|
HC COLOR FLOW DOPPLER- LIMITED
|
Facility
IP
|
$629.85
|
|
|
Service Code
|
CPT 93325 52
|
| Hospital Charge Code |
00864325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$472.39 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna Commercial |
$544.19
|
| Rate for Payer: Cash Price |
$390.51
|
| Rate for Payer: Cigna All Commercial |
$543.56
|
| Rate for Payer: CORVEL All Commercial |
$585.76
|
| Rate for Payer: Coventry All Commercial |
$554.27
|
| Rate for Payer: Encore All Commercial |
$579.78
|
| Rate for Payer: Frontpath All Commercial |
$579.46
|
| Rate for Payer: Humana ChoiceCare |
$544.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.86
|
| Rate for Payer: PHCS All Commercial |
$472.39
|
| Rate for Payer: PHP All Commercial |
$477.68
|
| Rate for Payer: Sagamore Health Network All Products |
$486.24
|
| Rate for Payer: Signature Care EPO |
$522.78
|
| Rate for Payer: Signature Care PPO |
$554.27
|
| Rate for Payer: United Healthcare Commercial |
$496.32
|
|
|
HC COMMON BILE DUCT EXPLORATION SET
|
Facility
IP
|
$3,531.60
|
|
| Hospital Charge Code |
41602102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,648.70 |
| Max. Negotiated Rate |
$3,284.39 |
| Rate for Payer: Aetna Commercial |
$3,051.30
|
| Rate for Payer: Cash Price |
$2,189.59
|
| Rate for Payer: Cigna All Commercial |
$3,047.77
|
| Rate for Payer: CORVEL All Commercial |
$3,284.39
|
| Rate for Payer: Coventry All Commercial |
$3,107.81
|
| Rate for Payer: Encore All Commercial |
$3,250.84
|
| Rate for Payer: Frontpath All Commercial |
$3,249.07
|
| Rate for Payer: Humana ChoiceCare |
$3,050.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,178.44
|
| Rate for Payer: PHCS All Commercial |
$2,648.70
|
| Rate for Payer: PHP All Commercial |
$2,678.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,726.40
|
| Rate for Payer: Signature Care EPO |
$2,931.23
|
| Rate for Payer: Signature Care PPO |
$3,107.81
|
| Rate for Payer: United Healthcare Commercial |
$2,782.90
|
|
|
HC COMMON BILE DUCT EXPLORATION SET
|
Facility
OP
|
$3,531.60
|
|
| Hospital Charge Code |
41602102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,284.39 |
| Rate for Payer: Aetna Commercial |
$2,980.67
|
| Rate for Payer: Aetna Medicare |
$1,165.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,165.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,028.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,207.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,340.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,281.97
|
| Rate for Payer: Cash Price |
$2,189.59
|
| Rate for Payer: Cash Price |
$2,189.59
|
| Rate for Payer: Centivo All Commercial |
$1,801.12
|
| Rate for Payer: Cigna All Commercial |
$3,047.77
|
| Rate for Payer: CORVEL All Commercial |
$3,284.39
|
| Rate for Payer: Coventry All Commercial |
$3,107.81
|
| Rate for Payer: Encore All Commercial |
$3,250.84
|
| Rate for Payer: Frontpath All Commercial |
$3,249.07
|
| Rate for Payer: Humana ChoiceCare |
$3,050.24
|
| Rate for Payer: Humana Medicare |
$1,801.12
|
| Rate for Payer: Lucent All Commercial |
$1,801.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,178.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,648.70
|
| Rate for Payer: PHP All Commercial |
$2,678.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,377.32
|
| Rate for Payer: Sagamore Health Network All Products |
$2,726.40
|
| Rate for Payer: Signature Care EPO |
$2,931.23
|
| Rate for Payer: Signature Care PPO |
$3,107.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,001.86
|
| Rate for Payer: United Healthcare Commercial |
$2,782.90
|
| Rate for Payer: United Healthcare Medicare |
$1,165.43
|
|
|
HC COMM/WORK REINT/JOB ANAL/15-OT
|
Facility
IP
|
$226.78
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
01738010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$170.08 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna Commercial |
$195.93
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: Cigna All Commercial |
$195.71
|
| Rate for Payer: CORVEL All Commercial |
$210.90
|
| Rate for Payer: Coventry All Commercial |
$199.56
|
| Rate for Payer: Encore All Commercial |
$208.75
|
| Rate for Payer: Frontpath All Commercial |
$208.63
|
| Rate for Payer: Humana ChoiceCare |
$195.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.10
|
| Rate for Payer: PHCS All Commercial |
$170.08
|
| Rate for Payer: PHP All Commercial |
$171.99
|
| Rate for Payer: Sagamore Health Network All Products |
$175.07
|
| Rate for Payer: Signature Care EPO |
$188.22
|
| Rate for Payer: Signature Care PPO |
$199.56
|
| Rate for Payer: United Healthcare Commercial |
$178.70
|
|
|
HC COMM/WORK REINT/JOB ANAL/15-OT
|
Facility
OP
|
$226.78
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
01738010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$74.84 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna Commercial |
$191.40
|
| Rate for Payer: Aetna Medicare |
$74.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$130.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.32
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: Centivo All Commercial |
$115.66
|
| Rate for Payer: Cigna All Commercial |
$195.71
|
| Rate for Payer: CORVEL All Commercial |
$210.90
|
| Rate for Payer: Coventry All Commercial |
$199.56
|
| Rate for Payer: Encore All Commercial |
$208.75
|
| Rate for Payer: Frontpath All Commercial |
$208.63
|
| Rate for Payer: Humana ChoiceCare |
$195.87
|
| Rate for Payer: Humana Medicare |
$115.66
|
| Rate for Payer: Lucent All Commercial |
$115.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.10
|
| Rate for Payer: PHCS All Commercial |
$170.08
|
| Rate for Payer: PHP All Commercial |
$171.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.44
|
| Rate for Payer: Sagamore Health Network All Products |
$175.07
|
| Rate for Payer: Signature Care EPO |
$188.22
|
| Rate for Payer: Signature Care PPO |
$199.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$192.76
|
| Rate for Payer: United Healthcare Commercial |
$178.70
|
| Rate for Payer: United Healthcare Medicare |
$74.84
|
|
|
HC COMM/WORK REINT/JOB ANAL/15-PT
|
Facility
OP
|
$122.40
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
01728010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.43
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Centivo All Commercial |
$62.42
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Humana Medicare |
$62.42
|
| Rate for Payer: Lucent All Commercial |
$62.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.04
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
| Rate for Payer: United Healthcare Medicare |
$40.39
|
|
|
HC COMM/WORK REINT/JOB ANAL/15-PT
|
Facility
IP
|
$122.40
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
01728010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
|
|
HC COMPATIBILITY-ANTIGLOBULI
|
Facility
OP
|
$230.01
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
63001350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$213.91 |
| Rate for Payer: Aetna Commercial |
$194.13
|
| Rate for Payer: Aetna Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$78.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.49
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Centivo All Commercial |
$117.31
|
| Rate for Payer: Cigna All Commercial |
$198.50
|
| Rate for Payer: CORVEL All Commercial |
$213.91
|
| Rate for Payer: Coventry All Commercial |
$202.41
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.61
|
| Rate for Payer: Humana ChoiceCare |
$198.66
|
| Rate for Payer: Humana Medicare |
$117.31
|
| Rate for Payer: Lucent All Commercial |
$117.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.01
|
| Rate for Payer: Managed Health Services Medicaid |
$78.00
|
| Rate for Payer: MDWise Medicaid |
$78.00
|
| Rate for Payer: PHCS All Commercial |
$172.51
|
| Rate for Payer: PHP All Commercial |
$174.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.70
|
| Rate for Payer: Sagamore Health Network All Products |
$177.57
|
| Rate for Payer: Signature Care EPO |
$190.91
|
| Rate for Payer: Signature Care PPO |
$202.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.51
|
| Rate for Payer: United Healthcare Commercial |
$181.25
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
|
|
HC COMPATIBILITY-ANTIGLOBULI
|
Facility
IP
|
$230.01
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
63001350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.51 |
| Max. Negotiated Rate |
$213.91 |
| Rate for Payer: Aetna Commercial |
$198.73
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cigna All Commercial |
$198.50
|
| Rate for Payer: CORVEL All Commercial |
$213.91
|
| Rate for Payer: Coventry All Commercial |
$202.41
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.61
|
| Rate for Payer: Humana ChoiceCare |
$198.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.01
|
| Rate for Payer: PHCS All Commercial |
$172.51
|
| Rate for Payer: PHP All Commercial |
$174.44
|
| Rate for Payer: Sagamore Health Network All Products |
$177.57
|
| Rate for Payer: Signature Care EPO |
$190.91
|
| Rate for Payer: Signature Care PPO |
$202.41
|
| Rate for Payer: United Healthcare Commercial |
$181.25
|
|
|
HC COMPATIBILITY-ELECTRONIC
|
Facility
OP
|
$214.30
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
63001128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$581.72 |
| Rate for Payer: Aetna Commercial |
$180.87
|
| Rate for Payer: Aetna Medicare |
$70.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$581.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.79
|
| Rate for Payer: Cash Price |
$132.87
|
| Rate for Payer: Cash Price |
$132.87
|
| Rate for Payer: Centivo All Commercial |
$109.29
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.59
|
| Rate for Payer: Encore All Commercial |
$197.26
|
| Rate for Payer: Frontpath All Commercial |
$197.16
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Humana Medicare |
$109.29
|
| Rate for Payer: Lucent All Commercial |
$109.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.87
|
| Rate for Payer: Managed Health Services Medicaid |
$581.72
|
| Rate for Payer: MDWise Medicaid |
$581.72
|
| Rate for Payer: PHCS All Commercial |
$160.73
|
| Rate for Payer: PHP All Commercial |
$162.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.58
|
| Rate for Payer: Sagamore Health Network All Products |
$165.44
|
| Rate for Payer: Signature Care EPO |
$177.87
|
| Rate for Payer: Signature Care PPO |
$188.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.16
|
| Rate for Payer: United Healthcare Commercial |
$168.87
|
| Rate for Payer: United Healthcare Medicare |
$70.72
|
|
|
HC COMPATIBILITY-ELECTRONIC
|
Facility
IP
|
$214.30
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
63001128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.73 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna Commercial |
$185.16
|
| Rate for Payer: Cash Price |
$132.87
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.59
|
| Rate for Payer: Encore All Commercial |
$197.26
|
| Rate for Payer: Frontpath All Commercial |
$197.16
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.87
|
| Rate for Payer: PHCS All Commercial |
$160.73
|
| Rate for Payer: PHP All Commercial |
$162.53
|
| Rate for Payer: Sagamore Health Network All Products |
$165.44
|
| Rate for Payer: Signature Care EPO |
$177.87
|
| Rate for Payer: Signature Care PPO |
$188.59
|
| Rate for Payer: United Healthcare Commercial |
$168.87
|
|
|
HC COMPLEMENT C1Q
|
Facility
OP
|
$79.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: Aetna Medicare |
$26.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.82
|
| Rate for Payer: Cash Price |
$49.23
|
| Rate for Payer: Cash Price |
$49.23
|
| Rate for Payer: Centivo All Commercial |
$40.49
|
| Rate for Payer: Cigna All Commercial |
$68.52
|
| Rate for Payer: CORVEL All Commercial |
$73.84
|
| Rate for Payer: Coventry All Commercial |
$69.87
|
| Rate for Payer: Encore All Commercial |
$73.08
|
| Rate for Payer: Frontpath All Commercial |
$73.05
|
| Rate for Payer: Humana ChoiceCare |
$68.58
|
| Rate for Payer: Humana Medicare |
$40.49
|
| Rate for Payer: Lucent All Commercial |
$40.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.46
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$59.55
|
| Rate for Payer: PHP All Commercial |
$60.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.96
|
| Rate for Payer: Sagamore Health Network All Products |
$61.29
|
| Rate for Payer: Signature Care EPO |
$65.90
|
| Rate for Payer: Signature Care PPO |
$69.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.49
|
| Rate for Payer: United Healthcare Commercial |
$62.56
|
| Rate for Payer: United Healthcare Medicare |
$26.20
|
|
|
HC COMPLEMENT C1Q
|
Facility
IP
|
$79.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna Commercial |
$68.60
|
| Rate for Payer: Cash Price |
$49.23
|
| Rate for Payer: Cigna All Commercial |
$68.52
|
| Rate for Payer: CORVEL All Commercial |
$73.84
|
| Rate for Payer: Coventry All Commercial |
$69.87
|
| Rate for Payer: Encore All Commercial |
$73.08
|
| Rate for Payer: Frontpath All Commercial |
$73.05
|
| Rate for Payer: Humana ChoiceCare |
$68.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.46
|
| Rate for Payer: PHCS All Commercial |
$59.55
|
| Rate for Payer: PHP All Commercial |
$60.21
|
| Rate for Payer: Sagamore Health Network All Products |
$61.29
|
| Rate for Payer: Signature Care EPO |
$65.90
|
| Rate for Payer: Signature Care PPO |
$69.87
|
| Rate for Payer: United Healthcare Commercial |
$62.56
|
|
|
HC COMPLEMENT C3
|
Facility
IP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna Commercial |
$55.12
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.33
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
|
|
HC COMPLEMENT C3
|
Facility
OP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: Aetna Medicare |
$21.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.16
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Centivo All Commercial |
$32.53
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.33
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Humana Medicare |
$32.53
|
| Rate for Payer: Lucent All Commercial |
$32.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.88
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.22
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
| Rate for Payer: United Healthcare Medicare |
$21.05
|
|
|
HC COMPLEMENT C4
|
Facility
IP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna Commercial |
$55.12
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.33
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
|
|
HC COMPLEMENT C4
|
Facility
OP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: Aetna Medicare |
$21.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.16
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Centivo All Commercial |
$32.53
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.33
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Humana Medicare |
$32.53
|
| Rate for Payer: Lucent All Commercial |
$32.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.88
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.22
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
| Rate for Payer: United Healthcare Medicare |
$21.05
|
|
|
HC COMPLEX STAIN-O&P
|
Facility
OP
|
$69.36
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
63002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.18
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Centivo All Commercial |
$35.37
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Humana Medicare |
$35.37
|
| Rate for Payer: Lucent All Commercial |
$35.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: Managed Health Services Medicaid |
$17.98
|
| Rate for Payer: MDWise Medicaid |
$17.98
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.05
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.96
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
| Rate for Payer: United Healthcare Medicare |
$22.89
|
|
|
HC COMPLEX STAIN-O&P
|
Facility
IP
|
$69.36
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
63002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
|
|
HC COMPREHENSIVE METABOLIC
|
Facility
OP
|
$150.47
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
63001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$139.94 |
| Rate for Payer: Aetna Commercial |
$127.00
|
| Rate for Payer: Aetna Medicare |
$49.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.62
|
| Rate for Payer: Cash Price |
$93.29
|
| Rate for Payer: Cash Price |
$93.29
|
| Rate for Payer: Centivo All Commercial |
$76.74
|
| Rate for Payer: Cigna All Commercial |
$129.86
|
| Rate for Payer: CORVEL All Commercial |
$139.94
|
| Rate for Payer: Coventry All Commercial |
$132.41
|
| Rate for Payer: Encore All Commercial |
$138.51
|
| Rate for Payer: Frontpath All Commercial |
$138.43
|
| Rate for Payer: Humana ChoiceCare |
$129.96
|
| Rate for Payer: Humana Medicare |
$76.74
|
| Rate for Payer: Lucent All Commercial |
$76.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.42
|
| Rate for Payer: Managed Health Services Medicaid |
$10.56
|
| Rate for Payer: MDWise Medicaid |
$10.56
|
| Rate for Payer: PHCS All Commercial |
$112.85
|
| Rate for Payer: PHP All Commercial |
$114.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.68
|
| Rate for Payer: Sagamore Health Network All Products |
$116.16
|
| Rate for Payer: Signature Care EPO |
$124.89
|
| Rate for Payer: Signature Care PPO |
$132.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$127.90
|
| Rate for Payer: United Healthcare Commercial |
$118.57
|
| Rate for Payer: United Healthcare Medicare |
$49.66
|
|
|
HC COMPREHENSIVE METABOLIC
|
Facility
IP
|
$150.47
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
63001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.85 |
| Max. Negotiated Rate |
$139.94 |
| Rate for Payer: Aetna Commercial |
$130.01
|
| Rate for Payer: Cash Price |
$93.29
|
| Rate for Payer: Cigna All Commercial |
$129.86
|
| Rate for Payer: CORVEL All Commercial |
$139.94
|
| Rate for Payer: Coventry All Commercial |
$132.41
|
| Rate for Payer: Encore All Commercial |
$138.51
|
| Rate for Payer: Frontpath All Commercial |
$138.43
|
| Rate for Payer: Humana ChoiceCare |
$129.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.42
|
| Rate for Payer: PHCS All Commercial |
$112.85
|
| Rate for Payer: PHP All Commercial |
$114.12
|
| Rate for Payer: Sagamore Health Network All Products |
$116.16
|
| Rate for Payer: Signature Care EPO |
$124.89
|
| Rate for Payer: Signature Care PPO |
$132.41
|
| Rate for Payer: United Healthcare Commercial |
$118.57
|
|
|
HC COMPRESSION ANKLE LG DUAL
|
Facility
OP
|
$109.48
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
41607749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Aetna Medicare |
$36.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.74
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: Centivo All Commercial |
$55.83
|
| Rate for Payer: Cigna All Commercial |
$94.48
|
| Rate for Payer: CORVEL All Commercial |
$101.82
|
| Rate for Payer: Coventry All Commercial |
$96.34
|
| Rate for Payer: Encore All Commercial |
$100.78
|
| Rate for Payer: Frontpath All Commercial |
$100.72
|
| Rate for Payer: Humana ChoiceCare |
$94.56
|
| Rate for Payer: Humana Medicare |
$55.83
|
| Rate for Payer: Lucent All Commercial |
$55.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$82.11
|
| Rate for Payer: PHP All Commercial |
$83.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.70
|
| Rate for Payer: Sagamore Health Network All Products |
$84.52
|
| Rate for Payer: Signature Care EPO |
$90.87
|
| Rate for Payer: Signature Care PPO |
$96.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.06
|
| Rate for Payer: United Healthcare Commercial |
$86.27
|
| Rate for Payer: United Healthcare Medicare |
$36.13
|
|
|
HC COMPRESSION ANKLE LG DUAL
|
Facility
IP
|
$109.48
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
41607749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$101.82 |
| Rate for Payer: Aetna Commercial |
$94.59
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: Cigna All Commercial |
$94.48
|
| Rate for Payer: CORVEL All Commercial |
$101.82
|
| Rate for Payer: Coventry All Commercial |
$96.34
|
| Rate for Payer: Encore All Commercial |
$100.78
|
| Rate for Payer: Frontpath All Commercial |
$100.72
|
| Rate for Payer: Humana ChoiceCare |
$94.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.53
|
| Rate for Payer: PHCS All Commercial |
$82.11
|
| Rate for Payer: PHP All Commercial |
$83.03
|
| Rate for Payer: Sagamore Health Network All Products |
$84.52
|
| Rate for Payer: Signature Care EPO |
$90.87
|
| Rate for Payer: Signature Care PPO |
$96.34
|
| Rate for Payer: United Healthcare Commercial |
$86.27
|
|
|
HC COMPRESSION ANKLE REG DUAL
|
Facility
OP
|
$92.89
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
41607750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$78.40
|
| Rate for Payer: Aetna Medicare |
$30.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.72
|
| Rate for Payer: Cash Price |
$57.59
|
| Rate for Payer: Cash Price |
$57.59
|
| Rate for Payer: Centivo All Commercial |
$47.37
|
| Rate for Payer: Cigna All Commercial |
$80.16
|
| Rate for Payer: CORVEL All Commercial |
$86.39
|
| Rate for Payer: Coventry All Commercial |
$81.74
|
| Rate for Payer: Encore All Commercial |
$85.51
|
| Rate for Payer: Frontpath All Commercial |
$85.46
|
| Rate for Payer: Humana ChoiceCare |
$80.23
|
| Rate for Payer: Humana Medicare |
$47.37
|
| Rate for Payer: Lucent All Commercial |
$47.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$69.67
|
| Rate for Payer: PHP All Commercial |
$70.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.23
|
| Rate for Payer: Sagamore Health Network All Products |
$71.71
|
| Rate for Payer: Signature Care EPO |
$77.10
|
| Rate for Payer: Signature Care PPO |
$81.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.96
|
| Rate for Payer: United Healthcare Commercial |
$73.20
|
| Rate for Payer: United Healthcare Medicare |
$30.65
|
|
|
HC COMPRESSION ANKLE REG DUAL
|
Facility
IP
|
$92.89
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
41607750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$86.39 |
| Rate for Payer: Aetna Commercial |
$80.26
|
| Rate for Payer: Cash Price |
$57.59
|
| Rate for Payer: Cigna All Commercial |
$80.16
|
| Rate for Payer: CORVEL All Commercial |
$86.39
|
| Rate for Payer: Coventry All Commercial |
$81.74
|
| Rate for Payer: Encore All Commercial |
$85.51
|
| Rate for Payer: Frontpath All Commercial |
$85.46
|
| Rate for Payer: Humana ChoiceCare |
$80.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.60
|
| Rate for Payer: PHCS All Commercial |
$69.67
|
| Rate for Payer: PHP All Commercial |
$70.45
|
| Rate for Payer: Sagamore Health Network All Products |
$71.71
|
| Rate for Payer: Signature Care EPO |
$77.10
|
| Rate for Payer: Signature Care PPO |
$81.74
|
| Rate for Payer: United Healthcare Commercial |
$73.20
|
|
