|
HC CAREGIVER TRAINING EA ADD'L 15 MIN OT
|
Facility
IP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GO
|
| Hospital Charge Code |
01737551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.51 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Cash Price |
$84.74
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
|
|
HC CAREGIVER TRAINING EA ADD'L 15 MIN OT
|
Facility
OP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GO
|
| Hospital Charge Code |
01737551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$115.36
|
| Rate for Payer: Aetna Medicare |
$45.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.61
|
| Rate for Payer: Cash Price |
$84.74
|
| Rate for Payer: Centivo All Commercial |
$69.71
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Humana Medicare |
$69.71
|
| Rate for Payer: Lucent All Commercial |
$69.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.31
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.18
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
| Rate for Payer: United Healthcare Medicare |
$45.10
|
|
|
HC CAREGIVER TRAINING EA ADD'L 15 MIN PT
|
Facility
IP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GP
|
| Hospital Charge Code |
01727551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.51 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Cash Price |
$84.74
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
|
|
HC CAREGIVER TRAINING EA ADD'L 15 MIN PT
|
Facility
OP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GP
|
| Hospital Charge Code |
01727551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$115.36
|
| Rate for Payer: Aetna Medicare |
$45.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.61
|
| Rate for Payer: Cash Price |
$84.74
|
| Rate for Payer: Centivo All Commercial |
$69.71
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Humana Medicare |
$69.71
|
| Rate for Payer: Lucent All Commercial |
$69.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.31
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.18
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
| Rate for Payer: United Healthcare Medicare |
$45.10
|
|
|
HC CAREGIVER TRAINING EA ADD'L 15 MIN ST
|
Facility
OP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GN
|
| Hospital Charge Code |
01747551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$115.36
|
| Rate for Payer: Aetna Medicare |
$45.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.61
|
| Rate for Payer: Cash Price |
$84.74
|
| Rate for Payer: Centivo All Commercial |
$69.71
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Humana Medicare |
$69.71
|
| Rate for Payer: Lucent All Commercial |
$69.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.31
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.18
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
| Rate for Payer: United Healthcare Medicare |
$45.10
|
|
|
HC CAREGIVER TRAINING EA ADD'L 15 MIN ST
|
Facility
IP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GN
|
| Hospital Charge Code |
01747551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.51 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Cash Price |
$84.74
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
|
|
HC C-ARMOR
|
Facility
OP
|
$318.01
|
|
| Hospital Charge Code |
41606536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.94 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Commercial |
$268.40
|
| Rate for Payer: Aetna Medicare |
$104.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$198.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.44
|
| Rate for Payer: Cash Price |
$197.17
|
| Rate for Payer: Cash Price |
$197.17
|
| Rate for Payer: Centivo All Commercial |
$162.19
|
| Rate for Payer: Cigna All Commercial |
$274.44
|
| Rate for Payer: CORVEL All Commercial |
$295.75
|
| Rate for Payer: Coventry All Commercial |
$279.85
|
| Rate for Payer: Encore All Commercial |
$292.73
|
| Rate for Payer: Frontpath All Commercial |
$292.57
|
| Rate for Payer: Humana ChoiceCare |
$274.67
|
| Rate for Payer: Humana Medicare |
$162.19
|
| Rate for Payer: Lucent All Commercial |
$162.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.21
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$238.51
|
| Rate for Payer: PHP All Commercial |
$241.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.02
|
| Rate for Payer: Sagamore Health Network All Products |
$245.50
|
| Rate for Payer: Signature Care EPO |
$263.95
|
| Rate for Payer: Signature Care PPO |
$279.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$270.31
|
| Rate for Payer: United Healthcare Commercial |
$250.59
|
| Rate for Payer: United Healthcare Medicare |
$104.94
|
|
|
HC C-ARMOR
|
Facility
IP
|
$318.01
|
|
| Hospital Charge Code |
41606536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.51 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Commercial |
$274.76
|
| Rate for Payer: Cash Price |
$197.17
|
| Rate for Payer: Cigna All Commercial |
$274.44
|
| Rate for Payer: CORVEL All Commercial |
$295.75
|
| Rate for Payer: Coventry All Commercial |
$279.85
|
| Rate for Payer: Encore All Commercial |
$292.73
|
| Rate for Payer: Frontpath All Commercial |
$292.57
|
| Rate for Payer: Humana ChoiceCare |
$274.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.21
|
| Rate for Payer: PHCS All Commercial |
$238.51
|
| Rate for Payer: PHP All Commercial |
$241.18
|
| Rate for Payer: Sagamore Health Network All Products |
$245.50
|
| Rate for Payer: Signature Care EPO |
$263.95
|
| Rate for Payer: Signature Care PPO |
$279.85
|
| Rate for Payer: United Healthcare Commercial |
$250.59
|
|
|
HC CARNITINE FREE&TOTAL
|
Facility
OP
|
$187.69
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
63001483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$174.55 |
| Rate for Payer: Aetna Commercial |
$158.41
|
| Rate for Payer: Aetna Medicare |
$61.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.13
|
| Rate for Payer: Cash Price |
$116.37
|
| Rate for Payer: Cash Price |
$116.37
|
| Rate for Payer: Centivo All Commercial |
$95.72
|
| Rate for Payer: Cigna All Commercial |
$161.98
|
| Rate for Payer: CORVEL All Commercial |
$174.55
|
| Rate for Payer: Coventry All Commercial |
$165.17
|
| Rate for Payer: Encore All Commercial |
$172.77
|
| Rate for Payer: Frontpath All Commercial |
$172.67
|
| Rate for Payer: Humana ChoiceCare |
$162.11
|
| Rate for Payer: Humana Medicare |
$95.72
|
| Rate for Payer: Lucent All Commercial |
$95.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16.87
|
| Rate for Payer: MDWise Medicaid |
$16.87
|
| Rate for Payer: PHCS All Commercial |
$140.77
|
| Rate for Payer: PHP All Commercial |
$142.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.90
|
| Rate for Payer: Signature Care EPO |
$155.78
|
| Rate for Payer: Signature Care PPO |
$165.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.54
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$61.94
|
|
|
HC CARNITINE FREE&TOTAL
|
Facility
IP
|
$187.69
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
63001483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$174.55 |
| Rate for Payer: Aetna Commercial |
$162.16
|
| Rate for Payer: Cash Price |
$116.37
|
| Rate for Payer: Cigna All Commercial |
$161.98
|
| Rate for Payer: CORVEL All Commercial |
$174.55
|
| Rate for Payer: Coventry All Commercial |
$165.17
|
| Rate for Payer: Encore All Commercial |
$172.77
|
| Rate for Payer: Frontpath All Commercial |
$172.67
|
| Rate for Payer: Humana ChoiceCare |
$162.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.92
|
| Rate for Payer: PHCS All Commercial |
$140.77
|
| Rate for Payer: PHP All Commercial |
$142.34
|
| Rate for Payer: Sagamore Health Network All Products |
$144.90
|
| Rate for Payer: Signature Care EPO |
$155.78
|
| Rate for Payer: Signature Care PPO |
$165.17
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
|
|
HC CARNITINE, TOTAL
|
Facility
OP
|
$169.32
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
63001632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$157.47 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.46
|
| Rate for Payer: Cash Price |
$104.98
|
| Rate for Payer: Cash Price |
$104.98
|
| Rate for Payer: Centivo All Commercial |
$86.35
|
| Rate for Payer: Cigna All Commercial |
$146.12
|
| Rate for Payer: CORVEL All Commercial |
$157.47
|
| Rate for Payer: Coventry All Commercial |
$149.00
|
| Rate for Payer: Encore All Commercial |
$155.86
|
| Rate for Payer: Frontpath All Commercial |
$155.77
|
| Rate for Payer: Humana ChoiceCare |
$146.24
|
| Rate for Payer: Humana Medicare |
$86.35
|
| Rate for Payer: Lucent All Commercial |
$86.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.39
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$126.99
|
| Rate for Payer: PHP All Commercial |
$128.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.03
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.92
|
| Rate for Payer: United Healthcare Commercial |
$133.42
|
| Rate for Payer: United Healthcare Medicare |
$55.88
|
|
|
HC CARNITINE, TOTAL
|
Facility
IP
|
$169.32
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
63001632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.99 |
| Max. Negotiated Rate |
$157.47 |
| Rate for Payer: Aetna Commercial |
$146.29
|
| Rate for Payer: Cash Price |
$104.98
|
| Rate for Payer: Cigna All Commercial |
$146.12
|
| Rate for Payer: CORVEL All Commercial |
$157.47
|
| Rate for Payer: Coventry All Commercial |
$149.00
|
| Rate for Payer: Encore All Commercial |
$155.86
|
| Rate for Payer: Frontpath All Commercial |
$155.77
|
| Rate for Payer: Humana ChoiceCare |
$146.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.39
|
| Rate for Payer: PHCS All Commercial |
$126.99
|
| Rate for Payer: PHP All Commercial |
$128.41
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.00
|
| Rate for Payer: United Healthcare Commercial |
$133.42
|
|
|
HC CAR SEAT/BED TEST EA AD 30 MN
|
Facility
OP
|
$212.16
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
01014781
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$70.01 |
| Max. Negotiated Rate |
$197.31 |
| Rate for Payer: Aetna Commercial |
$179.06
|
| Rate for Payer: Aetna Medicare |
$70.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.01
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Centivo All Commercial |
$108.20
|
| Rate for Payer: Cigna All Commercial |
$183.09
|
| Rate for Payer: CORVEL All Commercial |
$197.31
|
| Rate for Payer: Coventry All Commercial |
$186.70
|
| Rate for Payer: Encore All Commercial |
$195.29
|
| Rate for Payer: Frontpath All Commercial |
$195.19
|
| Rate for Payer: Humana ChoiceCare |
$183.24
|
| Rate for Payer: Humana Medicare |
$108.20
|
| Rate for Payer: Lucent All Commercial |
$108.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.94
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$159.12
|
| Rate for Payer: PHP All Commercial |
$160.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.74
|
| Rate for Payer: Sagamore Health Network All Products |
$163.79
|
| Rate for Payer: Signature Care EPO |
$176.09
|
| Rate for Payer: Signature Care PPO |
$186.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.34
|
| Rate for Payer: United Healthcare Commercial |
$167.18
|
| Rate for Payer: United Healthcare Medicare |
$70.01
|
|
|
HC CAR SEAT/BED TEST EA AD 30 MN
|
Facility
IP
|
$212.16
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
01014781
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$197.31 |
| Rate for Payer: Aetna Commercial |
$183.31
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cigna All Commercial |
$183.09
|
| Rate for Payer: CORVEL All Commercial |
$197.31
|
| Rate for Payer: Coventry All Commercial |
$186.70
|
| Rate for Payer: Encore All Commercial |
$195.29
|
| Rate for Payer: Frontpath All Commercial |
$195.19
|
| Rate for Payer: Humana ChoiceCare |
$183.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.94
|
| Rate for Payer: PHCS All Commercial |
$159.12
|
| Rate for Payer: PHP All Commercial |
$160.90
|
| Rate for Payer: Sagamore Health Network All Products |
$163.79
|
| Rate for Payer: Signature Care EPO |
$176.09
|
| Rate for Payer: Signature Care PPO |
$186.70
|
| Rate for Payer: United Healthcare Commercial |
$167.18
|
|
|
HC CAR SEAT/BED TEST INIT'L 60 MN
|
Facility
IP
|
$477.36
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
01014780
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$358.02 |
| Max. Negotiated Rate |
$443.94 |
| Rate for Payer: Aetna Commercial |
$412.44
|
| Rate for Payer: Cash Price |
$295.96
|
| Rate for Payer: Cigna All Commercial |
$411.96
|
| Rate for Payer: CORVEL All Commercial |
$443.94
|
| Rate for Payer: Coventry All Commercial |
$420.08
|
| Rate for Payer: Encore All Commercial |
$439.41
|
| Rate for Payer: Frontpath All Commercial |
$439.17
|
| Rate for Payer: Humana ChoiceCare |
$412.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.62
|
| Rate for Payer: PHCS All Commercial |
$358.02
|
| Rate for Payer: PHP All Commercial |
$362.03
|
| Rate for Payer: Sagamore Health Network All Products |
$368.52
|
| Rate for Payer: Signature Care EPO |
$396.21
|
| Rate for Payer: Signature Care PPO |
$420.08
|
| Rate for Payer: United Healthcare Commercial |
$376.16
|
|
|
HC CAR SEAT/BED TEST INIT'L 60 MN
|
Facility
OP
|
$477.36
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
01014780
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$443.94 |
| Rate for Payer: Aetna Commercial |
$402.89
|
| Rate for Payer: Aetna Medicare |
$157.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$274.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$173.28
|
| Rate for Payer: Cash Price |
$295.96
|
| Rate for Payer: Cash Price |
$295.96
|
| Rate for Payer: Centivo All Commercial |
$243.45
|
| Rate for Payer: Cigna All Commercial |
$411.96
|
| Rate for Payer: CORVEL All Commercial |
$443.94
|
| Rate for Payer: Coventry All Commercial |
$420.08
|
| Rate for Payer: Encore All Commercial |
$439.41
|
| Rate for Payer: Frontpath All Commercial |
$439.17
|
| Rate for Payer: Humana ChoiceCare |
$412.30
|
| Rate for Payer: Humana Medicare |
$243.45
|
| Rate for Payer: Lucent All Commercial |
$243.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.62
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$358.02
|
| Rate for Payer: PHP All Commercial |
$362.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.17
|
| Rate for Payer: Sagamore Health Network All Products |
$368.52
|
| Rate for Payer: Signature Care EPO |
$396.21
|
| Rate for Payer: Signature Care PPO |
$420.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.76
|
| Rate for Payer: United Healthcare Commercial |
$376.16
|
| Rate for Payer: United Healthcare Medicare |
$157.53
|
|
|
HC CAT BLADE 15 DEG ALCON
|
Facility
OP
|
$66.50
|
|
| Hospital Charge Code |
41602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$56.13
|
| Rate for Payer: Aetna Medicare |
$21.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.14
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Centivo All Commercial |
$33.92
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Humana Medicare |
$33.92
|
| Rate for Payer: Lucent All Commercial |
$33.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.94
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
| Rate for Payer: United Healthcare Medicare |
$21.94
|
|
|
HC CAT BLADE 15 DEG ALCON
|
Facility
IP
|
$66.50
|
|
| Hospital Charge Code |
41602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$57.46
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
|
|
HC CAT BLADE 15 DEG VANTAGE
|
Facility
IP
|
$53.55
|
|
| Hospital Charge Code |
41602070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC CAT BLADE 15 DEG VANTAGE
|
Facility
OP
|
$53.55
|
|
| Hospital Charge Code |
41602070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC CAT BLADE 15 VOOOO21
|
Facility
IP
|
$68.81
|
|
| Hospital Charge Code |
41604378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Commercial |
$59.45
|
| Rate for Payer: Cash Price |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$59.38
|
| Rate for Payer: CORVEL All Commercial |
$63.99
|
| Rate for Payer: Coventry All Commercial |
$60.55
|
| Rate for Payer: Encore All Commercial |
$63.34
|
| Rate for Payer: Frontpath All Commercial |
$63.31
|
| Rate for Payer: Humana ChoiceCare |
$59.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.93
|
| Rate for Payer: PHCS All Commercial |
$51.61
|
| Rate for Payer: PHP All Commercial |
$52.19
|
| Rate for Payer: Sagamore Health Network All Products |
$53.12
|
| Rate for Payer: Signature Care EPO |
$57.11
|
| Rate for Payer: Signature Care PPO |
$60.55
|
| Rate for Payer: United Healthcare Commercial |
$54.22
|
|
|
HC CAT BLADE 15 VOOOO21
|
Facility
OP
|
$68.81
|
|
| Hospital Charge Code |
41604378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$58.08
|
| Rate for Payer: Aetna Medicare |
$22.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.98
|
| Rate for Payer: Cash Price |
$42.66
|
| Rate for Payer: Cash Price |
$42.66
|
| Rate for Payer: Centivo All Commercial |
$35.09
|
| Rate for Payer: Cigna All Commercial |
$59.38
|
| Rate for Payer: CORVEL All Commercial |
$63.99
|
| Rate for Payer: Coventry All Commercial |
$60.55
|
| Rate for Payer: Encore All Commercial |
$63.34
|
| Rate for Payer: Frontpath All Commercial |
$63.31
|
| Rate for Payer: Humana ChoiceCare |
$59.43
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Lucent All Commercial |
$35.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.93
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$51.61
|
| Rate for Payer: PHP All Commercial |
$52.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.84
|
| Rate for Payer: Sagamore Health Network All Products |
$53.12
|
| Rate for Payer: Signature Care EPO |
$57.11
|
| Rate for Payer: Signature Care PPO |
$60.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.49
|
| Rate for Payer: United Healthcare Commercial |
$54.22
|
| Rate for Payer: United Healthcare Medicare |
$22.71
|
|
|
HC CAT BLADE 2.75 ANG ALCON
|
Facility
IP
|
$178.50
|
|
| Hospital Charge Code |
41602296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
|
|
HC CAT BLADE 2.75 ANG ALCON
|
Facility
OP
|
$178.50
|
|
| Hospital Charge Code |
41602296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Centivo All Commercial |
$91.04
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Humana Medicare |
$91.04
|
| Rate for Payer: Lucent All Commercial |
$91.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.72
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
| Rate for Payer: United Healthcare Medicare |
$58.90
|
|
|
HC CAT BLADE 2.75 ANG VANTAGE
|
Facility
OP
|
$133.88
|
|
| Hospital Charge Code |
41602297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$124.51 |
| Rate for Payer: Aetna Commercial |
$112.99
|
| Rate for Payer: Aetna Medicare |
$44.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.60
|
| Rate for Payer: Cash Price |
$83.01
|
| Rate for Payer: Cash Price |
$83.01
|
| Rate for Payer: Centivo All Commercial |
$68.28
|
| Rate for Payer: Cigna All Commercial |
$115.54
|
| Rate for Payer: CORVEL All Commercial |
$124.51
|
| Rate for Payer: Coventry All Commercial |
$117.81
|
| Rate for Payer: Encore All Commercial |
$123.24
|
| Rate for Payer: Frontpath All Commercial |
$123.17
|
| Rate for Payer: Humana ChoiceCare |
$115.63
|
| Rate for Payer: Humana Medicare |
$68.28
|
| Rate for Payer: Lucent All Commercial |
$68.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$100.41
|
| Rate for Payer: PHP All Commercial |
$101.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.21
|
| Rate for Payer: Sagamore Health Network All Products |
$103.36
|
| Rate for Payer: Signature Care EPO |
$111.12
|
| Rate for Payer: Signature Care PPO |
$117.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113.80
|
| Rate for Payer: United Healthcare Commercial |
$105.50
|
| Rate for Payer: United Healthcare Medicare |
$44.18
|
|
