|
HC CT UPPER EXT W/CONTRAST RT
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
11663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.24 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT UPPER EXT W/CONTRAST RT
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
11663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$672.86 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$740.15
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Centivo All Commercial |
$1,039.88
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$1,039.88
|
| Rate for Payer: Lucent All Commercial |
$1,039.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$672.86
|
|
|
HC CT UPPER EXT W/O CONTRAST BI
|
Facility
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 73200 50
|
| Hospital Charge Code |
21663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
|
|
HC CT UPPER EXT W/O CONTRAST BI
|
Facility
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 73200 50
|
| Hospital Charge Code |
21663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,152.20
|
| Rate for Payer: Aetna Medicare |
$841.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$841.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$967.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$925.65
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Centivo All Commercial |
$1,300.50
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.44
|
| Rate for Payer: Humana Medicare |
$1,300.50
|
| Rate for Payer: Lucent All Commercial |
$1,300.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,167.50
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
| Rate for Payer: United Healthcare Medicare |
$841.50
|
|
|
HC CT UPPER EXT W/O CONTRAST LT
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
01663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT UPPER EXT W/O CONTRAST LT
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
01663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC CT UPPER EXT W/O CONTRAST RT
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
11663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT UPPER EXT W/O CONTRAST RT
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
11663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC CT UPPER EXT W/WO CONTRAST BI
|
Facility
OP
|
$4,564.50
|
|
|
Service Code
|
CPT 73202 50
|
| Hospital Charge Code |
21663202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,506.28 |
| Max. Negotiated Rate |
$4,244.98 |
| Rate for Payer: Aetna Commercial |
$3,852.44
|
| Rate for Payer: Aetna Medicare |
$1,506.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,506.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,621.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,853.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,732.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,656.91
|
| Rate for Payer: Cash Price |
$2,829.99
|
| Rate for Payer: Centivo All Commercial |
$2,327.90
|
| Rate for Payer: Cigna All Commercial |
$3,939.16
|
| Rate for Payer: CORVEL All Commercial |
$4,244.98
|
| Rate for Payer: Coventry All Commercial |
$4,016.76
|
| Rate for Payer: Encore All Commercial |
$4,201.62
|
| Rate for Payer: Frontpath All Commercial |
$4,199.34
|
| Rate for Payer: Humana ChoiceCare |
$3,942.36
|
| Rate for Payer: Humana Medicare |
$2,327.90
|
| Rate for Payer: Lucent All Commercial |
$2,327.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,108.05
|
| Rate for Payer: PHCS All Commercial |
$3,423.38
|
| Rate for Payer: PHP All Commercial |
$3,461.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,780.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,523.79
|
| Rate for Payer: Signature Care EPO |
$3,788.54
|
| Rate for Payer: Signature Care PPO |
$4,016.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,879.82
|
| Rate for Payer: United Healthcare Commercial |
$3,596.83
|
| Rate for Payer: United Healthcare Medicare |
$1,506.28
|
|
|
HC CT UPPER EXT W/WO CONTRAST BI
|
Facility
IP
|
$4,564.50
|
|
|
Service Code
|
CPT 73202 50
|
| Hospital Charge Code |
21663202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,423.38 |
| Max. Negotiated Rate |
$4,244.98 |
| Rate for Payer: Aetna Commercial |
$3,943.73
|
| Rate for Payer: Cash Price |
$2,829.99
|
| Rate for Payer: Cigna All Commercial |
$3,939.16
|
| Rate for Payer: CORVEL All Commercial |
$4,244.98
|
| Rate for Payer: Coventry All Commercial |
$4,016.76
|
| Rate for Payer: Encore All Commercial |
$4,201.62
|
| Rate for Payer: Frontpath All Commercial |
$4,199.34
|
| Rate for Payer: Humana ChoiceCare |
$3,942.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,108.05
|
| Rate for Payer: PHCS All Commercial |
$3,423.38
|
| Rate for Payer: PHP All Commercial |
$3,461.72
|
| Rate for Payer: Sagamore Health Network All Products |
$3,523.79
|
| Rate for Payer: Signature Care EPO |
$3,788.54
|
| Rate for Payer: Signature Care PPO |
$4,016.76
|
| Rate for Payer: United Healthcare Commercial |
$3,596.83
|
|
|
HC CT UPPER EXT W/WO CONTRAST LT
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
01663202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$992.97 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,141.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,092.27
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Centivo All Commercial |
$1,534.59
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$1,534.59
|
| Rate for Payer: Lucent All Commercial |
$1,534.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$992.97
|
|
|
HC CT UPPER EXT W/WO CONTRAST LT
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
01663202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CT UPPER EXT W/WO CONTRAST RT
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
11663202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$992.97 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,141.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,092.27
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Centivo All Commercial |
$1,534.59
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$1,534.59
|
| Rate for Payer: Lucent All Commercial |
$1,534.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$992.97
|
|
|
HC CT UPPER EXT W/WO CONTRAST RT
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
11663202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CUFF TOURNIQUET 12 IN
|
Facility
IP
|
$120.53
|
|
| Hospital Charge Code |
41605854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna Commercial |
$104.14
|
| Rate for Payer: Cash Price |
$74.73
|
| Rate for Payer: Cigna All Commercial |
$104.02
|
| Rate for Payer: CORVEL All Commercial |
$112.09
|
| Rate for Payer: Coventry All Commercial |
$106.07
|
| Rate for Payer: Encore All Commercial |
$110.95
|
| Rate for Payer: Frontpath All Commercial |
$110.89
|
| Rate for Payer: Humana ChoiceCare |
$104.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.48
|
| Rate for Payer: PHCS All Commercial |
$90.40
|
| Rate for Payer: PHP All Commercial |
$91.41
|
| Rate for Payer: Sagamore Health Network All Products |
$93.05
|
| Rate for Payer: Signature Care EPO |
$100.04
|
| Rate for Payer: Signature Care PPO |
$106.07
|
| Rate for Payer: United Healthcare Commercial |
$94.98
|
|
|
HC CUFF TOURNIQUET 12 IN
|
Facility
OP
|
$120.53
|
|
| Hospital Charge Code |
41605854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.77 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$101.73
|
| Rate for Payer: Aetna Medicare |
$39.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.75
|
| Rate for Payer: Cash Price |
$74.73
|
| Rate for Payer: Cash Price |
$74.73
|
| Rate for Payer: Centivo All Commercial |
$61.47
|
| Rate for Payer: Cigna All Commercial |
$104.02
|
| Rate for Payer: CORVEL All Commercial |
$112.09
|
| Rate for Payer: Coventry All Commercial |
$106.07
|
| Rate for Payer: Encore All Commercial |
$110.95
|
| Rate for Payer: Frontpath All Commercial |
$110.89
|
| Rate for Payer: Humana ChoiceCare |
$104.10
|
| Rate for Payer: Humana Medicare |
$61.47
|
| Rate for Payer: Lucent All Commercial |
$61.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$90.40
|
| Rate for Payer: PHP All Commercial |
$91.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.01
|
| Rate for Payer: Sagamore Health Network All Products |
$93.05
|
| Rate for Payer: Signature Care EPO |
$100.04
|
| Rate for Payer: Signature Care PPO |
$106.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.45
|
| Rate for Payer: United Healthcare Commercial |
$94.98
|
| Rate for Payer: United Healthcare Medicare |
$39.77
|
|
|
HC CUFF TOURNIQUET 18 IN
|
Facility
IP
|
$135.56
|
|
| Hospital Charge Code |
41601245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.67 |
| Max. Negotiated Rate |
$126.07 |
| Rate for Payer: Aetna Commercial |
$117.12
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cigna All Commercial |
$116.99
|
| Rate for Payer: CORVEL All Commercial |
$126.07
|
| Rate for Payer: Coventry All Commercial |
$119.29
|
| Rate for Payer: Encore All Commercial |
$124.78
|
| Rate for Payer: Frontpath All Commercial |
$124.72
|
| Rate for Payer: Humana ChoiceCare |
$117.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: PHCS All Commercial |
$101.67
|
| Rate for Payer: PHP All Commercial |
$102.81
|
| Rate for Payer: Sagamore Health Network All Products |
$104.65
|
| Rate for Payer: Signature Care EPO |
$112.51
|
| Rate for Payer: Signature Care PPO |
$119.29
|
| Rate for Payer: United Healthcare Commercial |
$106.82
|
|
|
HC CUFF TOURNIQUET 18 IN
|
Facility
OP
|
$135.56
|
|
| Hospital Charge Code |
41601245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$126.07 |
| Rate for Payer: Aetna Commercial |
$114.41
|
| Rate for Payer: Aetna Medicare |
$44.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$84.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.21
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Centivo All Commercial |
$69.14
|
| Rate for Payer: Cigna All Commercial |
$116.99
|
| Rate for Payer: CORVEL All Commercial |
$126.07
|
| Rate for Payer: Coventry All Commercial |
$119.29
|
| Rate for Payer: Encore All Commercial |
$124.78
|
| Rate for Payer: Frontpath All Commercial |
$124.72
|
| Rate for Payer: Humana ChoiceCare |
$117.08
|
| Rate for Payer: Humana Medicare |
$69.14
|
| Rate for Payer: Lucent All Commercial |
$69.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$101.67
|
| Rate for Payer: PHP All Commercial |
$102.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.87
|
| Rate for Payer: Sagamore Health Network All Products |
$104.65
|
| Rate for Payer: Signature Care EPO |
$112.51
|
| Rate for Payer: Signature Care PPO |
$119.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.23
|
| Rate for Payer: United Healthcare Commercial |
$106.82
|
| Rate for Payer: United Healthcare Medicare |
$44.73
|
|
|
HC CUFF TOURNIQUET 24 IN
|
Facility
IP
|
$151.03
|
|
| Hospital Charge Code |
41601247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.27 |
| Max. Negotiated Rate |
$140.46 |
| Rate for Payer: Aetna Commercial |
$130.49
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: Cigna All Commercial |
$130.34
|
| Rate for Payer: CORVEL All Commercial |
$140.46
|
| Rate for Payer: Coventry All Commercial |
$132.91
|
| Rate for Payer: Encore All Commercial |
$139.02
|
| Rate for Payer: Frontpath All Commercial |
$138.95
|
| Rate for Payer: Humana ChoiceCare |
$130.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.93
|
| Rate for Payer: PHCS All Commercial |
$113.27
|
| Rate for Payer: PHP All Commercial |
$114.54
|
| Rate for Payer: Sagamore Health Network All Products |
$116.60
|
| Rate for Payer: Signature Care EPO |
$125.35
|
| Rate for Payer: Signature Care PPO |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$119.01
|
|
|
HC CUFF TOURNIQUET 24 IN
|
Facility
OP
|
$151.03
|
|
| Hospital Charge Code |
41601247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$140.46 |
| Rate for Payer: Aetna Commercial |
$127.47
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.82
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: Centivo All Commercial |
$77.03
|
| Rate for Payer: Cigna All Commercial |
$130.34
|
| Rate for Payer: CORVEL All Commercial |
$140.46
|
| Rate for Payer: Coventry All Commercial |
$132.91
|
| Rate for Payer: Encore All Commercial |
$139.02
|
| Rate for Payer: Frontpath All Commercial |
$138.95
|
| Rate for Payer: Humana ChoiceCare |
$130.44
|
| Rate for Payer: Humana Medicare |
$77.03
|
| Rate for Payer: Lucent All Commercial |
$77.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.93
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$113.27
|
| Rate for Payer: PHP All Commercial |
$114.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.90
|
| Rate for Payer: Sagamore Health Network All Products |
$116.60
|
| Rate for Payer: Signature Care EPO |
$125.35
|
| Rate for Payer: Signature Care PPO |
$132.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.38
|
| Rate for Payer: United Healthcare Commercial |
$119.01
|
| Rate for Payer: United Healthcare Medicare |
$49.84
|
|
|
HC CUFF TOURNIQUET 34 IN
|
Facility
IP
|
$173.64
|
|
| Hospital Charge Code |
41601248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.23 |
| Max. Negotiated Rate |
$161.49 |
| Rate for Payer: Aetna Commercial |
$150.02
|
| Rate for Payer: Cash Price |
$107.66
|
| Rate for Payer: Cigna All Commercial |
$149.85
|
| Rate for Payer: CORVEL All Commercial |
$161.49
|
| Rate for Payer: Coventry All Commercial |
$152.80
|
| Rate for Payer: Encore All Commercial |
$159.84
|
| Rate for Payer: Frontpath All Commercial |
$159.75
|
| Rate for Payer: Humana ChoiceCare |
$149.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.28
|
| Rate for Payer: PHCS All Commercial |
$130.23
|
| Rate for Payer: PHP All Commercial |
$131.69
|
| Rate for Payer: Sagamore Health Network All Products |
$134.05
|
| Rate for Payer: Signature Care EPO |
$144.12
|
| Rate for Payer: Signature Care PPO |
$152.80
|
| Rate for Payer: United Healthcare Commercial |
$136.83
|
|
|
HC CUFF TOURNIQUET 34 IN
|
Facility
OP
|
$173.64
|
|
| Hospital Charge Code |
41601248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$161.49 |
| Rate for Payer: Aetna Commercial |
$146.55
|
| Rate for Payer: Aetna Medicare |
$57.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.03
|
| Rate for Payer: Cash Price |
$107.66
|
| Rate for Payer: Cash Price |
$107.66
|
| Rate for Payer: Centivo All Commercial |
$88.56
|
| Rate for Payer: Cigna All Commercial |
$149.85
|
| Rate for Payer: CORVEL All Commercial |
$161.49
|
| Rate for Payer: Coventry All Commercial |
$152.80
|
| Rate for Payer: Encore All Commercial |
$159.84
|
| Rate for Payer: Frontpath All Commercial |
$159.75
|
| Rate for Payer: Humana ChoiceCare |
$149.97
|
| Rate for Payer: Humana Medicare |
$88.56
|
| Rate for Payer: Lucent All Commercial |
$88.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$130.23
|
| Rate for Payer: PHP All Commercial |
$131.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.72
|
| Rate for Payer: Sagamore Health Network All Products |
$134.05
|
| Rate for Payer: Signature Care EPO |
$144.12
|
| Rate for Payer: Signature Care PPO |
$152.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.59
|
| Rate for Payer: United Healthcare Commercial |
$136.83
|
| Rate for Payer: United Healthcare Medicare |
$57.30
|
|
|
HC CUFF TOURNIQUET 44 IN
|
Facility
OP
|
$188.71
|
|
| Hospital Charge Code |
41605853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$159.27
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.50
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Centivo All Commercial |
$96.24
|
| Rate for Payer: Cigna All Commercial |
$162.86
|
| Rate for Payer: CORVEL All Commercial |
$175.50
|
| Rate for Payer: Coventry All Commercial |
$166.06
|
| Rate for Payer: Encore All Commercial |
$173.71
|
| Rate for Payer: Frontpath All Commercial |
$173.61
|
| Rate for Payer: Humana ChoiceCare |
$162.99
|
| Rate for Payer: Humana Medicare |
$96.24
|
| Rate for Payer: Lucent All Commercial |
$96.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$141.53
|
| Rate for Payer: PHP All Commercial |
$143.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.60
|
| Rate for Payer: Sagamore Health Network All Products |
$145.68
|
| Rate for Payer: Signature Care EPO |
$156.63
|
| Rate for Payer: Signature Care PPO |
$166.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.40
|
| Rate for Payer: United Healthcare Commercial |
$148.70
|
| Rate for Payer: United Healthcare Medicare |
$62.27
|
|
|
HC CUFF TOURNIQUET 44 IN
|
Facility
IP
|
$188.71
|
|
| Hospital Charge Code |
41605853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.53 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$163.05
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna All Commercial |
$162.86
|
| Rate for Payer: CORVEL All Commercial |
$175.50
|
| Rate for Payer: Coventry All Commercial |
$166.06
|
| Rate for Payer: Encore All Commercial |
$173.71
|
| Rate for Payer: Frontpath All Commercial |
$173.61
|
| Rate for Payer: Humana ChoiceCare |
$162.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.84
|
| Rate for Payer: PHCS All Commercial |
$141.53
|
| Rate for Payer: PHP All Commercial |
$143.12
|
| Rate for Payer: Sagamore Health Network All Products |
$145.68
|
| Rate for Payer: Signature Care EPO |
$156.63
|
| Rate for Payer: Signature Care PPO |
$166.06
|
| Rate for Payer: United Healthcare Commercial |
$148.70
|
|
|
HC CULTURE ROUTINE W/SUSCEPTIBILITY IF IND
|
Facility
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
