|
HC DYSPHAGIA TREATMENT-60 MIN-SP
|
Facility
IP
|
$321.36
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748090
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$241.02 |
| Max. Negotiated Rate |
$298.87 |
| Rate for Payer: Aetna Commercial |
$277.66
|
| Rate for Payer: Cash Price |
$199.24
|
| Rate for Payer: Cigna All Commercial |
$277.33
|
| Rate for Payer: CORVEL All Commercial |
$298.87
|
| Rate for Payer: Coventry All Commercial |
$282.80
|
| Rate for Payer: Encore All Commercial |
$295.81
|
| Rate for Payer: Frontpath All Commercial |
$295.65
|
| Rate for Payer: Humana ChoiceCare |
$277.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.23
|
| Rate for Payer: PHCS All Commercial |
$241.02
|
| Rate for Payer: PHP All Commercial |
$243.72
|
| Rate for Payer: Sagamore Health Network All Products |
$248.09
|
| Rate for Payer: Signature Care EPO |
$266.73
|
| Rate for Payer: Signature Care PPO |
$282.80
|
| Rate for Payer: United Healthcare Commercial |
$253.23
|
|
|
HC DYSPHAGIA TREATMENT-60 MIN-SP
|
Facility
OP
|
$321.36
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748090
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$106.05 |
| Max. Negotiated Rate |
$298.87 |
| Rate for Payer: Aetna Commercial |
$271.23
|
| Rate for Payer: Aetna Medicare |
$106.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$184.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.65
|
| Rate for Payer: Cash Price |
$199.24
|
| Rate for Payer: Centivo All Commercial |
$163.89
|
| Rate for Payer: Cigna All Commercial |
$277.33
|
| Rate for Payer: CORVEL All Commercial |
$298.87
|
| Rate for Payer: Coventry All Commercial |
$282.80
|
| Rate for Payer: Encore All Commercial |
$295.81
|
| Rate for Payer: Frontpath All Commercial |
$295.65
|
| Rate for Payer: Humana ChoiceCare |
$277.56
|
| Rate for Payer: Humana Medicare |
$163.89
|
| Rate for Payer: Lucent All Commercial |
$163.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.23
|
| Rate for Payer: PHCS All Commercial |
$241.02
|
| Rate for Payer: PHP All Commercial |
$243.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.33
|
| Rate for Payer: Sagamore Health Network All Products |
$248.09
|
| Rate for Payer: Signature Care EPO |
$266.73
|
| Rate for Payer: Signature Care PPO |
$282.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$273.16
|
| Rate for Payer: United Healthcare Commercial |
$253.23
|
| Rate for Payer: United Healthcare Medicare |
$106.05
|
|
|
HC DYSPHAGIA TREATMENT - SP
|
Facility
IP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01742526
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$281.43
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
|
|
HC DYSPHAGIA TREATMENT - SP
|
Facility
OP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01742526
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$274.91
|
| Rate for Payer: Aetna Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.24
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Centivo All Commercial |
$166.12
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Humana Medicare |
$166.12
|
| Rate for Payer: Lucent All Commercial |
$166.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.87
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
| Rate for Payer: United Healthcare Medicare |
$107.49
|
|
|
HC EAR CULTURE
|
Facility
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC EAR CULTURE
|
Facility
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
|
HC EBI DISTAL RADIUS FIXATOR
|
Facility
IP
|
$11,970.00
|
|
| Hospital Charge Code |
41603090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,977.50 |
| Max. Negotiated Rate |
$11,132.10 |
| Rate for Payer: Aetna Commercial |
$10,342.08
|
| Rate for Payer: Cash Price |
$7,421.40
|
| Rate for Payer: Cigna All Commercial |
$10,330.11
|
| Rate for Payer: CORVEL All Commercial |
$11,132.10
|
| Rate for Payer: Coventry All Commercial |
$10,533.60
|
| Rate for Payer: Encore All Commercial |
$11,018.38
|
| Rate for Payer: Frontpath All Commercial |
$11,012.40
|
| Rate for Payer: Humana ChoiceCare |
$10,338.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,773.00
|
| Rate for Payer: PHCS All Commercial |
$8,977.50
|
| Rate for Payer: PHP All Commercial |
$9,078.05
|
| Rate for Payer: Sagamore Health Network All Products |
$9,240.84
|
| Rate for Payer: Signature Care EPO |
$9,935.10
|
| Rate for Payer: Signature Care PPO |
$10,533.60
|
| Rate for Payer: United Healthcare Commercial |
$9,432.36
|
|
|
HC EBI DISTAL RADIUS FIXATOR
|
Facility
OP
|
$11,970.00
|
|
| Hospital Charge Code |
41603090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,132.10 |
| Rate for Payer: Aetna Commercial |
$10,102.68
|
| Rate for Payer: Aetna Medicare |
$3,950.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,950.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,874.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,482.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,542.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,345.11
|
| Rate for Payer: Cash Price |
$7,421.40
|
| Rate for Payer: Cash Price |
$7,421.40
|
| Rate for Payer: Centivo All Commercial |
$6,104.70
|
| Rate for Payer: Cigna All Commercial |
$10,330.11
|
| Rate for Payer: CORVEL All Commercial |
$11,132.10
|
| Rate for Payer: Coventry All Commercial |
$10,533.60
|
| Rate for Payer: Encore All Commercial |
$11,018.38
|
| Rate for Payer: Frontpath All Commercial |
$11,012.40
|
| Rate for Payer: Humana ChoiceCare |
$10,338.49
|
| Rate for Payer: Humana Medicare |
$6,104.70
|
| Rate for Payer: Lucent All Commercial |
$6,104.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,773.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,977.50
|
| Rate for Payer: PHP All Commercial |
$9,078.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,668.30
|
| Rate for Payer: Sagamore Health Network All Products |
$9,240.84
|
| Rate for Payer: Signature Care EPO |
$9,935.10
|
| Rate for Payer: Signature Care PPO |
$10,533.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,174.50
|
| Rate for Payer: United Healthcare Commercial |
$9,432.36
|
| Rate for Payer: United Healthcare Medicare |
$3,950.10
|
|
|
HC EBI DISTAL RADIUS FIXATOR W/ DISTRACTOR
|
Facility
IP
|
$14,284.80
|
|
| Hospital Charge Code |
41601389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,713.60 |
| Max. Negotiated Rate |
$13,284.86 |
| Rate for Payer: Aetna Commercial |
$12,342.07
|
| Rate for Payer: Cash Price |
$8,856.58
|
| Rate for Payer: Cigna All Commercial |
$12,327.78
|
| Rate for Payer: CORVEL All Commercial |
$13,284.86
|
| Rate for Payer: Coventry All Commercial |
$12,570.62
|
| Rate for Payer: Encore All Commercial |
$13,149.16
|
| Rate for Payer: Frontpath All Commercial |
$13,142.02
|
| Rate for Payer: Humana ChoiceCare |
$12,337.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,856.32
|
| Rate for Payer: PHCS All Commercial |
$10,713.60
|
| Rate for Payer: PHP All Commercial |
$10,833.59
|
| Rate for Payer: Sagamore Health Network All Products |
$11,027.87
|
| Rate for Payer: Signature Care EPO |
$11,856.38
|
| Rate for Payer: Signature Care PPO |
$12,570.62
|
| Rate for Payer: United Healthcare Commercial |
$11,256.42
|
|
|
HC EBI DISTAL RADIUS FIXATOR W/ DISTRACTOR
|
Facility
OP
|
$14,284.80
|
|
| Hospital Charge Code |
41601389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$13,284.86 |
| Rate for Payer: Aetna Commercial |
$12,056.37
|
| Rate for Payer: Aetna Medicare |
$4,713.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,713.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,203.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,929.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,421.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,185.38
|
| Rate for Payer: Cash Price |
$8,856.58
|
| Rate for Payer: Cash Price |
$8,856.58
|
| Rate for Payer: Centivo All Commercial |
$7,285.25
|
| Rate for Payer: Cigna All Commercial |
$12,327.78
|
| Rate for Payer: CORVEL All Commercial |
$13,284.86
|
| Rate for Payer: Coventry All Commercial |
$12,570.62
|
| Rate for Payer: Encore All Commercial |
$13,149.16
|
| Rate for Payer: Frontpath All Commercial |
$13,142.02
|
| Rate for Payer: Humana ChoiceCare |
$12,337.78
|
| Rate for Payer: Humana Medicare |
$7,285.25
|
| Rate for Payer: Lucent All Commercial |
$7,285.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,856.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,713.60
|
| Rate for Payer: PHP All Commercial |
$10,833.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,571.07
|
| Rate for Payer: Sagamore Health Network All Products |
$11,027.87
|
| Rate for Payer: Signature Care EPO |
$11,856.38
|
| Rate for Payer: Signature Care PPO |
$12,570.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,142.08
|
| Rate for Payer: United Healthcare Commercial |
$11,256.42
|
| Rate for Payer: United Healthcare Medicare |
$4,713.98
|
|
|
HC EBI DRILL BIT 2.0
|
Facility
IP
|
$1,590.00
|
|
| Hospital Charge Code |
41603096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,192.50 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Aetna Commercial |
$1,373.76
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna All Commercial |
$1,372.17
|
| Rate for Payer: CORVEL All Commercial |
$1,478.70
|
| Rate for Payer: Coventry All Commercial |
$1,399.20
|
| Rate for Payer: Encore All Commercial |
$1,463.60
|
| Rate for Payer: Frontpath All Commercial |
$1,462.80
|
| Rate for Payer: Humana ChoiceCare |
$1,373.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,431.00
|
| Rate for Payer: PHCS All Commercial |
$1,192.50
|
| Rate for Payer: PHP All Commercial |
$1,205.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,227.48
|
| Rate for Payer: Signature Care EPO |
$1,319.70
|
| Rate for Payer: Signature Care PPO |
$1,399.20
|
| Rate for Payer: United Healthcare Commercial |
$1,252.92
|
|
|
HC EBI DRILL BIT 2.0
|
Facility
OP
|
$1,590.00
|
|
| Hospital Charge Code |
41603096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Aetna Commercial |
$1,341.96
|
| Rate for Payer: Aetna Medicare |
$524.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$524.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$913.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$993.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$577.17
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Centivo All Commercial |
$810.90
|
| Rate for Payer: Cigna All Commercial |
$1,372.17
|
| Rate for Payer: CORVEL All Commercial |
$1,478.70
|
| Rate for Payer: Coventry All Commercial |
$1,399.20
|
| Rate for Payer: Encore All Commercial |
$1,463.60
|
| Rate for Payer: Frontpath All Commercial |
$1,462.80
|
| Rate for Payer: Humana ChoiceCare |
$1,373.28
|
| Rate for Payer: Humana Medicare |
$810.90
|
| Rate for Payer: Lucent All Commercial |
$810.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,431.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,192.50
|
| Rate for Payer: PHP All Commercial |
$1,205.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$620.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,227.48
|
| Rate for Payer: Signature Care EPO |
$1,319.70
|
| Rate for Payer: Signature Care PPO |
$1,399.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,351.50
|
| Rate for Payer: United Healthcare Commercial |
$1,252.92
|
| Rate for Payer: United Healthcare Medicare |
$524.70
|
|
|
HC EBI DRILL BIT 2.7
|
Facility
IP
|
$1,785.00
|
|
| Hospital Charge Code |
41601390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.75 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna All Commercial |
$1,540.46
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
|
|
HC EBI DRILL BIT 2.7
|
Facility
OP
|
$1,785.00
|
|
| Hospital Charge Code |
41601390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,506.54
|
| Rate for Payer: Aetna Medicare |
$589.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$589.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,025.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,115.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$677.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$647.96
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Centivo All Commercial |
$910.35
|
| Rate for Payer: Cigna All Commercial |
$1,540.46
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Humana Medicare |
$910.35
|
| Rate for Payer: Lucent All Commercial |
$910.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$696.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,517.25
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
| Rate for Payer: United Healthcare Medicare |
$589.05
|
|
|
HC EBI SCREW 70/20MM, 30/2.5
|
Facility
OP
|
$990.00
|
|
| Hospital Charge Code |
41603091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$835.56
|
| Rate for Payer: Aetna Medicare |
$326.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.37
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Centivo All Commercial |
$504.90
|
| Rate for Payer: Cigna All Commercial |
$854.37
|
| Rate for Payer: CORVEL All Commercial |
$920.70
|
| Rate for Payer: Coventry All Commercial |
$871.20
|
| Rate for Payer: Encore All Commercial |
$911.30
|
| Rate for Payer: Frontpath All Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$855.06
|
| Rate for Payer: Humana Medicare |
$504.90
|
| Rate for Payer: Lucent All Commercial |
$504.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$742.50
|
| Rate for Payer: PHP All Commercial |
$750.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.10
|
| Rate for Payer: Sagamore Health Network All Products |
$764.28
|
| Rate for Payer: Signature Care EPO |
$821.70
|
| Rate for Payer: Signature Care PPO |
$871.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$841.50
|
| Rate for Payer: United Healthcare Commercial |
$780.12
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
|
|
HC EBI SCREW 70/20MM, 30/2.5
|
Facility
IP
|
$990.00
|
|
| Hospital Charge Code |
41603091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$742.50 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$855.36
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna All Commercial |
$854.37
|
| Rate for Payer: CORVEL All Commercial |
$920.70
|
| Rate for Payer: Coventry All Commercial |
$871.20
|
| Rate for Payer: Encore All Commercial |
$911.30
|
| Rate for Payer: Frontpath All Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$855.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.00
|
| Rate for Payer: PHCS All Commercial |
$742.50
|
| Rate for Payer: PHP All Commercial |
$750.82
|
| Rate for Payer: Sagamore Health Network All Products |
$764.28
|
| Rate for Payer: Signature Care EPO |
$821.70
|
| Rate for Payer: Signature Care PPO |
$871.20
|
| Rate for Payer: United Healthcare Commercial |
$780.12
|
|
|
HC EBI SCREW 70/20MM, 30/3.3
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC EBI SCREW 70/20MM, 30/3.3
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC EBI SCREW 80/35MM, 30/3.3
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC EBI SCREW 80/35MM, 30/3.3
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC EBI SCREW 90/40MM, 30/2.5
|
Facility
OP
|
$990.00
|
|
| Hospital Charge Code |
41603089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$835.56
|
| Rate for Payer: Aetna Medicare |
$326.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.37
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Centivo All Commercial |
$504.90
|
| Rate for Payer: Cigna All Commercial |
$854.37
|
| Rate for Payer: CORVEL All Commercial |
$920.70
|
| Rate for Payer: Coventry All Commercial |
$871.20
|
| Rate for Payer: Encore All Commercial |
$911.30
|
| Rate for Payer: Frontpath All Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$855.06
|
| Rate for Payer: Humana Medicare |
$504.90
|
| Rate for Payer: Lucent All Commercial |
$504.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$742.50
|
| Rate for Payer: PHP All Commercial |
$750.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.10
|
| Rate for Payer: Sagamore Health Network All Products |
$764.28
|
| Rate for Payer: Signature Care EPO |
$821.70
|
| Rate for Payer: Signature Care PPO |
$871.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$841.50
|
| Rate for Payer: United Healthcare Commercial |
$780.12
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
|
|
HC EBI SCREW 90/40MM, 30/2.5
|
Facility
IP
|
$990.00
|
|
| Hospital Charge Code |
41603089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$742.50 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$855.36
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna All Commercial |
$854.37
|
| Rate for Payer: CORVEL All Commercial |
$920.70
|
| Rate for Payer: Coventry All Commercial |
$871.20
|
| Rate for Payer: Encore All Commercial |
$911.30
|
| Rate for Payer: Frontpath All Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$855.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.00
|
| Rate for Payer: PHCS All Commercial |
$742.50
|
| Rate for Payer: PHP All Commercial |
$750.82
|
| Rate for Payer: Sagamore Health Network All Products |
$764.28
|
| Rate for Payer: Signature Care EPO |
$821.70
|
| Rate for Payer: Signature Care PPO |
$871.20
|
| Rate for Payer: United Healthcare Commercial |
$780.12
|
|
|
HC EBV EARLY ANTIGEN
|
Facility
OP
|
$108.27
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
63001937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$100.69 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$35.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.30
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Centivo All Commercial |
$55.22
|
| Rate for Payer: Cigna All Commercial |
$93.44
|
| Rate for Payer: CORVEL All Commercial |
$100.69
|
| Rate for Payer: Coventry All Commercial |
$95.28
|
| Rate for Payer: Encore All Commercial |
$99.67
|
| Rate for Payer: Frontpath All Commercial |
$99.61
|
| Rate for Payer: Humana ChoiceCare |
$93.52
|
| Rate for Payer: Humana Medicare |
$55.22
|
| Rate for Payer: Lucent All Commercial |
$55.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.45
|
| Rate for Payer: Managed Health Services Medicaid |
$13.12
|
| Rate for Payer: MDWise Medicaid |
$13.12
|
| Rate for Payer: PHCS All Commercial |
$81.20
|
| Rate for Payer: PHP All Commercial |
$82.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.23
|
| Rate for Payer: Sagamore Health Network All Products |
$83.59
|
| Rate for Payer: Signature Care EPO |
$89.87
|
| Rate for Payer: Signature Care PPO |
$95.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.03
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
| Rate for Payer: United Healthcare Medicare |
$35.73
|
|
|
HC EBV EARLY ANTIGEN
|
Facility
IP
|
$108.27
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
63001937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$100.69 |
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cigna All Commercial |
$93.44
|
| Rate for Payer: CORVEL All Commercial |
$100.69
|
| Rate for Payer: Coventry All Commercial |
$95.28
|
| Rate for Payer: Encore All Commercial |
$99.67
|
| Rate for Payer: Frontpath All Commercial |
$99.61
|
| Rate for Payer: Humana ChoiceCare |
$93.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.45
|
| Rate for Payer: PHCS All Commercial |
$81.20
|
| Rate for Payer: PHP All Commercial |
$82.11
|
| Rate for Payer: Sagamore Health Network All Products |
$83.59
|
| Rate for Payer: Signature Care EPO |
$89.87
|
| Rate for Payer: Signature Care PPO |
$95.28
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
|
|
HC EBV EPSTEIN-BARR CAPSID VCA
|
Facility
OP
|
$31.62
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63087808
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Commercial |
$26.69
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.48
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Centivo All Commercial |
$16.13
|
| Rate for Payer: Cigna All Commercial |
$27.29
|
| Rate for Payer: CORVEL All Commercial |
$29.41
|
| Rate for Payer: Coventry All Commercial |
$27.83
|
| Rate for Payer: Encore All Commercial |
$29.11
|
| Rate for Payer: Frontpath All Commercial |
$29.09
|
| Rate for Payer: Humana ChoiceCare |
$27.31
|
| Rate for Payer: Humana Medicare |
$16.13
|
| Rate for Payer: Lucent All Commercial |
$16.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.46
|
| Rate for Payer: Managed Health Services Medicaid |
$18.14
|
| Rate for Payer: MDWise Medicaid |
$18.14
|
| Rate for Payer: PHCS All Commercial |
$23.72
|
| Rate for Payer: PHP All Commercial |
$23.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.33
|
| Rate for Payer: Sagamore Health Network All Products |
$24.41
|
| Rate for Payer: Signature Care EPO |
$26.24
|
| Rate for Payer: Signature Care PPO |
$27.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.88
|
| Rate for Payer: United Healthcare Commercial |
$24.92
|
| Rate for Payer: United Healthcare Medicare |
$10.43
|
|
