|
HC DEBRIDE-SHARP<20 SQCM-45 MIN-PT
|
Facility
IP
|
$425.43
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01729597
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$367.57
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
|
|
HC DEBRIDE-SHARP<20 SQCM-OT
|
Facility
OP
|
$442.45
|
|
|
Service Code
|
CPT 97597 GO
|
| Hospital Charge Code |
01732003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$146.01 |
| Max. Negotiated Rate |
$411.47 |
| Rate for Payer: Aetna Commercial |
$373.42
|
| Rate for Payer: Aetna Medicare |
$146.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.61
|
| Rate for Payer: Cash Price |
$274.32
|
| Rate for Payer: Centivo All Commercial |
$225.65
|
| Rate for Payer: Cigna All Commercial |
$381.83
|
| Rate for Payer: CORVEL All Commercial |
$411.47
|
| Rate for Payer: Coventry All Commercial |
$389.35
|
| Rate for Payer: Encore All Commercial |
$407.27
|
| Rate for Payer: Frontpath All Commercial |
$407.05
|
| Rate for Payer: Humana ChoiceCare |
$382.14
|
| Rate for Payer: Humana Medicare |
$225.65
|
| Rate for Payer: Lucent All Commercial |
$225.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.20
|
| Rate for Payer: PHCS All Commercial |
$331.83
|
| Rate for Payer: PHP All Commercial |
$335.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.55
|
| Rate for Payer: Sagamore Health Network All Products |
$341.57
|
| Rate for Payer: Signature Care EPO |
$367.23
|
| Rate for Payer: Signature Care PPO |
$389.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$376.08
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
| Rate for Payer: United Healthcare Medicare |
$146.01
|
|
|
HC DEBRIDE-SHARP<20 SQCM-OT
|
Facility
IP
|
$442.45
|
|
|
Service Code
|
CPT 97597 GO
|
| Hospital Charge Code |
01732003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$331.83 |
| Max. Negotiated Rate |
$411.47 |
| Rate for Payer: Aetna Commercial |
$382.27
|
| Rate for Payer: Cash Price |
$274.32
|
| Rate for Payer: Cigna All Commercial |
$381.83
|
| Rate for Payer: CORVEL All Commercial |
$411.47
|
| Rate for Payer: Coventry All Commercial |
$389.35
|
| Rate for Payer: Encore All Commercial |
$407.27
|
| Rate for Payer: Frontpath All Commercial |
$407.05
|
| Rate for Payer: Humana ChoiceCare |
$382.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.20
|
| Rate for Payer: PHCS All Commercial |
$331.83
|
| Rate for Payer: PHP All Commercial |
$335.55
|
| Rate for Payer: Sagamore Health Network All Products |
$341.57
|
| Rate for Payer: Signature Care EPO |
$367.23
|
| Rate for Payer: Signature Care PPO |
$389.35
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
|
|
HC DEBRIDE-SHARP<20 SQCM - PT
|
Facility
IP
|
$178.50
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01728050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
|
|
HC DEBRIDE-SHARP<20 SQCM - PT
|
Facility
OP
|
$178.50
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01728050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Centivo All Commercial |
$91.04
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Humana Medicare |
$91.04
|
| Rate for Payer: Lucent All Commercial |
$91.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.72
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
| Rate for Payer: United Healthcare Medicare |
$58.90
|
|
|
HC DEBR-SHARP EA AD 20CM/< -15 MN
|
Facility
IP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01727598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$367.57
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
|
|
HC DEBR-SHARP EA AD 20CM/< -15 MN
|
Facility
OP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01727598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$359.06
|
| Rate for Payer: Aetna Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.43
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Centivo All Commercial |
$216.97
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Humana Medicare |
$216.97
|
| Rate for Payer: Lucent All Commercial |
$216.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.92
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.62
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
| Rate for Payer: United Healthcare Medicare |
$140.39
|
|
|
HC DEBR-SHARP EA AD 20CM/< -30 MN
|
Facility
IP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01728598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$367.57
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
|
|
HC DEBR-SHARP EA AD 20CM/< -30 MN
|
Facility
OP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01728598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$359.06
|
| Rate for Payer: Aetna Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.43
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Centivo All Commercial |
$216.97
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Humana Medicare |
$216.97
|
| Rate for Payer: Lucent All Commercial |
$216.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.92
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.62
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
| Rate for Payer: United Healthcare Medicare |
$140.39
|
|
|
HC DEBR-SHARP EA AD 20CM/< -45 MN -PT
|
Facility
IP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01729598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$367.57
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
|
|
HC DEBR-SHARP EA AD 20CM/< -45 MN -PT
|
Facility
OP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01729598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$359.06
|
| Rate for Payer: Aetna Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.43
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Centivo All Commercial |
$216.97
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Humana Medicare |
$216.97
|
| Rate for Payer: Lucent All Commercial |
$216.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.92
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.62
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
| Rate for Payer: United Healthcare Medicare |
$140.39
|
|
|
HC DEBR-SHARP EA AD 20CM/< -OT
|
Facility
OP
|
$442.45
|
|
|
Service Code
|
CPT 97598 GO
|
| Hospital Charge Code |
01732002
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$146.01 |
| Max. Negotiated Rate |
$411.47 |
| Rate for Payer: Aetna Commercial |
$373.42
|
| Rate for Payer: Aetna Medicare |
$146.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.61
|
| Rate for Payer: Cash Price |
$274.32
|
| Rate for Payer: Centivo All Commercial |
$225.65
|
| Rate for Payer: Cigna All Commercial |
$381.83
|
| Rate for Payer: CORVEL All Commercial |
$411.47
|
| Rate for Payer: Coventry All Commercial |
$389.35
|
| Rate for Payer: Encore All Commercial |
$407.27
|
| Rate for Payer: Frontpath All Commercial |
$407.05
|
| Rate for Payer: Humana ChoiceCare |
$382.14
|
| Rate for Payer: Humana Medicare |
$225.65
|
| Rate for Payer: Lucent All Commercial |
$225.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.20
|
| Rate for Payer: PHCS All Commercial |
$331.83
|
| Rate for Payer: PHP All Commercial |
$335.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.55
|
| Rate for Payer: Sagamore Health Network All Products |
$341.57
|
| Rate for Payer: Signature Care EPO |
$367.23
|
| Rate for Payer: Signature Care PPO |
$389.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$376.08
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
| Rate for Payer: United Healthcare Medicare |
$146.01
|
|
|
HC DEBR-SHARP EA AD 20CM/< -OT
|
Facility
IP
|
$442.45
|
|
|
Service Code
|
CPT 97598 GO
|
| Hospital Charge Code |
01732002
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$331.83 |
| Max. Negotiated Rate |
$411.47 |
| Rate for Payer: Aetna Commercial |
$382.27
|
| Rate for Payer: Cash Price |
$274.32
|
| Rate for Payer: Cigna All Commercial |
$381.83
|
| Rate for Payer: CORVEL All Commercial |
$411.47
|
| Rate for Payer: Coventry All Commercial |
$389.35
|
| Rate for Payer: Encore All Commercial |
$407.27
|
| Rate for Payer: Frontpath All Commercial |
$407.05
|
| Rate for Payer: Humana ChoiceCare |
$382.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.20
|
| Rate for Payer: PHCS All Commercial |
$331.83
|
| Rate for Payer: PHP All Commercial |
$335.55
|
| Rate for Payer: Sagamore Health Network All Products |
$341.57
|
| Rate for Payer: Signature Care EPO |
$367.23
|
| Rate for Payer: Signature Care PPO |
$389.35
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
|
|
HC DEBR-SHARP EA AD 20CM/< - PT
|
Facility
IP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01728070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$367.57
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
|
|
HC DEBR-SHARP EA AD 20CM/< - PT
|
Facility
OP
|
$425.43
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
01728070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$359.06
|
| Rate for Payer: Aetna Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.43
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Centivo All Commercial |
$216.97
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Humana Medicare |
$216.97
|
| Rate for Payer: Lucent All Commercial |
$216.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.92
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.62
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
| Rate for Payer: United Healthcare Medicare |
$140.39
|
|
|
HC DECALCIFICATION PATH PROCEDURE
|
Facility
IP
|
$161.57
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
63001261
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$150.26 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Cash Price |
$100.17
|
| Rate for Payer: Cigna All Commercial |
$139.43
|
| Rate for Payer: CORVEL All Commercial |
$150.26
|
| Rate for Payer: Coventry All Commercial |
$142.18
|
| Rate for Payer: Encore All Commercial |
$148.72
|
| Rate for Payer: Frontpath All Commercial |
$148.64
|
| Rate for Payer: Humana ChoiceCare |
$139.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.41
|
| Rate for Payer: PHCS All Commercial |
$121.18
|
| Rate for Payer: PHP All Commercial |
$122.53
|
| Rate for Payer: Sagamore Health Network All Products |
$124.73
|
| Rate for Payer: Signature Care EPO |
$134.10
|
| Rate for Payer: Signature Care PPO |
$142.18
|
| Rate for Payer: United Healthcare Commercial |
$127.32
|
|
|
HC DECALCIFICATION PATH PROCEDURE
|
Facility
OP
|
$161.57
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
63001261
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$150.26 |
| Rate for Payer: Aetna Commercial |
$136.36
|
| Rate for Payer: Aetna Medicare |
$53.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$48.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.65
|
| Rate for Payer: Cash Price |
$100.17
|
| Rate for Payer: Cash Price |
$100.17
|
| Rate for Payer: Centivo All Commercial |
$82.40
|
| Rate for Payer: Cigna All Commercial |
$139.43
|
| Rate for Payer: CORVEL All Commercial |
$150.26
|
| Rate for Payer: Coventry All Commercial |
$142.18
|
| Rate for Payer: Encore All Commercial |
$148.72
|
| Rate for Payer: Frontpath All Commercial |
$148.64
|
| Rate for Payer: Humana ChoiceCare |
$139.55
|
| Rate for Payer: Humana Medicare |
$82.40
|
| Rate for Payer: Lucent All Commercial |
$82.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.41
|
| Rate for Payer: Managed Health Services Medicaid |
$48.01
|
| Rate for Payer: MDWise Medicaid |
$48.01
|
| Rate for Payer: PHCS All Commercial |
$121.18
|
| Rate for Payer: PHP All Commercial |
$122.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.01
|
| Rate for Payer: Sagamore Health Network All Products |
$124.73
|
| Rate for Payer: Signature Care EPO |
$134.10
|
| Rate for Payer: Signature Care PPO |
$142.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.33
|
| Rate for Payer: United Healthcare Commercial |
$127.32
|
| Rate for Payer: United Healthcare Medicare |
$53.32
|
|
|
HC DECALCIFICATION PATH PROCEDURE
|
Facility
IP
|
$99.79
|
|
|
Service Code
|
CPT 88311 59
|
| Hospital Charge Code |
63002184
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.84 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna Commercial |
$86.22
|
| Rate for Payer: Cash Price |
$61.87
|
| Rate for Payer: Cigna All Commercial |
$86.12
|
| Rate for Payer: CORVEL All Commercial |
$92.80
|
| Rate for Payer: Coventry All Commercial |
$87.81
|
| Rate for Payer: Encore All Commercial |
$91.85
|
| Rate for Payer: Frontpath All Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$86.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.81
|
| Rate for Payer: PHCS All Commercial |
$74.84
|
| Rate for Payer: PHP All Commercial |
$75.68
|
| Rate for Payer: Sagamore Health Network All Products |
$77.04
|
| Rate for Payer: Signature Care EPO |
$82.82
|
| Rate for Payer: Signature Care PPO |
$87.81
|
| Rate for Payer: United Healthcare Commercial |
$78.63
|
|
|
HC DECALCIFICATION PATH PROCEDURE
|
Facility
OP
|
$99.79
|
|
|
Service Code
|
CPT 88311 59
|
| Hospital Charge Code |
63002184
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna Commercial |
$84.22
|
| Rate for Payer: Aetna Medicare |
$32.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.22
|
| Rate for Payer: Cash Price |
$61.87
|
| Rate for Payer: Centivo All Commercial |
$50.89
|
| Rate for Payer: Cigna All Commercial |
$86.12
|
| Rate for Payer: CORVEL All Commercial |
$92.80
|
| Rate for Payer: Coventry All Commercial |
$87.81
|
| Rate for Payer: Encore All Commercial |
$91.85
|
| Rate for Payer: Frontpath All Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$86.19
|
| Rate for Payer: Humana Medicare |
$50.89
|
| Rate for Payer: Lucent All Commercial |
$50.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.81
|
| Rate for Payer: PHCS All Commercial |
$74.84
|
| Rate for Payer: PHP All Commercial |
$75.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.92
|
| Rate for Payer: Sagamore Health Network All Products |
$77.04
|
| Rate for Payer: Signature Care EPO |
$82.82
|
| Rate for Payer: Signature Care PPO |
$87.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.82
|
| Rate for Payer: United Healthcare Commercial |
$78.63
|
| Rate for Payer: United Healthcare Medicare |
$32.93
|
|
|
HC DECLOT W/THROMBOLYTIC AGENT
|
Facility
IP
|
$685.81
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
00956550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$514.36 |
| Max. Negotiated Rate |
$637.80 |
| Rate for Payer: Aetna Commercial |
$592.54
|
| Rate for Payer: Cash Price |
$425.20
|
| Rate for Payer: Cigna All Commercial |
$591.85
|
| Rate for Payer: CORVEL All Commercial |
$637.80
|
| Rate for Payer: Coventry All Commercial |
$603.51
|
| Rate for Payer: Encore All Commercial |
$631.29
|
| Rate for Payer: Frontpath All Commercial |
$630.94
|
| Rate for Payer: Humana ChoiceCare |
$592.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$617.23
|
| Rate for Payer: PHCS All Commercial |
$514.36
|
| Rate for Payer: PHP All Commercial |
$520.12
|
| Rate for Payer: Sagamore Health Network All Products |
$529.44
|
| Rate for Payer: Signature Care EPO |
$569.22
|
| Rate for Payer: Signature Care PPO |
$603.51
|
| Rate for Payer: United Healthcare Commercial |
$540.42
|
|
|
HC DECLOT W/THROMBOLYTIC AGENT
|
Facility
OP
|
$685.81
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
00956550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.32 |
| Max. Negotiated Rate |
$637.80 |
| Rate for Payer: Aetna Commercial |
$578.82
|
| Rate for Payer: Aetna Medicare |
$226.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$226.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$393.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$428.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$260.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$248.95
|
| Rate for Payer: Cash Price |
$425.20
|
| Rate for Payer: Centivo All Commercial |
$349.76
|
| Rate for Payer: Cigna All Commercial |
$591.85
|
| Rate for Payer: CORVEL All Commercial |
$637.80
|
| Rate for Payer: Coventry All Commercial |
$603.51
|
| Rate for Payer: Encore All Commercial |
$631.29
|
| Rate for Payer: Frontpath All Commercial |
$630.94
|
| Rate for Payer: Humana ChoiceCare |
$592.33
|
| Rate for Payer: Humana Medicare |
$349.76
|
| Rate for Payer: Lucent All Commercial |
$349.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$617.23
|
| Rate for Payer: PHCS All Commercial |
$514.36
|
| Rate for Payer: PHP All Commercial |
$520.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$267.46
|
| Rate for Payer: Sagamore Health Network All Products |
$529.44
|
| Rate for Payer: Signature Care EPO |
$569.22
|
| Rate for Payer: Signature Care PPO |
$603.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$582.94
|
| Rate for Payer: United Healthcare Commercial |
$540.42
|
| Rate for Payer: United Healthcare Medicare |
$226.32
|
|
|
HC DEPAKANE
|
Facility
OP
|
$242.10
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
63001192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$204.33
|
| Rate for Payer: Aetna Medicare |
$79.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$151.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.88
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Centivo All Commercial |
$123.47
|
| Rate for Payer: Cigna All Commercial |
$208.93
|
| Rate for Payer: CORVEL All Commercial |
$225.15
|
| Rate for Payer: Coventry All Commercial |
$213.05
|
| Rate for Payer: Encore All Commercial |
$222.85
|
| Rate for Payer: Frontpath All Commercial |
$222.73
|
| Rate for Payer: Humana ChoiceCare |
$209.10
|
| Rate for Payer: Humana Medicare |
$123.47
|
| Rate for Payer: Lucent All Commercial |
$123.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.89
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$181.57
|
| Rate for Payer: PHP All Commercial |
$183.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.42
|
| Rate for Payer: Sagamore Health Network All Products |
$186.90
|
| Rate for Payer: Signature Care EPO |
$200.94
|
| Rate for Payer: Signature Care PPO |
$213.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$205.78
|
| Rate for Payer: United Healthcare Commercial |
$190.77
|
| Rate for Payer: United Healthcare Medicare |
$79.89
|
|
|
HC DEPAKANE
|
Facility
IP
|
$242.10
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
63001192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.57 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$209.17
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cigna All Commercial |
$208.93
|
| Rate for Payer: CORVEL All Commercial |
$225.15
|
| Rate for Payer: Coventry All Commercial |
$213.05
|
| Rate for Payer: Encore All Commercial |
$222.85
|
| Rate for Payer: Frontpath All Commercial |
$222.73
|
| Rate for Payer: Humana ChoiceCare |
$209.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.89
|
| Rate for Payer: PHCS All Commercial |
$181.57
|
| Rate for Payer: PHP All Commercial |
$183.61
|
| Rate for Payer: Sagamore Health Network All Products |
$186.90
|
| Rate for Payer: Signature Care EPO |
$200.94
|
| Rate for Payer: Signature Care PPO |
$213.05
|
| Rate for Payer: United Healthcare Commercial |
$190.77
|
|
|
HC DERMABOND PRINEO 22CM
|
Facility
OP
|
$594.62
|
|
| Hospital Charge Code |
41607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna Commercial |
$501.86
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$341.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.85
|
| Rate for Payer: Cash Price |
$368.66
|
| Rate for Payer: Cash Price |
$368.66
|
| Rate for Payer: Centivo All Commercial |
$303.26
|
| Rate for Payer: Cigna All Commercial |
$513.16
|
| Rate for Payer: CORVEL All Commercial |
$553.00
|
| Rate for Payer: Coventry All Commercial |
$523.27
|
| Rate for Payer: Encore All Commercial |
$547.35
|
| Rate for Payer: Frontpath All Commercial |
$547.05
|
| Rate for Payer: Humana ChoiceCare |
$513.57
|
| Rate for Payer: Humana Medicare |
$303.26
|
| Rate for Payer: Lucent All Commercial |
$303.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.16
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$445.96
|
| Rate for Payer: PHP All Commercial |
$450.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$231.90
|
| Rate for Payer: Sagamore Health Network All Products |
$459.05
|
| Rate for Payer: Signature Care EPO |
$493.53
|
| Rate for Payer: Signature Care PPO |
$523.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$505.43
|
| Rate for Payer: United Healthcare Commercial |
$468.56
|
| Rate for Payer: United Healthcare Medicare |
$196.22
|
|
|
HC DERMABOND PRINEO 22CM
|
Facility
IP
|
$594.62
|
|
| Hospital Charge Code |
41607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.96 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna Commercial |
$513.75
|
| Rate for Payer: Cash Price |
$368.66
|
| Rate for Payer: Cigna All Commercial |
$513.16
|
| Rate for Payer: CORVEL All Commercial |
$553.00
|
| Rate for Payer: Coventry All Commercial |
$523.27
|
| Rate for Payer: Encore All Commercial |
$547.35
|
| Rate for Payer: Frontpath All Commercial |
$547.05
|
| Rate for Payer: Humana ChoiceCare |
$513.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.16
|
| Rate for Payer: PHCS All Commercial |
$445.96
|
| Rate for Payer: PHP All Commercial |
$450.96
|
| Rate for Payer: Sagamore Health Network All Products |
$459.05
|
| Rate for Payer: Signature Care EPO |
$493.53
|
| Rate for Payer: Signature Care PPO |
$523.27
|
| Rate for Payer: United Healthcare Commercial |
$468.56
|
|
