|
HC APOLIPOPROTEIN B
|
Facility
IP
|
$94.25
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
63001468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$87.65 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Cash Price |
$58.43
|
| Rate for Payer: Cigna All Commercial |
$81.34
|
| Rate for Payer: CORVEL All Commercial |
$87.65
|
| Rate for Payer: Coventry All Commercial |
$82.94
|
| Rate for Payer: Encore All Commercial |
$86.76
|
| Rate for Payer: Frontpath All Commercial |
$86.71
|
| Rate for Payer: Humana ChoiceCare |
$81.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.82
|
| Rate for Payer: PHCS All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$71.48
|
| Rate for Payer: Sagamore Health Network All Products |
$72.76
|
| Rate for Payer: Signature Care EPO |
$78.23
|
| Rate for Payer: Signature Care PPO |
$82.94
|
| Rate for Payer: United Healthcare Commercial |
$74.27
|
|
|
HC APOLIPOPROTEIN B
|
Facility
OP
|
$94.25
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
63001468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$87.65 |
| Rate for Payer: Aetna Commercial |
$79.55
|
| Rate for Payer: Aetna Medicare |
$31.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.21
|
| Rate for Payer: Cash Price |
$58.43
|
| Rate for Payer: Cash Price |
$58.43
|
| Rate for Payer: Centivo All Commercial |
$48.07
|
| Rate for Payer: Cigna All Commercial |
$81.34
|
| Rate for Payer: CORVEL All Commercial |
$87.65
|
| Rate for Payer: Coventry All Commercial |
$82.94
|
| Rate for Payer: Encore All Commercial |
$86.76
|
| Rate for Payer: Frontpath All Commercial |
$86.71
|
| Rate for Payer: Humana ChoiceCare |
$81.40
|
| Rate for Payer: Humana Medicare |
$48.07
|
| Rate for Payer: Lucent All Commercial |
$48.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.82
|
| Rate for Payer: Managed Health Services Medicaid |
$6.40
|
| Rate for Payer: MDWise Medicaid |
$6.40
|
| Rate for Payer: PHCS All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$71.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.76
|
| Rate for Payer: Sagamore Health Network All Products |
$72.76
|
| Rate for Payer: Signature Care EPO |
$78.23
|
| Rate for Payer: Signature Care PPO |
$82.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.11
|
| Rate for Payer: United Healthcare Commercial |
$74.27
|
| Rate for Payer: United Healthcare Medicare |
$31.10
|
|
|
HC APPLICATOR TIP EVICEL 35 CM
|
Facility
IP
|
$272.56
|
|
| Hospital Charge Code |
41603435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.42 |
| Max. Negotiated Rate |
$253.48 |
| Rate for Payer: Aetna Commercial |
$235.49
|
| Rate for Payer: Cash Price |
$168.99
|
| Rate for Payer: Cigna All Commercial |
$235.22
|
| Rate for Payer: CORVEL All Commercial |
$253.48
|
| Rate for Payer: Coventry All Commercial |
$239.85
|
| Rate for Payer: Encore All Commercial |
$250.89
|
| Rate for Payer: Frontpath All Commercial |
$250.76
|
| Rate for Payer: Humana ChoiceCare |
$235.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.30
|
| Rate for Payer: PHCS All Commercial |
$204.42
|
| Rate for Payer: PHP All Commercial |
$206.71
|
| Rate for Payer: Sagamore Health Network All Products |
$210.42
|
| Rate for Payer: Signature Care EPO |
$226.22
|
| Rate for Payer: Signature Care PPO |
$239.85
|
| Rate for Payer: United Healthcare Commercial |
$214.78
|
|
|
HC APPLICATOR TIP EVICEL 35 CM
|
Facility
OP
|
$272.56
|
|
| Hospital Charge Code |
41603435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.94 |
| Max. Negotiated Rate |
$253.48 |
| Rate for Payer: Aetna Commercial |
$230.04
|
| Rate for Payer: Aetna Medicare |
$89.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.94
|
| Rate for Payer: Cash Price |
$168.99
|
| Rate for Payer: Cash Price |
$168.99
|
| Rate for Payer: Centivo All Commercial |
$139.01
|
| Rate for Payer: Cigna All Commercial |
$235.22
|
| Rate for Payer: CORVEL All Commercial |
$253.48
|
| Rate for Payer: Coventry All Commercial |
$239.85
|
| Rate for Payer: Encore All Commercial |
$250.89
|
| Rate for Payer: Frontpath All Commercial |
$250.76
|
| Rate for Payer: Humana ChoiceCare |
$235.41
|
| Rate for Payer: Humana Medicare |
$139.01
|
| Rate for Payer: Lucent All Commercial |
$139.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$204.42
|
| Rate for Payer: PHP All Commercial |
$206.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.30
|
| Rate for Payer: Sagamore Health Network All Products |
$210.42
|
| Rate for Payer: Signature Care EPO |
$226.22
|
| Rate for Payer: Signature Care PPO |
$239.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$231.68
|
| Rate for Payer: United Healthcare Commercial |
$214.78
|
| Rate for Payer: United Healthcare Medicare |
$89.94
|
|
|
HC APPL SPLINT LEG LONG - PT
|
Facility
IP
|
$330.71
|
|
|
Service Code
|
CPT 29505 GP
|
| Hospital Charge Code |
01722002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$248.04 |
| Max. Negotiated Rate |
$307.56 |
| Rate for Payer: Aetna Commercial |
$285.74
|
| Rate for Payer: Cash Price |
$205.04
|
| Rate for Payer: Cigna All Commercial |
$285.41
|
| Rate for Payer: CORVEL All Commercial |
$307.56
|
| Rate for Payer: Coventry All Commercial |
$291.03
|
| Rate for Payer: Encore All Commercial |
$304.42
|
| Rate for Payer: Frontpath All Commercial |
$304.26
|
| Rate for Payer: Humana ChoiceCare |
$285.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.64
|
| Rate for Payer: PHCS All Commercial |
$248.04
|
| Rate for Payer: PHP All Commercial |
$250.81
|
| Rate for Payer: Sagamore Health Network All Products |
$255.31
|
| Rate for Payer: Signature Care EPO |
$274.49
|
| Rate for Payer: Signature Care PPO |
$291.03
|
| Rate for Payer: United Healthcare Commercial |
$260.60
|
|
|
HC APPL SPLINT LEG LONG - PT
|
Facility
OP
|
$330.71
|
|
|
Service Code
|
CPT 29505 GP
|
| Hospital Charge Code |
01722002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$307.56 |
| Rate for Payer: Aetna Commercial |
$279.12
|
| Rate for Payer: Aetna Medicare |
$109.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.05
|
| Rate for Payer: Cash Price |
$205.04
|
| Rate for Payer: Centivo All Commercial |
$168.66
|
| Rate for Payer: Cigna All Commercial |
$285.41
|
| Rate for Payer: CORVEL All Commercial |
$307.56
|
| Rate for Payer: Coventry All Commercial |
$291.03
|
| Rate for Payer: Encore All Commercial |
$304.42
|
| Rate for Payer: Frontpath All Commercial |
$304.26
|
| Rate for Payer: Humana ChoiceCare |
$285.64
|
| Rate for Payer: Humana Medicare |
$168.66
|
| Rate for Payer: Lucent All Commercial |
$168.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.64
|
| Rate for Payer: PHCS All Commercial |
$248.04
|
| Rate for Payer: PHP All Commercial |
$250.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.98
|
| Rate for Payer: Sagamore Health Network All Products |
$255.31
|
| Rate for Payer: Signature Care EPO |
$274.49
|
| Rate for Payer: Signature Care PPO |
$291.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$281.11
|
| Rate for Payer: United Healthcare Commercial |
$260.60
|
| Rate for Payer: United Healthcare Medicare |
$109.14
|
|
|
HC APPL SPLINT LEG SHORT - PT
|
Facility
IP
|
$330.71
|
|
|
Service Code
|
CPT 29515 GP
|
| Hospital Charge Code |
01722003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$248.04 |
| Max. Negotiated Rate |
$307.56 |
| Rate for Payer: Aetna Commercial |
$285.74
|
| Rate for Payer: Cash Price |
$205.04
|
| Rate for Payer: Cigna All Commercial |
$285.41
|
| Rate for Payer: CORVEL All Commercial |
$307.56
|
| Rate for Payer: Coventry All Commercial |
$291.03
|
| Rate for Payer: Encore All Commercial |
$304.42
|
| Rate for Payer: Frontpath All Commercial |
$304.26
|
| Rate for Payer: Humana ChoiceCare |
$285.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.64
|
| Rate for Payer: PHCS All Commercial |
$248.04
|
| Rate for Payer: PHP All Commercial |
$250.81
|
| Rate for Payer: Sagamore Health Network All Products |
$255.31
|
| Rate for Payer: Signature Care EPO |
$274.49
|
| Rate for Payer: Signature Care PPO |
$291.03
|
| Rate for Payer: United Healthcare Commercial |
$260.60
|
|
|
HC APPL SPLINT LEG SHORT - PT
|
Facility
OP
|
$330.71
|
|
|
Service Code
|
CPT 29515 GP
|
| Hospital Charge Code |
01722003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$307.56 |
| Rate for Payer: Aetna Commercial |
$279.12
|
| Rate for Payer: Aetna Medicare |
$109.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.05
|
| Rate for Payer: Cash Price |
$205.04
|
| Rate for Payer: Centivo All Commercial |
$168.66
|
| Rate for Payer: Cigna All Commercial |
$285.41
|
| Rate for Payer: CORVEL All Commercial |
$307.56
|
| Rate for Payer: Coventry All Commercial |
$291.03
|
| Rate for Payer: Encore All Commercial |
$304.42
|
| Rate for Payer: Frontpath All Commercial |
$304.26
|
| Rate for Payer: Humana ChoiceCare |
$285.64
|
| Rate for Payer: Humana Medicare |
$168.66
|
| Rate for Payer: Lucent All Commercial |
$168.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.64
|
| Rate for Payer: PHCS All Commercial |
$248.04
|
| Rate for Payer: PHP All Commercial |
$250.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.98
|
| Rate for Payer: Sagamore Health Network All Products |
$255.31
|
| Rate for Payer: Signature Care EPO |
$274.49
|
| Rate for Payer: Signature Care PPO |
$291.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$281.11
|
| Rate for Payer: United Healthcare Commercial |
$260.60
|
| Rate for Payer: United Healthcare Medicare |
$109.14
|
|
|
HC APTT W/MIXING STUDIES IF INDICATED
|
Facility
IP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001275
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.91
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
|
|
HC APTT W/MIXING STUDIES IF INDICATED
|
Facility
OP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001275
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Aetna Medicare |
$45.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.68
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Centivo All Commercial |
$69.80
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.91
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Humana Medicare |
$69.80
|
| Rate for Payer: Lucent All Commercial |
$69.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: Managed Health Services Medicaid |
$6.01
|
| Rate for Payer: MDWise Medicaid |
$6.01
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.37
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.33
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
| Rate for Payer: United Healthcare Medicare |
$45.16
|
|
|
HC AQUAMANTYS BIPOLAR SEAL
|
Facility
OP
|
$2,530.80
|
|
| Hospital Charge Code |
41602820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,353.64 |
| Rate for Payer: Aetna Commercial |
$2,136.00
|
| Rate for Payer: Aetna Medicare |
$835.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$835.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,453.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,582.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$960.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$918.68
|
| Rate for Payer: Cash Price |
$1,569.10
|
| Rate for Payer: Cash Price |
$1,569.10
|
| Rate for Payer: Centivo All Commercial |
$1,290.71
|
| Rate for Payer: Cigna All Commercial |
$2,184.08
|
| Rate for Payer: CORVEL All Commercial |
$2,353.64
|
| Rate for Payer: Coventry All Commercial |
$2,227.10
|
| Rate for Payer: Encore All Commercial |
$2,329.60
|
| Rate for Payer: Frontpath All Commercial |
$2,328.34
|
| Rate for Payer: Humana ChoiceCare |
$2,185.85
|
| Rate for Payer: Humana Medicare |
$1,290.71
|
| Rate for Payer: Lucent All Commercial |
$1,290.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,277.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,898.10
|
| Rate for Payer: PHP All Commercial |
$1,919.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$987.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,953.78
|
| Rate for Payer: Signature Care EPO |
$2,100.56
|
| Rate for Payer: Signature Care PPO |
$2,227.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,151.18
|
| Rate for Payer: United Healthcare Commercial |
$1,994.27
|
| Rate for Payer: United Healthcare Medicare |
$835.16
|
|
|
HC AQUAMANTYS BIPOLAR SEAL
|
Facility
IP
|
$2,530.80
|
|
| Hospital Charge Code |
41602820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,898.10 |
| Max. Negotiated Rate |
$2,353.64 |
| Rate for Payer: Aetna Commercial |
$2,186.61
|
| Rate for Payer: Cash Price |
$1,569.10
|
| Rate for Payer: Cigna All Commercial |
$2,184.08
|
| Rate for Payer: CORVEL All Commercial |
$2,353.64
|
| Rate for Payer: Coventry All Commercial |
$2,227.10
|
| Rate for Payer: Encore All Commercial |
$2,329.60
|
| Rate for Payer: Frontpath All Commercial |
$2,328.34
|
| Rate for Payer: Humana ChoiceCare |
$2,185.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,277.72
|
| Rate for Payer: PHCS All Commercial |
$1,898.10
|
| Rate for Payer: PHP All Commercial |
$1,919.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,953.78
|
| Rate for Payer: Signature Care EPO |
$2,100.56
|
| Rate for Payer: Signature Care PPO |
$2,227.10
|
| Rate for Payer: United Healthcare Commercial |
$1,994.27
|
|
|
HC AQUA PAD 15X22 DISP
|
Facility
OP
|
$162.82
|
|
| Hospital Charge Code |
41601085
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$151.42 |
| Rate for Payer: Aetna Commercial |
$137.42
|
| Rate for Payer: Aetna Medicare |
$53.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.10
|
| Rate for Payer: Cash Price |
$100.95
|
| Rate for Payer: Cash Price |
$100.95
|
| Rate for Payer: Centivo All Commercial |
$83.04
|
| Rate for Payer: Cigna All Commercial |
$140.51
|
| Rate for Payer: CORVEL All Commercial |
$151.42
|
| Rate for Payer: Coventry All Commercial |
$143.28
|
| Rate for Payer: Encore All Commercial |
$149.88
|
| Rate for Payer: Frontpath All Commercial |
$149.79
|
| Rate for Payer: Humana ChoiceCare |
$140.63
|
| Rate for Payer: Humana Medicare |
$83.04
|
| Rate for Payer: Lucent All Commercial |
$83.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.54
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$122.12
|
| Rate for Payer: PHP All Commercial |
$123.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.50
|
| Rate for Payer: Sagamore Health Network All Products |
$125.70
|
| Rate for Payer: Signature Care EPO |
$135.14
|
| Rate for Payer: Signature Care PPO |
$143.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.40
|
| Rate for Payer: United Healthcare Commercial |
$128.30
|
| Rate for Payer: United Healthcare Medicare |
$53.73
|
|
|
HC AQUA PAD 15X22 DISP
|
Facility
IP
|
$162.82
|
|
| Hospital Charge Code |
41601085
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$122.12 |
| Max. Negotiated Rate |
$151.42 |
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Cash Price |
$100.95
|
| Rate for Payer: Cigna All Commercial |
$140.51
|
| Rate for Payer: CORVEL All Commercial |
$151.42
|
| Rate for Payer: Coventry All Commercial |
$143.28
|
| Rate for Payer: Encore All Commercial |
$149.88
|
| Rate for Payer: Frontpath All Commercial |
$149.79
|
| Rate for Payer: Humana ChoiceCare |
$140.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.54
|
| Rate for Payer: PHCS All Commercial |
$122.12
|
| Rate for Payer: PHP All Commercial |
$123.48
|
| Rate for Payer: Sagamore Health Network All Products |
$125.70
|
| Rate for Payer: Signature Care EPO |
$135.14
|
| Rate for Payer: Signature Care PPO |
$143.28
|
| Rate for Payer: United Healthcare Commercial |
$128.30
|
|
|
HC AQUATIC THERAPY/15 MIN-OT
|
Facility
IP
|
$140.33
|
|
|
Service Code
|
CPT 97113 GO
|
| Hospital Charge Code |
01738202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$130.51 |
| Rate for Payer: Aetna Commercial |
$121.25
|
| Rate for Payer: Cash Price |
$87.01
|
| Rate for Payer: Cigna All Commercial |
$121.11
|
| Rate for Payer: CORVEL All Commercial |
$130.51
|
| Rate for Payer: Coventry All Commercial |
$123.49
|
| Rate for Payer: Encore All Commercial |
$129.18
|
| Rate for Payer: Frontpath All Commercial |
$129.11
|
| Rate for Payer: Humana ChoiceCare |
$121.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.30
|
| Rate for Payer: PHCS All Commercial |
$105.25
|
| Rate for Payer: PHP All Commercial |
$106.43
|
| Rate for Payer: Sagamore Health Network All Products |
$108.34
|
| Rate for Payer: Signature Care EPO |
$116.48
|
| Rate for Payer: Signature Care PPO |
$123.49
|
| Rate for Payer: United Healthcare Commercial |
$110.58
|
|
|
HC AQUATIC THERAPY/15 MIN-OT
|
Facility
OP
|
$140.33
|
|
|
Service Code
|
CPT 97113 GO
|
| Hospital Charge Code |
01738202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.31 |
| Max. Negotiated Rate |
$130.51 |
| Rate for Payer: Aetna Commercial |
$118.44
|
| Rate for Payer: Aetna Medicare |
$46.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.94
|
| Rate for Payer: Cash Price |
$87.01
|
| Rate for Payer: Centivo All Commercial |
$71.57
|
| Rate for Payer: Cigna All Commercial |
$121.11
|
| Rate for Payer: CORVEL All Commercial |
$130.51
|
| Rate for Payer: Coventry All Commercial |
$123.49
|
| Rate for Payer: Encore All Commercial |
$129.18
|
| Rate for Payer: Frontpath All Commercial |
$129.11
|
| Rate for Payer: Humana ChoiceCare |
$121.20
|
| Rate for Payer: Humana Medicare |
$71.57
|
| Rate for Payer: Lucent All Commercial |
$71.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.30
|
| Rate for Payer: PHCS All Commercial |
$105.25
|
| Rate for Payer: PHP All Commercial |
$106.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.73
|
| Rate for Payer: Sagamore Health Network All Products |
$108.34
|
| Rate for Payer: Signature Care EPO |
$116.48
|
| Rate for Payer: Signature Care PPO |
$123.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.28
|
| Rate for Payer: United Healthcare Commercial |
$110.58
|
| Rate for Payer: United Healthcare Medicare |
$46.31
|
|
|
HC AQUATIC THERAPY/15 MIN-PT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97113 GP
|
| Hospital Charge Code |
01728002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC AQUATIC THERAPY/15 MIN-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97113 GP
|
| Hospital Charge Code |
01728002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC AR .039 GUIDEWIRE GOLD
|
Facility
IP
|
$25.67
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cigna All Commercial |
$22.15
|
| Rate for Payer: CORVEL All Commercial |
$23.87
|
| Rate for Payer: Coventry All Commercial |
$22.59
|
| Rate for Payer: Encore All Commercial |
$23.63
|
| Rate for Payer: Frontpath All Commercial |
$23.62
|
| Rate for Payer: Humana ChoiceCare |
$22.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.10
|
| Rate for Payer: PHCS All Commercial |
$19.25
|
| Rate for Payer: PHP All Commercial |
$19.47
|
| Rate for Payer: Sagamore Health Network All Products |
$19.82
|
| Rate for Payer: Signature Care EPO |
$21.31
|
| Rate for Payer: Signature Care PPO |
$22.59
|
| Rate for Payer: United Healthcare Commercial |
$20.23
|
|
|
HC AR .039 GUIDEWIRE GOLD
|
Facility
OP
|
$25.67
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$21.67
|
| Rate for Payer: Aetna Medicare |
$8.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.32
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Centivo All Commercial |
$13.09
|
| Rate for Payer: Cigna All Commercial |
$22.15
|
| Rate for Payer: CORVEL All Commercial |
$23.87
|
| Rate for Payer: Coventry All Commercial |
$22.59
|
| Rate for Payer: Encore All Commercial |
$23.63
|
| Rate for Payer: Frontpath All Commercial |
$23.62
|
| Rate for Payer: Humana ChoiceCare |
$22.17
|
| Rate for Payer: Humana Medicare |
$13.09
|
| Rate for Payer: Lucent All Commercial |
$13.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$19.25
|
| Rate for Payer: PHP All Commercial |
$19.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.01
|
| Rate for Payer: Sagamore Health Network All Products |
$19.82
|
| Rate for Payer: Signature Care EPO |
$21.31
|
| Rate for Payer: Signature Care PPO |
$22.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.82
|
| Rate for Payer: United Healthcare Commercial |
$20.23
|
| Rate for Payer: United Healthcare Medicare |
$8.47
|
|
|
HC AR .045" GUIDE WIRE TROC TIP
|
Facility
OP
|
$169.40
|
|
| Hospital Charge Code |
41602602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.49
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Centivo All Commercial |
$86.39
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$86.39
|
| Rate for Payer: Lucent All Commercial |
$86.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$55.90
|
|
|
HC AR .045" GUIDE WIRE TROC TIP
|
Facility
IP
|
$169.40
|
|
| Hospital Charge Code |
41602602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC AR 0.62 GUIDEWIRE TROC TIP
|
Facility
IP
|
$115.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$107.42 |
| Rate for Payer: Aetna Commercial |
$99.79
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cigna All Commercial |
$99.68
|
| Rate for Payer: CORVEL All Commercial |
$107.42
|
| Rate for Payer: Coventry All Commercial |
$101.64
|
| Rate for Payer: Encore All Commercial |
$106.32
|
| Rate for Payer: Frontpath All Commercial |
$106.26
|
| Rate for Payer: Humana ChoiceCare |
$99.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.95
|
| Rate for Payer: PHCS All Commercial |
$86.62
|
| Rate for Payer: PHP All Commercial |
$87.60
|
| Rate for Payer: Sagamore Health Network All Products |
$89.17
|
| Rate for Payer: Signature Care EPO |
$95.86
|
| Rate for Payer: Signature Care PPO |
$101.64
|
| Rate for Payer: United Healthcare Commercial |
$91.01
|
|
|
HC AR 0.62 GUIDEWIRE TROC TIP
|
Facility
OP
|
$115.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$97.48
|
| Rate for Payer: Aetna Medicare |
$38.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.93
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Centivo All Commercial |
$58.90
|
| Rate for Payer: Cigna All Commercial |
$99.68
|
| Rate for Payer: CORVEL All Commercial |
$107.42
|
| Rate for Payer: Coventry All Commercial |
$101.64
|
| Rate for Payer: Encore All Commercial |
$106.32
|
| Rate for Payer: Frontpath All Commercial |
$106.26
|
| Rate for Payer: Humana ChoiceCare |
$99.76
|
| Rate for Payer: Humana Medicare |
$58.90
|
| Rate for Payer: Lucent All Commercial |
$58.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.95
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$86.62
|
| Rate for Payer: PHP All Commercial |
$87.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.04
|
| Rate for Payer: Sagamore Health Network All Products |
$89.17
|
| Rate for Payer: Signature Care EPO |
$95.86
|
| Rate for Payer: Signature Care PPO |
$101.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.18
|
| Rate for Payer: United Healthcare Commercial |
$91.01
|
| Rate for Payer: United Healthcare Medicare |
$38.12
|
|
|
HC AR .062 GUIDWIRE
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$286.44 |
| Rate for Payer: Aetna Commercial |
$266.11
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cigna All Commercial |
$265.80
|
| Rate for Payer: CORVEL All Commercial |
$286.44
|
| Rate for Payer: Coventry All Commercial |
$271.04
|
| Rate for Payer: Encore All Commercial |
$283.51
|
| Rate for Payer: Frontpath All Commercial |
$283.36
|
| Rate for Payer: Humana ChoiceCare |
$266.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.20
|
| Rate for Payer: PHCS All Commercial |
$231.00
|
| Rate for Payer: PHP All Commercial |
$233.59
|
| Rate for Payer: Sagamore Health Network All Products |
$237.78
|
| Rate for Payer: Signature Care EPO |
$255.64
|
| Rate for Payer: Signature Care PPO |
$271.04
|
| Rate for Payer: United Healthcare Commercial |
$242.70
|
|
