|
HC AR TENODESIS SCREW 7X10
|
Facility
IP
|
$1,732.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,299.38 |
| Max. Negotiated Rate |
$1,611.22 |
| Rate for Payer: Aetna Commercial |
$1,496.88
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cigna All Commercial |
$1,495.15
|
| Rate for Payer: CORVEL All Commercial |
$1,611.22
|
| Rate for Payer: Coventry All Commercial |
$1,524.60
|
| Rate for Payer: Encore All Commercial |
$1,594.77
|
| Rate for Payer: Frontpath All Commercial |
$1,593.90
|
| Rate for Payer: Humana ChoiceCare |
$1,496.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,559.25
|
| Rate for Payer: PHCS All Commercial |
$1,299.38
|
| Rate for Payer: PHP All Commercial |
$1,313.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,337.49
|
| Rate for Payer: Signature Care EPO |
$1,437.98
|
| Rate for Payer: Signature Care PPO |
$1,524.60
|
| Rate for Payer: United Healthcare Commercial |
$1,365.21
|
|
|
HC AR TENODESIS SET
|
Facility
IP
|
$27,126.00
|
|
| Hospital Charge Code |
41605565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20,344.50 |
| Max. Negotiated Rate |
$25,227.18 |
| Rate for Payer: Aetna Commercial |
$23,436.86
|
| Rate for Payer: Cash Price |
$16,818.12
|
| Rate for Payer: Cigna All Commercial |
$23,409.74
|
| Rate for Payer: CORVEL All Commercial |
$25,227.18
|
| Rate for Payer: Coventry All Commercial |
$23,870.88
|
| Rate for Payer: Encore All Commercial |
$24,969.48
|
| Rate for Payer: Frontpath All Commercial |
$24,955.92
|
| Rate for Payer: Humana ChoiceCare |
$23,428.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,413.40
|
| Rate for Payer: PHCS All Commercial |
$20,344.50
|
| Rate for Payer: PHP All Commercial |
$20,572.36
|
| Rate for Payer: Sagamore Health Network All Products |
$20,941.27
|
| Rate for Payer: Signature Care EPO |
$22,514.58
|
| Rate for Payer: Signature Care PPO |
$23,870.88
|
| Rate for Payer: United Healthcare Commercial |
$21,375.29
|
|
|
HC AR TENODESIS SET
|
Facility
OP
|
$27,126.00
|
|
| Hospital Charge Code |
41605565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$25,227.18 |
| Rate for Payer: Aetna Commercial |
$22,894.34
|
| Rate for Payer: Aetna Medicare |
$8,951.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,951.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,578.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16,956.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,294.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,846.74
|
| Rate for Payer: Cash Price |
$16,818.12
|
| Rate for Payer: Cash Price |
$16,818.12
|
| Rate for Payer: Centivo All Commercial |
$13,834.26
|
| Rate for Payer: Cigna All Commercial |
$23,409.74
|
| Rate for Payer: CORVEL All Commercial |
$25,227.18
|
| Rate for Payer: Coventry All Commercial |
$23,870.88
|
| Rate for Payer: Encore All Commercial |
$24,969.48
|
| Rate for Payer: Frontpath All Commercial |
$24,955.92
|
| Rate for Payer: Humana ChoiceCare |
$23,428.73
|
| Rate for Payer: Humana Medicare |
$13,834.26
|
| Rate for Payer: Lucent All Commercial |
$13,834.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,413.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20,344.50
|
| Rate for Payer: PHP All Commercial |
$20,572.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,579.14
|
| Rate for Payer: Sagamore Health Network All Products |
$20,941.27
|
| Rate for Payer: Signature Care EPO |
$22,514.58
|
| Rate for Payer: Signature Care PPO |
$23,870.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,057.10
|
| Rate for Payer: United Healthcare Commercial |
$21,375.29
|
| Rate for Payer: United Healthcare Medicare |
$8,951.58
|
|
|
HC ARTERIAL BLOOD GASES
|
Facility
IP
|
$339.63
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
63001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$254.72 |
| Max. Negotiated Rate |
$315.86 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Cash Price |
$210.57
|
| Rate for Payer: Cigna All Commercial |
$293.10
|
| Rate for Payer: CORVEL All Commercial |
$315.86
|
| Rate for Payer: Coventry All Commercial |
$298.87
|
| Rate for Payer: Encore All Commercial |
$312.63
|
| Rate for Payer: Frontpath All Commercial |
$312.46
|
| Rate for Payer: Humana ChoiceCare |
$293.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$305.67
|
| Rate for Payer: PHCS All Commercial |
$254.72
|
| Rate for Payer: PHP All Commercial |
$257.57
|
| Rate for Payer: Sagamore Health Network All Products |
$262.19
|
| Rate for Payer: Signature Care EPO |
$281.89
|
| Rate for Payer: Signature Care PPO |
$298.87
|
| Rate for Payer: United Healthcare Commercial |
$267.63
|
|
|
HC ARTERIAL BLOOD GASES
|
Facility
OP
|
$339.63
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
63001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$315.86 |
| Rate for Payer: Aetna Commercial |
$286.65
|
| Rate for Payer: Aetna Medicare |
$112.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$156.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.29
|
| Rate for Payer: Cash Price |
$210.57
|
| Rate for Payer: Cash Price |
$210.57
|
| Rate for Payer: Centivo All Commercial |
$173.21
|
| Rate for Payer: Cigna All Commercial |
$293.10
|
| Rate for Payer: CORVEL All Commercial |
$315.86
|
| Rate for Payer: Coventry All Commercial |
$298.87
|
| Rate for Payer: Encore All Commercial |
$312.63
|
| Rate for Payer: Frontpath All Commercial |
$312.46
|
| Rate for Payer: Humana ChoiceCare |
$293.34
|
| Rate for Payer: Humana Medicare |
$173.21
|
| Rate for Payer: Lucent All Commercial |
$173.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$305.67
|
| Rate for Payer: Managed Health Services Medicaid |
$23.55
|
| Rate for Payer: MDWise Medicaid |
$23.55
|
| Rate for Payer: PHCS All Commercial |
$254.72
|
| Rate for Payer: PHP All Commercial |
$257.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.46
|
| Rate for Payer: Sagamore Health Network All Products |
$262.19
|
| Rate for Payer: Signature Care EPO |
$281.89
|
| Rate for Payer: Signature Care PPO |
$298.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$288.68
|
| Rate for Payer: United Healthcare Commercial |
$267.63
|
| Rate for Payer: United Healthcare Medicare |
$112.08
|
|
|
HC ARTERIAL DRAW
|
Facility
OP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
01260762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$83.11
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.74
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Centivo All Commercial |
$50.22
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Humana Medicare |
$50.22
|
| Rate for Payer: Lucent All Commercial |
$50.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.40
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
| Rate for Payer: United Healthcare Medicare |
$32.50
|
|
|
HC ARTERIAL DRAW
|
Facility
IP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
01260762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
|
|
HC ARTERIAL LINE INSERTION
|
Facility
OP
|
$415.21
|
|
| Hospital Charge Code |
01682004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.02 |
| Max. Negotiated Rate |
$386.15 |
| Rate for Payer: Aetna Commercial |
$350.44
|
| Rate for Payer: Aetna Medicare |
$137.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$238.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.72
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Centivo All Commercial |
$211.76
|
| Rate for Payer: Cigna All Commercial |
$358.33
|
| Rate for Payer: CORVEL All Commercial |
$386.15
|
| Rate for Payer: Coventry All Commercial |
$365.39
|
| Rate for Payer: Encore All Commercial |
$382.20
|
| Rate for Payer: Frontpath All Commercial |
$381.99
|
| Rate for Payer: Humana ChoiceCare |
$358.62
|
| Rate for Payer: Humana Medicare |
$211.76
|
| Rate for Payer: Lucent All Commercial |
$211.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.69
|
| Rate for Payer: PHCS All Commercial |
$311.41
|
| Rate for Payer: PHP All Commercial |
$314.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.93
|
| Rate for Payer: Sagamore Health Network All Products |
$320.54
|
| Rate for Payer: Signature Care EPO |
$344.63
|
| Rate for Payer: Signature Care PPO |
$365.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.93
|
| Rate for Payer: United Healthcare Commercial |
$327.19
|
| Rate for Payer: United Healthcare Medicare |
$137.02
|
|
|
HC ARTERIAL LINE INSERTION
|
Facility
IP
|
$415.21
|
|
| Hospital Charge Code |
01682004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.41 |
| Max. Negotiated Rate |
$386.15 |
| Rate for Payer: Aetna Commercial |
$358.74
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cigna All Commercial |
$358.33
|
| Rate for Payer: CORVEL All Commercial |
$386.15
|
| Rate for Payer: Coventry All Commercial |
$365.39
|
| Rate for Payer: Encore All Commercial |
$382.20
|
| Rate for Payer: Frontpath All Commercial |
$381.99
|
| Rate for Payer: Humana ChoiceCare |
$358.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.69
|
| Rate for Payer: PHCS All Commercial |
$311.41
|
| Rate for Payer: PHP All Commercial |
$314.90
|
| Rate for Payer: Sagamore Health Network All Products |
$320.54
|
| Rate for Payer: Signature Care EPO |
$344.63
|
| Rate for Payer: Signature Care PPO |
$365.39
|
| Rate for Payer: United Healthcare Commercial |
$327.19
|
|
|
HC ARTERIAL PUNCTURE
|
Facility
OP
|
$335.11
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
63001359
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$311.65 |
| Rate for Payer: Aetna Commercial |
$282.83
|
| Rate for Payer: Aetna Medicare |
$110.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.65
|
| Rate for Payer: Cash Price |
$207.77
|
| Rate for Payer: Centivo All Commercial |
$170.91
|
| Rate for Payer: Cigna All Commercial |
$289.20
|
| Rate for Payer: CORVEL All Commercial |
$311.65
|
| Rate for Payer: Coventry All Commercial |
$294.90
|
| Rate for Payer: Encore All Commercial |
$308.47
|
| Rate for Payer: Frontpath All Commercial |
$308.30
|
| Rate for Payer: Humana ChoiceCare |
$289.44
|
| Rate for Payer: Humana Medicare |
$170.91
|
| Rate for Payer: Lucent All Commercial |
$170.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.60
|
| Rate for Payer: PHCS All Commercial |
$251.33
|
| Rate for Payer: PHP All Commercial |
$254.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.69
|
| Rate for Payer: Sagamore Health Network All Products |
$258.71
|
| Rate for Payer: Signature Care EPO |
$278.14
|
| Rate for Payer: Signature Care PPO |
$294.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$284.84
|
| Rate for Payer: United Healthcare Commercial |
$264.07
|
| Rate for Payer: United Healthcare Medicare |
$110.59
|
|
|
HC ARTERIAL PUNCTURE
|
Facility
IP
|
$335.11
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
63001359
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.33 |
| Max. Negotiated Rate |
$311.65 |
| Rate for Payer: Aetna Commercial |
$289.54
|
| Rate for Payer: Cash Price |
$207.77
|
| Rate for Payer: Cigna All Commercial |
$289.20
|
| Rate for Payer: CORVEL All Commercial |
$311.65
|
| Rate for Payer: Coventry All Commercial |
$294.90
|
| Rate for Payer: Encore All Commercial |
$308.47
|
| Rate for Payer: Frontpath All Commercial |
$308.30
|
| Rate for Payer: Humana ChoiceCare |
$289.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.60
|
| Rate for Payer: PHCS All Commercial |
$251.33
|
| Rate for Payer: PHP All Commercial |
$254.15
|
| Rate for Payer: Sagamore Health Network All Products |
$258.71
|
| Rate for Payer: Signature Care EPO |
$278.14
|
| Rate for Payer: Signature Care PPO |
$294.90
|
| Rate for Payer: United Healthcare Commercial |
$264.07
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
OP
|
$340.68
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
01620605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.42 |
| Max. Negotiated Rate |
$316.83 |
| Rate for Payer: Aetna Commercial |
$287.53
|
| Rate for Payer: Aetna Medicare |
$112.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$195.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$212.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$129.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.67
|
| Rate for Payer: Cash Price |
$211.22
|
| Rate for Payer: Cash Price |
$211.22
|
| Rate for Payer: Centivo All Commercial |
$173.75
|
| Rate for Payer: Cigna All Commercial |
$294.01
|
| Rate for Payer: CORVEL All Commercial |
$316.83
|
| Rate for Payer: Coventry All Commercial |
$299.80
|
| Rate for Payer: Encore All Commercial |
$313.60
|
| Rate for Payer: Frontpath All Commercial |
$313.43
|
| Rate for Payer: Humana ChoiceCare |
$294.25
|
| Rate for Payer: Humana Medicare |
$173.75
|
| Rate for Payer: Lucent All Commercial |
$173.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$306.61
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$255.51
|
| Rate for Payer: PHP All Commercial |
$258.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.87
|
| Rate for Payer: Sagamore Health Network All Products |
$263.00
|
| Rate for Payer: Signature Care EPO |
$282.76
|
| Rate for Payer: Signature Care PPO |
$299.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$289.58
|
| Rate for Payer: United Healthcare Commercial |
$268.46
|
| Rate for Payer: United Healthcare Medicare |
$112.42
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
IP
|
$340.68
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
01620605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.51 |
| Max. Negotiated Rate |
$316.83 |
| Rate for Payer: Aetna Commercial |
$294.35
|
| Rate for Payer: Cash Price |
$211.22
|
| Rate for Payer: Cigna All Commercial |
$294.01
|
| Rate for Payer: CORVEL All Commercial |
$316.83
|
| Rate for Payer: Coventry All Commercial |
$299.80
|
| Rate for Payer: Encore All Commercial |
$313.60
|
| Rate for Payer: Frontpath All Commercial |
$313.43
|
| Rate for Payer: Humana ChoiceCare |
$294.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$306.61
|
| Rate for Payer: PHCS All Commercial |
$255.51
|
| Rate for Payer: PHP All Commercial |
$258.37
|
| Rate for Payer: Sagamore Health Network All Products |
$263.00
|
| Rate for Payer: Signature Care EPO |
$282.76
|
| Rate for Payer: Signature Care PPO |
$299.80
|
| Rate for Payer: United Healthcare Commercial |
$268.46
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
OP
|
$528.36
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
01620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.36 |
| Max. Negotiated Rate |
$648.18 |
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: Aetna Medicare |
$174.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$174.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$303.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$330.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$191.79
|
| Rate for Payer: Cash Price |
$327.58
|
| Rate for Payer: Cash Price |
$327.58
|
| Rate for Payer: Centivo All Commercial |
$269.46
|
| Rate for Payer: Cigna All Commercial |
$455.97
|
| Rate for Payer: CORVEL All Commercial |
$491.37
|
| Rate for Payer: Coventry All Commercial |
$464.96
|
| Rate for Payer: Encore All Commercial |
$486.36
|
| Rate for Payer: Frontpath All Commercial |
$486.09
|
| Rate for Payer: Humana ChoiceCare |
$456.34
|
| Rate for Payer: Humana Medicare |
$269.46
|
| Rate for Payer: Lucent All Commercial |
$269.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.52
|
| Rate for Payer: Managed Health Services Medicaid |
$648.18
|
| Rate for Payer: MDWise Medicaid |
$648.18
|
| Rate for Payer: PHCS All Commercial |
$396.27
|
| Rate for Payer: PHP All Commercial |
$400.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.06
|
| Rate for Payer: Sagamore Health Network All Products |
$407.89
|
| Rate for Payer: Signature Care EPO |
$438.54
|
| Rate for Payer: Signature Care PPO |
$464.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$449.11
|
| Rate for Payer: United Healthcare Commercial |
$416.35
|
| Rate for Payer: United Healthcare Medicare |
$174.36
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
IP
|
$528.36
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
01620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.27 |
| Max. Negotiated Rate |
$491.37 |
| Rate for Payer: Aetna Commercial |
$456.50
|
| Rate for Payer: Cash Price |
$327.58
|
| Rate for Payer: Cigna All Commercial |
$455.97
|
| Rate for Payer: CORVEL All Commercial |
$491.37
|
| Rate for Payer: Coventry All Commercial |
$464.96
|
| Rate for Payer: Encore All Commercial |
$486.36
|
| Rate for Payer: Frontpath All Commercial |
$486.09
|
| Rate for Payer: Humana ChoiceCare |
$456.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.52
|
| Rate for Payer: PHCS All Commercial |
$396.27
|
| Rate for Payer: PHP All Commercial |
$400.71
|
| Rate for Payer: Sagamore Health Network All Products |
$407.89
|
| Rate for Payer: Signature Care EPO |
$438.54
|
| Rate for Payer: Signature Care PPO |
$464.96
|
| Rate for Payer: United Healthcare Commercial |
$416.35
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
IP
|
$378.42
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
01620610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.82 |
| Max. Negotiated Rate |
$351.93 |
| Rate for Payer: Aetna Commercial |
$326.95
|
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Cigna All Commercial |
$326.58
|
| Rate for Payer: CORVEL All Commercial |
$351.93
|
| Rate for Payer: Coventry All Commercial |
$333.01
|
| Rate for Payer: Encore All Commercial |
$348.34
|
| Rate for Payer: Frontpath All Commercial |
$348.15
|
| Rate for Payer: Humana ChoiceCare |
$326.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.58
|
| Rate for Payer: PHCS All Commercial |
$283.82
|
| Rate for Payer: PHP All Commercial |
$286.99
|
| Rate for Payer: Sagamore Health Network All Products |
$292.14
|
| Rate for Payer: Signature Care EPO |
$314.09
|
| Rate for Payer: Signature Care PPO |
$333.01
|
| Rate for Payer: United Healthcare Commercial |
$298.19
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
OP
|
$378.42
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
01620610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.88 |
| Max. Negotiated Rate |
$351.93 |
| Rate for Payer: Aetna Commercial |
$319.39
|
| Rate for Payer: Aetna Medicare |
$124.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$217.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$236.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.37
|
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Centivo All Commercial |
$192.99
|
| Rate for Payer: Cigna All Commercial |
$326.58
|
| Rate for Payer: CORVEL All Commercial |
$351.93
|
| Rate for Payer: Coventry All Commercial |
$333.01
|
| Rate for Payer: Encore All Commercial |
$348.34
|
| Rate for Payer: Frontpath All Commercial |
$348.15
|
| Rate for Payer: Humana ChoiceCare |
$326.84
|
| Rate for Payer: Humana Medicare |
$192.99
|
| Rate for Payer: Lucent All Commercial |
$192.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.58
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$283.82
|
| Rate for Payer: PHP All Commercial |
$286.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.58
|
| Rate for Payer: Sagamore Health Network All Products |
$292.14
|
| Rate for Payer: Signature Care EPO |
$314.09
|
| Rate for Payer: Signature Care PPO |
$333.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$321.66
|
| Rate for Payer: United Healthcare Commercial |
$298.19
|
| Rate for Payer: United Healthcare Medicare |
$124.88
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
IP
|
$415.14
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
01620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.36 |
| Max. Negotiated Rate |
$386.08 |
| Rate for Payer: Aetna Commercial |
$358.68
|
| Rate for Payer: Cash Price |
$257.39
|
| Rate for Payer: Cigna All Commercial |
$358.27
|
| Rate for Payer: CORVEL All Commercial |
$386.08
|
| Rate for Payer: Coventry All Commercial |
$365.32
|
| Rate for Payer: Encore All Commercial |
$382.14
|
| Rate for Payer: Frontpath All Commercial |
$381.93
|
| Rate for Payer: Humana ChoiceCare |
$358.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.63
|
| Rate for Payer: PHCS All Commercial |
$311.36
|
| Rate for Payer: PHP All Commercial |
$314.84
|
| Rate for Payer: Sagamore Health Network All Products |
$320.49
|
| Rate for Payer: Signature Care EPO |
$344.57
|
| Rate for Payer: Signature Care PPO |
$365.32
|
| Rate for Payer: United Healthcare Commercial |
$327.13
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
OP
|
$415.14
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
01620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$648.18 |
| Rate for Payer: Aetna Commercial |
$350.38
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$238.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.70
|
| Rate for Payer: Cash Price |
$257.39
|
| Rate for Payer: Cash Price |
$257.39
|
| Rate for Payer: Centivo All Commercial |
$211.72
|
| Rate for Payer: Cigna All Commercial |
$358.27
|
| Rate for Payer: CORVEL All Commercial |
$386.08
|
| Rate for Payer: Coventry All Commercial |
$365.32
|
| Rate for Payer: Encore All Commercial |
$382.14
|
| Rate for Payer: Frontpath All Commercial |
$381.93
|
| Rate for Payer: Humana ChoiceCare |
$358.56
|
| Rate for Payer: Humana Medicare |
$211.72
|
| Rate for Payer: Lucent All Commercial |
$211.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.63
|
| Rate for Payer: Managed Health Services Medicaid |
$648.18
|
| Rate for Payer: MDWise Medicaid |
$648.18
|
| Rate for Payer: PHCS All Commercial |
$311.36
|
| Rate for Payer: PHP All Commercial |
$314.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.90
|
| Rate for Payer: Sagamore Health Network All Products |
$320.49
|
| Rate for Payer: Signature Care EPO |
$344.57
|
| Rate for Payer: Signature Care PPO |
$365.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.87
|
| Rate for Payer: United Healthcare Commercial |
$327.13
|
| Rate for Payer: United Healthcare Medicare |
$137.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
IP
|
$321.30
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
01620600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.98 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$277.60
|
| Rate for Payer: Cash Price |
$199.21
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: PHCS All Commercial |
$240.98
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
OP
|
$321.30
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
01620600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.03 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$271.18
|
| Rate for Payer: Aetna Medicare |
$106.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$184.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.63
|
| Rate for Payer: Cash Price |
$199.21
|
| Rate for Payer: Cash Price |
$199.21
|
| Rate for Payer: Centivo All Commercial |
$163.86
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Humana Medicare |
$163.86
|
| Rate for Payer: Lucent All Commercial |
$163.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$240.98
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.31
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$273.10
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
| Rate for Payer: United Healthcare Medicare |
$106.03
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
OP
|
$367.20
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
01620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$648.18 |
| Rate for Payer: Aetna Commercial |
$309.92
|
| Rate for Payer: Aetna Medicare |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$210.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.29
|
| Rate for Payer: Cash Price |
$227.66
|
| Rate for Payer: Cash Price |
$227.66
|
| Rate for Payer: Centivo All Commercial |
$187.27
|
| Rate for Payer: Cigna All Commercial |
$316.89
|
| Rate for Payer: CORVEL All Commercial |
$341.50
|
| Rate for Payer: Coventry All Commercial |
$323.14
|
| Rate for Payer: Encore All Commercial |
$338.01
|
| Rate for Payer: Frontpath All Commercial |
$337.82
|
| Rate for Payer: Humana ChoiceCare |
$317.15
|
| Rate for Payer: Humana Medicare |
$187.27
|
| Rate for Payer: Lucent All Commercial |
$187.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$330.48
|
| Rate for Payer: Managed Health Services Medicaid |
$648.18
|
| Rate for Payer: MDWise Medicaid |
$648.18
|
| Rate for Payer: PHCS All Commercial |
$275.40
|
| Rate for Payer: PHP All Commercial |
$278.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.21
|
| Rate for Payer: Sagamore Health Network All Products |
$283.48
|
| Rate for Payer: Signature Care EPO |
$304.78
|
| Rate for Payer: Signature Care PPO |
$323.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$312.12
|
| Rate for Payer: United Healthcare Commercial |
$289.35
|
| Rate for Payer: United Healthcare Medicare |
$121.18
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
IP
|
$367.20
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
01620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$341.50 |
| Rate for Payer: Aetna Commercial |
$317.26
|
| Rate for Payer: Cash Price |
$227.66
|
| Rate for Payer: Cigna All Commercial |
$316.89
|
| Rate for Payer: CORVEL All Commercial |
$341.50
|
| Rate for Payer: Coventry All Commercial |
$323.14
|
| Rate for Payer: Encore All Commercial |
$338.01
|
| Rate for Payer: Frontpath All Commercial |
$337.82
|
| Rate for Payer: Humana ChoiceCare |
$317.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$330.48
|
| Rate for Payer: PHCS All Commercial |
$275.40
|
| Rate for Payer: PHP All Commercial |
$278.48
|
| Rate for Payer: Sagamore Health Network All Products |
$283.48
|
| Rate for Payer: Signature Care EPO |
$304.78
|
| Rate for Payer: Signature Care PPO |
$323.14
|
| Rate for Payer: United Healthcare Commercial |
$289.35
|
|
|
HC AR TIGERLINK 2
|
Facility
OP
|
$423.50
|
|
| Hospital Charge Code |
41606526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$393.86 |
| Rate for Payer: Aetna Commercial |
$357.43
|
| Rate for Payer: Aetna Medicare |
$139.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$264.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.73
|
| Rate for Payer: Cash Price |
$262.57
|
| Rate for Payer: Cash Price |
$262.57
|
| Rate for Payer: Centivo All Commercial |
$215.98
|
| Rate for Payer: Cigna All Commercial |
$365.48
|
| Rate for Payer: CORVEL All Commercial |
$393.86
|
| Rate for Payer: Coventry All Commercial |
$372.68
|
| Rate for Payer: Encore All Commercial |
$389.83
|
| Rate for Payer: Frontpath All Commercial |
$389.62
|
| Rate for Payer: Humana ChoiceCare |
$365.78
|
| Rate for Payer: Humana Medicare |
$215.98
|
| Rate for Payer: Lucent All Commercial |
$215.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.15
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$317.62
|
| Rate for Payer: PHP All Commercial |
$321.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.16
|
| Rate for Payer: Sagamore Health Network All Products |
$326.94
|
| Rate for Payer: Signature Care EPO |
$351.50
|
| Rate for Payer: Signature Care PPO |
$372.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$359.98
|
| Rate for Payer: United Healthcare Commercial |
$333.72
|
| Rate for Payer: United Healthcare Medicare |
$139.76
|
|
|
HC AR TIGERLINK 2
|
Facility
IP
|
$423.50
|
|
| Hospital Charge Code |
41606526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.62 |
| Max. Negotiated Rate |
$393.86 |
| Rate for Payer: Aetna Commercial |
$365.90
|
| Rate for Payer: Cash Price |
$262.57
|
| Rate for Payer: Cigna All Commercial |
$365.48
|
| Rate for Payer: CORVEL All Commercial |
$393.86
|
| Rate for Payer: Coventry All Commercial |
$372.68
|
| Rate for Payer: Encore All Commercial |
$389.83
|
| Rate for Payer: Frontpath All Commercial |
$389.62
|
| Rate for Payer: Humana ChoiceCare |
$365.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.15
|
| Rate for Payer: PHCS All Commercial |
$317.62
|
| Rate for Payer: PHP All Commercial |
$321.18
|
| Rate for Payer: Sagamore Health Network All Products |
$326.94
|
| Rate for Payer: Signature Care EPO |
$351.50
|
| Rate for Payer: Signature Care PPO |
$372.68
|
| Rate for Payer: United Healthcare Commercial |
$333.72
|
|
