|
HC CLINICL SWALLOW EVAL-45 MIN-SP
|
Facility
IP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01748012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$387.51 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$446.41
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
|
|
HC CLINICL SWALLOW EVAL-45 MIN-SP
|
Facility
OP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01748012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$436.08
|
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.56
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Centivo All Commercial |
$263.51
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Humana Medicare |
$263.51
|
| Rate for Payer: Lucent All Commercial |
$263.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.51
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.18
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
| Rate for Payer: United Healthcare Medicare |
$170.50
|
|
|
HC CLINICL SWALLOW EVAL-60 MIN-SP
|
Facility
IP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01749012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$387.51 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$446.41
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
|
|
HC CLINICL SWALLOW EVAL-60 MIN-SP
|
Facility
OP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01749012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$436.08
|
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.56
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Centivo All Commercial |
$263.51
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Humana Medicare |
$263.51
|
| Rate for Payer: Lucent All Commercial |
$263.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.51
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.18
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
| Rate for Payer: United Healthcare Medicare |
$170.50
|
|
|
HC CLINICL SWALLOW EVAL - SP
|
Facility
IP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01742610
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$387.51 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$446.41
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
|
|
HC CLINICL SWALLOW EVAL - SP
|
Facility
OP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01742610
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$436.08
|
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.56
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Centivo All Commercial |
$263.51
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Humana Medicare |
$263.51
|
| Rate for Payer: Lucent All Commercial |
$263.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.51
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.18
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
| Rate for Payer: United Healthcare Medicare |
$170.50
|
|
|
HC CLINIC VISIT
|
Facility
OP
|
$132.12
|
|
|
Service Code
|
CPT G0463 25
|
| Hospital Charge Code |
00410104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$122.87 |
| Rate for Payer: Aetna Commercial |
$111.51
|
| Rate for Payer: Aetna Medicare |
$43.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.96
|
| Rate for Payer: Cash Price |
$81.92
|
| Rate for Payer: Centivo All Commercial |
$67.38
|
| Rate for Payer: Cigna All Commercial |
$114.02
|
| Rate for Payer: CORVEL All Commercial |
$122.87
|
| Rate for Payer: Coventry All Commercial |
$116.27
|
| Rate for Payer: Encore All Commercial |
$121.62
|
| Rate for Payer: Frontpath All Commercial |
$121.55
|
| Rate for Payer: Humana ChoiceCare |
$114.11
|
| Rate for Payer: Humana Medicare |
$67.38
|
| Rate for Payer: Lucent All Commercial |
$67.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.91
|
| Rate for Payer: PHCS All Commercial |
$99.09
|
| Rate for Payer: PHP All Commercial |
$100.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.53
|
| Rate for Payer: Sagamore Health Network All Products |
$102.00
|
| Rate for Payer: Signature Care EPO |
$109.66
|
| Rate for Payer: Signature Care PPO |
$116.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.30
|
| Rate for Payer: United Healthcare Commercial |
$104.11
|
| Rate for Payer: United Healthcare Medicare |
$43.60
|
|
|
HC CLINIC VISIT
|
Facility
IP
|
$132.12
|
|
|
Service Code
|
CPT G0463 25
|
| Hospital Charge Code |
00410104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.09 |
| Max. Negotiated Rate |
$122.87 |
| Rate for Payer: Aetna Commercial |
$114.15
|
| Rate for Payer: Cash Price |
$81.92
|
| Rate for Payer: Cigna All Commercial |
$114.02
|
| Rate for Payer: CORVEL All Commercial |
$122.87
|
| Rate for Payer: Coventry All Commercial |
$116.27
|
| Rate for Payer: Encore All Commercial |
$121.62
|
| Rate for Payer: Frontpath All Commercial |
$121.55
|
| Rate for Payer: Humana ChoiceCare |
$114.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.91
|
| Rate for Payer: PHCS All Commercial |
$99.09
|
| Rate for Payer: PHP All Commercial |
$100.20
|
| Rate for Payer: Sagamore Health Network All Products |
$102.00
|
| Rate for Payer: Signature Care EPO |
$109.66
|
| Rate for Payer: Signature Care PPO |
$116.27
|
| Rate for Payer: United Healthcare Commercial |
$104.11
|
|
|
HC CLIP FILSHIE
|
Facility
IP
|
$424.86
|
|
| Hospital Charge Code |
41601907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.64 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna Commercial |
$367.08
|
| Rate for Payer: Cash Price |
$263.41
|
| Rate for Payer: Cigna All Commercial |
$366.65
|
| Rate for Payer: CORVEL All Commercial |
$395.12
|
| Rate for Payer: Coventry All Commercial |
$373.88
|
| Rate for Payer: Encore All Commercial |
$391.08
|
| Rate for Payer: Frontpath All Commercial |
$390.87
|
| Rate for Payer: Humana ChoiceCare |
$366.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.37
|
| Rate for Payer: PHCS All Commercial |
$318.64
|
| Rate for Payer: PHP All Commercial |
$322.21
|
| Rate for Payer: Sagamore Health Network All Products |
$327.99
|
| Rate for Payer: Signature Care EPO |
$352.63
|
| Rate for Payer: Signature Care PPO |
$373.88
|
| Rate for Payer: United Healthcare Commercial |
$334.79
|
|
|
HC CLIP FILSHIE
|
Facility
OP
|
$424.86
|
|
| Hospital Charge Code |
41601907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna Commercial |
$358.58
|
| Rate for Payer: Aetna Medicare |
$140.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.22
|
| Rate for Payer: Cash Price |
$263.41
|
| Rate for Payer: Cash Price |
$263.41
|
| Rate for Payer: Centivo All Commercial |
$216.68
|
| Rate for Payer: Cigna All Commercial |
$366.65
|
| Rate for Payer: CORVEL All Commercial |
$395.12
|
| Rate for Payer: Coventry All Commercial |
$373.88
|
| Rate for Payer: Encore All Commercial |
$391.08
|
| Rate for Payer: Frontpath All Commercial |
$390.87
|
| Rate for Payer: Humana ChoiceCare |
$366.95
|
| Rate for Payer: Humana Medicare |
$216.68
|
| Rate for Payer: Lucent All Commercial |
$216.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.37
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$318.64
|
| Rate for Payer: PHP All Commercial |
$322.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.70
|
| Rate for Payer: Sagamore Health Network All Products |
$327.99
|
| Rate for Payer: Signature Care EPO |
$352.63
|
| Rate for Payer: Signature Care PPO |
$373.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.13
|
| Rate for Payer: United Healthcare Commercial |
$334.79
|
| Rate for Payer: United Healthcare Medicare |
$140.20
|
|
|
HC CLIP LAPRA TY
|
Facility
OP
|
$1,177.25
|
|
| Hospital Charge Code |
41602488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,094.84 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Aetna Medicare |
$388.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$388.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$676.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$735.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.34
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Centivo All Commercial |
$600.40
|
| Rate for Payer: Cigna All Commercial |
$1,015.97
|
| Rate for Payer: CORVEL All Commercial |
$1,094.84
|
| Rate for Payer: Coventry All Commercial |
$1,035.98
|
| Rate for Payer: Encore All Commercial |
$1,083.66
|
| Rate for Payer: Frontpath All Commercial |
$1,083.07
|
| Rate for Payer: Humana ChoiceCare |
$1,016.79
|
| Rate for Payer: Humana Medicare |
$600.40
|
| Rate for Payer: Lucent All Commercial |
$600.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,059.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$882.94
|
| Rate for Payer: PHP All Commercial |
$892.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$459.13
|
| Rate for Payer: Sagamore Health Network All Products |
$908.84
|
| Rate for Payer: Signature Care EPO |
$977.12
|
| Rate for Payer: Signature Care PPO |
$1,035.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,000.66
|
| Rate for Payer: United Healthcare Commercial |
$927.67
|
| Rate for Payer: United Healthcare Medicare |
$388.49
|
|
|
HC CLIP LAPRA TY
|
Facility
IP
|
$1,177.25
|
|
| Hospital Charge Code |
41602488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.94 |
| Max. Negotiated Rate |
$1,094.84 |
| Rate for Payer: Aetna Commercial |
$1,017.14
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cigna All Commercial |
$1,015.97
|
| Rate for Payer: CORVEL All Commercial |
$1,094.84
|
| Rate for Payer: Coventry All Commercial |
$1,035.98
|
| Rate for Payer: Encore All Commercial |
$1,083.66
|
| Rate for Payer: Frontpath All Commercial |
$1,083.07
|
| Rate for Payer: Humana ChoiceCare |
$1,016.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,059.52
|
| Rate for Payer: PHCS All Commercial |
$882.94
|
| Rate for Payer: PHP All Commercial |
$892.83
|
| Rate for Payer: Sagamore Health Network All Products |
$908.84
|
| Rate for Payer: Signature Care EPO |
$977.12
|
| Rate for Payer: Signature Care PPO |
$1,035.98
|
| Rate for Payer: United Healthcare Commercial |
$927.67
|
|
|
HC CLIP PADLOCK
|
Facility
OP
|
$2,250.00
|
|
| Hospital Charge Code |
41604630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Aetna Commercial |
$1,899.00
|
| Rate for Payer: Aetna Medicare |
$742.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$742.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,292.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,406.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$853.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$816.75
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Centivo All Commercial |
$1,147.50
|
| Rate for Payer: Cigna All Commercial |
$1,941.75
|
| Rate for Payer: CORVEL All Commercial |
$2,092.50
|
| Rate for Payer: Coventry All Commercial |
$1,980.00
|
| Rate for Payer: Encore All Commercial |
$2,071.12
|
| Rate for Payer: Frontpath All Commercial |
$2,070.00
|
| Rate for Payer: Humana ChoiceCare |
$1,943.32
|
| Rate for Payer: Humana Medicare |
$1,147.50
|
| Rate for Payer: Lucent All Commercial |
$1,147.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,025.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,687.50
|
| Rate for Payer: PHP All Commercial |
$1,706.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$877.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,737.00
|
| Rate for Payer: Signature Care EPO |
$1,867.50
|
| Rate for Payer: Signature Care PPO |
$1,980.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,912.50
|
| Rate for Payer: United Healthcare Commercial |
$1,773.00
|
| Rate for Payer: United Healthcare Medicare |
$742.50
|
|
|
HC CLIP PADLOCK
|
Facility
IP
|
$2,250.00
|
|
| Hospital Charge Code |
41604630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Aetna Commercial |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna All Commercial |
$1,941.75
|
| Rate for Payer: CORVEL All Commercial |
$2,092.50
|
| Rate for Payer: Coventry All Commercial |
$1,980.00
|
| Rate for Payer: Encore All Commercial |
$2,071.12
|
| Rate for Payer: Frontpath All Commercial |
$2,070.00
|
| Rate for Payer: Humana ChoiceCare |
$1,943.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,025.00
|
| Rate for Payer: PHCS All Commercial |
$1,687.50
|
| Rate for Payer: PHP All Commercial |
$1,706.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,737.00
|
| Rate for Payer: Signature Care EPO |
$1,867.50
|
| Rate for Payer: Signature Care PPO |
$1,980.00
|
| Rate for Payer: United Healthcare Commercial |
$1,773.00
|
|
|
HC CLIP REPLAY HEMOSTASIS
|
Facility
IP
|
$553.00
|
|
| Hospital Charge Code |
41604628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.75 |
| Max. Negotiated Rate |
$514.29 |
| Rate for Payer: Aetna Commercial |
$477.79
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cigna All Commercial |
$477.24
|
| Rate for Payer: CORVEL All Commercial |
$514.29
|
| Rate for Payer: Coventry All Commercial |
$486.64
|
| Rate for Payer: Encore All Commercial |
$509.04
|
| Rate for Payer: Frontpath All Commercial |
$508.76
|
| Rate for Payer: Humana ChoiceCare |
$477.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$497.70
|
| Rate for Payer: PHCS All Commercial |
$414.75
|
| Rate for Payer: PHP All Commercial |
$419.40
|
| Rate for Payer: Sagamore Health Network All Products |
$426.92
|
| Rate for Payer: Signature Care EPO |
$458.99
|
| Rate for Payer: Signature Care PPO |
$486.64
|
| Rate for Payer: United Healthcare Commercial |
$435.76
|
|
|
HC CLIP REPLAY HEMOSTASIS
|
Facility
OP
|
$553.00
|
|
| Hospital Charge Code |
41604628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$514.29 |
| Rate for Payer: Aetna Commercial |
$466.73
|
| Rate for Payer: Aetna Medicare |
$182.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$317.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$345.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$209.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.74
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Centivo All Commercial |
$282.03
|
| Rate for Payer: Cigna All Commercial |
$477.24
|
| Rate for Payer: CORVEL All Commercial |
$514.29
|
| Rate for Payer: Coventry All Commercial |
$486.64
|
| Rate for Payer: Encore All Commercial |
$509.04
|
| Rate for Payer: Frontpath All Commercial |
$508.76
|
| Rate for Payer: Humana ChoiceCare |
$477.63
|
| Rate for Payer: Humana Medicare |
$282.03
|
| Rate for Payer: Lucent All Commercial |
$282.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$497.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$414.75
|
| Rate for Payer: PHP All Commercial |
$419.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.67
|
| Rate for Payer: Sagamore Health Network All Products |
$426.92
|
| Rate for Payer: Signature Care EPO |
$458.99
|
| Rate for Payer: Signature Care PPO |
$486.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$470.05
|
| Rate for Payer: United Healthcare Commercial |
$435.76
|
| Rate for Payer: United Healthcare Medicare |
$182.49
|
|
|
HC CLONAZEPAM
|
Facility
IP
|
$113.99
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.49 |
| Max. Negotiated Rate |
$106.01 |
| Rate for Payer: Aetna Commercial |
$98.48
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cigna All Commercial |
$98.37
|
| Rate for Payer: CORVEL All Commercial |
$106.01
|
| Rate for Payer: Coventry All Commercial |
$100.31
|
| Rate for Payer: Encore All Commercial |
$104.92
|
| Rate for Payer: Frontpath All Commercial |
$104.87
|
| Rate for Payer: Humana ChoiceCare |
$98.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.59
|
| Rate for Payer: PHCS All Commercial |
$85.49
|
| Rate for Payer: PHP All Commercial |
$86.45
|
| Rate for Payer: Sagamore Health Network All Products |
$88.00
|
| Rate for Payer: Signature Care EPO |
$94.61
|
| Rate for Payer: Signature Care PPO |
$100.31
|
| Rate for Payer: United Healthcare Commercial |
$89.82
|
|
|
HC CLONAZEPAM
|
Facility
OP
|
$113.99
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$106.01 |
| Rate for Payer: Aetna Commercial |
$96.20
|
| Rate for Payer: Aetna Medicare |
$37.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.38
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Centivo All Commercial |
$58.13
|
| Rate for Payer: Cigna All Commercial |
$98.37
|
| Rate for Payer: CORVEL All Commercial |
$106.01
|
| Rate for Payer: Coventry All Commercial |
$100.31
|
| Rate for Payer: Encore All Commercial |
$104.92
|
| Rate for Payer: Frontpath All Commercial |
$104.87
|
| Rate for Payer: Humana ChoiceCare |
$98.45
|
| Rate for Payer: Humana Medicare |
$58.13
|
| Rate for Payer: Lucent All Commercial |
$58.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.59
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$85.49
|
| Rate for Payer: PHP All Commercial |
$86.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.45
|
| Rate for Payer: Sagamore Health Network All Products |
$88.00
|
| Rate for Payer: Signature Care EPO |
$94.61
|
| Rate for Payer: Signature Care PPO |
$100.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.89
|
| Rate for Payer: United Healthcare Commercial |
$89.82
|
| Rate for Payer: United Healthcare Medicare |
$37.62
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIGENIC CULTURE
|
Facility
OP
|
$99.45
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63044040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$92.49 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare |
$32.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.10
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Centivo All Commercial |
$50.72
|
| Rate for Payer: Cigna All Commercial |
$85.83
|
| Rate for Payer: CORVEL All Commercial |
$92.49
|
| Rate for Payer: Coventry All Commercial |
$87.52
|
| Rate for Payer: Encore All Commercial |
$91.54
|
| Rate for Payer: Frontpath All Commercial |
$91.49
|
| Rate for Payer: Humana ChoiceCare |
$85.89
|
| Rate for Payer: Humana Medicare |
$50.72
|
| Rate for Payer: Lucent All Commercial |
$50.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.50
|
| Rate for Payer: Managed Health Services Medicaid |
$8.48
|
| Rate for Payer: MDWise Medicaid |
$8.48
|
| Rate for Payer: PHCS All Commercial |
$74.59
|
| Rate for Payer: PHP All Commercial |
$75.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.79
|
| Rate for Payer: Sagamore Health Network All Products |
$76.78
|
| Rate for Payer: Signature Care EPO |
$82.54
|
| Rate for Payer: Signature Care PPO |
$87.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.53
|
| Rate for Payer: United Healthcare Commercial |
$78.37
|
| Rate for Payer: United Healthcare Medicare |
$32.82
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIGENIC CULTURE
|
Facility
IP
|
$99.45
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63044040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.59 |
| Max. Negotiated Rate |
$92.49 |
| Rate for Payer: Aetna Commercial |
$85.92
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cigna All Commercial |
$85.83
|
| Rate for Payer: CORVEL All Commercial |
$92.49
|
| Rate for Payer: Coventry All Commercial |
$87.52
|
| Rate for Payer: Encore All Commercial |
$91.54
|
| Rate for Payer: Frontpath All Commercial |
$91.49
|
| Rate for Payer: Humana ChoiceCare |
$85.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.50
|
| Rate for Payer: PHCS All Commercial |
$74.59
|
| Rate for Payer: PHP All Commercial |
$75.42
|
| Rate for Payer: Sagamore Health Network All Products |
$76.78
|
| Rate for Payer: Signature Care EPO |
$82.54
|
| Rate for Payer: Signature Care PPO |
$87.52
|
| Rate for Payer: United Healthcare Commercial |
$78.37
|
|
|
HC CLOSURE SYSTEM
|
Facility
OP
|
$1,020.60
|
|
| Hospital Charge Code |
41602091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$949.16 |
| Rate for Payer: Aetna Commercial |
$861.39
|
| Rate for Payer: Aetna Medicare |
$336.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$336.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$586.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$387.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$370.48
|
| Rate for Payer: Cash Price |
$632.77
|
| Rate for Payer: Cash Price |
$632.77
|
| Rate for Payer: Centivo All Commercial |
$520.51
|
| Rate for Payer: Cigna All Commercial |
$880.78
|
| Rate for Payer: CORVEL All Commercial |
$949.16
|
| Rate for Payer: Coventry All Commercial |
$898.13
|
| Rate for Payer: Encore All Commercial |
$939.46
|
| Rate for Payer: Frontpath All Commercial |
$938.95
|
| Rate for Payer: Humana ChoiceCare |
$881.49
|
| Rate for Payer: Humana Medicare |
$520.51
|
| Rate for Payer: Lucent All Commercial |
$520.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.54
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$765.45
|
| Rate for Payer: PHP All Commercial |
$774.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$398.03
|
| Rate for Payer: Sagamore Health Network All Products |
$787.90
|
| Rate for Payer: Signature Care EPO |
$847.10
|
| Rate for Payer: Signature Care PPO |
$898.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$867.51
|
| Rate for Payer: United Healthcare Commercial |
$804.23
|
| Rate for Payer: United Healthcare Medicare |
$336.80
|
|
|
HC CLOSURE SYSTEM
|
Facility
IP
|
$1,020.60
|
|
| Hospital Charge Code |
41602091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$765.45 |
| Max. Negotiated Rate |
$949.16 |
| Rate for Payer: Aetna Commercial |
$881.80
|
| Rate for Payer: Cash Price |
$632.77
|
| Rate for Payer: Cigna All Commercial |
$880.78
|
| Rate for Payer: CORVEL All Commercial |
$949.16
|
| Rate for Payer: Coventry All Commercial |
$898.13
|
| Rate for Payer: Encore All Commercial |
$939.46
|
| Rate for Payer: Frontpath All Commercial |
$938.95
|
| Rate for Payer: Humana ChoiceCare |
$881.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.54
|
| Rate for Payer: PHCS All Commercial |
$765.45
|
| Rate for Payer: PHP All Commercial |
$774.02
|
| Rate for Payer: Sagamore Health Network All Products |
$787.90
|
| Rate for Payer: Signature Care EPO |
$847.10
|
| Rate for Payer: Signature Care PPO |
$898.13
|
| Rate for Payer: United Healthcare Commercial |
$804.23
|
|
|
HC CLOT INTERPETATION
|
Facility
IP
|
$337.65
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$291.73
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
|
|
HC CLOT INTERPETATION
|
Facility
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.42 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$277.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.57
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Centivo All Commercial |
$172.20
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Humana Medicare |
$172.20
|
| Rate for Payer: Lucent All Commercial |
$172.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: Managed Health Services Medicaid |
$277.37
|
| Rate for Payer: MDWise Medicaid |
$277.37
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.68
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.00
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
HC CMA CYTOGENETIC INTERP
|
Facility
IP
|
$375.91
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
63002095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$281.93 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna Commercial |
$324.79
|
| Rate for Payer: Cash Price |
$233.07
|
| Rate for Payer: Cigna All Commercial |
$324.41
|
| Rate for Payer: CORVEL All Commercial |
$349.60
|
| Rate for Payer: Coventry All Commercial |
$330.80
|
| Rate for Payer: Encore All Commercial |
$346.03
|
| Rate for Payer: Frontpath All Commercial |
$345.84
|
| Rate for Payer: Humana ChoiceCare |
$324.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$338.32
|
| Rate for Payer: PHCS All Commercial |
$281.93
|
| Rate for Payer: PHP All Commercial |
$285.09
|
| Rate for Payer: Sagamore Health Network All Products |
$290.20
|
| Rate for Payer: Signature Care EPO |
$312.01
|
| Rate for Payer: Signature Care PPO |
$330.80
|
| Rate for Payer: United Healthcare Commercial |
$296.22
|
|
