|
HC BIV PM VISIONIST LV1
|
Facility
IP
|
$27,562.50
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607259
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,671.88 |
| Max. Negotiated Rate |
$25,633.12 |
| Rate for Payer: Aetna Commercial |
$23,814.00
|
| Rate for Payer: Cash Price |
$17,088.75
|
| Rate for Payer: Cigna All Commercial |
$23,786.44
|
| Rate for Payer: CORVEL All Commercial |
$25,633.12
|
| Rate for Payer: Coventry All Commercial |
$24,255.00
|
| Rate for Payer: Encore All Commercial |
$25,371.28
|
| Rate for Payer: Frontpath All Commercial |
$25,357.50
|
| Rate for Payer: Humana ChoiceCare |
$23,805.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,806.25
|
| Rate for Payer: PHCS All Commercial |
$20,671.88
|
| Rate for Payer: PHP All Commercial |
$20,903.40
|
| Rate for Payer: Sagamore Health Network All Products |
$21,278.25
|
| Rate for Payer: Signature Care EPO |
$22,876.88
|
| Rate for Payer: Signature Care PPO |
$24,255.00
|
| Rate for Payer: United Healthcare Commercial |
$21,719.25
|
|
|
HC BIV PM VISIONIST LV1
|
Facility
OP
|
$27,562.50
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607259
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$25,633.12 |
| Rate for Payer: Aetna Commercial |
$23,262.75
|
| Rate for Payer: Aetna Medicare |
$9,095.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,095.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,829.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17,229.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,459.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10,005.19
|
| Rate for Payer: Cash Price |
$17,088.75
|
| Rate for Payer: Cash Price |
$17,088.75
|
| Rate for Payer: Centivo All Commercial |
$14,056.88
|
| Rate for Payer: Cigna All Commercial |
$23,786.44
|
| Rate for Payer: CORVEL All Commercial |
$25,633.12
|
| Rate for Payer: Coventry All Commercial |
$24,255.00
|
| Rate for Payer: Encore All Commercial |
$25,371.28
|
| Rate for Payer: Frontpath All Commercial |
$25,357.50
|
| Rate for Payer: Humana ChoiceCare |
$23,805.73
|
| Rate for Payer: Humana Medicare |
$14,056.88
|
| Rate for Payer: Lucent All Commercial |
$14,056.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,806.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$20,671.88
|
| Rate for Payer: PHP All Commercial |
$20,903.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,749.38
|
| Rate for Payer: Sagamore Health Network All Products |
$21,278.25
|
| Rate for Payer: Signature Care EPO |
$22,876.88
|
| Rate for Payer: Signature Care PPO |
$24,255.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,428.12
|
| Rate for Payer: United Healthcare Commercial |
$21,719.25
|
| Rate for Payer: United Healthcare Medicare |
$9,095.62
|
|
|
HC BIV PM VISIONIST X4
|
Facility
OP
|
$28,743.75
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
41607257
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$26,731.69 |
| Rate for Payer: Aetna Commercial |
$24,259.72
|
| Rate for Payer: Aetna Medicare |
$9,485.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,485.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16,507.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17,967.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,908.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10,433.98
|
| Rate for Payer: Cash Price |
$17,821.13
|
| Rate for Payer: Cash Price |
$17,821.13
|
| Rate for Payer: Centivo All Commercial |
$14,659.31
|
| Rate for Payer: Cigna All Commercial |
$24,805.86
|
| Rate for Payer: CORVEL All Commercial |
$26,731.69
|
| Rate for Payer: Coventry All Commercial |
$25,294.50
|
| Rate for Payer: Encore All Commercial |
$26,458.62
|
| Rate for Payer: Frontpath All Commercial |
$26,444.25
|
| Rate for Payer: Humana ChoiceCare |
$24,825.98
|
| Rate for Payer: Humana Medicare |
$14,659.31
|
| Rate for Payer: Lucent All Commercial |
$14,659.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25,869.38
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$21,557.81
|
| Rate for Payer: PHP All Commercial |
$21,799.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11,210.06
|
| Rate for Payer: Sagamore Health Network All Products |
$22,190.18
|
| Rate for Payer: Signature Care EPO |
$23,857.31
|
| Rate for Payer: Signature Care PPO |
$25,294.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,432.19
|
| Rate for Payer: United Healthcare Commercial |
$22,650.08
|
| Rate for Payer: United Healthcare Medicare |
$9,485.44
|
|
|
HC BIV PM VISIONIST X4
|
Facility
IP
|
$28,743.75
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
41607257
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,557.81 |
| Max. Negotiated Rate |
$26,731.69 |
| Rate for Payer: Aetna Commercial |
$24,834.60
|
| Rate for Payer: Cash Price |
$17,821.13
|
| Rate for Payer: Cigna All Commercial |
$24,805.86
|
| Rate for Payer: CORVEL All Commercial |
$26,731.69
|
| Rate for Payer: Coventry All Commercial |
$25,294.50
|
| Rate for Payer: Encore All Commercial |
$26,458.62
|
| Rate for Payer: Frontpath All Commercial |
$26,444.25
|
| Rate for Payer: Humana ChoiceCare |
$24,825.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25,869.38
|
| Rate for Payer: PHCS All Commercial |
$21,557.81
|
| Rate for Payer: PHP All Commercial |
$21,799.26
|
| Rate for Payer: Sagamore Health Network All Products |
$22,190.18
|
| Rate for Payer: Signature Care EPO |
$23,857.31
|
| Rate for Payer: Signature Care PPO |
$25,294.50
|
| Rate for Payer: United Healthcare Commercial |
$22,650.08
|
|
|
HC BK VIRUS QT-PCR-BLOOD
|
Facility
OP
|
$497.05
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63001030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$462.25 |
| Rate for Payer: Aetna Commercial |
$419.51
|
| Rate for Payer: Aetna Medicare |
$164.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.43
|
| Rate for Payer: Cash Price |
$308.17
|
| Rate for Payer: Cash Price |
$308.17
|
| Rate for Payer: Centivo All Commercial |
$253.49
|
| Rate for Payer: Cigna All Commercial |
$428.95
|
| Rate for Payer: CORVEL All Commercial |
$462.25
|
| Rate for Payer: Coventry All Commercial |
$437.40
|
| Rate for Payer: Encore All Commercial |
$457.53
|
| Rate for Payer: Frontpath All Commercial |
$457.28
|
| Rate for Payer: Humana ChoiceCare |
$429.30
|
| Rate for Payer: Humana Medicare |
$253.49
|
| Rate for Payer: Lucent All Commercial |
$253.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.34
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$372.78
|
| Rate for Payer: PHP All Commercial |
$376.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$193.85
|
| Rate for Payer: Sagamore Health Network All Products |
$383.72
|
| Rate for Payer: Signature Care EPO |
$412.55
|
| Rate for Payer: Signature Care PPO |
$437.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$422.49
|
| Rate for Payer: United Healthcare Commercial |
$391.67
|
| Rate for Payer: United Healthcare Medicare |
$164.03
|
|
|
HC BK VIRUS QT-PCR-BLOOD
|
Facility
IP
|
$497.05
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63001030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$372.78 |
| Max. Negotiated Rate |
$462.25 |
| Rate for Payer: Aetna Commercial |
$429.45
|
| Rate for Payer: Cash Price |
$308.17
|
| Rate for Payer: Cigna All Commercial |
$428.95
|
| Rate for Payer: CORVEL All Commercial |
$462.25
|
| Rate for Payer: Coventry All Commercial |
$437.40
|
| Rate for Payer: Encore All Commercial |
$457.53
|
| Rate for Payer: Frontpath All Commercial |
$457.28
|
| Rate for Payer: Humana ChoiceCare |
$429.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.34
|
| Rate for Payer: PHCS All Commercial |
$372.78
|
| Rate for Payer: PHP All Commercial |
$376.96
|
| Rate for Payer: Sagamore Health Network All Products |
$383.72
|
| Rate for Payer: Signature Care EPO |
$412.55
|
| Rate for Payer: Signature Care PPO |
$437.40
|
| Rate for Payer: United Healthcare Commercial |
$391.67
|
|
|
HC BK VIRUS QT-PCR-URINE
|
Facility
IP
|
$497.05
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63002053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$372.78 |
| Max. Negotiated Rate |
$462.25 |
| Rate for Payer: Aetna Commercial |
$429.45
|
| Rate for Payer: Cash Price |
$308.17
|
| Rate for Payer: Cigna All Commercial |
$428.95
|
| Rate for Payer: CORVEL All Commercial |
$462.25
|
| Rate for Payer: Coventry All Commercial |
$437.40
|
| Rate for Payer: Encore All Commercial |
$457.53
|
| Rate for Payer: Frontpath All Commercial |
$457.28
|
| Rate for Payer: Humana ChoiceCare |
$429.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.34
|
| Rate for Payer: PHCS All Commercial |
$372.78
|
| Rate for Payer: PHP All Commercial |
$376.96
|
| Rate for Payer: Sagamore Health Network All Products |
$383.72
|
| Rate for Payer: Signature Care EPO |
$412.55
|
| Rate for Payer: Signature Care PPO |
$437.40
|
| Rate for Payer: United Healthcare Commercial |
$391.67
|
|
|
HC BK VIRUS QT-PCR-URINE
|
Facility
OP
|
$497.05
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63002053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$462.25 |
| Rate for Payer: Aetna Commercial |
$419.51
|
| Rate for Payer: Aetna Medicare |
$164.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.43
|
| Rate for Payer: Cash Price |
$308.17
|
| Rate for Payer: Cash Price |
$308.17
|
| Rate for Payer: Centivo All Commercial |
$253.49
|
| Rate for Payer: Cigna All Commercial |
$428.95
|
| Rate for Payer: CORVEL All Commercial |
$462.25
|
| Rate for Payer: Coventry All Commercial |
$437.40
|
| Rate for Payer: Encore All Commercial |
$457.53
|
| Rate for Payer: Frontpath All Commercial |
$457.28
|
| Rate for Payer: Humana ChoiceCare |
$429.30
|
| Rate for Payer: Humana Medicare |
$253.49
|
| Rate for Payer: Lucent All Commercial |
$253.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.34
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$372.78
|
| Rate for Payer: PHP All Commercial |
$376.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$193.85
|
| Rate for Payer: Sagamore Health Network All Products |
$383.72
|
| Rate for Payer: Signature Care EPO |
$412.55
|
| Rate for Payer: Signature Care PPO |
$437.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$422.49
|
| Rate for Payer: United Healthcare Commercial |
$391.67
|
| Rate for Payer: United Healthcare Medicare |
$164.03
|
|
|
HC BLACK GRANUFOAM KIT LG
|
Facility
OP
|
$401.91
|
|
| Hospital Charge Code |
41606589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: Aetna Commercial |
$339.21
|
| Rate for Payer: Aetna Medicare |
$132.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$230.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.89
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Centivo All Commercial |
$204.97
|
| Rate for Payer: Cigna All Commercial |
$346.85
|
| Rate for Payer: CORVEL All Commercial |
$373.78
|
| Rate for Payer: Coventry All Commercial |
$353.68
|
| Rate for Payer: Encore All Commercial |
$369.96
|
| Rate for Payer: Frontpath All Commercial |
$369.76
|
| Rate for Payer: Humana ChoiceCare |
$347.13
|
| Rate for Payer: Humana Medicare |
$204.97
|
| Rate for Payer: Lucent All Commercial |
$204.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$361.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$301.43
|
| Rate for Payer: PHP All Commercial |
$304.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.74
|
| Rate for Payer: Sagamore Health Network All Products |
$310.27
|
| Rate for Payer: Signature Care EPO |
$333.59
|
| Rate for Payer: Signature Care PPO |
$353.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$341.62
|
| Rate for Payer: United Healthcare Commercial |
$316.71
|
| Rate for Payer: United Healthcare Medicare |
$132.63
|
|
|
HC BLACK GRANUFOAM KIT LG
|
Facility
IP
|
$401.91
|
|
| Hospital Charge Code |
41606589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.43 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: Aetna Commercial |
$347.25
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cigna All Commercial |
$346.85
|
| Rate for Payer: CORVEL All Commercial |
$373.78
|
| Rate for Payer: Coventry All Commercial |
$353.68
|
| Rate for Payer: Encore All Commercial |
$369.96
|
| Rate for Payer: Frontpath All Commercial |
$369.76
|
| Rate for Payer: Humana ChoiceCare |
$347.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$361.72
|
| Rate for Payer: PHCS All Commercial |
$301.43
|
| Rate for Payer: PHP All Commercial |
$304.81
|
| Rate for Payer: Sagamore Health Network All Products |
$310.27
|
| Rate for Payer: Signature Care EPO |
$333.59
|
| Rate for Payer: Signature Care PPO |
$353.68
|
| Rate for Payer: United Healthcare Commercial |
$316.71
|
|
|
HC BLACK GRANUFOAM KIT MD
|
Facility
IP
|
$326.55
|
|
| Hospital Charge Code |
41606590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.91 |
| Max. Negotiated Rate |
$303.69 |
| Rate for Payer: Aetna Commercial |
$282.14
|
| Rate for Payer: Cash Price |
$202.46
|
| Rate for Payer: Cigna All Commercial |
$281.81
|
| Rate for Payer: CORVEL All Commercial |
$303.69
|
| Rate for Payer: Coventry All Commercial |
$287.36
|
| Rate for Payer: Encore All Commercial |
$300.59
|
| Rate for Payer: Frontpath All Commercial |
$300.43
|
| Rate for Payer: Humana ChoiceCare |
$282.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.90
|
| Rate for Payer: PHCS All Commercial |
$244.91
|
| Rate for Payer: PHP All Commercial |
$247.66
|
| Rate for Payer: Sagamore Health Network All Products |
$252.10
|
| Rate for Payer: Signature Care EPO |
$271.04
|
| Rate for Payer: Signature Care PPO |
$287.36
|
| Rate for Payer: United Healthcare Commercial |
$257.32
|
|
|
HC BLACK GRANUFOAM KIT MD
|
Facility
OP
|
$326.55
|
|
| Hospital Charge Code |
41606590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$303.69 |
| Rate for Payer: Aetna Commercial |
$275.61
|
| Rate for Payer: Aetna Medicare |
$107.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.54
|
| Rate for Payer: Cash Price |
$202.46
|
| Rate for Payer: Cash Price |
$202.46
|
| Rate for Payer: Centivo All Commercial |
$166.54
|
| Rate for Payer: Cigna All Commercial |
$281.81
|
| Rate for Payer: CORVEL All Commercial |
$303.69
|
| Rate for Payer: Coventry All Commercial |
$287.36
|
| Rate for Payer: Encore All Commercial |
$300.59
|
| Rate for Payer: Frontpath All Commercial |
$300.43
|
| Rate for Payer: Humana ChoiceCare |
$282.04
|
| Rate for Payer: Humana Medicare |
$166.54
|
| Rate for Payer: Lucent All Commercial |
$166.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$244.91
|
| Rate for Payer: PHP All Commercial |
$247.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.35
|
| Rate for Payer: Sagamore Health Network All Products |
$252.10
|
| Rate for Payer: Signature Care EPO |
$271.04
|
| Rate for Payer: Signature Care PPO |
$287.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$277.57
|
| Rate for Payer: United Healthcare Commercial |
$257.32
|
| Rate for Payer: United Healthcare Medicare |
$107.76
|
|
|
HC BLADDER SCAN RESIDUAL BEDSIDE
|
Facility
IP
|
$533.51
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
01681798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.13 |
| Max. Negotiated Rate |
$496.17 |
| Rate for Payer: Aetna Commercial |
$460.95
|
| Rate for Payer: Cash Price |
$330.78
|
| Rate for Payer: Cigna All Commercial |
$460.42
|
| Rate for Payer: CORVEL All Commercial |
$496.17
|
| Rate for Payer: Coventry All Commercial |
$469.49
|
| Rate for Payer: Encore All Commercial |
$491.10
|
| Rate for Payer: Frontpath All Commercial |
$490.83
|
| Rate for Payer: Humana ChoiceCare |
$460.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$480.16
|
| Rate for Payer: PHCS All Commercial |
$400.13
|
| Rate for Payer: PHP All Commercial |
$404.61
|
| Rate for Payer: Sagamore Health Network All Products |
$411.87
|
| Rate for Payer: Signature Care EPO |
$442.81
|
| Rate for Payer: Signature Care PPO |
$469.49
|
| Rate for Payer: United Healthcare Commercial |
$420.41
|
|
|
HC BLADDER SCAN RESIDUAL BEDSIDE
|
Facility
OP
|
$533.51
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
01681798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$496.17 |
| Rate for Payer: Aetna Commercial |
$450.28
|
| Rate for Payer: Aetna Medicare |
$176.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$176.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$306.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$85.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$202.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.66
|
| Rate for Payer: Cash Price |
$330.78
|
| Rate for Payer: Cash Price |
$330.78
|
| Rate for Payer: Centivo All Commercial |
$272.09
|
| Rate for Payer: Cigna All Commercial |
$460.42
|
| Rate for Payer: CORVEL All Commercial |
$496.17
|
| Rate for Payer: Coventry All Commercial |
$469.49
|
| Rate for Payer: Encore All Commercial |
$491.10
|
| Rate for Payer: Frontpath All Commercial |
$490.83
|
| Rate for Payer: Humana ChoiceCare |
$460.79
|
| Rate for Payer: Humana Medicare |
$272.09
|
| Rate for Payer: Lucent All Commercial |
$272.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$480.16
|
| Rate for Payer: Managed Health Services Medicaid |
$85.25
|
| Rate for Payer: MDWise Medicaid |
$85.25
|
| Rate for Payer: PHCS All Commercial |
$400.13
|
| Rate for Payer: PHP All Commercial |
$404.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$208.07
|
| Rate for Payer: Sagamore Health Network All Products |
$411.87
|
| Rate for Payer: Signature Care EPO |
$442.81
|
| Rate for Payer: Signature Care PPO |
$469.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$453.48
|
| Rate for Payer: United Healthcare Commercial |
$420.41
|
| Rate for Payer: United Healthcare Medicare |
$176.06
|
|
|
HC BLADE BEAVER
|
Facility
OP
|
$68.74
|
|
| Hospital Charge Code |
41602204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$58.02
|
| Rate for Payer: Aetna Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.95
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Centivo All Commercial |
$35.06
|
| Rate for Payer: Cigna All Commercial |
$59.32
|
| Rate for Payer: CORVEL All Commercial |
$63.93
|
| Rate for Payer: Coventry All Commercial |
$60.49
|
| Rate for Payer: Encore All Commercial |
$63.28
|
| Rate for Payer: Frontpath All Commercial |
$63.24
|
| Rate for Payer: Humana ChoiceCare |
$59.37
|
| Rate for Payer: Humana Medicare |
$35.06
|
| Rate for Payer: Lucent All Commercial |
$35.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$51.56
|
| Rate for Payer: PHP All Commercial |
$52.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.81
|
| Rate for Payer: Sagamore Health Network All Products |
$53.07
|
| Rate for Payer: Signature Care EPO |
$57.05
|
| Rate for Payer: Signature Care PPO |
$60.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.43
|
| Rate for Payer: United Healthcare Commercial |
$54.17
|
| Rate for Payer: United Healthcare Medicare |
$22.68
|
|
|
HC BLADE BEAVER
|
Facility
IP
|
$68.74
|
|
| Hospital Charge Code |
41602204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.56 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cigna All Commercial |
$59.32
|
| Rate for Payer: CORVEL All Commercial |
$63.93
|
| Rate for Payer: Coventry All Commercial |
$60.49
|
| Rate for Payer: Encore All Commercial |
$63.28
|
| Rate for Payer: Frontpath All Commercial |
$63.24
|
| Rate for Payer: Humana ChoiceCare |
$59.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.87
|
| Rate for Payer: PHCS All Commercial |
$51.56
|
| Rate for Payer: PHP All Commercial |
$52.13
|
| Rate for Payer: Sagamore Health Network All Products |
$53.07
|
| Rate for Payer: Signature Care EPO |
$57.05
|
| Rate for Payer: Signature Care PPO |
$60.49
|
| Rate for Payer: United Healthcare Commercial |
$54.17
|
|
|
HC BLADE DERMATOME
|
Facility
OP
|
$1,846.25
|
|
| Hospital Charge Code |
41602082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,717.01 |
| Rate for Payer: Aetna Commercial |
$1,558.24
|
| Rate for Payer: Aetna Medicare |
$609.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$609.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,060.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,154.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$700.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$670.19
|
| Rate for Payer: Cash Price |
$1,144.68
|
| Rate for Payer: Cash Price |
$1,144.68
|
| Rate for Payer: Centivo All Commercial |
$941.59
|
| Rate for Payer: Cigna All Commercial |
$1,593.31
|
| Rate for Payer: CORVEL All Commercial |
$1,717.01
|
| Rate for Payer: Coventry All Commercial |
$1,624.70
|
| Rate for Payer: Encore All Commercial |
$1,699.47
|
| Rate for Payer: Frontpath All Commercial |
$1,698.55
|
| Rate for Payer: Humana ChoiceCare |
$1,594.61
|
| Rate for Payer: Humana Medicare |
$941.59
|
| Rate for Payer: Lucent All Commercial |
$941.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,661.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,384.69
|
| Rate for Payer: PHP All Commercial |
$1,400.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$720.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,425.30
|
| Rate for Payer: Signature Care EPO |
$1,532.39
|
| Rate for Payer: Signature Care PPO |
$1,624.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,569.31
|
| Rate for Payer: United Healthcare Commercial |
$1,454.84
|
| Rate for Payer: United Healthcare Medicare |
$609.26
|
|
|
HC BLADE DERMATOME
|
Facility
IP
|
$1,846.25
|
|
| Hospital Charge Code |
41602082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,384.69 |
| Max. Negotiated Rate |
$1,717.01 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Cash Price |
$1,144.68
|
| Rate for Payer: Cigna All Commercial |
$1,593.31
|
| Rate for Payer: CORVEL All Commercial |
$1,717.01
|
| Rate for Payer: Coventry All Commercial |
$1,624.70
|
| Rate for Payer: Encore All Commercial |
$1,699.47
|
| Rate for Payer: Frontpath All Commercial |
$1,698.55
|
| Rate for Payer: Humana ChoiceCare |
$1,594.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,661.62
|
| Rate for Payer: PHCS All Commercial |
$1,384.69
|
| Rate for Payer: PHP All Commercial |
$1,400.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,425.30
|
| Rate for Payer: Signature Care EPO |
$1,532.39
|
| Rate for Payer: Signature Care PPO |
$1,624.70
|
| Rate for Payer: United Healthcare Commercial |
$1,454.84
|
|
|
HC BLADE ECTR STANDARD
|
Facility
IP
|
$1,320.00
|
|
| Hospital Charge Code |
41602477
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$1,227.60 |
| Rate for Payer: Aetna Commercial |
$1,140.48
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna All Commercial |
$1,139.16
|
| Rate for Payer: CORVEL All Commercial |
$1,227.60
|
| Rate for Payer: Coventry All Commercial |
$1,161.60
|
| Rate for Payer: Encore All Commercial |
$1,215.06
|
| Rate for Payer: Frontpath All Commercial |
$1,214.40
|
| Rate for Payer: Humana ChoiceCare |
$1,140.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,188.00
|
| Rate for Payer: PHCS All Commercial |
$990.00
|
| Rate for Payer: PHP All Commercial |
$1,001.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,019.04
|
| Rate for Payer: Signature Care EPO |
$1,095.60
|
| Rate for Payer: Signature Care PPO |
$1,161.60
|
| Rate for Payer: United Healthcare Commercial |
$1,040.16
|
|
|
HC BLADE ECTR STANDARD
|
Facility
OP
|
$1,320.00
|
|
| Hospital Charge Code |
41602477
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$1,227.60 |
| Rate for Payer: Aetna Commercial |
$1,114.08
|
| Rate for Payer: Aetna Medicare |
$435.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$435.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$758.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$825.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$500.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$479.16
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Centivo All Commercial |
$673.20
|
| Rate for Payer: Cigna All Commercial |
$1,139.16
|
| Rate for Payer: CORVEL All Commercial |
$1,227.60
|
| Rate for Payer: Coventry All Commercial |
$1,161.60
|
| Rate for Payer: Encore All Commercial |
$1,215.06
|
| Rate for Payer: Frontpath All Commercial |
$1,214.40
|
| Rate for Payer: Humana ChoiceCare |
$1,140.08
|
| Rate for Payer: Humana Medicare |
$673.20
|
| Rate for Payer: Lucent All Commercial |
$673.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,188.00
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$990.00
|
| Rate for Payer: PHP All Commercial |
$1,001.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$514.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,019.04
|
| Rate for Payer: Signature Care EPO |
$1,095.60
|
| Rate for Payer: Signature Care PPO |
$1,161.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare Commercial |
$1,040.16
|
| Rate for Payer: United Healthcare Medicare |
$435.60
|
|
|
HC BLADE GLIDESCOPE GVL 1
|
Facility
OP
|
$153.89
|
|
| Hospital Charge Code |
41602333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Aetna Commercial |
$129.88
|
| Rate for Payer: Aetna Medicare |
$50.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$88.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.86
|
| Rate for Payer: Cash Price |
$95.41
|
| Rate for Payer: Cash Price |
$95.41
|
| Rate for Payer: Centivo All Commercial |
$78.48
|
| Rate for Payer: Cigna All Commercial |
$132.81
|
| Rate for Payer: CORVEL All Commercial |
$143.12
|
| Rate for Payer: Coventry All Commercial |
$135.42
|
| Rate for Payer: Encore All Commercial |
$141.66
|
| Rate for Payer: Frontpath All Commercial |
$141.58
|
| Rate for Payer: Humana ChoiceCare |
$132.91
|
| Rate for Payer: Humana Medicare |
$78.48
|
| Rate for Payer: Lucent All Commercial |
$78.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$115.42
|
| Rate for Payer: PHP All Commercial |
$116.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.02
|
| Rate for Payer: Sagamore Health Network All Products |
$118.80
|
| Rate for Payer: Signature Care EPO |
$127.73
|
| Rate for Payer: Signature Care PPO |
$135.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.81
|
| Rate for Payer: United Healthcare Commercial |
$121.27
|
| Rate for Payer: United Healthcare Medicare |
$50.78
|
|
|
HC BLADE GLIDESCOPE GVL 1
|
Facility
IP
|
$153.89
|
|
| Hospital Charge Code |
41602333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.42 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Aetna Commercial |
$132.96
|
| Rate for Payer: Cash Price |
$95.41
|
| Rate for Payer: Cigna All Commercial |
$132.81
|
| Rate for Payer: CORVEL All Commercial |
$143.12
|
| Rate for Payer: Coventry All Commercial |
$135.42
|
| Rate for Payer: Encore All Commercial |
$141.66
|
| Rate for Payer: Frontpath All Commercial |
$141.58
|
| Rate for Payer: Humana ChoiceCare |
$132.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.50
|
| Rate for Payer: PHCS All Commercial |
$115.42
|
| Rate for Payer: PHP All Commercial |
$116.71
|
| Rate for Payer: Sagamore Health Network All Products |
$118.80
|
| Rate for Payer: Signature Care EPO |
$127.73
|
| Rate for Payer: Signature Care PPO |
$135.42
|
| Rate for Payer: United Healthcare Commercial |
$121.27
|
|
|
HC BLADE GLIDESCOPE GVL 2
|
Facility
OP
|
$160.30
|
|
| Hospital Charge Code |
41602151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$149.08 |
| Rate for Payer: Aetna Commercial |
$135.29
|
| Rate for Payer: Aetna Medicare |
$52.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.19
|
| Rate for Payer: Cash Price |
$99.39
|
| Rate for Payer: Cash Price |
$99.39
|
| Rate for Payer: Centivo All Commercial |
$81.75
|
| Rate for Payer: Cigna All Commercial |
$138.34
|
| Rate for Payer: CORVEL All Commercial |
$149.08
|
| Rate for Payer: Coventry All Commercial |
$141.06
|
| Rate for Payer: Encore All Commercial |
$147.56
|
| Rate for Payer: Frontpath All Commercial |
$147.48
|
| Rate for Payer: Humana ChoiceCare |
$138.45
|
| Rate for Payer: Humana Medicare |
$81.75
|
| Rate for Payer: Lucent All Commercial |
$81.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$120.22
|
| Rate for Payer: PHP All Commercial |
$121.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.52
|
| Rate for Payer: Sagamore Health Network All Products |
$123.75
|
| Rate for Payer: Signature Care EPO |
$133.05
|
| Rate for Payer: Signature Care PPO |
$141.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.26
|
| Rate for Payer: United Healthcare Commercial |
$126.32
|
| Rate for Payer: United Healthcare Medicare |
$52.90
|
|
|
HC BLADE GLIDESCOPE GVL 2
|
Facility
IP
|
$160.30
|
|
| Hospital Charge Code |
41602151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.22 |
| Max. Negotiated Rate |
$149.08 |
| Rate for Payer: Aetna Commercial |
$138.50
|
| Rate for Payer: Cash Price |
$99.39
|
| Rate for Payer: Cigna All Commercial |
$138.34
|
| Rate for Payer: CORVEL All Commercial |
$149.08
|
| Rate for Payer: Coventry All Commercial |
$141.06
|
| Rate for Payer: Encore All Commercial |
$147.56
|
| Rate for Payer: Frontpath All Commercial |
$147.48
|
| Rate for Payer: Humana ChoiceCare |
$138.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.27
|
| Rate for Payer: PHCS All Commercial |
$120.22
|
| Rate for Payer: PHP All Commercial |
$121.57
|
| Rate for Payer: Sagamore Health Network All Products |
$123.75
|
| Rate for Payer: Signature Care EPO |
$133.05
|
| Rate for Payer: Signature Care PPO |
$141.06
|
| Rate for Payer: United Healthcare Commercial |
$126.32
|
|
|
HC BLADE GLIDESCOPE GVL 3
|
Facility
OP
|
$136.71
|
|
| Hospital Charge Code |
41601226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.11 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Aetna Commercial |
$115.38
|
| Rate for Payer: Aetna Medicare |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.63
|
| Rate for Payer: Cash Price |
$84.76
|
| Rate for Payer: Cash Price |
$84.76
|
| Rate for Payer: Centivo All Commercial |
$69.72
|
| Rate for Payer: Cigna All Commercial |
$117.98
|
| Rate for Payer: CORVEL All Commercial |
$127.14
|
| Rate for Payer: Coventry All Commercial |
$120.30
|
| Rate for Payer: Encore All Commercial |
$125.84
|
| Rate for Payer: Frontpath All Commercial |
$125.77
|
| Rate for Payer: Humana ChoiceCare |
$118.08
|
| Rate for Payer: Humana Medicare |
$69.72
|
| Rate for Payer: Lucent All Commercial |
$69.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$102.53
|
| Rate for Payer: PHP All Commercial |
$103.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.32
|
| Rate for Payer: Sagamore Health Network All Products |
$105.54
|
| Rate for Payer: Signature Care EPO |
$113.47
|
| Rate for Payer: Signature Care PPO |
$120.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.20
|
| Rate for Payer: United Healthcare Commercial |
$107.73
|
| Rate for Payer: United Healthcare Medicare |
$45.11
|
|
