frontpath All Commercial |
$1,325.65
|
| Rate for Payer: Humana ChoiceCare |
$1,011.72
|
| Rate for Payer: Humana ChoiceCare |
$1,011.72
|
| Rate for Payer: Humana Medicare |
$953.24
|
| Rate for Payer: Humana Medicare |
$953.24
|
| Rate for Payer: Lucent All Commercial |
$1,334.54
|
| Rate for Payer: Lucent All Commercial |
$1,334.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,326.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,326.00
|
| Rate for Payer: Managed Health Services Medicaid |
$926.99
|
| Rate for Payer: Managed Health Services Medicaid |
$926.99
|
| Rate for Payer: MDWise Medicaid |
$926.99
|
| Rate for Payer: MDWise Medicaid |
$926.99
|
| Rate for Payer: PHCS All Commercial |
$953.24
|
| Rate for Payer: PHCS All Commercial |
$953.24
|
| Rate for Payer: PHP All Commercial |
$1,219.40
|
| Rate for Payer: PHP All Commercial |
$1,219.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$953.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$953.24
|
| Rate for Payer: Sagamore Health Network All Products |
$953.24
|
| Rate for Payer: Sagamore Health Network All Products |
$953.24
|
| Rate for Payer: Signature Care EPO |
$1,214.65
|
| Rate for Payer: Signature Care EPO |
$1,214.65
|
| Rate for Payer: Signature Care PPO |
$1,214.65
|
| Rate for Payer: Signature Care PPO |
$1,214.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123,100.00
|
| Rate for Payer: United Healthcare Commercial |
$1,115.96
|
| Rate for Payer: United Healthcare Commercial |
$1,115.96
|
| Rate for Payer: United Healthcare Medicare |
$923.79
|
| Rate for Payer: United Healthcare Medicare |
$923.79
|
|
|
PR TOTAL HIP ARTHROPLASTY
|
Professional
|
Both
|
$2,355.72
|
|
|
Service Code
|
CPT 27130
|
| Hospital Charge Code |
z27130
|
| Min. Negotiated Rate |
$1,157.12 |
| Max. Negotiated Rate |
$177,900.00 |
| Rate for Payer: Aetna Commercial |
$1,191.62
|
| Rate for Payer: Aetna Commercial |
$1,191.62
|
| Rate for Payer: Aetna Medicare |
$1,191.62
|
| Rate for Payer: Aetna Medicare |
$1,191.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,975.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,158.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,158.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,370.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,370.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,310.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,310.78
|
| Rate for Payer: Cash Price |
$1,460.55
|
| Rate for Payer: Cash Price |
$1,434.83
|
| Rate for Payer: Centivo All Commercial |
$1,847.01
|
| Rate for Payer: Centivo All Commercial |
$1,847.01
|
| Rate for Payer: Cigna All Commercial |
$1,191.62
|
| Rate for Payer: Cigna All Commercial |
$1,191.62
|
| Rate for Payer: CORVEL All Commercial |
$1,191.62
|
| Rate for Payer: CORVEL All Commercial |
$1,191.62
|
| Rate for Payer: Coventry All Commercial |
$1,429.94
|
| Rate for Payer: Coventry All Commercial |
$1,429.94
|
| Rate for Payer: Encore All Commercial |
$1,191.62
|
| Rate for Payer: Encore All Commercial |
$1,191.62
|
| Rate for Payer: Frontpath All Commercial |
$1,671.01
|
| Rate for Payer: Frontpath All Commercial |
$1,671.01
|
| Rate for Payer: Humana ChoiceCare |
$1,471.36
|
| Rate for Payer: Humana ChoiceCare |
$1,471.36
|
| Rate for Payer: Humana Medicare |
$1,191.62
|
| Rate for Payer: Humana Medicare |
$1,191.62
|
| Rate for Payer: Lucent All Commercial |
$1,668.27
|
| Rate for Payer: Lucent All Commercial |
$1,668.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,898.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,898.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,158.64
|
| Rate for Payer: Managed Health Services Medicaid |
$1,158.64
|
| Rate for Payer: MDWise Medicaid |
$1,158.64
|
| Rate for Payer: MDWise Medicaid |
$1,158.64
|
| Rate for Payer: PHCS All Commercial |
$1,191.62
|
| Rate for Payer: PHCS All Commercial |
$1,191.62
|
| Rate for Payer: PHP All Commercial |
$2,013.39
|
| Rate for Payer: PHP All Commercial |
$2,013.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,191.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,191.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,191.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,191.62
|
| Rate for Payer: Signature Care EPO |
$2,025.75
|
| Rate for Payer: Signature Care EPO |
$2,025.75
|
| Rate for Payer: Signature Care PPO |
$2,025.75
|
| Rate for Payer: Signature Care PPO |
$2,025.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177,900.00
|
| Rate for Payer: United Healthcare Commercial |
$1,589.68
|
| Rate for Payer: United Healthcare Commercial |
$1,589.68
|
| Rate for Payer: United Healthcare Medicare |
$1,157.12
|
| Rate for Payer: United Healthcare Medicare |
$1,157.12
|
|
|
PR TOTAL KNEE ARTHROPLASTY
|
Professional
|
Both
|
$2,352.62
|
|
|
Service Code
|
CPT 27447
|
| Hospital Charge Code |
z27447
|
| Min. Negotiated Rate |
$1,156.06 |
| Max. Negotiated Rate |
$177,700.00 |
| Rate for Payer: Aetna Commercial |
$1,190.52
|
| Rate for Payer: Aetna Commercial |
$1,190.52
|
| Rate for Payer: Aetna Medicare |
$1,190.52
|
| Rate for Payer: Aetna Medicare |
$1,190.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,089.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,157.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,157.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,369.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,369.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,309.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,309.57
|
| Rate for Payer: Cash Price |
$1,458.62
|
| Rate for Payer: Cash Price |
$1,433.51
|
| Rate for Payer: Centivo All Commercial |
$1,845.31
|
| Rate for Payer: Centivo All Commercial |
$1,845.31
|
| Rate for Payer: Cigna All Commercial |
$1,190.52
|
| Rate for Payer: Cigna All Commercial |
$1,190.52
|
| Rate for Payer: CORVEL All Commercial |
$1,190.52
|
| Rate for Payer: CORVEL All Commercial |
$1,190.52
|
| Rate for Payer: Coventry All Commercial |
$1,428.62
|
| Rate for Payer: Coventry All Commercial |
$1,428.62
|
| Rate for Payer: Encore All Commercial |
$1,190.52
|
| Rate for Payer: Encore All Commercial |
$1,190.52
|
| Rate for Payer: Frontpath All Commercial |
$1,669.28
|
| Rate for Payer: Frontpath All Commercial |
$1,669.28
|
| Rate for Payer: Humana ChoiceCare |
$1,587.67
|
| Rate for Payer: Humana ChoiceCare |
$1,587.67
|
| Rate for Payer: Humana Medicare |
$1,190.52
|
| Rate for Payer: Humana Medicare |
$1,190.52
|
| Rate for Payer: Lucent All Commercial |
$1,666.73
|
| Rate for Payer: Lucent All Commercial |
$1,666.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,896.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,896.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,157.11
|
| Rate for Payer: Managed Health Services Medicaid |
$1,157.11
|
| Rate for Payer: MDWise Medicaid |
$1,157.11
|
| Rate for Payer: MDWise Medicaid |
$1,157.11
|
| Rate for Payer: PHCS All Commercial |
$1,190.52
|
| Rate for Payer: PHCS All Commercial |
$1,190.52
|
| Rate for Payer: PHP All Commercial |
$2,011.54
|
| Rate for Payer: PHP All Commercial |
$2,011.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,190.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,190.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,190.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,190.52
|
| Rate for Payer: Signature Care EPO |
$2,023.88
|
| Rate for Payer: Signature Care EPO |
$2,023.88
|
| Rate for Payer: Signature Care PPO |
$2,023.88
|
| Rate for Payer: Signature Care PPO |
$2,023.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,701.71
|
| Rate for Payer: United Healthcare Commercial |
$1,701.71
|
| Rate for Payer: United Healthcare Medicare |
$1,156.06
|
| Rate for Payer: United Healthcare Medicare |
$1,156.06
|
|
|
PR TRACHEOBRNCHSC THRU EST TRACHS INC
|
Professional
|
Both
|
$320.24
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
z31615
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$16,100.00 |
| Rate for Payer: Aetna Commercial |
$107.88
|
| Rate for Payer: Aetna Commercial |
$107.88
|
| Rate for Payer: Aetna Medicare |
$107.88
|
| Rate for Payer: Aetna Medicare |
$107.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$227.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.36
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$157.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$157.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.67
|
| Rate for Payer: Cash Price |
$195.70
|
| Rate for Payer: Cash Price |
$198.55
|
| Rate for Payer: Centivo All Commercial |
$167.21
|
| Rate for Payer: Centivo All Commercial |
$167.21
|
| Rate for Payer: Cigna All Commercial |
$107.88
|
| Rate for Payer: Cigna All Commercial |
$107.88
|
| Rate for Payer: CORVEL All Commercial |
$107.88
|
| Rate for Payer: CORVEL All Commercial |
$107.88
|
| Rate for Payer: Coventry All Commercial |
$129.46
|
| Rate for Payer: Coventry All Commercial |
$129.46
|
| Rate for Payer: Encore All Commercial |
$107.88
|
| Rate for Payer: Encore All Commercial |
$107.88
|
| Rate for Payer: Frontpath All Commercial |
$148.07
|
| Rate for Payer: Frontpath All Commercial |
$148.07
|
| Rate for Payer: Humana ChoiceCare |
$149.51
|
| Rate for Payer: Humana ChoiceCare |
$149.51
|
| Rate for Payer: Humana Medicare |
$107.88
|
| Rate for Payer: Humana Medicare |
$107.88
|
| Rate for Payer: Lucent All Commercial |
$151.03
|
| Rate for Payer: Lucent All Commercial |
$151.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.00
|
| Rate for Payer: Managed Health Services Medicaid |
$157.51
|
| Rate for Payer: Managed Health Services Medicaid |
$157.51
|
| Rate for Payer: MDWise Medicaid |
$157.51
|
| Rate for Payer: MDWise Medicaid |
$157.51
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$74.36
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$74.36
|
| Rate for Payer: PHCS All Commercial |
$107.88
|
| Rate for Payer: PHCS All Commercial |
$107.88
|
| Rate for Payer: PHP All Commercial |
$146.74
|
| Rate for Payer: PHP All Commercial |
$146.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.88
|
| Rate for Payer: Sagamore Health Network All Products |
$107.88
|
| Rate for Payer: Sagamore Health Network All Products |
$107.88
|
| Rate for Payer: Signature Care EPO |
$246.50
|
| Rate for Payer: Signature Care EPO |
$246.50
|
| Rate for Payer: Signature Care PPO |
$246.50
|
| Rate for Payer: Signature Care PPO |
$246.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,100.00
|
| Rate for Payer: United Healthcare Commercial |
$144.49
|
| Rate for Payer: United Healthcare Commercial |
$144.49
|
| Rate for Payer: United Healthcare Medicare |
$157.82
|
| Rate for Payer: United Healthcare Medicare |
$157.82
|
|
|
PR TRANSFER SKIN PEDICLE FLAP
|
Professional
|
Both
|
$983.02
|
|
|
Service Code
|
CPT 15650
|
| Hospital Charge Code |
z15650
|
| Min. Negotiated Rate |
$193.97 |
| Max. Negotiated Rate |
$44,900.00 |
| Rate for Payer: Aetna Commercial |
$354.66
|
| Rate for Payer: Aetna Commercial |
$354.66
|
| Rate for Payer: Aetna Medicare |
$354.66
|
| Rate for Payer: Aetna Medicare |
$354.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$193.97
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$193.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$493.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$493.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$390.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$390.13
|
| Rate for Payer: Cash Price |
$621.91
|
| Rate for Payer: Cash Price |
$609.47
|
| Rate for Payer: Centivo All Commercial |
$549.72
|
| Rate for Payer: Centivo All Commercial |
$549.72
|
| Rate for Payer: Cigna All Commercial |
$354.66
|
| Rate for Payer: Cigna All Commercial |
$354.66
|
| Rate for Payer: CORVEL All Commercial |
$354.66
|
| Rate for Payer: CORVEL All Commercial |
$354.66
|
| Rate for Payer: Coventry All Commercial |
$425.59
|
| Rate for Payer: Coventry All Commercial |
$425.59
|
| Rate for Payer: Encore All Commercial |
$354.66
|
| Rate for Payer: Encore All Commercial |
$354.66
|
| Rate for Payer: Frontpath All Commercial |
$485.06
|
| Rate for Payer: Frontpath All Commercial |
$485.06
|
| Rate for Payer: Humana ChoiceCare |
$301.91
|
| Rate for Payer: Humana ChoiceCare |
$301.91
|
| Rate for Payer: Humana Medicare |
$354.66
|
| Rate for Payer: Humana Medicare |
$354.66
|
| Rate for Payer: Lucent All Commercial |
$496.52
|
| Rate for Payer: Lucent All Commercial |
$496.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$487.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$487.00
|
| Rate for Payer: Managed Health Services Medicaid |
$493.36
|
| Rate for Payer: Managed Health Services Medicaid |
$493.36
|
| Rate for Payer: MDWise Medicaid |
$493.36
|
| Rate for Payer: MDWise Medicaid |
$493.36
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$193.97
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$193.97
|
| Rate for Payer: PHCS All Commercial |
$354.66
|
| Rate for Payer: PHCS All Commercial |
$354.66
|
| Rate for Payer: PHP All Commercial |
$511.44
|
| Rate for Payer: PHP All Commercial |
$511.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$354.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$354.66
|
| Rate for Payer: Sagamore Health Network All Products |
$354.66
|
| Rate for Payer: Sagamore Health Network All Products |
$354.66
|
| Rate for Payer: Signature Care EPO |
$432.65
|
| Rate for Payer: Signature Care EPO |
$432.65
|
| Rate for Payer: Signature Care PPO |
$432.65
|
| Rate for Payer: Signature Care PPO |
$432.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,900.00
|
| Rate for Payer: United Healthcare Commercial |
$412.15
|
| Rate for Payer: United Healthcare Commercial |
$412.15
|
| Rate for Payer: United Healthcare Medicare |
$491.51
|
| Rate for Payer: United Healthcare Medicare |
$491.51
|
|
|
PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
Both
|
$509.64
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
z99496
|
| Min. Negotiated Rate |
$185.79 |
| Max. Negotiated Rate |
$287.97 |
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Medicare |
$185.79
|
| Rate for Payer: Aetna Medicare |
$185.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.37
|
| Rate for Payer: Cash Price |
$327.55
|
| Rate for Payer: Cash Price |
$315.98
|
| Rate for Payer: Centivo All Commercial |
$287.97
|
| Rate for Payer: Centivo All Commercial |
$287.97
|
| Rate for Payer: Cigna All Commercial |
$185.79
|
| Rate for Payer: Cigna All Commercial |
$185.79
|
| Rate for Payer: CORVEL All Commercial |
$185.79
|
| Rate for Payer: CORVEL All Commercial |
$185.79
|
| Rate for Payer: Coventry All Commercial |
$222.95
|
| Rate for Payer: Coventry All Commercial |
$222.95
|
| Rate for Payer: Encore All Commercial |
$185.79
|
| Rate for Payer: Encore All Commercial |
$185.79
|
| Rate for Payer: Frontpath All Commercial |
$199.41
|
| Rate for Payer: Frontpath All Commercial |
$199.41
|
| Rate for Payer: Humana ChoiceCare |
$200.38
|
| Rate for Payer: Humana ChoiceCare |
$200.38
|
| Rate for Payer: Humana Medicare |
$185.79
|
| Rate for Payer: Humana Medicare |
$185.79
|
| Rate for Payer: Lucent All Commercial |
$260.11
|
| Rate for Payer: Lucent All Commercial |
$260.11
|
| Rate for Payer: PHCS All Commercial |
$185.79
|
| Rate for Payer: PHCS All Commercial |
$185.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.79
|
| Rate for Payer: Sagamore Health Network All Products |
$185.79
|
| Rate for Payer: Sagamore Health Network All Products |
$185.79
|
| Rate for Payer: United Healthcare Commercial |
$209.03
|
| Rate for Payer: United Healthcare Commercial |
$209.03
|
| Rate for Payer: United Healthcare Medicare |
$254.82
|
| Rate for Payer: United Healthcare Medicare |
$254.82
|
|
|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$376.20
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
z99495
|
| Min. Negotiated Rate |
$136.63 |
| Max. Negotiated Rate |
$212.27 |
| Rate for Payer: Aetna Commercial |
$136.95
|
| Rate for Payer: Aetna Commercial |
$136.95
|
| Rate for Payer: Aetna Medicare |
$136.95
|
| Rate for Payer: Aetna Medicare |
$136.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.65
|
| Rate for Payer: Cash Price |
$242.04
|
| Rate for Payer: Cash Price |
$233.24
|
| Rate for Payer: Centivo All Commercial |
$212.27
|
| Rate for Payer: Centivo All Commercial |
$212.27
|
| Rate for Payer: Cigna All Commercial |
$136.95
|
| Rate for Payer: Cigna All Commercial |
$136.95
|
| Rate for Payer: CORVEL All Commercial |
$136.95
|
| Rate for Payer: CORVEL All Commercial |
$136.95
|
| Rate for Payer: Coventry All Commercial |
$164.34
|
| Rate for Payer: Coventry All Commercial |
$164.34
|
| Rate for Payer: Encore All Commercial |
$136.95
|
| Rate for Payer: Encore All Commercial |
$136.95
|
| Rate for Payer: Frontpath All Commercial |
$147.30
|
| Rate for Payer: Frontpath All Commercial |
$147.30
|
| Rate for Payer: Humana ChoiceCare |
$136.63
|
| Rate for Payer: Humana ChoiceCare |
$136.63
|
| Rate for Payer: Humana Medicare |
$136.95
|
| Rate for Payer: Humana Medicare |
$136.95
|
| Rate for Payer: Lucent All Commercial |
$191.73
|
| Rate for Payer: Lucent All Commercial |
$191.73
|
| Rate for Payer: PHCS All Commercial |
$136.95
|
| Rate for Payer: PHCS All Commercial |
$136.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.95
|
| Rate for Payer: Sagamore Health Network All Products |
$136.95
|
| Rate for Payer: Sagamore Health Network All Products |
$136.95
|
| Rate for Payer: United Healthcare Commercial |
$142.53
|
| Rate for Payer: United Healthcare Commercial |
$142.53
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
|
|
PR TRANSURETHRAL ELEC-SURG PROSTATECTOM
|
Professional
|
Both
|
$1,325.34
|
|
|
Service Code
|
CPT 52601
|
| Hospital Charge Code |
z52601
|
| Min. Negotiated Rate |
$662.57 |
| Max. Negotiated Rate |
$1,062.21 |
| Rate for Payer: Aetna Commercial |
$685.30
|
| Rate for Payer: Aetna Medicare |
$685.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$666.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$788.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$753.83
|
| Rate for Payer: Cash Price |
$821.71
|
| Rate for Payer: Centivo All Commercial |
$1,062.21
|
| Rate for Payer: Cigna All Commercial |
$685.30
|
| Rate for Payer: CORVEL All Commercial |
$685.30
|
| Rate for Payer: Coventry All Commercial |
$822.36
|
| Rate for Payer: Encore All Commercial |
$685.30
|
| Rate for Payer: Frontpath All Commercial |
$938.60
|
| Rate for Payer: Humana ChoiceCare |
$663.12
|
| Rate for Payer: Humana Medicare |
$685.30
|
| Rate for Payer: Lucent All Commercial |
$959.42
|
| Rate for Payer: Managed Health Services Medicaid |
$666.61
|
| Rate for Payer: MDWise Medicaid |
$666.61
|
| Rate for Payer: PHCS All Commercial |
$685.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$685.30
|
| Rate for Payer: Sagamore Health Network All Products |
$685.30
|
| Rate for Payer: United Healthcare Commercial |
$1,021.39
|
| Rate for Payer: United Healthcare Medicare |
$662.57
|
|
|
PR TREAT ECTOPIC PREG,NON REMVAL
|
Professional
|
Both
|
$1,473.12
|
|
|
Service Code
|
CPT 59121
|
| Hospital Charge Code |
z59121
|
| Min. Negotiated Rate |
$705.13 |
| Max. Negotiated Rate |
$96,500.00 |
| Rate for Payer: Aetna Commercial |
$747.24
|
| Rate for Payer: Aetna Commercial |
$747.24
|
| Rate for Payer: Aetna Medicare |
$747.24
|
| Rate for Payer: Aetna Medicare |
$747.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,016.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$724.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$724.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$859.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$859.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$821.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$821.96
|
| Rate for Payer: Cash Price |
$913.33
|
| Rate for Payer: Cash Price |
$898.39
|
| Rate for Payer: Centivo All Commercial |
$1,158.22
|
| Rate for Payer: Centivo All Commercial |
$1,158.22
|
| Rate for Payer: Cigna All Commercial |
$747.24
|
| Rate for Payer: Cigna All Commercial |
$747.24
|
| Rate for Payer: CORVEL All Commercial |
$747.24
|
| Rate for Payer: CORVEL All Commercial |
$747.24
|
| Rate for Payer: Coventry All Commercial |
$896.69
|
| Rate for Payer: Coventry All Commercial |
$896.69
|
| Rate for Payer: Encore All Commercial |
$747.24
|
| Rate for Payer: Encore All Commercial |
$747.24
|
| Rate for Payer: Frontpath All Commercial |
$1,063.28
|
| Rate for Payer: Frontpath All Commercial |
$1,063.28
|
| Rate for Payer: Humana ChoiceCare |
$705.13
|
| Rate for Payer: Humana ChoiceCare |
$705.13
|
| Rate for Payer: Humana Medicare |
$747.24
|
| Rate for Payer: Humana Medicare |
$747.24
|
| Rate for Payer: Lucent All Commercial |
$1,046.14
|
| Rate for Payer: Lucent All Commercial |
$1,046.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,040.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,040.00
|
| Rate for Payer: Managed Health Services Medicaid |
$724.54
|
| Rate for Payer: Managed Health Services Medicaid |
$724.54
|
| Rate for Payer: MDWise Medicaid |
$724.54
|
| Rate for Payer: MDWise Medicaid |
$724.54
|
| Rate for Payer: PHCS All Commercial |
$747.24
|
| Rate for Payer: PHCS All Commercial |
$747.24
|
| Rate for Payer: PHP All Commercial |
$956.36
|
| Rate for Payer: PHP All Commercial |
$956.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$747.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$747.24
|
| Rate for Payer: Sagamore Health Network All Products |
$747.24
|
| Rate for Payer: Sagamore Health Network All Products |
$747.24
|
| Rate for Payer: Signature Care EPO |
$906.10
|
| Rate for Payer: Signature Care EPO |
$906.10
|
| Rate for Payer: Signature Care PPO |
$906.10
|
| Rate for Payer: Signature Care PPO |
$906.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,500.00
|
| Rate for Payer: United Healthcare Commercial |
$883.59
|
| Rate for Payer: United Healthcare Commercial |
$883.59
|
| Rate for Payer: United Healthcare Medicare |
$724.51
|
| Rate for Payer: United Healthcare Medicare |
$724.51
|
|
|
PR TREAT ECTOPIC PREG,RMV TUBE/OVARY
|
Professional
|
Both
|
$1,472.74
|
|
|
Service Code
|
CPT 59120
|
| Hospital Charge Code |
z59120
|
| Min. Negotiated Rate |
$694.57 |
| Max. Negotiated Rate |
$96,500.00 |
| Rate for Payer: Aetna Commercial |
$746.67
|
| Rate for Payer: Aetna Commercial |
$746.67
|
| Rate for Payer: Aetna Medicare |
$746.67
|
| Rate for Payer: Aetna Medicare |
$746.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,001.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$724.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$724.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$858.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$858.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$821.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$821.34
|
| Rate for Payer: Cash Price |
$913.10
|
| Rate for Payer: Cash Price |
$898.14
|
| Rate for Payer: Centivo All Commercial |
$1,157.34
|
| Rate for Payer: Centivo All Commercial |
$1,157.34
|
| Rate for Payer: Cigna All Commercial |
$746.67
|
| Rate for Payer: Cigna All Commercial |
$746.67
|
| Rate for Payer: CORVEL All Commercial |
$746.67
|
| Rate for Payer: CORVEL All Commercial |
$746.67
|
| Rate for Payer: Coventry All Commercial |
$896.00
|
| Rate for Payer: Coventry All Commercial |
$896.00
|
| Rate for Payer: Encore All Commercial |
$746.67
|
| Rate for Payer: Encore All Commercial |
$746.67
|
| Rate for Payer: Frontpath All Commercial |
$1,062.05
|
| Rate for Payer: Frontpath All Commercial |
$1,062.05
|
| Rate for Payer: Humana ChoiceCare |
$694.57
|
| Rate for Payer: Humana ChoiceCare |
$694.57
|
| Rate for Payer: Humana Medicare |
$746.67
|
| Rate for Payer: Humana Medicare |
$746.67
|
| Rate for Payer: Lucent All Commercial |
$1,045.34
|
| Rate for Payer: Lucent All Commercial |
$1,045.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.00
|
| Rate for Payer: Managed Health Services Medicaid |
$724.35
|
| Rate for Payer: Managed Health Services Medicaid |
$724.35
|
| Rate for Payer: MDWise Medicaid |
$724.35
|
| Rate for Payer: MDWise Medicaid |
$724.35
|
| Rate for Payer: PHCS All Commercial |
$746.67
|
| Rate for Payer: PHCS All Commercial |
$746.67
|
| Rate for Payer: PHP All Commercial |
$956.08
|
| Rate for Payer: PHP All Commercial |
$956.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$746.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$746.67
|
| Rate for Payer: Sagamore Health Network All Products |
$746.67
|
| Rate for Payer: Sagamore Health Network All Products |
$746.67
|
| Rate for Payer: Signature Care EPO |
$893.35
|
| Rate for Payer: Signature Care EPO |
$893.35
|
| Rate for Payer: Signature Care PPO |
$893.35
|
| Rate for Payer: Signature Care PPO |
$893.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,500.00
|
| Rate for Payer: United Healthcare Commercial |
$879.60
|
| Rate for Payer: United Healthcare Commercial |
$879.60
|
| Rate for Payer: United Healthcare Medicare |
$724.31
|
| Rate for Payer: United Healthcare Medicare |
$724.31
|
|
|
PR TREAT INTER/SUBTROCH FX,W/PLATE/SCREW
|
Professional
|
Both
|
$2,257.32
|
|
|
Service Code
|
CPT 27244
|
| Hospital Charge Code |
z27244
|
| Min. Negotiated Rate |
$1,107.41 |
| Max. Negotiated Rate |
$170,300.00 |
| Rate for Payer: Aetna Commercial |
$1,139.84
|
| Rate for Payer: Aetna Commercial |
$1,139.84
|
| Rate for Payer: Aetna Medicare |
$1,139.84
|
| Rate for Payer: Aetna Medicare |
$1,139.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,520.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,110.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,110.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,310.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,310.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,253.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,253.82
|
| Rate for Payer: Cash Price |
$1,399.54
|
| Rate for Payer: Cash Price |
$1,373.19
|
| Rate for Payer: Centivo All Commercial |
$1,766.75
|
| Rate for Payer: Centivo All Commercial |
$1,766.75
|
| Rate for Payer: Cigna All Commercial |
$1,139.84
|
| Rate for Payer: Cigna All Commercial |
$1,139.84
|
| Rate for Payer: CORVEL All Commercial |
$1,139.84
|
| Rate for Payer: CORVEL All Commercial |
$1,139.84
|
| Rate for Payer: Coventry All Commercial |
$1,367.81
|
| Rate for Payer: Coventry All Commercial |
$1,367.81
|
| Rate for Payer: Encore All Commercial |
$1,139.84
|
| Rate for Payer: Encore All Commercial |
$1,139.84
|
| Rate for Payer: Frontpath All Commercial |
$1,595.80
|
| Rate for Payer: Frontpath All Commercial |
$1,595.80
|
| Rate for Payer: Humana ChoiceCare |
$1,195.90
|
| Rate for Payer: Humana ChoiceCare |
$1,195.90
|
| Rate for Payer: Humana Medicare |
$1,139.84
|
| Rate for Payer: Humana Medicare |
$1,139.84
|
| Rate for Payer: Lucent All Commercial |
$1,595.78
|
| Rate for Payer: Lucent All Commercial |
$1,595.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,816.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,816.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,110.24
|
| Rate for Payer: Managed Health Services Medicaid |
$1,110.24
|
| Rate for Payer: MDWise Medicaid |
$1,110.24
|
| Rate for Payer: MDWise Medicaid |
$1,110.24
|
| Rate for Payer: PHCS All Commercial |
$1,139.84
|
| Rate for Payer: PHCS All Commercial |
$1,139.84
|
| Rate for Payer: PHP All Commercial |
$1,926.90
|
| Rate for Payer: PHP All Commercial |
$1,926.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,139.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,139.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,139.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,139.84
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170,300.00
|
| Rate for Payer: United Healthcare Commercial |
$1,339.75
|
| Rate for Payer: United Healthcare Commercial |
$1,339.75
|
| Rate for Payer: United Healthcare Medicare |
$1,107.41
|
| Rate for Payer: United Healthcare Medicare |
$1,107.41
|
|
|
PR TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT
|
Professional
|
Both
|
$1,838.94
|
|
|
Service Code
|
CPT 27759
|
| Hospital Charge Code |
z27759
|
| Min. Negotiated Rate |
$901.99 |
| Max. Negotiated Rate |
$138,700.00 |
| Rate for Payer: Aetna Commercial |
$927.67
|
| Rate for Payer: Aetna Commercial |
$927.67
|
| Rate for Payer: Aetna Medicare |
$927.67
|
| Rate for Payer: Aetna Medicare |
$927.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,345.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$904.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$904.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,066.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,066.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,020.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,020.44
|
| Rate for Payer: Cash Price |
$1,140.14
|
| Rate for Payer: Cash Price |
$1,118.47
|
| Rate for Payer: Centivo All Commercial |
$1,437.89
|
| Rate for Payer: Centivo All Commercial |
$1,437.89
|
| Rate for Payer: Cigna All Commercial |
$927.67
|
| Rate for Payer: Cigna All Commercial |
$927.67
|
| Rate for Payer: CORVEL All Commercial |
$927.67
|
| Rate for Payer: CORVEL All Commercial |
$927.67
|
| Rate for Payer: Coventry All Commercial |
$1,113.20
|
| Rate for Payer: Coventry All Commercial |
$1,113.20
|
| Rate for Payer: Encore All Commercial |
$927.67
|
| Rate for Payer: Encore All Commercial |
$927.67
|
| Rate for Payer: Frontpath All Commercial |
$1,296.87
|
| Rate for Payer: Frontpath All Commercial |
$1,296.87
|
| Rate for Payer: Humana ChoiceCare |
$1,054.15
|
| Rate for Payer: Humana ChoiceCare |
$1,054.15
|
| Rate for Payer: Humana Medicare |
$927.67
|
| Rate for Payer: Humana Medicare |
$927.67
|
| Rate for Payer: Lucent All Commercial |
$1,298.74
|
| Rate for Payer: Lucent All Commercial |
$1,298.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,479.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,479.00
|
| Rate for Payer: Managed Health Services Medicaid |
$904.47
|
| Rate for Payer: Managed Health Services Medicaid |
$904.47
|
| Rate for Payer: MDWise Medicaid |
$904.47
|
| Rate for Payer: MDWise Medicaid |
$904.47
|
| Rate for Payer: PHCS All Commercial |
$927.67
|
| Rate for Payer: PHCS All Commercial |
$927.67
|
| Rate for Payer: PHP All Commercial |
$1,569.46
|
| Rate for Payer: PHP All Commercial |
$1,569.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$927.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$927.67
|
| Rate for Payer: Sagamore Health Network All Products |
$927.67
|
| Rate for Payer: Sagamore Health Network All Products |
$927.67
|
| Rate for Payer: Signature Care EPO |
$1,412.70
|
| Rate for Payer: Signature Care EPO |
$1,412.70
|
| Rate for Payer: Signature Care PPO |
$1,412.70
|
| Rate for Payer: Signature Care PPO |
$1,412.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,096.65
|
| Rate for Payer: United Healthcare Commercial |
$1,096.65
|
| Rate for Payer: United Healthcare Medicare |
$901.99
|
| Rate for Payer: United Healthcare Medicare |
$901.99
|
|
|
PR TRIM NAIL(S)
|
Professional
|
Both
|
$26.98
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
z11719
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$13.27 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Centivo All Commercial |
$11.30
|
| Rate for Payer: Centivo All Commercial |
$11.30
|
| Rate for Payer: Cigna All Commercial |
$7.29
|
| Rate for Payer: Cigna All Commercial |
$7.29
|
| Rate for Payer: CORVEL All Commercial |
$7.29
|
| Rate for Payer: CORVEL All Commercial |
$7.29
|
| Rate for Payer: Coventry All Commercial |
$8.75
|
| Rate for Payer: Coventry All Commercial |
$8.75
|
| Rate for Payer: Encore All Commercial |
$7.29
|
| Rate for Payer: Encore All Commercial |
$7.29
|
| Rate for Payer: Frontpath All Commercial |
$9.79
|
| Rate for Payer: Frontpath All Commercial |
$9.79
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Humana Medicare |
$7.29
|
| Rate for Payer: Humana Medicare |
$7.29
|
| Rate for Payer: Lucent All Commercial |
$10.21
|
| Rate for Payer: Lucent All Commercial |
$10.21
|
| Rate for Payer: Managed Health Services Medicaid |
$13.27
|
| Rate for Payer: Managed Health Services Medicaid |
$13.27
|
| Rate for Payer: MDWise Medicaid |
$13.27
|
| Rate for Payer: MDWise Medicaid |
$13.27
|
| Rate for Payer: PHCS All Commercial |
$7.29
|
| Rate for Payer: PHCS All Commercial |
$7.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.29
|
| Rate for Payer: Sagamore Health Network All Products |
$7.29
|
| Rate for Payer: Sagamore Health Network All Products |
$7.29
|
| Rate for Payer: United Healthcare Commercial |
$10.28
|
| Rate for Payer: United Healthcare Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare |
$13.01
|
| Rate for Payer: United Healthcare Medicare |
$13.01
|
|
|
PR TRIM NAIL(S)
|
Professional
|
Both
|
$26.02
|
|
|
Service Code
|
CPT G0127
|
| Hospital Charge Code |
zG0127
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Centivo All Commercial |
$11.30
|
| Rate for Payer: Cigna All Commercial |
$7.29
|
| Rate for Payer: CORVEL All Commercial |
$7.29
|
| Rate for Payer: Coventry All Commercial |
$8.75
|
| Rate for Payer: Encore All Commercial |
$7.29
|
| Rate for Payer: Humana ChoiceCare |
$6.09
|
| Rate for Payer: Humana Medicare |
$7.29
|
| Rate for Payer: Lucent All Commercial |
$10.21
|
| Rate for Payer: Managed Health Services Medicaid |
$22.03
|
| Rate for Payer: MDWise Medicaid |
$22.03
|
| Rate for Payer: PHCS All Commercial |
$7.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.29
|
| Rate for Payer: Sagamore Health Network All Products |
$7.29
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
PR TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Professional
|
Both
|
$282.12
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
z32551
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$21,400.00 |
| Rate for Payer: Aetna Commercial |
$145.82
|
| Rate for Payer: Aetna Commercial |
$145.82
|
| Rate for Payer: Aetna Medicare |
$145.82
|
| Rate for Payer: Aetna Medicare |
$145.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$242.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$242.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$242.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$242.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$242.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$242.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.40
|
| Rate for Payer: Cash Price |
$174.91
|
| Rate for Payer: Cash Price |
$172.67
|
| Rate for Payer: Centivo All Commercial |
$226.02
|
| Rate for Payer: Centivo All Commercial |
$226.02
|
| Rate for Payer: Cigna All Commercial |
$145.82
|
| Rate for Payer: Cigna All Commercial |
$145.82
|
| Rate for Payer: CORVEL All Commercial |
$145.82
|
| Rate for Payer: CORVEL All Commercial |
$145.82
|
| Rate for Payer: Coventry All Commercial |
$174.98
|
| Rate for Payer: Coventry All Commercial |
$174.98
|
| Rate for Payer: Encore All Commercial |
$145.82
|
| Rate for Payer: Encore All Commercial |
$145.82
|
| Rate for Payer: Frontpath All Commercial |
$205.72
|
| Rate for Payer: Frontpath All Commercial |
$205.72
|
| Rate for Payer: Humana ChoiceCare |
$193.38
|
| Rate for Payer: Humana ChoiceCare |
$193.38
|
| Rate for Payer: Humana Medicare |
$145.82
|
| Rate for Payer: Humana Medicare |
$145.82
|
| Rate for Payer: Lucent All Commercial |
$204.15
|
| Rate for Payer: Lucent All Commercial |
$204.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Managed Health Services Medicaid |
$138.75
|
| Rate for Payer: Managed Health Services Medicaid |
$138.75
|
| Rate for Payer: MDWise Medicaid |
$138.75
|
| Rate for Payer: MDWise Medicaid |
$138.75
|
| Rate for Payer: PHCS All Commercial |
$145.82
|
| Rate for Payer: PHCS All Commercial |
$145.82
|
| Rate for Payer: PHP All Commercial |
$194.95
|
| Rate for Payer: PHP All Commercial |
$194.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.82
|
| Rate for Payer: Sagamore Health Network All Products |
$145.82
|
| Rate for Payer: Sagamore Health Network All Products |
$145.82
|
| Rate for Payer: Signature Care EPO |
$206.99
|
| Rate for Payer: Signature Care EPO |
$206.99
|
| Rate for Payer: Signature Care PPO |
$206.99
|
| Rate for Payer: Signature Care PPO |
$206.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,400.00
|
| Rate for Payer: United Healthcare Commercial |
$206.70
|
| Rate for Payer: United Healthcare Commercial |
$206.70
|
| Rate for Payer: United Healthcare Medicare |
$139.25
|
| Rate for Payer: United Healthcare Medicare |
$139.25
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$555.92
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
z12020
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$174.99
|
| Rate for Payer: Aetna Commercial |
$174.99
|
| Rate for Payer: Aetna Medicare |
$174.99
|
| Rate for Payer: Aetna Medicare |
$174.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$327.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$327.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$327.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$327.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$327.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$327.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$327.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$327.55
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$95.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$95.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$273.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$273.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.49
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$344.67
|
| Rate for Payer: Centivo All Commercial |
$271.23
|
| Rate for Payer: Centivo All Commercial |
$271.23
|
| Rate for Payer: Cigna All Commercial |
$174.99
|
| Rate for Payer: Cigna All Commercial |
$174.99
|
| Rate for Payer: CORVEL All Commercial |
$174.99
|
| Rate for Payer: CORVEL All Commercial |
$174.99
|
| Rate for Payer: Coventry All Commercial |
$209.99
|
| Rate for Payer: Coventry All Commercial |
$209.99
|
| Rate for Payer: Encore All Commercial |
$174.99
|
| Rate for Payer: Encore All Commercial |
$174.99
|
| Rate for Payer: Frontpath All Commercial |
$240.51
|
| Rate for Payer: Frontpath All Commercial |
$240.51
|
| Rate for Payer: Humana ChoiceCare |
$170.52
|
| Rate for Payer: Humana ChoiceCare |
$170.52
|
| Rate for Payer: Humana Medicare |
$174.99
|
| Rate for Payer: Humana Medicare |
$174.99
|
| Rate for Payer: Lucent All Commercial |
$244.99
|
| Rate for Payer: Lucent All Commercial |
$244.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Managed Health Services Medicaid |
$273.43
|
| Rate for Payer: Managed Health Services Medicaid |
$273.43
|
| Rate for Payer: MDWise Medicaid |
$273.43
|
| Rate for Payer: MDWise Medicaid |
$273.43
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$95.52
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$95.52
|
| Rate for Payer: PHCS All Commercial |
$174.99
|
| Rate for Payer: PHCS All Commercial |
$174.99
|
| Rate for Payer: PHP All Commercial |
$239.29
|
| Rate for Payer: PHP All Commercial |
$239.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.99
|
| Rate for Payer: Sagamore Health Network All Products |
$174.99
|
| Rate for Payer: Sagamore Health Network All Products |
$174.99
|
| Rate for Payer: Signature Care EPO |
$240.35
|
| Rate for Payer: Signature Care EPO |
$240.35
|
| Rate for Payer: Signature Care PPO |
$240.35
|
| Rate for Payer: Signature Care PPO |
$240.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare Commercial |
$201.61
|
| Rate for Payer: United Healthcare Commercial |
$201.61
|
| Rate for Payer: United Healthcare Medicare |
$273.63
|
| Rate for Payer: United Healthcare Medicare |
$273.63
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$329.20
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
z12021
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Aetna Commercial |
$131.13
|
| Rate for Payer: Aetna Commercial |
$131.13
|
| Rate for Payer: Aetna Medicare |
$131.13
|
| Rate for Payer: Aetna Medicare |
$131.13
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$71.81
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$71.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.24
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cash Price |
$204.10
|
| Rate for Payer: Centivo All Commercial |
$203.25
|
| Rate for Payer: Centivo All Commercial |
$203.25
|
| Rate for Payer: Cigna All Commercial |
$131.13
|
| Rate for Payer: Cigna All Commercial |
$131.13
|
| Rate for Payer: CORVEL All Commercial |
$131.13
|
| Rate for Payer: CORVEL All Commercial |
$131.13
|
| Rate for Payer: Coventry All Commercial |
$157.36
|
| Rate for Payer: Coventry All Commercial |
$157.36
|
| Rate for Payer: Encore All Commercial |
$131.13
|
| Rate for Payer: Encore All Commercial |
$131.13
|
| Rate for Payer: Frontpath All Commercial |
$180.38
|
| Rate for Payer: Frontpath All Commercial |
$180.38
|
| Rate for Payer: Humana ChoiceCare |
$122.11
|
| Rate for Payer: Humana ChoiceCare |
$122.11
|
| Rate for Payer: Humana Medicare |
$131.13
|
| Rate for Payer: Humana Medicare |
$131.13
|
| Rate for Payer: Lucent All Commercial |
$183.58
|
| Rate for Payer: Lucent All Commercial |
$183.58
|
| Rate for Payer: Managed Health Services Medicaid |
$161.91
|
| Rate for Payer: Managed Health Services Medicaid |
$161.91
|
| Rate for Payer: MDWise Medicaid |
$161.91
|
| Rate for Payer: MDWise Medicaid |
$161.91
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$71.81
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$71.81
|
| Rate for Payer: PHCS All Commercial |
$131.13
|
| Rate for Payer: PHCS All Commercial |
$131.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.13
|
| Rate for Payer: Sagamore Health Network All Products |
$131.13
|
| Rate for Payer: Sagamore Health Network All Products |
$131.13
|
| Rate for Payer: United Healthcare Commercial |
$146.21
|
| Rate for Payer: United Healthcare Commercial |
$146.21
|
| Rate for Payer: United Healthcare Medicare |
$161.47
|
| Rate for Payer: United Healthcare Medicare |
$161.47
|
|
|
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 |
$18.85
|
| Rate for Payer: Cash Price |
$19.11
|
| 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 Medicare |
$9.55
|
| Rate for Payer: Molina Healthcare of OH 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 |
$25.74
|
| Rate for Payer: Cash Price |
$25.68
|
| 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 |
$83.54
|
| Rate for Payer: Cash Price |
$120.39
|
| 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 |
$98.96
|
| Rate for Payer: Cash Price |
$136.45
|
| 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 |
$1,584.10
|
|
|
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 |
$32.82
|
| Rate for Payer: Cash Price |
$32.82
|
| 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
|
|
