|
HC CARDIAC REHAB II; 37+
|
Facility
IP
|
$236.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
01603798
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$219.48 |
| Rate for Payer: Aetna Commercial |
$203.90
|
| Rate for Payer: Cash Price |
$146.32
|
| Rate for Payer: Cigna All Commercial |
$203.67
|
| Rate for Payer: CORVEL All Commercial |
$219.48
|
| Rate for Payer: Coventry All Commercial |
$207.68
|
| Rate for Payer: Encore All Commercial |
$217.24
|
| Rate for Payer: Frontpath All Commercial |
$217.12
|
| Rate for Payer: Humana ChoiceCare |
$203.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.40
|
| Rate for Payer: PHCS All Commercial |
$177.00
|
| Rate for Payer: PHP All Commercial |
$178.98
|
| Rate for Payer: Sagamore Health Network All Products |
$182.19
|
| Rate for Payer: Signature Care EPO |
$195.88
|
| Rate for Payer: Signature Care PPO |
$207.68
|
| Rate for Payer: United Healthcare Commercial |
$185.97
|
|
|
HC CARDIOLIPIN AB EA
|
Facility
IP
|
$101.61
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.21 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$87.79
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna All Commercial |
$87.69
|
| Rate for Payer: CORVEL All Commercial |
$94.50
|
| Rate for Payer: Coventry All Commercial |
$89.42
|
| Rate for Payer: Encore All Commercial |
$93.53
|
| Rate for Payer: Frontpath All Commercial |
$93.48
|
| Rate for Payer: Humana ChoiceCare |
$87.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.45
|
| Rate for Payer: PHCS All Commercial |
$76.21
|
| Rate for Payer: PHP All Commercial |
$77.06
|
| Rate for Payer: Sagamore Health Network All Products |
$78.44
|
| Rate for Payer: Signature Care EPO |
$84.34
|
| Rate for Payer: Signature Care PPO |
$89.42
|
| Rate for Payer: United Healthcare Commercial |
$80.07
|
|
|
HC CARDIOLIPIN AB EA
|
Facility
OP
|
$101.61
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.76
|
| Rate for Payer: Aetna Medicare |
$33.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Centivo All Commercial |
$51.82
|
| Rate for Payer: Cigna All Commercial |
$87.69
|
| Rate for Payer: CORVEL All Commercial |
$94.50
|
| Rate for Payer: Coventry All Commercial |
$89.42
|
| Rate for Payer: Encore All Commercial |
$93.53
|
| Rate for Payer: Frontpath All Commercial |
$93.48
|
| Rate for Payer: Humana ChoiceCare |
$87.76
|
| Rate for Payer: Humana Medicare |
$51.82
|
| Rate for Payer: Lucent All Commercial |
$51.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$76.21
|
| Rate for Payer: PHP All Commercial |
$77.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.63
|
| Rate for Payer: Sagamore Health Network All Products |
$78.44
|
| Rate for Payer: Signature Care EPO |
$84.34
|
| Rate for Payer: Signature Care PPO |
$89.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.37
|
| Rate for Payer: United Healthcare Commercial |
$80.07
|
| Rate for Payer: United Healthcare Medicare |
$33.53
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
OP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna Commercial |
$116.31
|
| Rate for Payer: Aetna Medicare |
$45.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.03
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Centivo All Commercial |
$70.28
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.17
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.86
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Humana Medicare |
$70.28
|
| Rate for Payer: Lucent All Commercial |
$70.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.75
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.14
|
| Rate for Payer: United Healthcare Commercial |
$108.60
|
| Rate for Payer: United Healthcare Medicare |
$45.48
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
IP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.17
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.86
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: United Healthcare Commercial |
$108.60
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
OP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna Commercial |
$116.31
|
| Rate for Payer: Aetna Medicare |
$45.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.03
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Centivo All Commercial |
$70.28
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.17
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.86
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Humana Medicare |
$70.28
|
| Rate for Payer: Lucent All Commercial |
$70.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.75
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.14
|
| Rate for Payer: United Healthcare Commercial |
$108.60
|
| Rate for Payer: United Healthcare Medicare |
$45.48
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
IP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.17
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.86
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: United Healthcare Commercial |
$108.60
|
|
|
HC CARDIOLIPIN AB IGG, IGA, IGM
|
Facility
OP
|
$92.76
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63002195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$86.27 |
| Rate for Payer: Aetna Commercial |
$78.29
|
| Rate for Payer: Aetna Medicare |
$30.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.67
|
| Rate for Payer: Cash Price |
$57.51
|
| Rate for Payer: Cash Price |
$57.51
|
| Rate for Payer: Centivo All Commercial |
$47.31
|
| Rate for Payer: Cigna All Commercial |
$80.05
|
| Rate for Payer: CORVEL All Commercial |
$86.27
|
| Rate for Payer: Coventry All Commercial |
$81.63
|
| Rate for Payer: Encore All Commercial |
$85.38
|
| Rate for Payer: Frontpath All Commercial |
$85.34
|
| Rate for Payer: Humana ChoiceCare |
$80.12
|
| Rate for Payer: Humana Medicare |
$47.31
|
| Rate for Payer: Lucent All Commercial |
$47.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.48
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$69.57
|
| Rate for Payer: PHP All Commercial |
$70.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.18
|
| Rate for Payer: Sagamore Health Network All Products |
$71.61
|
| Rate for Payer: Signature Care EPO |
$76.99
|
| Rate for Payer: Signature Care PPO |
$81.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.84
|
| Rate for Payer: United Healthcare Commercial |
$73.09
|
| Rate for Payer: United Healthcare Medicare |
$30.61
|
|
|
HC CARDIOLIPIN AB IGG, IGA, IGM
|
Facility
IP
|
$92.76
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63002195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.57 |
| Max. Negotiated Rate |
$86.27 |
| Rate for Payer: Aetna Commercial |
$80.14
|
| Rate for Payer: Cash Price |
$57.51
|
| Rate for Payer: Cigna All Commercial |
$80.05
|
| Rate for Payer: CORVEL All Commercial |
$86.27
|
| Rate for Payer: Coventry All Commercial |
$81.63
|
| Rate for Payer: Encore All Commercial |
$85.38
|
| Rate for Payer: Frontpath All Commercial |
$85.34
|
| Rate for Payer: Humana ChoiceCare |
$80.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.48
|
| Rate for Payer: PHCS All Commercial |
$69.57
|
| Rate for Payer: PHP All Commercial |
$70.35
|
| Rate for Payer: Sagamore Health Network All Products |
$71.61
|
| Rate for Payer: Signature Care EPO |
$76.99
|
| Rate for Payer: Signature Care PPO |
$81.63
|
| Rate for Payer: United Healthcare Commercial |
$73.09
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
IP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.17
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.86
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: United Healthcare Commercial |
$108.60
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
OP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna Commercial |
$116.31
|
| Rate for Payer: Aetna Medicare |
$45.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.03
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Centivo All Commercial |
$70.28
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.17
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.86
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Humana Medicare |
$70.28
|
| Rate for Payer: Lucent All Commercial |
$70.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.75
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.14
|
| Rate for Payer: United Healthcare Commercial |
$108.60
|
| Rate for Payer: United Healthcare Medicare |
$45.48
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
IP
|
$990.68
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
01706484
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$743.01 |
| Max. Negotiated Rate |
$921.33 |
| Rate for Payer: Aetna Commercial |
$855.94
|
| Rate for Payer: Cash Price |
$614.22
|
| Rate for Payer: Cigna All Commercial |
$854.95
|
| Rate for Payer: CORVEL All Commercial |
$921.33
|
| Rate for Payer: Coventry All Commercial |
$871.79
|
| Rate for Payer: Encore All Commercial |
$911.92
|
| Rate for Payer: Frontpath All Commercial |
$911.42
|
| Rate for Payer: Humana ChoiceCare |
$855.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.61
|
| Rate for Payer: PHCS All Commercial |
$743.01
|
| Rate for Payer: PHP All Commercial |
$751.33
|
| Rate for Payer: Sagamore Health Network All Products |
$764.80
|
| Rate for Payer: Signature Care EPO |
$822.26
|
| Rate for Payer: Signature Care PPO |
$871.79
|
| Rate for Payer: United Healthcare Commercial |
$780.65
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
OP
|
$990.68
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
01706484
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$326.92 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: Aetna Commercial |
$836.13
|
| Rate for Payer: Aetna Medicare |
$326.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$619.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.62
|
| Rate for Payer: Cash Price |
$614.22
|
| Rate for Payer: Cash Price |
$614.22
|
| Rate for Payer: Centivo All Commercial |
$505.24
|
| Rate for Payer: Cigna All Commercial |
$854.95
|
| Rate for Payer: CORVEL All Commercial |
$921.33
|
| Rate for Payer: Coventry All Commercial |
$871.79
|
| Rate for Payer: Encore All Commercial |
$911.92
|
| Rate for Payer: Frontpath All Commercial |
$911.42
|
| Rate for Payer: Humana ChoiceCare |
$855.65
|
| Rate for Payer: Humana Medicare |
$505.24
|
| Rate for Payer: Lucent All Commercial |
$505.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.61
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
| Rate for Payer: PHCS All Commercial |
$743.01
|
| Rate for Payer: PHP All Commercial |
$751.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.36
|
| Rate for Payer: Sagamore Health Network All Products |
$764.80
|
| Rate for Payer: Signature Care EPO |
$822.26
|
| Rate for Payer: Signature Care PPO |
$871.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$842.07
|
| Rate for Payer: United Healthcare Commercial |
$780.65
|
| Rate for Payer: United Healthcare Medicare |
$326.92
|
|
|
HC CARDIOVASCULAR FUNCTION EVAL /TILT TABLE W/MNTR
|
Facility
IP
|
$1,586.96
|
|
| Hospital Charge Code |
01203660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,190.22 |
| Max. Negotiated Rate |
$1,475.87 |
| Rate for Payer: Aetna Commercial |
$1,371.13
|
| Rate for Payer: Cash Price |
$983.91
|
| Rate for Payer: Cigna All Commercial |
$1,369.54
|
| Rate for Payer: CORVEL All Commercial |
$1,475.87
|
| Rate for Payer: Coventry All Commercial |
$1,396.52
|
| Rate for Payer: Encore All Commercial |
$1,460.79
|
| Rate for Payer: Frontpath All Commercial |
$1,460.00
|
| Rate for Payer: Humana ChoiceCare |
$1,370.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,428.26
|
| Rate for Payer: PHCS All Commercial |
$1,190.22
|
| Rate for Payer: PHP All Commercial |
$1,203.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,225.13
|
| Rate for Payer: Signature Care EPO |
$1,317.17
|
| Rate for Payer: Signature Care PPO |
$1,396.52
|
| Rate for Payer: United Healthcare Commercial |
$1,250.52
|
|
|
HC CARDIOVASCULAR FUNCTION EVAL /TILT TABLE W/MNTR
|
Facility
OP
|
$1,586.96
|
|
| Hospital Charge Code |
01203660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$523.70 |
| Max. Negotiated Rate |
$1,475.87 |
| Rate for Payer: Aetna Commercial |
$1,339.39
|
| Rate for Payer: Aetna Medicare |
$523.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$523.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$911.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$602.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$576.07
|
| Rate for Payer: Cash Price |
$983.91
|
| Rate for Payer: Centivo All Commercial |
$809.35
|
| Rate for Payer: Cigna All Commercial |
$1,369.54
|
| Rate for Payer: CORVEL All Commercial |
$1,475.87
|
| Rate for Payer: Coventry All Commercial |
$1,396.52
|
| Rate for Payer: Encore All Commercial |
$1,460.79
|
| Rate for Payer: Frontpath All Commercial |
$1,460.00
|
| Rate for Payer: Humana ChoiceCare |
$1,370.65
|
| Rate for Payer: Humana Medicare |
$809.35
|
| Rate for Payer: Lucent All Commercial |
$809.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,428.26
|
| Rate for Payer: PHCS All Commercial |
$1,190.22
|
| Rate for Payer: PHP All Commercial |
$1,203.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$618.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,225.13
|
| Rate for Payer: Signature Care EPO |
$1,317.17
|
| Rate for Payer: Signature Care PPO |
$1,396.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,348.91
|
| Rate for Payer: United Healthcare Commercial |
$1,250.52
|
| Rate for Payer: United Healthcare Medicare |
$523.70
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
IP
|
$1,257.32
|
|
| Hospital Charge Code |
01652960
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$942.99 |
| Max. Negotiated Rate |
$1,169.31 |
| Rate for Payer: Aetna Commercial |
$1,086.33
|
| Rate for Payer: Cash Price |
$779.54
|
| Rate for Payer: Cigna All Commercial |
$1,085.07
|
| Rate for Payer: CORVEL All Commercial |
$1,169.31
|
| Rate for Payer: Coventry All Commercial |
$1,106.44
|
| Rate for Payer: Encore All Commercial |
$1,157.37
|
| Rate for Payer: Frontpath All Commercial |
$1,156.74
|
| Rate for Payer: Humana ChoiceCare |
$1,085.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,131.59
|
| Rate for Payer: PHCS All Commercial |
$942.99
|
| Rate for Payer: PHP All Commercial |
$953.55
|
| Rate for Payer: Sagamore Health Network All Products |
$970.65
|
| Rate for Payer: Signature Care EPO |
$1,043.58
|
| Rate for Payer: Signature Care PPO |
$1,106.44
|
| Rate for Payer: United Healthcare Commercial |
$990.77
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
OP
|
$1,257.32
|
|
| Hospital Charge Code |
01652960
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$414.92 |
| Max. Negotiated Rate |
$1,854.49 |
| Rate for Payer: Aetna Commercial |
$1,061.18
|
| Rate for Payer: Aetna Medicare |
$414.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$722.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$785.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,854.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$477.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$456.41
|
| Rate for Payer: Cash Price |
$779.54
|
| Rate for Payer: Cash Price |
$779.54
|
| Rate for Payer: Centivo All Commercial |
$641.23
|
| Rate for Payer: Cigna All Commercial |
$1,085.07
|
| Rate for Payer: CORVEL All Commercial |
$1,169.31
|
| Rate for Payer: Coventry All Commercial |
$1,106.44
|
| Rate for Payer: Encore All Commercial |
$1,157.37
|
| Rate for Payer: Frontpath All Commercial |
$1,156.74
|
| Rate for Payer: Humana ChoiceCare |
$1,085.95
|
| Rate for Payer: Humana Medicare |
$641.23
|
| Rate for Payer: Lucent All Commercial |
$641.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,131.59
|
| Rate for Payer: Managed Health Services Medicaid |
$1,854.49
|
| Rate for Payer: MDWise Medicaid |
$1,854.49
|
| Rate for Payer: PHCS All Commercial |
$942.99
|
| Rate for Payer: PHP All Commercial |
$953.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$490.36
|
| Rate for Payer: Sagamore Health Network All Products |
$970.65
|
| Rate for Payer: Signature Care EPO |
$1,043.58
|
| Rate for Payer: Signature Care PPO |
$1,106.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,068.72
|
| Rate for Payer: United Healthcare Commercial |
$990.77
|
| Rate for Payer: United Healthcare Medicare |
$414.92
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
IP
|
$1,776.17
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
01158137
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,332.13 |
| Max. Negotiated Rate |
$1,651.84 |
| Rate for Payer: Aetna Commercial |
$1,534.61
|
| Rate for Payer: Cash Price |
$1,101.22
|
| Rate for Payer: Cigna All Commercial |
$1,532.83
|
| Rate for Payer: CORVEL All Commercial |
$1,651.84
|
| Rate for Payer: Coventry All Commercial |
$1,563.03
|
| Rate for Payer: Encore All Commercial |
$1,634.96
|
| Rate for Payer: Frontpath All Commercial |
$1,634.07
|
| Rate for Payer: Humana ChoiceCare |
$1,534.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,598.55
|
| Rate for Payer: PHCS All Commercial |
$1,332.13
|
| Rate for Payer: PHP All Commercial |
$1,347.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,371.20
|
| Rate for Payer: Signature Care EPO |
$1,474.22
|
| Rate for Payer: Signature Care PPO |
$1,563.03
|
| Rate for Payer: United Healthcare Commercial |
$1,399.62
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
OP
|
$1,776.17
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
01158137
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$586.14 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: Aetna Commercial |
$1,499.08
|
| Rate for Payer: Aetna Medicare |
$586.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,020.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,110.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$674.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$644.75
|
| Rate for Payer: Cash Price |
$1,101.22
|
| Rate for Payer: Cash Price |
$1,101.22
|
| Rate for Payer: Centivo All Commercial |
$905.85
|
| Rate for Payer: Cigna All Commercial |
$1,532.83
|
| Rate for Payer: CORVEL All Commercial |
$1,651.84
|
| Rate for Payer: Coventry All Commercial |
$1,563.03
|
| Rate for Payer: Encore All Commercial |
$1,634.96
|
| Rate for Payer: Frontpath All Commercial |
$1,634.07
|
| Rate for Payer: Humana ChoiceCare |
$1,534.08
|
| Rate for Payer: Humana Medicare |
$905.85
|
| Rate for Payer: Lucent All Commercial |
$905.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,598.55
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
| Rate for Payer: PHCS All Commercial |
$1,332.13
|
| Rate for Payer: PHP All Commercial |
$1,347.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$692.71
|
| Rate for Payer: Sagamore Health Network All Products |
$1,371.20
|
| Rate for Payer: Signature Care EPO |
$1,474.22
|
| Rate for Payer: Signature Care PPO |
$1,563.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,509.74
|
| Rate for Payer: United Healthcare Commercial |
$1,399.62
|
| Rate for Payer: United Healthcare Medicare |
$586.14
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN OT
|
Facility
IP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GO
|
| Hospital Charge Code |
01737550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$236.18
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN OT
|
Facility
OP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GO
|
| Hospital Charge Code |
01737550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Medicare |
$90.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.23
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Centivo All Commercial |
$139.41
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Humana Medicare |
$139.41
|
| Rate for Payer: Lucent All Commercial |
$139.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.61
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.36
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
| Rate for Payer: United Healthcare Medicare |
$90.21
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN PT
|
Facility
IP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GP
|
| Hospital Charge Code |
01727550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$236.18
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN PT
|
Facility
OP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GP
|
| Hospital Charge Code |
01727550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Medicare |
$90.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.23
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Centivo All Commercial |
$139.41
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Humana Medicare |
$139.41
|
| Rate for Payer: Lucent All Commercial |
$139.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.61
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.36
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
| Rate for Payer: United Healthcare Medicare |
$90.21
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN ST
|
Facility
IP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GN
|
| Hospital Charge Code |
01747550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$236.18
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN ST
|
Facility
OP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GN
|
| Hospital Charge Code |
01747550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Medicare |
$90.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.23
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Centivo All Commercial |
$139.41
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Humana Medicare |
$139.41
|
| Rate for Payer: Lucent All Commercial |
$139.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.61
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.36
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
| Rate for Payer: United Healthcare Medicare |
$90.21
|
|
