|
HC CAPTIVATOR 10MM
|
Facility
|
IP
|
$91.00
|
|
| Hospital Charge Code |
41608236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna All Commercial |
$78.53
|
| Rate for Payer: CORVEL All Commercial |
$84.63
|
| Rate for Payer: Coventry All Commercial |
$80.08
|
| Rate for Payer: Encore All Commercial |
$83.77
|
| Rate for Payer: Frontpath All Commercial |
$83.72
|
| Rate for Payer: Humana ChoiceCare |
$78.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.90
|
| Rate for Payer: PHCS All Commercial |
$68.25
|
| Rate for Payer: PHP All Commercial |
$69.01
|
| Rate for Payer: Sagamore Health Network All Products |
$70.25
|
| Rate for Payer: Signature Care EPO |
$75.53
|
| Rate for Payer: Signature Care PPO |
$80.08
|
| Rate for Payer: United Healthcare Commercial |
$71.71
|
|
|
HC CAPTIVATOR 20MM
|
Facility
|
OP
|
$93.73
|
|
| Hospital Charge Code |
41608209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$87.17 |
| Rate for Payer: Aetna Commercial |
$79.11
|
| Rate for Payer: Aetna Medicare |
$29.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$53.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.99
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Centivo All Commercial |
$50.99
|
| Rate for Payer: Cigna All Commercial |
$80.89
|
| Rate for Payer: CORVEL All Commercial |
$87.17
|
| Rate for Payer: Coventry All Commercial |
$82.48
|
| Rate for Payer: Encore All Commercial |
$86.28
|
| Rate for Payer: Frontpath All Commercial |
$86.23
|
| Rate for Payer: Humana ChoiceCare |
$80.95
|
| Rate for Payer: Humana Medicare |
$29.99
|
| Rate for Payer: Lucent All Commercial |
$50.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.36
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$70.30
|
| Rate for Payer: PHP All Commercial |
$71.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.55
|
| Rate for Payer: Sagamore Health Network All Products |
$72.36
|
| Rate for Payer: Signature Care EPO |
$77.80
|
| Rate for Payer: Signature Care PPO |
$82.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.67
|
| Rate for Payer: United Healthcare Commercial |
$73.86
|
| Rate for Payer: United Healthcare Medicare |
$29.99
|
|
|
HC CAPTIVATOR 20MM
|
Facility
|
OP
|
$63.60
|
|
| Hospital Charge Code |
41608210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Commercial |
$53.68
|
| Rate for Payer: Aetna Medicare |
$20.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.39
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Centivo All Commercial |
$34.60
|
| Rate for Payer: Cigna All Commercial |
$54.89
|
| Rate for Payer: CORVEL All Commercial |
$59.15
|
| Rate for Payer: Coventry All Commercial |
$55.97
|
| Rate for Payer: Encore All Commercial |
$58.54
|
| Rate for Payer: Frontpath All Commercial |
$58.51
|
| Rate for Payer: Humana ChoiceCare |
$54.93
|
| Rate for Payer: Humana Medicare |
$20.35
|
| Rate for Payer: Lucent All Commercial |
$34.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.24
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$47.70
|
| Rate for Payer: PHP All Commercial |
$48.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.80
|
| Rate for Payer: Sagamore Health Network All Products |
$49.10
|
| Rate for Payer: Signature Care EPO |
$52.79
|
| Rate for Payer: Signature Care PPO |
$55.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.06
|
| Rate for Payer: United Healthcare Commercial |
$50.12
|
| Rate for Payer: United Healthcare Medicare |
$20.35
|
|
|
HC CAPTIVATOR 20MM
|
Facility
|
IP
|
$63.60
|
|
| Hospital Charge Code |
41608210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Commercial |
$54.95
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Cigna All Commercial |
$54.89
|
| Rate for Payer: CORVEL All Commercial |
$59.15
|
| Rate for Payer: Coventry All Commercial |
$55.97
|
| Rate for Payer: Encore All Commercial |
$58.54
|
| Rate for Payer: Frontpath All Commercial |
$58.51
|
| Rate for Payer: Humana ChoiceCare |
$54.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.24
|
| Rate for Payer: PHCS All Commercial |
$47.70
|
| Rate for Payer: PHP All Commercial |
$48.23
|
| Rate for Payer: Sagamore Health Network All Products |
$49.10
|
| Rate for Payer: Signature Care EPO |
$52.79
|
| Rate for Payer: Signature Care PPO |
$55.97
|
| Rate for Payer: United Healthcare Commercial |
$50.12
|
|
|
HC CAPTIVATOR 20MM
|
Facility
|
IP
|
$93.73
|
|
| Hospital Charge Code |
41608209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$87.17 |
| Rate for Payer: Aetna Commercial |
$80.98
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cigna All Commercial |
$80.89
|
| Rate for Payer: CORVEL All Commercial |
$87.17
|
| Rate for Payer: Coventry All Commercial |
$82.48
|
| Rate for Payer: Encore All Commercial |
$86.28
|
| Rate for Payer: Frontpath All Commercial |
$86.23
|
| Rate for Payer: Humana ChoiceCare |
$80.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.36
|
| Rate for Payer: PHCS All Commercial |
$70.30
|
| Rate for Payer: PHP All Commercial |
$71.08
|
| Rate for Payer: Sagamore Health Network All Products |
$72.36
|
| Rate for Payer: Signature Care EPO |
$77.80
|
| Rate for Payer: Signature Care PPO |
$82.48
|
| Rate for Payer: United Healthcare Commercial |
$73.86
|
|
|
HC CARBOXY HGB
|
Facility
|
OP
|
$176.15
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
63001164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$163.82 |
| Rate for Payer: Aetna Commercial |
$148.67
|
| Rate for Payer: Aetna Medicare |
$56.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.00
|
| Rate for Payer: Cash Price |
$105.69
|
| Rate for Payer: Cash Price |
$105.69
|
| Rate for Payer: Centivo All Commercial |
$95.83
|
| Rate for Payer: Cigna All Commercial |
$152.02
|
| Rate for Payer: CORVEL All Commercial |
$163.82
|
| Rate for Payer: Coventry All Commercial |
$155.01
|
| Rate for Payer: Encore All Commercial |
$162.15
|
| Rate for Payer: Frontpath All Commercial |
$162.06
|
| Rate for Payer: Humana ChoiceCare |
$152.14
|
| Rate for Payer: Humana Medicare |
$56.37
|
| Rate for Payer: Lucent All Commercial |
$95.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.32
|
| Rate for Payer: MDWise Medicaid |
$12.32
|
| Rate for Payer: PHCS All Commercial |
$132.11
|
| Rate for Payer: PHP All Commercial |
$133.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.70
|
| Rate for Payer: Sagamore Health Network All Products |
$135.99
|
| Rate for Payer: Signature Care EPO |
$146.20
|
| Rate for Payer: Signature Care PPO |
$155.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.73
|
| Rate for Payer: United Healthcare Commercial |
$138.81
|
| Rate for Payer: United Healthcare Medicare |
$56.37
|
|
|
HC CARBOXY HGB
|
Facility
|
IP
|
$176.15
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
63001164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.11 |
| Max. Negotiated Rate |
$163.82 |
| Rate for Payer: Aetna Commercial |
$152.19
|
| Rate for Payer: Cash Price |
$105.69
|
| Rate for Payer: Cigna All Commercial |
$152.02
|
| Rate for Payer: CORVEL All Commercial |
$163.82
|
| Rate for Payer: Coventry All Commercial |
$155.01
|
| Rate for Payer: Encore All Commercial |
$162.15
|
| Rate for Payer: Frontpath All Commercial |
$162.06
|
| Rate for Payer: Humana ChoiceCare |
$152.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.53
|
| Rate for Payer: PHCS All Commercial |
$132.11
|
| Rate for Payer: PHP All Commercial |
$133.59
|
| Rate for Payer: Sagamore Health Network All Products |
$135.99
|
| Rate for Payer: Signature Care EPO |
$146.20
|
| Rate for Payer: Signature Care PPO |
$155.01
|
| Rate for Payer: United Healthcare Commercial |
$138.81
|
|
|
HC CARDIAC DOPPLER
|
Facility
|
OP
|
$708.90
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
863320
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$202.23 |
| Max. Negotiated Rate |
$659.28 |
| Rate for Payer: Aetna Commercial |
$598.31
|
| Rate for Payer: Aetna Medicare |
$226.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$219.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$407.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$443.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$260.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$249.53
|
| Rate for Payer: Cash Price |
$425.34
|
| Rate for Payer: Cash Price |
$425.34
|
| Rate for Payer: Centivo All Commercial |
$385.64
|
| Rate for Payer: Cigna All Commercial |
$611.78
|
| Rate for Payer: CORVEL All Commercial |
$659.28
|
| Rate for Payer: Coventry All Commercial |
$623.83
|
| Rate for Payer: Encore All Commercial |
$652.54
|
| Rate for Payer: Frontpath All Commercial |
$652.19
|
| Rate for Payer: Humana ChoiceCare |
$612.28
|
| Rate for Payer: Humana Medicare |
$226.85
|
| Rate for Payer: Lucent All Commercial |
$385.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$638.01
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$531.67
|
| Rate for Payer: PHP All Commercial |
$537.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$276.47
|
| Rate for Payer: Sagamore Health Network All Products |
$547.27
|
| Rate for Payer: Signature Care EPO |
$588.39
|
| Rate for Payer: Signature Care PPO |
$623.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$602.57
|
| Rate for Payer: United Healthcare Commercial |
$558.61
|
| Rate for Payer: United Healthcare Medicare |
$226.85
|
|
|
HC CARDIAC DOPPLER
|
Facility
|
IP
|
$708.90
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
863320
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$531.67 |
| Max. Negotiated Rate |
$659.28 |
| Rate for Payer: Aetna Commercial |
$612.49
|
| Rate for Payer: Cash Price |
$425.34
|
| Rate for Payer: Cigna All Commercial |
$611.78
|
| Rate for Payer: CORVEL All Commercial |
$659.28
|
| Rate for Payer: Coventry All Commercial |
$623.83
|
| Rate for Payer: Encore All Commercial |
$652.54
|
| Rate for Payer: Frontpath All Commercial |
$652.19
|
| Rate for Payer: Humana ChoiceCare |
$612.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$638.01
|
| Rate for Payer: PHCS All Commercial |
$531.67
|
| Rate for Payer: PHP All Commercial |
$537.63
|
| Rate for Payer: Sagamore Health Network All Products |
$547.27
|
| Rate for Payer: Signature Care EPO |
$588.39
|
| Rate for Payer: Signature Care PPO |
$623.83
|
| Rate for Payer: United Healthcare Commercial |
$558.61
|
|
|
HC CARDIAC DOPPLER - LIMITED
|
Facility
|
IP
|
$535.50
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
863321
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$401.62 |
| Max. Negotiated Rate |
$498.01 |
| Rate for Payer: Aetna Commercial |
$462.67
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna All Commercial |
$462.14
|
| Rate for Payer: CORVEL All Commercial |
$498.01
|
| Rate for Payer: Coventry All Commercial |
$471.24
|
| Rate for Payer: Encore All Commercial |
$492.93
|
| Rate for Payer: Frontpath All Commercial |
$492.66
|
| Rate for Payer: Humana ChoiceCare |
$462.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$481.95
|
| Rate for Payer: PHCS All Commercial |
$401.62
|
| Rate for Payer: PHP All Commercial |
$406.12
|
| Rate for Payer: Sagamore Health Network All Products |
$413.41
|
| Rate for Payer: Signature Care EPO |
$444.46
|
| Rate for Payer: Signature Care PPO |
$471.24
|
| Rate for Payer: United Healthcare Commercial |
$421.97
|
|
|
HC CARDIAC DOPPLER - LIMITED
|
Facility
|
OP
|
$535.50
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
863321
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$498.01 |
| Rate for Payer: Aetna Commercial |
$451.96
|
| Rate for Payer: Aetna Medicare |
$171.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$166.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$307.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$334.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$197.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.50
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Centivo All Commercial |
$291.31
|
| Rate for Payer: Cigna All Commercial |
$462.14
|
| Rate for Payer: CORVEL All Commercial |
$498.01
|
| Rate for Payer: Coventry All Commercial |
$471.24
|
| Rate for Payer: Encore All Commercial |
$492.93
|
| Rate for Payer: Frontpath All Commercial |
$492.66
|
| Rate for Payer: Humana ChoiceCare |
$462.51
|
| Rate for Payer: Humana Medicare |
$171.36
|
| Rate for Payer: Lucent All Commercial |
$291.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$481.95
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$401.62
|
| Rate for Payer: PHP All Commercial |
$406.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$208.84
|
| Rate for Payer: Sagamore Health Network All Products |
$413.41
|
| Rate for Payer: Signature Care EPO |
$444.46
|
| Rate for Payer: Signature Care PPO |
$471.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$455.18
|
| Rate for Payer: United Healthcare Commercial |
$421.97
|
| Rate for Payer: United Healthcare Medicare |
$171.36
|
|
|
HC CARDIAC REHAB II; 1-36
|
Facility
|
IP
|
$243.98
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
1609063
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$182.99 |
| Max. Negotiated Rate |
$226.90 |
| Rate for Payer: Aetna Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$146.39
|
| Rate for Payer: Cigna All Commercial |
$210.55
|
| Rate for Payer: CORVEL All Commercial |
$226.90
|
| Rate for Payer: Coventry All Commercial |
$214.70
|
| Rate for Payer: Encore All Commercial |
$224.58
|
| Rate for Payer: Frontpath All Commercial |
$224.46
|
| Rate for Payer: Humana ChoiceCare |
$210.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.58
|
| Rate for Payer: PHCS All Commercial |
$182.99
|
| Rate for Payer: PHP All Commercial |
$185.03
|
| Rate for Payer: Sagamore Health Network All Products |
$188.35
|
| Rate for Payer: Signature Care EPO |
$202.50
|
| Rate for Payer: Signature Care PPO |
$214.70
|
| Rate for Payer: United Healthcare Commercial |
$192.26
|
|
|
HC CARDIAC REHAB II; 1-36
|
Facility
|
OP
|
$243.98
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
1609063
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$226.90 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Medicare |
$78.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$61.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.88
|
| Rate for Payer: Cash Price |
$146.39
|
| Rate for Payer: Cash Price |
$146.39
|
| Rate for Payer: Centivo All Commercial |
$132.73
|
| Rate for Payer: Cigna All Commercial |
$210.55
|
| Rate for Payer: CORVEL All Commercial |
$226.90
|
| Rate for Payer: Coventry All Commercial |
$214.70
|
| Rate for Payer: Encore All Commercial |
$224.58
|
| Rate for Payer: Frontpath All Commercial |
$224.46
|
| Rate for Payer: Humana ChoiceCare |
$210.73
|
| Rate for Payer: Humana Medicare |
$78.07
|
| Rate for Payer: Lucent All Commercial |
$132.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.58
|
| Rate for Payer: Managed Health Services Medicaid |
$61.61
|
| Rate for Payer: MDWise Medicaid |
$61.61
|
| Rate for Payer: PHCS All Commercial |
$182.99
|
| Rate for Payer: PHP All Commercial |
$185.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.15
|
| Rate for Payer: Sagamore Health Network All Products |
$188.35
|
| Rate for Payer: Signature Care EPO |
$202.50
|
| Rate for Payer: Signature Care PPO |
$214.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$207.38
|
| Rate for Payer: United Healthcare Commercial |
$192.26
|
| Rate for Payer: United Healthcare Medicare |
$78.07
|
|
|
HC CARDIAC REHAB II; 37+
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
1603798
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$219.48 |
| Rate for Payer: Aetna Commercial |
$203.90
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna All Commercial |
$203.67
|
| Rate for Payer: CORVEL All Commercial |
$219.48
|
| Rate for Payer: Coventry All Commercial |
$207.68
|
| Rate for Payer: Encore All Commercial |
$217.24
|
| Rate for Payer: Frontpath All Commercial |
$217.12
|
| Rate for Payer: Humana ChoiceCare |
$203.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.40
|
| Rate for Payer: PHCS All Commercial |
$177.00
|
| Rate for Payer: PHP All Commercial |
$178.98
|
| Rate for Payer: Sagamore Health Network All Products |
$182.19
|
| Rate for Payer: Signature Care EPO |
$195.88
|
| Rate for Payer: Signature Care PPO |
$207.68
|
| Rate for Payer: United Healthcare Commercial |
$185.97
|
|
|
HC CARDIAC REHAB II; 37+
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
1603798
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$219.48 |
| Rate for Payer: Aetna Commercial |
$199.18
|
| Rate for Payer: Aetna Medicare |
$75.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$61.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$147.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.07
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Centivo All Commercial |
$128.38
|
| Rate for Payer: Cigna All Commercial |
$203.67
|
| Rate for Payer: CORVEL All Commercial |
$219.48
|
| Rate for Payer: Coventry All Commercial |
$207.68
|
| Rate for Payer: Encore All Commercial |
$217.24
|
| Rate for Payer: Frontpath All Commercial |
$217.12
|
| Rate for Payer: Humana ChoiceCare |
$203.83
|
| Rate for Payer: Humana Medicare |
$75.52
|
| Rate for Payer: Lucent All Commercial |
$128.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.40
|
| Rate for Payer: Managed Health Services Medicaid |
$61.61
|
| Rate for Payer: MDWise Medicaid |
$61.61
|
| Rate for Payer: PHCS All Commercial |
$177.00
|
| Rate for Payer: PHP All Commercial |
$178.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.04
|
| Rate for Payer: Sagamore Health Network All Products |
$182.19
|
| Rate for Payer: Signature Care EPO |
$195.88
|
| Rate for Payer: Signature Care PPO |
$207.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.60
|
| Rate for Payer: United Healthcare Commercial |
$185.97
|
| Rate for Payer: United Healthcare Medicare |
$75.52
|
|
|
HC CARDIOLIPIN AB EA
|
Facility
|
OP
|
$101.61
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$85.76
|
| Rate for Payer: Aetna Medicare |
$32.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$46.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.77
|
| Rate for Payer: Cash Price |
$60.97
|
| Rate for Payer: Cash Price |
$60.97
|
| Rate for Payer: Centivo All Commercial |
$55.28
|
| Rate for Payer: Cigna All Commercial |
$87.69
|
| Rate for Payer: CORVEL All Commercial |
$94.50
|
| Rate for Payer: Coventry All Commercial |
$89.42
|
| Rate for Payer: Encore All Commercial |
$93.53
|
| Rate for Payer: Frontpath All Commercial |
$93.48
|
| Rate for Payer: Humana ChoiceCare |
$87.76
|
| Rate for Payer: Humana Medicare |
$32.52
|
| Rate for Payer: Lucent All Commercial |
$55.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.45
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$76.21
|
| Rate for Payer: PHP All Commercial |
$77.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.63
|
| Rate for Payer: Sagamore Health Network All Products |
$78.44
|
| Rate for Payer: Signature Care EPO |
$84.34
|
| Rate for Payer: Signature Care PPO |
$89.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.37
|
| Rate for Payer: United Healthcare Commercial |
$80.07
|
| Rate for Payer: United Healthcare Medicare |
$32.52
|
|
|
HC CARDIOLIPIN AB EA
|
Facility
|
IP
|
$101.61
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.21 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$87.79
|
| Rate for Payer: Cash Price |
$60.97
|
| Rate for Payer: Cigna All Commercial |
$87.69
|
| Rate for Payer: CORVEL All Commercial |
$94.50
|
| Rate for Payer: Coventry All Commercial |
$89.42
|
| Rate for Payer: Encore All Commercial |
$93.53
|
| Rate for Payer: Frontpath All Commercial |
$93.48
|
| Rate for Payer: Humana ChoiceCare |
$87.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.45
|
| Rate for Payer: PHCS All Commercial |
$76.21
|
| Rate for Payer: PHP All Commercial |
$77.06
|
| Rate for Payer: Sagamore Health Network All Products |
$78.44
|
| Rate for Payer: Signature Care EPO |
$84.34
|
| Rate for Payer: Signature Care PPO |
$89.42
|
| Rate for Payer: United Healthcare Commercial |
$80.07
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
OP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$116.31
|
| Rate for Payer: Aetna Medicare |
$44.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.51
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Centivo All Commercial |
$74.97
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.16
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.85
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Humana Medicare |
$44.10
|
| Rate for Payer: Lucent All Commercial |
$74.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.75
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.14
|
| Rate for Payer: United Healthcare Commercial |
$108.59
|
| Rate for Payer: United Healthcare Medicare |
$44.10
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
IP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.16
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.85
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: United Healthcare Commercial |
$108.59
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
OP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$116.31
|
| Rate for Payer: Aetna Medicare |
$44.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.51
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Centivo All Commercial |
$74.97
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.16
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.85
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Humana Medicare |
$44.10
|
| Rate for Payer: Lucent All Commercial |
$74.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.75
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.14
|
| Rate for Payer: United Healthcare Commercial |
$108.59
|
| Rate for Payer: United Healthcare Medicare |
$44.10
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
IP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.16
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.85
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: United Healthcare Commercial |
$108.59
|
|
|
HC CARDIOLIPIN AB IGG, IGA, IGM
|
Facility
|
IP
|
$92.76
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63002195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.57 |
| Max. Negotiated Rate |
$86.27 |
| Rate for Payer: Aetna Commercial |
$80.14
|
| Rate for Payer: Cash Price |
$55.66
|
| Rate for Payer: Cigna All Commercial |
$80.05
|
| Rate for Payer: CORVEL All Commercial |
$86.27
|
| Rate for Payer: Coventry All Commercial |
$81.63
|
| Rate for Payer: Encore All Commercial |
$85.39
|
| Rate for Payer: Frontpath All Commercial |
$85.34
|
| Rate for Payer: Humana ChoiceCare |
$80.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.48
|
| Rate for Payer: PHCS All Commercial |
$69.57
|
| Rate for Payer: PHP All Commercial |
$70.35
|
| Rate for Payer: Sagamore Health Network All Products |
$71.61
|
| Rate for Payer: Signature Care EPO |
$76.99
|
| Rate for Payer: Signature Care PPO |
$81.63
|
| Rate for Payer: United Healthcare Commercial |
$73.09
|
|
|
HC CARDIOLIPIN AB IGG, IGA, IGM
|
Facility
|
OP
|
$92.76
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63002195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$86.27 |
| Rate for Payer: Aetna Commercial |
$78.29
|
| Rate for Payer: Aetna Medicare |
$29.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.65
|
| Rate for Payer: Cash Price |
$55.66
|
| Rate for Payer: Cash Price |
$55.66
|
| Rate for Payer: Centivo All Commercial |
$50.46
|
| Rate for Payer: Cigna All Commercial |
$80.05
|
| Rate for Payer: CORVEL All Commercial |
$86.27
|
| Rate for Payer: Coventry All Commercial |
$81.63
|
| Rate for Payer: Encore All Commercial |
$85.39
|
| Rate for Payer: Frontpath All Commercial |
$85.34
|
| Rate for Payer: Humana ChoiceCare |
$80.12
|
| Rate for Payer: Humana Medicare |
$29.68
|
| Rate for Payer: Lucent All Commercial |
$50.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.48
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$69.57
|
| Rate for Payer: PHP All Commercial |
$70.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.18
|
| Rate for Payer: Sagamore Health Network All Products |
$71.61
|
| Rate for Payer: Signature Care EPO |
$76.99
|
| Rate for Payer: Signature Care PPO |
$81.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.85
|
| Rate for Payer: United Healthcare Commercial |
$73.09
|
| Rate for Payer: United Healthcare Medicare |
$29.68
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
IP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.16
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.85
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: United Healthcare Commercial |
$108.59
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
OP
|
$137.81
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
63001865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$116.31
|
| Rate for Payer: Aetna Medicare |
$44.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.51
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Centivo All Commercial |
$74.97
|
| Rate for Payer: Cigna All Commercial |
$118.93
|
| Rate for Payer: CORVEL All Commercial |
$128.16
|
| Rate for Payer: Coventry All Commercial |
$121.27
|
| Rate for Payer: Encore All Commercial |
$126.85
|
| Rate for Payer: Frontpath All Commercial |
$126.79
|
| Rate for Payer: Humana ChoiceCare |
$119.03
|
| Rate for Payer: Humana Medicare |
$44.10
|
| Rate for Payer: Lucent All Commercial |
$74.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.03
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$103.36
|
| Rate for Payer: PHP All Commercial |
$104.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.75
|
| Rate for Payer: Sagamore Health Network All Products |
$106.39
|
| Rate for Payer: Signature Care EPO |
$114.38
|
| Rate for Payer: Signature Care PPO |
$121.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.14
|
| Rate for Payer: United Healthcare Commercial |
$108.59
|
| Rate for Payer: United Healthcare Medicare |
$44.10
|
|
