|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$990.68
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
1706484
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$743.01 |
| Max. Negotiated Rate |
$921.33 |
| Rate for Payer: Aetna Commercial |
$855.95
|
| Rate for Payer: Cash Price |
$594.41
|
| Rate for Payer: Cigna All Commercial |
$854.96
|
| Rate for Payer: CORVEL All Commercial |
$921.33
|
| Rate for Payer: Coventry All Commercial |
$871.80
|
| Rate for Payer: Encore All Commercial |
$911.92
|
| Rate for Payer: Frontpath All Commercial |
$911.43
|
| Rate for Payer: Humana ChoiceCare |
$855.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.61
|
| Rate for Payer: PHCS All Commercial |
$743.01
|
| Rate for Payer: PHP All Commercial |
$751.33
|
| Rate for Payer: Sagamore Health Network All Products |
$764.80
|
| Rate for Payer: Signature Care EPO |
$822.26
|
| Rate for Payer: Signature Care PPO |
$871.80
|
| Rate for Payer: United Healthcare Commercial |
$780.66
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$990.68
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
1706484
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$307.11 |
| Max. Negotiated Rate |
$921.33 |
| Rate for Payer: Aetna Commercial |
$836.13
|
| Rate for Payer: Aetna Medicare |
$317.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$443.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$568.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$619.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$443.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$364.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$348.72
|
| Rate for Payer: Cash Price |
$594.41
|
| Rate for Payer: Cash Price |
$594.41
|
| Rate for Payer: Centivo All Commercial |
$538.93
|
| Rate for Payer: Cigna All Commercial |
$854.96
|
| Rate for Payer: CORVEL All Commercial |
$921.33
|
| Rate for Payer: Coventry All Commercial |
$871.80
|
| Rate for Payer: Encore All Commercial |
$911.92
|
| Rate for Payer: Frontpath All Commercial |
$911.43
|
| Rate for Payer: Humana ChoiceCare |
$855.65
|
| Rate for Payer: Humana Medicare |
$317.02
|
| Rate for Payer: Lucent All Commercial |
$538.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.61
|
| Rate for Payer: Managed Health Services Medicaid |
$443.28
|
| Rate for Payer: MDWise Medicaid |
$443.28
|
| Rate for Payer: PHCS All Commercial |
$743.01
|
| Rate for Payer: PHP All Commercial |
$751.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.37
|
| Rate for Payer: Sagamore Health Network All Products |
$764.80
|
| Rate for Payer: Signature Care EPO |
$822.26
|
| Rate for Payer: Signature Care PPO |
$871.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$842.08
|
| Rate for Payer: United Healthcare Commercial |
$780.66
|
| Rate for Payer: United Healthcare Medicare |
$317.02
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
|
IP
|
$1,257.32
|
|
| Hospital Charge Code |
1652960
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$942.99 |
| Max. Negotiated Rate |
$1,169.31 |
| Rate for Payer: Aetna Commercial |
$1,086.32
|
| Rate for Payer: Cash Price |
$754.39
|
| Rate for Payer: Cigna All Commercial |
$1,085.07
|
| Rate for Payer: CORVEL All Commercial |
$1,169.31
|
| Rate for Payer: Coventry All Commercial |
$1,106.44
|
| Rate for Payer: Encore All Commercial |
$1,157.36
|
| Rate for Payer: Frontpath All Commercial |
$1,156.73
|
| Rate for Payer: Humana ChoiceCare |
$1,085.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,131.59
|
| Rate for Payer: PHCS All Commercial |
$942.99
|
| Rate for Payer: PHP All Commercial |
$953.55
|
| Rate for Payer: Sagamore Health Network All Products |
$970.65
|
| Rate for Payer: Signature Care EPO |
$1,043.58
|
| Rate for Payer: Signature Care PPO |
$1,106.44
|
| Rate for Payer: United Healthcare Commercial |
$990.77
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
|
OP
|
$1,776.17
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
1158137
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$443.28 |
| Max. Negotiated Rate |
$1,651.84 |
| Rate for Payer: Aetna Commercial |
$1,499.09
|
| Rate for Payer: Aetna Medicare |
$568.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$443.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$550.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,020.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,110.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$443.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$653.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$625.21
|
| Rate for Payer: Cash Price |
$1,065.70
|
| Rate for Payer: Cash Price |
$1,065.70
|
| Rate for Payer: Centivo All Commercial |
$966.24
|
| Rate for Payer: Cigna All Commercial |
$1,532.83
|
| Rate for Payer: CORVEL All Commercial |
$1,651.84
|
| Rate for Payer: Coventry All Commercial |
$1,563.03
|
| Rate for Payer: Encore All Commercial |
$1,634.96
|
| Rate for Payer: Frontpath All Commercial |
$1,634.08
|
| Rate for Payer: Humana ChoiceCare |
$1,534.08
|
| Rate for Payer: Humana Medicare |
$568.37
|
| Rate for Payer: Lucent All Commercial |
$966.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,598.55
|
| Rate for Payer: Managed Health Services Medicaid |
$443.28
|
| Rate for Payer: MDWise Medicaid |
$443.28
|
| Rate for Payer: PHCS All Commercial |
$1,332.13
|
| Rate for Payer: PHP All Commercial |
$1,347.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$692.71
|
| Rate for Payer: Sagamore Health Network All Products |
$1,371.20
|
| Rate for Payer: Signature Care EPO |
$1,474.22
|
| Rate for Payer: Signature Care PPO |
$1,563.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,509.74
|
| Rate for Payer: United Healthcare Commercial |
$1,399.62
|
| Rate for Payer: United Healthcare Medicare |
$568.37
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
|
IP
|
$1,776.17
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
1158137
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,332.13 |
| Max. Negotiated Rate |
$1,651.84 |
| Rate for Payer: Aetna Commercial |
$1,534.61
|
| Rate for Payer: Cash Price |
$1,065.70
|
| Rate for Payer: Cigna All Commercial |
$1,532.83
|
| Rate for Payer: CORVEL All Commercial |
$1,651.84
|
| Rate for Payer: Coventry All Commercial |
$1,563.03
|
| Rate for Payer: Encore All Commercial |
$1,634.96
|
| Rate for Payer: Frontpath All Commercial |
$1,634.08
|
| Rate for Payer: Humana ChoiceCare |
$1,534.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,598.55
|
| Rate for Payer: PHCS All Commercial |
$1,332.13
|
| Rate for Payer: PHP All Commercial |
$1,347.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,371.20
|
| Rate for Payer: Signature Care EPO |
$1,474.22
|
| Rate for Payer: Signature Care PPO |
$1,563.03
|
| Rate for Payer: United Healthcare Commercial |
$1,399.62
|
|
|
HC CARDIOVERSION ELECTRICAL
|
Facility
|
OP
|
$1,257.32
|
|
| Hospital Charge Code |
1652960
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$389.77 |
| Max. Negotiated Rate |
$1,169.31 |
| Rate for Payer: Aetna Commercial |
$1,061.18
|
| Rate for Payer: Aetna Medicare |
$402.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$475.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$389.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$722.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$785.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$475.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$462.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$442.58
|
| Rate for Payer: Cash Price |
$754.39
|
| Rate for Payer: Cash Price |
$754.39
|
| Rate for Payer: Centivo All Commercial |
$683.98
|
| Rate for Payer: Cigna All Commercial |
$1,085.07
|
| Rate for Payer: CORVEL All Commercial |
$1,169.31
|
| Rate for Payer: Coventry All Commercial |
$1,106.44
|
| Rate for Payer: Encore All Commercial |
$1,157.36
|
| Rate for Payer: Frontpath All Commercial |
$1,156.73
|
| Rate for Payer: Humana ChoiceCare |
$1,085.95
|
| Rate for Payer: Humana Medicare |
$402.34
|
| Rate for Payer: Lucent All Commercial |
$683.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,131.59
|
| Rate for Payer: Managed Health Services Medicaid |
$475.51
|
| Rate for Payer: MDWise Medicaid |
$475.51
|
| Rate for Payer: PHCS All Commercial |
$942.99
|
| Rate for Payer: PHP All Commercial |
$953.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$490.35
|
| Rate for Payer: Sagamore Health Network All Products |
$970.65
|
| Rate for Payer: Signature Care EPO |
$1,043.58
|
| Rate for Payer: Signature Care PPO |
$1,106.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,068.72
|
| Rate for Payer: United Healthcare Commercial |
$990.77
|
| Rate for Payer: United Healthcare Medicare |
$402.34
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN OT
|
Facility
|
OP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GO
|
| Hospital Charge Code |
1737550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Medicare |
$87.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$156.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.22
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Centivo All Commercial |
$148.71
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Humana Medicare |
$87.48
|
| Rate for Payer: Lucent All Commercial |
$148.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.61
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.36
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
| Rate for Payer: United Healthcare Medicare |
$87.48
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN OT
|
Facility
|
IP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GO
|
| Hospital Charge Code |
1737550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$236.18
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN PT
|
Facility
|
IP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GP
|
| Hospital Charge Code |
1727550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$236.18
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN PT
|
Facility
|
OP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GP
|
| Hospital Charge Code |
1727550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Medicare |
$87.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$156.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.22
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Centivo All Commercial |
$148.71
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Humana Medicare |
$87.48
|
| Rate for Payer: Lucent All Commercial |
$148.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.61
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.36
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
| Rate for Payer: United Healthcare Medicare |
$87.48
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN ST
|
Facility
|
IP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GN
|
| Hospital Charge Code |
1747550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$236.18
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN ST
|
Facility
|
OP
|
$273.36
|
|
|
Service Code
|
CPT 97550 GN
|
| Hospital Charge Code |
1747550
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$254.22 |
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Medicare |
$87.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$156.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.22
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Centivo All Commercial |
$148.71
|
| Rate for Payer: Cigna All Commercial |
$235.91
|
| Rate for Payer: CORVEL All Commercial |
$254.22
|
| Rate for Payer: Coventry All Commercial |
$240.56
|
| Rate for Payer: Encore All Commercial |
$251.63
|
| Rate for Payer: Frontpath All Commercial |
$251.49
|
| Rate for Payer: Humana ChoiceCare |
$236.10
|
| Rate for Payer: Humana Medicare |
$87.48
|
| Rate for Payer: Lucent All Commercial |
$148.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.02
|
| Rate for Payer: PHCS All Commercial |
$205.02
|
| Rate for Payer: PHP All Commercial |
$207.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.61
|
| Rate for Payer: Sagamore Health Network All Products |
$211.03
|
| Rate for Payer: Signature Care EPO |
$226.89
|
| Rate for Payer: Signature Care PPO |
$240.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.36
|
| Rate for Payer: United Healthcare Commercial |
$215.41
|
| Rate for Payer: United Healthcare Medicare |
$87.48
|
|
|
HC CAREGIVER TRAINING EA ADD'L 15 MIN PT
|
Facility
|
OP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GP
|
| Hospital Charge Code |
1727551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$115.36
|
| Rate for Payer: Aetna Medicare |
$43.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.11
|
| Rate for Payer: Cash Price |
$82.01
|
| Rate for Payer: Centivo All Commercial |
$74.35
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Humana Medicare |
$43.74
|
| Rate for Payer: Lucent All Commercial |
$74.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.31
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.18
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
| Rate for Payer: United Healthcare Medicare |
$43.74
|
|
|
HC CAREGIVER TRAINING EA ADD'L 15 MIN PT
|
Facility
|
IP
|
$136.68
|
|
|
Service Code
|
CPT 97551 GP
|
| Hospital Charge Code |
1727551
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.51 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Cash Price |
$82.01
|
| Rate for Payer: Cigna All Commercial |
$117.95
|
| Rate for Payer: CORVEL All Commercial |
$127.11
|
| Rate for Payer: Coventry All Commercial |
$120.28
|
| Rate for Payer: Encore All Commercial |
$125.81
|
| Rate for Payer: Frontpath All Commercial |
$125.75
|
| Rate for Payer: Humana ChoiceCare |
$118.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.01
|
| Rate for Payer: PHCS All Commercial |
$102.51
|
| Rate for Payer: PHP All Commercial |
$103.66
|
| Rate for Payer: Sagamore Health Network All Products |
$105.52
|
| Rate for Payer: Signature Care EPO |
$113.44
|
| Rate for Payer: Signature Care PPO |
$120.28
|
| Rate for Payer: United Healthcare Commercial |
$107.70
|
|
|
HC C-ARMOR
|
Facility
|
IP
|
$869.54
|
|
| Hospital Charge Code |
41606536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.15 |
| Max. Negotiated Rate |
$808.67 |
| Rate for Payer: Aetna Commercial |
$751.28
|
| Rate for Payer: Cash Price |
$521.72
|
| Rate for Payer: Cigna All Commercial |
$750.41
|
| Rate for Payer: CORVEL All Commercial |
$808.67
|
| Rate for Payer: Coventry All Commercial |
$765.20
|
| Rate for Payer: Encore All Commercial |
$800.41
|
| Rate for Payer: Frontpath All Commercial |
$799.98
|
| Rate for Payer: Humana ChoiceCare |
$751.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$782.59
|
| Rate for Payer: PHCS All Commercial |
$652.15
|
| Rate for Payer: PHP All Commercial |
$659.46
|
| Rate for Payer: Sagamore Health Network All Products |
$671.28
|
| Rate for Payer: Signature Care EPO |
$721.72
|
| Rate for Payer: Signature Care PPO |
$765.20
|
| Rate for Payer: United Healthcare Commercial |
$685.20
|
|
|
HC C-ARMOR
|
Facility
|
OP
|
$869.54
|
|
| Hospital Charge Code |
41606536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$808.67 |
| Rate for Payer: Aetna Commercial |
$733.89
|
| Rate for Payer: Aetna Medicare |
$278.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$499.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$543.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$319.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$306.08
|
| Rate for Payer: Cash Price |
$521.72
|
| Rate for Payer: Cash Price |
$521.72
|
| Rate for Payer: Centivo All Commercial |
$473.03
|
| Rate for Payer: Cigna All Commercial |
$750.41
|
| Rate for Payer: CORVEL All Commercial |
$808.67
|
| Rate for Payer: Coventry All Commercial |
$765.20
|
| Rate for Payer: Encore All Commercial |
$800.41
|
| Rate for Payer: Frontpath All Commercial |
$799.98
|
| Rate for Payer: Humana ChoiceCare |
$751.02
|
| Rate for Payer: Humana Medicare |
$278.25
|
| Rate for Payer: Lucent All Commercial |
$473.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$782.59
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$652.15
|
| Rate for Payer: PHP All Commercial |
$659.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$339.12
|
| Rate for Payer: Sagamore Health Network All Products |
$671.28
|
| Rate for Payer: Signature Care EPO |
$721.72
|
| Rate for Payer: Signature Care PPO |
$765.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$739.11
|
| Rate for Payer: United Healthcare Commercial |
$685.20
|
| Rate for Payer: United Healthcare Medicare |
$278.25
|
|
|
HC CARNITINE FREE&TOTAL
|
Facility
|
IP
|
$187.69
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
63001483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$174.55 |
| Rate for Payer: Aetna Commercial |
$162.16
|
| Rate for Payer: Cash Price |
$112.61
|
| Rate for Payer: Cigna All Commercial |
$161.98
|
| Rate for Payer: CORVEL All Commercial |
$174.55
|
| Rate for Payer: Coventry All Commercial |
$165.17
|
| Rate for Payer: Encore All Commercial |
$172.77
|
| Rate for Payer: Frontpath All Commercial |
$172.67
|
| Rate for Payer: Humana ChoiceCare |
$162.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.92
|
| Rate for Payer: PHCS All Commercial |
$140.77
|
| Rate for Payer: PHP All Commercial |
$142.34
|
| Rate for Payer: Sagamore Health Network All Products |
$144.90
|
| Rate for Payer: Signature Care EPO |
$155.78
|
| Rate for Payer: Signature Care PPO |
$165.17
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
|
|
HC CARNITINE FREE&TOTAL
|
Facility
|
OP
|
$187.69
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
63001483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$174.55 |
| Rate for Payer: Aetna Commercial |
$158.41
|
| Rate for Payer: Aetna Medicare |
$60.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.07
|
| Rate for Payer: Cash Price |
$112.61
|
| Rate for Payer: Cash Price |
$112.61
|
| Rate for Payer: Centivo All Commercial |
$102.10
|
| Rate for Payer: Cigna All Commercial |
$161.98
|
| Rate for Payer: CORVEL All Commercial |
$174.55
|
| Rate for Payer: Coventry All Commercial |
$165.17
|
| Rate for Payer: Encore All Commercial |
$172.77
|
| Rate for Payer: Frontpath All Commercial |
$172.67
|
| Rate for Payer: Humana ChoiceCare |
$162.11
|
| Rate for Payer: Humana Medicare |
$60.06
|
| Rate for Payer: Lucent All Commercial |
$102.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16.87
|
| Rate for Payer: MDWise Medicaid |
$16.87
|
| Rate for Payer: PHCS All Commercial |
$140.77
|
| Rate for Payer: PHP All Commercial |
$142.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.90
|
| Rate for Payer: Signature Care EPO |
$155.78
|
| Rate for Payer: Signature Care PPO |
$165.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.54
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$60.06
|
|
|
HC CAR SEAT/BED TEST EA AD 30 MN
|
Facility
|
IP
|
$212.16
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
1014781
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$197.31 |
| Rate for Payer: Aetna Commercial |
$183.31
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cigna All Commercial |
$183.09
|
| Rate for Payer: CORVEL All Commercial |
$197.31
|
| Rate for Payer: Coventry All Commercial |
$186.70
|
| Rate for Payer: Encore All Commercial |
$195.29
|
| Rate for Payer: Frontpath All Commercial |
$195.19
|
| Rate for Payer: Humana ChoiceCare |
$183.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.94
|
| Rate for Payer: PHCS All Commercial |
$159.12
|
| Rate for Payer: PHP All Commercial |
$160.90
|
| Rate for Payer: Sagamore Health Network All Products |
$163.79
|
| Rate for Payer: Signature Care EPO |
$176.09
|
| Rate for Payer: Signature Care PPO |
$186.70
|
| Rate for Payer: United Healthcare Commercial |
$167.18
|
|
|
HC CAR SEAT/BED TEST EA AD 30 MN
|
Facility
|
OP
|
$212.16
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
1014781
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$197.31 |
| Rate for Payer: Aetna Commercial |
$179.06
|
| Rate for Payer: Aetna Medicare |
$67.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$121.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.68
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Centivo All Commercial |
$115.42
|
| Rate for Payer: Cigna All Commercial |
$183.09
|
| Rate for Payer: CORVEL All Commercial |
$197.31
|
| Rate for Payer: Coventry All Commercial |
$186.70
|
| Rate for Payer: Encore All Commercial |
$195.29
|
| Rate for Payer: Frontpath All Commercial |
$195.19
|
| Rate for Payer: Humana ChoiceCare |
$183.24
|
| Rate for Payer: Humana Medicare |
$67.89
|
| Rate for Payer: Lucent All Commercial |
$115.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.94
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$159.12
|
| Rate for Payer: PHP All Commercial |
$160.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.74
|
| Rate for Payer: Sagamore Health Network All Products |
$163.79
|
| Rate for Payer: Signature Care EPO |
$176.09
|
| Rate for Payer: Signature Care PPO |
$186.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.34
|
| Rate for Payer: United Healthcare Commercial |
$167.18
|
| Rate for Payer: United Healthcare Medicare |
$67.89
|
|
|
HC CAR SEAT/BED TEST INIT'L 60 MN
|
Facility
|
OP
|
$477.36
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
1014780
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$443.94 |
| Rate for Payer: Aetna Commercial |
$402.89
|
| Rate for Payer: Aetna Medicare |
$152.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$274.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.03
|
| Rate for Payer: Cash Price |
$286.42
|
| Rate for Payer: Cash Price |
$286.42
|
| Rate for Payer: Centivo All Commercial |
$259.68
|
| Rate for Payer: Cigna All Commercial |
$411.96
|
| Rate for Payer: CORVEL All Commercial |
$443.94
|
| Rate for Payer: Coventry All Commercial |
$420.08
|
| Rate for Payer: Encore All Commercial |
$439.41
|
| Rate for Payer: Frontpath All Commercial |
$439.17
|
| Rate for Payer: Humana ChoiceCare |
$412.30
|
| Rate for Payer: Humana Medicare |
$152.76
|
| Rate for Payer: Lucent All Commercial |
$259.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.62
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$358.02
|
| Rate for Payer: PHP All Commercial |
$362.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.17
|
| Rate for Payer: Sagamore Health Network All Products |
$368.52
|
| Rate for Payer: Signature Care EPO |
$396.21
|
| Rate for Payer: Signature Care PPO |
$420.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.76
|
| Rate for Payer: United Healthcare Commercial |
$376.16
|
| Rate for Payer: United Healthcare Medicare |
$152.76
|
|
|
HC CAR SEAT/BED TEST INIT'L 60 MN
|
Facility
|
IP
|
$477.36
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
1014780
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$358.02 |
| Max. Negotiated Rate |
$443.94 |
| Rate for Payer: Aetna Commercial |
$412.44
|
| Rate for Payer: Cash Price |
$286.42
|
| Rate for Payer: Cigna All Commercial |
$411.96
|
| Rate for Payer: CORVEL All Commercial |
$443.94
|
| Rate for Payer: Coventry All Commercial |
$420.08
|
| Rate for Payer: Encore All Commercial |
$439.41
|
| Rate for Payer: Frontpath All Commercial |
$439.17
|
| Rate for Payer: Humana ChoiceCare |
$412.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.62
|
| Rate for Payer: PHCS All Commercial |
$358.02
|
| Rate for Payer: PHP All Commercial |
$362.03
|
| Rate for Payer: Sagamore Health Network All Products |
$368.52
|
| Rate for Payer: Signature Care EPO |
$396.21
|
| Rate for Payer: Signature Care PPO |
$420.08
|
| Rate for Payer: United Healthcare Commercial |
$376.16
|
|
|
HC CAT BLADE MANI 2.8
|
Facility
|
OP
|
$118.16
|
|
| Hospital Charge Code |
41603266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$109.89 |
| Rate for Payer: Aetna Commercial |
$99.73
|
| Rate for Payer: Aetna Medicare |
$37.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.59
|
| Rate for Payer: Cash Price |
$70.90
|
| Rate for Payer: Cash Price |
$70.90
|
| Rate for Payer: Centivo All Commercial |
$64.28
|
| Rate for Payer: Cigna All Commercial |
$101.97
|
| Rate for Payer: CORVEL All Commercial |
$109.89
|
| Rate for Payer: Coventry All Commercial |
$103.98
|
| Rate for Payer: Encore All Commercial |
$108.77
|
| Rate for Payer: Frontpath All Commercial |
$108.71
|
| Rate for Payer: Humana ChoiceCare |
$102.05
|
| Rate for Payer: Humana Medicare |
$37.81
|
| Rate for Payer: Lucent All Commercial |
$64.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.34
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$88.62
|
| Rate for Payer: PHP All Commercial |
$89.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.08
|
| Rate for Payer: Sagamore Health Network All Products |
$91.22
|
| Rate for Payer: Signature Care EPO |
$98.07
|
| Rate for Payer: Signature Care PPO |
$103.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.44
|
| Rate for Payer: United Healthcare Commercial |
$93.11
|
| Rate for Payer: United Healthcare Medicare |
$37.81
|
|
|
HC CAT BLADE MANI 2.8
|
Facility
|
IP
|
$118.16
|
|
| Hospital Charge Code |
41603266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$109.89 |
| Rate for Payer: Aetna Commercial |
$102.09
|
| Rate for Payer: Cash Price |
$70.90
|
| Rate for Payer: Cigna All Commercial |
$101.97
|
| Rate for Payer: CORVEL All Commercial |
$109.89
|
| Rate for Payer: Coventry All Commercial |
$103.98
|
| Rate for Payer: Encore All Commercial |
$108.77
|
| Rate for Payer: Frontpath All Commercial |
$108.71
|
| Rate for Payer: Humana ChoiceCare |
$102.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.34
|
| Rate for Payer: PHCS All Commercial |
$88.62
|
| Rate for Payer: PHP All Commercial |
$89.61
|
| Rate for Payer: Sagamore Health Network All Products |
$91.22
|
| Rate for Payer: Signature Care EPO |
$98.07
|
| Rate for Payer: Signature Care PPO |
$103.98
|
| Rate for Payer: United Healthcare Commercial |
$93.11
|
|
|
HC CATECHOLAMINE FRACT - PLASMA
|
Facility
|
OP
|
$306.31
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$284.87 |
| Rate for Payer: Aetna Commercial |
$258.53
|
| Rate for Payer: Aetna Medicare |
$98.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.82
|
| Rate for Payer: Cash Price |
$183.79
|
| Rate for Payer: Cash Price |
$183.79
|
| Rate for Payer: Centivo All Commercial |
$166.63
|
| Rate for Payer: Cigna All Commercial |
$264.35
|
| Rate for Payer: CORVEL All Commercial |
$284.87
|
| Rate for Payer: Coventry All Commercial |
$269.55
|
| Rate for Payer: Encore All Commercial |
$281.96
|
| Rate for Payer: Frontpath All Commercial |
$281.81
|
| Rate for Payer: Humana ChoiceCare |
$264.56
|
| Rate for Payer: Humana Medicare |
$98.02
|
| Rate for Payer: Lucent All Commercial |
$166.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.68
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$229.73
|
| Rate for Payer: PHP All Commercial |
$232.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.46
|
| Rate for Payer: Sagamore Health Network All Products |
$236.47
|
| Rate for Payer: Signature Care EPO |
$254.24
|
| Rate for Payer: Signature Care PPO |
$269.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.36
|
| Rate for Payer: United Healthcare Commercial |
$241.37
|
| Rate for Payer: United Healthcare Medicare |
$98.02
|
|
