|
HC EEG AWAKE & DROWSY
|
Facility
IP
|
$1,227.38
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
01523383
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$920.53 |
| Max. Negotiated Rate |
$1,141.46 |
| Rate for Payer: Aetna Commercial |
$1,060.45
|
| Rate for Payer: Cash Price |
$760.97
|
| Rate for Payer: Cigna All Commercial |
$1,059.23
|
| Rate for Payer: CORVEL All Commercial |
$1,141.46
|
| Rate for Payer: Coventry All Commercial |
$1,080.09
|
| Rate for Payer: Encore All Commercial |
$1,129.80
|
| Rate for Payer: Frontpath All Commercial |
$1,129.19
|
| Rate for Payer: Humana ChoiceCare |
$1,060.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,104.64
|
| Rate for Payer: PHCS All Commercial |
$920.53
|
| Rate for Payer: PHP All Commercial |
$930.84
|
| Rate for Payer: Sagamore Health Network All Products |
$947.53
|
| Rate for Payer: Signature Care EPO |
$1,018.72
|
| Rate for Payer: Signature Care PPO |
$1,080.09
|
| Rate for Payer: United Healthcare Commercial |
$967.17
|
|
|
HC EEG AWAKE & DROWSY
|
Facility
OP
|
$1,227.38
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
01523383
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$405.03 |
| Max. Negotiated Rate |
$1,141.46 |
| Rate for Payer: Aetna Commercial |
$1,035.91
|
| Rate for Payer: Aetna Medicare |
$405.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$405.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$704.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$767.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$780.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$465.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$445.54
|
| Rate for Payer: Cash Price |
$760.97
|
| Rate for Payer: Cash Price |
$760.97
|
| Rate for Payer: Centivo All Commercial |
$625.96
|
| Rate for Payer: Cigna All Commercial |
$1,059.23
|
| Rate for Payer: CORVEL All Commercial |
$1,141.46
|
| Rate for Payer: Coventry All Commercial |
$1,080.09
|
| Rate for Payer: Encore All Commercial |
$1,129.80
|
| Rate for Payer: Frontpath All Commercial |
$1,129.19
|
| Rate for Payer: Humana ChoiceCare |
$1,060.08
|
| Rate for Payer: Humana Medicare |
$625.96
|
| Rate for Payer: Lucent All Commercial |
$625.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,104.64
|
| Rate for Payer: Managed Health Services Medicaid |
$780.39
|
| Rate for Payer: MDWise Medicaid |
$780.39
|
| Rate for Payer: PHCS All Commercial |
$920.53
|
| Rate for Payer: PHP All Commercial |
$930.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$478.68
|
| Rate for Payer: Sagamore Health Network All Products |
$947.53
|
| Rate for Payer: Signature Care EPO |
$1,018.72
|
| Rate for Payer: Signature Care PPO |
$1,080.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,043.27
|
| Rate for Payer: United Healthcare Commercial |
$967.17
|
| Rate for Payer: United Healthcare Medicare |
$405.03
|
|
|
HC EKG RHYTHM STRIP
|
Facility
OP
|
$178.79
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
01503826
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$166.27 |
| Rate for Payer: Aetna Commercial |
$150.90
|
| Rate for Payer: Aetna Medicare |
$59.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$136.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.90
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Centivo All Commercial |
$91.18
|
| Rate for Payer: Cigna All Commercial |
$154.29
|
| Rate for Payer: CORVEL All Commercial |
$166.27
|
| Rate for Payer: Coventry All Commercial |
$157.33
|
| Rate for Payer: Encore All Commercial |
$164.57
|
| Rate for Payer: Frontpath All Commercial |
$164.48
|
| Rate for Payer: Humana ChoiceCare |
$154.42
|
| Rate for Payer: Humana Medicare |
$91.18
|
| Rate for Payer: Lucent All Commercial |
$91.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.91
|
| Rate for Payer: Managed Health Services Medicaid |
$136.38
|
| Rate for Payer: MDWise Medicaid |
$136.38
|
| Rate for Payer: PHCS All Commercial |
$134.09
|
| Rate for Payer: PHP All Commercial |
$135.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.73
|
| Rate for Payer: Sagamore Health Network All Products |
$138.02
|
| Rate for Payer: Signature Care EPO |
$148.39
|
| Rate for Payer: Signature Care PPO |
$157.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.97
|
| Rate for Payer: United Healthcare Commercial |
$140.88
|
| Rate for Payer: United Healthcare Medicare |
$59.00
|
|
|
HC EKG RHYTHM STRIP
|
Facility
IP
|
$178.79
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
01503826
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$134.09 |
| Max. Negotiated Rate |
$166.27 |
| Rate for Payer: Aetna Commercial |
$154.47
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cigna All Commercial |
$154.29
|
| Rate for Payer: CORVEL All Commercial |
$166.27
|
| Rate for Payer: Coventry All Commercial |
$157.33
|
| Rate for Payer: Encore All Commercial |
$164.57
|
| Rate for Payer: Frontpath All Commercial |
$164.48
|
| Rate for Payer: Humana ChoiceCare |
$154.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.91
|
| Rate for Payer: PHCS All Commercial |
$134.09
|
| Rate for Payer: PHP All Commercial |
$135.59
|
| Rate for Payer: Sagamore Health Network All Products |
$138.02
|
| Rate for Payer: Signature Care EPO |
$148.39
|
| Rate for Payer: Signature Care PPO |
$157.33
|
| Rate for Payer: United Healthcare Commercial |
$140.88
|
|
|
HC EKG STRESS TEST
|
Facility
OP
|
$1,089.44
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
01503935
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$359.52 |
| Max. Negotiated Rate |
$1,013.18 |
| Rate for Payer: Aetna Commercial |
$919.49
|
| Rate for Payer: Aetna Medicare |
$359.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$359.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$625.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$681.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$475.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$413.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$395.47
|
| Rate for Payer: Cash Price |
$675.45
|
| Rate for Payer: Cash Price |
$675.45
|
| Rate for Payer: Centivo All Commercial |
$555.62
|
| Rate for Payer: Cigna All Commercial |
$940.19
|
| Rate for Payer: CORVEL All Commercial |
$1,013.18
|
| Rate for Payer: Coventry All Commercial |
$958.71
|
| Rate for Payer: Encore All Commercial |
$1,002.83
|
| Rate for Payer: Frontpath All Commercial |
$1,002.29
|
| Rate for Payer: Humana ChoiceCare |
$940.95
|
| Rate for Payer: Humana Medicare |
$555.62
|
| Rate for Payer: Lucent All Commercial |
$555.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$980.50
|
| Rate for Payer: Managed Health Services Medicaid |
$475.45
|
| Rate for Payer: MDWise Medicaid |
$475.45
|
| Rate for Payer: PHCS All Commercial |
$817.08
|
| Rate for Payer: PHP All Commercial |
$826.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$424.88
|
| Rate for Payer: Sagamore Health Network All Products |
$841.05
|
| Rate for Payer: Signature Care EPO |
$904.24
|
| Rate for Payer: Signature Care PPO |
$958.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$926.03
|
| Rate for Payer: United Healthcare Commercial |
$858.48
|
| Rate for Payer: United Healthcare Medicare |
$359.52
|
|
|
HC EKG STRESS TEST
|
Facility
IP
|
$1,089.44
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
01503935
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$817.08 |
| Max. Negotiated Rate |
$1,013.18 |
| Rate for Payer: Aetna Commercial |
$941.28
|
| Rate for Payer: Cash Price |
$675.45
|
| Rate for Payer: Cigna All Commercial |
$940.19
|
| Rate for Payer: CORVEL All Commercial |
$1,013.18
|
| Rate for Payer: Coventry All Commercial |
$958.71
|
| Rate for Payer: Encore All Commercial |
$1,002.83
|
| Rate for Payer: Frontpath All Commercial |
$1,002.29
|
| Rate for Payer: Humana ChoiceCare |
$940.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$980.50
|
| Rate for Payer: PHCS All Commercial |
$817.08
|
| Rate for Payer: PHP All Commercial |
$826.23
|
| Rate for Payer: Sagamore Health Network All Products |
$841.05
|
| Rate for Payer: Signature Care EPO |
$904.24
|
| Rate for Payer: Signature Care PPO |
$958.71
|
| Rate for Payer: United Healthcare Commercial |
$858.48
|
|
|
HC ELEC STIM (UNATTENDED)-OT
|
Facility
OP
|
$125.36
|
|
|
Service Code
|
CPT G0283 GO
|
| Hospital Charge Code |
01738018
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$105.80
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.50
|
| Rate for Payer: Cash Price |
$77.72
|
| Rate for Payer: Centivo All Commercial |
$63.93
|
| Rate for Payer: Cigna All Commercial |
$108.18
|
| Rate for Payer: CORVEL All Commercial |
$116.58
|
| Rate for Payer: Coventry All Commercial |
$110.32
|
| Rate for Payer: Encore All Commercial |
$115.39
|
| Rate for Payer: Frontpath All Commercial |
$115.33
|
| Rate for Payer: Humana ChoiceCare |
$108.27
|
| Rate for Payer: Humana Medicare |
$63.93
|
| Rate for Payer: Lucent All Commercial |
$63.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.82
|
| Rate for Payer: PHCS All Commercial |
$94.02
|
| Rate for Payer: PHP All Commercial |
$95.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.89
|
| Rate for Payer: Sagamore Health Network All Products |
$96.78
|
| Rate for Payer: Signature Care EPO |
$104.05
|
| Rate for Payer: Signature Care PPO |
$110.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.55
|
| Rate for Payer: United Healthcare Commercial |
$98.78
|
| Rate for Payer: United Healthcare Medicare |
$41.37
|
|
|
HC ELEC STIM (UNATTENDED)-OT
|
Facility
IP
|
$125.36
|
|
|
Service Code
|
CPT G0283 GO
|
| Hospital Charge Code |
01738018
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$94.02 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$108.31
|
| Rate for Payer: Cash Price |
$77.72
|
| Rate for Payer: Cigna All Commercial |
$108.18
|
| Rate for Payer: CORVEL All Commercial |
$116.58
|
| Rate for Payer: Coventry All Commercial |
$110.32
|
| Rate for Payer: Encore All Commercial |
$115.39
|
| Rate for Payer: Frontpath All Commercial |
$115.33
|
| Rate for Payer: Humana ChoiceCare |
$108.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.82
|
| Rate for Payer: PHCS All Commercial |
$94.02
|
| Rate for Payer: PHP All Commercial |
$95.07
|
| Rate for Payer: Sagamore Health Network All Products |
$96.78
|
| Rate for Payer: Signature Care EPO |
$104.05
|
| Rate for Payer: Signature Care PPO |
$110.32
|
| Rate for Payer: United Healthcare Commercial |
$98.78
|
|
|
HC ELECTRIC STIM UNATTENDED - PT
|
Facility
IP
|
$122.42
|
|
|
Service Code
|
CPT G0283 GP
|
| Hospital Charge Code |
01722005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: PHCS All Commercial |
$91.82
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
|
|
HC ELECTRIC STIM UNATTENDED - PT
|
Facility
OP
|
$122.42
|
|
|
Service Code
|
CPT G0283 GP
|
| Hospital Charge Code |
01722005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$103.32
|
| Rate for Payer: Aetna Medicare |
$40.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Centivo All Commercial |
$62.43
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Humana Medicare |
$62.43
|
| Rate for Payer: Lucent All Commercial |
$62.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: PHCS All Commercial |
$91.82
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.06
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
| Rate for Payer: United Healthcare Medicare |
$40.40
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
IP
|
$323.10
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
01503215
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$242.32 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$279.15
|
| Rate for Payer: Cash Price |
$200.32
|
| Rate for Payer: Cigna All Commercial |
$278.83
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.32
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.32
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
OP
|
$323.10
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
01503215
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$106.62 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Medicare |
$106.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$136.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.28
|
| Rate for Payer: Cash Price |
$200.32
|
| Rate for Payer: Cash Price |
$200.32
|
| Rate for Payer: Centivo All Commercial |
$164.78
|
| Rate for Payer: Cigna All Commercial |
$278.83
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.32
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Humana Medicare |
$164.78
|
| Rate for Payer: Lucent All Commercial |
$164.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: Managed Health Services Medicaid |
$136.38
|
| Rate for Payer: MDWise Medicaid |
$136.38
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.01
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$274.63
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare |
$106.62
|
|
|
HC ELECTROCARDIOGRAM PREVENTATIVE
|
Facility
OP
|
$323.10
|
|
|
Service Code
|
CPT G0404
|
| Hospital Charge Code |
01500367
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$106.62 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Medicare |
$106.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$136.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.28
|
| Rate for Payer: Cash Price |
$200.32
|
| Rate for Payer: Cash Price |
$200.32
|
| Rate for Payer: Centivo All Commercial |
$164.78
|
| Rate for Payer: Cigna All Commercial |
$278.83
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.32
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Humana Medicare |
$164.78
|
| Rate for Payer: Lucent All Commercial |
$164.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: Managed Health Services Medicaid |
$136.38
|
| Rate for Payer: MDWise Medicaid |
$136.38
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.01
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$274.63
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare |
$106.62
|
|
|
HC ELECTROCARDIOGRAM PREVENTATIVE
|
Facility
IP
|
$323.10
|
|
|
Service Code
|
CPT G0404
|
| Hospital Charge Code |
01500367
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$242.32 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$279.15
|
| Rate for Payer: Cash Price |
$200.32
|
| Rate for Payer: Cigna All Commercial |
$278.83
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.32
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.32
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
HC ELECTRODE BAND HF 12 D BIPOLAR
|
Facility
IP
|
$2,479.17
|
|
| Hospital Charge Code |
41602499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,859.38 |
| Max. Negotiated Rate |
$2,305.63 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Cash Price |
$1,537.09
|
| Rate for Payer: Cigna All Commercial |
$2,139.52
|
| Rate for Payer: CORVEL All Commercial |
$2,305.63
|
| Rate for Payer: Coventry All Commercial |
$2,181.67
|
| Rate for Payer: Encore All Commercial |
$2,282.08
|
| Rate for Payer: Frontpath All Commercial |
$2,280.84
|
| Rate for Payer: Humana ChoiceCare |
$2,141.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,231.25
|
| Rate for Payer: PHCS All Commercial |
$1,859.38
|
| Rate for Payer: PHP All Commercial |
$1,880.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,913.92
|
| Rate for Payer: Signature Care EPO |
$2,057.71
|
| Rate for Payer: Signature Care PPO |
$2,181.67
|
| Rate for Payer: United Healthcare Commercial |
$1,953.59
|
|
|
HC ELECTRODE BAND HF 12 D BIPOLAR
|
Facility
OP
|
$2,479.17
|
|
| Hospital Charge Code |
41602499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,305.63 |
| Rate for Payer: Aetna Commercial |
$2,092.42
|
| Rate for Payer: Aetna Medicare |
$818.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$818.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,423.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,549.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$940.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$899.94
|
| Rate for Payer: Cash Price |
$1,537.09
|
| Rate for Payer: Cash Price |
$1,537.09
|
| Rate for Payer: Centivo All Commercial |
$1,264.38
|
| Rate for Payer: Cigna All Commercial |
$2,139.52
|
| Rate for Payer: CORVEL All Commercial |
$2,305.63
|
| Rate for Payer: Coventry All Commercial |
$2,181.67
|
| Rate for Payer: Encore All Commercial |
$2,282.08
|
| Rate for Payer: Frontpath All Commercial |
$2,280.84
|
| Rate for Payer: Humana ChoiceCare |
$2,141.26
|
| Rate for Payer: Humana Medicare |
$1,264.38
|
| Rate for Payer: Lucent All Commercial |
$1,264.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,231.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,859.38
|
| Rate for Payer: PHP All Commercial |
$1,880.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$966.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,913.92
|
| Rate for Payer: Signature Care EPO |
$2,057.71
|
| Rate for Payer: Signature Care PPO |
$2,181.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,107.29
|
| Rate for Payer: United Healthcare Commercial |
$1,953.59
|
| Rate for Payer: United Healthcare Medicare |
$818.13
|
|
|
HC ELECTRODE BUTTON HF 12/30 D BI
|
Facility
OP
|
$2,494.00
|
|
| Hospital Charge Code |
41602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,319.42 |
| Rate for Payer: Aetna Commercial |
$2,104.94
|
| Rate for Payer: Aetna Medicare |
$823.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$823.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,432.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,559.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$946.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$905.32
|
| Rate for Payer: Cash Price |
$1,546.28
|
| Rate for Payer: Cash Price |
$1,546.28
|
| Rate for Payer: Centivo All Commercial |
$1,271.94
|
| Rate for Payer: Cigna All Commercial |
$2,152.32
|
| Rate for Payer: CORVEL All Commercial |
$2,319.42
|
| Rate for Payer: Coventry All Commercial |
$2,194.72
|
| Rate for Payer: Encore All Commercial |
$2,295.73
|
| Rate for Payer: Frontpath All Commercial |
$2,294.48
|
| Rate for Payer: Humana ChoiceCare |
$2,154.07
|
| Rate for Payer: Humana Medicare |
$1,271.94
|
| Rate for Payer: Lucent All Commercial |
$1,271.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,244.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,870.50
|
| Rate for Payer: PHP All Commercial |
$1,891.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$972.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,925.37
|
| Rate for Payer: Signature Care EPO |
$2,070.02
|
| Rate for Payer: Signature Care PPO |
$2,194.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,119.90
|
| Rate for Payer: United Healthcare Commercial |
$1,965.27
|
| Rate for Payer: United Healthcare Medicare |
$823.02
|
|
|
HC ELECTRODE BUTTON HF 12/30 D BI
|
Facility
IP
|
$2,494.00
|
|
| Hospital Charge Code |
41602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,870.50 |
| Max. Negotiated Rate |
$2,319.42 |
| Rate for Payer: Aetna Commercial |
$2,154.82
|
| Rate for Payer: Cash Price |
$1,546.28
|
| Rate for Payer: Cigna All Commercial |
$2,152.32
|
| Rate for Payer: CORVEL All Commercial |
$2,319.42
|
| Rate for Payer: Coventry All Commercial |
$2,194.72
|
| Rate for Payer: Encore All Commercial |
$2,295.73
|
| Rate for Payer: Frontpath All Commercial |
$2,294.48
|
| Rate for Payer: Humana ChoiceCare |
$2,154.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,244.60
|
| Rate for Payer: PHCS All Commercial |
$1,870.50
|
| Rate for Payer: PHP All Commercial |
$1,891.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,925.37
|
| Rate for Payer: Signature Care EPO |
$2,070.02
|
| Rate for Payer: Signature Care PPO |
$2,194.72
|
| Rate for Payer: United Healthcare Commercial |
$1,965.27
|
|
|
HC ELECTRODE COLORADO TIP
|
Facility
IP
|
$670.60
|
|
| Hospital Charge Code |
41603399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.95 |
| Max. Negotiated Rate |
$623.66 |
| Rate for Payer: Aetna Commercial |
$579.40
|
| Rate for Payer: Cash Price |
$415.77
|
| Rate for Payer: Cigna All Commercial |
$578.73
|
| Rate for Payer: CORVEL All Commercial |
$623.66
|
| Rate for Payer: Coventry All Commercial |
$590.13
|
| Rate for Payer: Encore All Commercial |
$617.29
|
| Rate for Payer: Frontpath All Commercial |
$616.95
|
| Rate for Payer: Humana ChoiceCare |
$579.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$603.54
|
| Rate for Payer: PHCS All Commercial |
$502.95
|
| Rate for Payer: PHP All Commercial |
$508.58
|
| Rate for Payer: Sagamore Health Network All Products |
$517.70
|
| Rate for Payer: Signature Care EPO |
$556.60
|
| Rate for Payer: Signature Care PPO |
$590.13
|
| Rate for Payer: United Healthcare Commercial |
$528.43
|
|
|
HC ELECTRODE COLORADO TIP
|
Facility
OP
|
$670.60
|
|
| Hospital Charge Code |
41603399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$623.66 |
| Rate for Payer: Aetna Commercial |
$565.99
|
| Rate for Payer: Aetna Medicare |
$221.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$221.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$385.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$419.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$254.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$243.43
|
| Rate for Payer: Cash Price |
$415.77
|
| Rate for Payer: Cash Price |
$415.77
|
| Rate for Payer: Centivo All Commercial |
$342.01
|
| Rate for Payer: Cigna All Commercial |
$578.73
|
| Rate for Payer: CORVEL All Commercial |
$623.66
|
| Rate for Payer: Coventry All Commercial |
$590.13
|
| Rate for Payer: Encore All Commercial |
$617.29
|
| Rate for Payer: Frontpath All Commercial |
$616.95
|
| Rate for Payer: Humana ChoiceCare |
$579.20
|
| Rate for Payer: Humana Medicare |
$342.01
|
| Rate for Payer: Lucent All Commercial |
$342.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$603.54
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$502.95
|
| Rate for Payer: PHP All Commercial |
$508.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$261.53
|
| Rate for Payer: Sagamore Health Network All Products |
$517.70
|
| Rate for Payer: Signature Care EPO |
$556.60
|
| Rate for Payer: Signature Care PPO |
$590.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$570.01
|
| Rate for Payer: United Healthcare Commercial |
$528.43
|
| Rate for Payer: United Healthcare Medicare |
$221.30
|
|
|
HC ELECTRODE HF 45 D NEEDLE
|
Facility
OP
|
$2,386.50
|
|
| Hospital Charge Code |
41603277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,219.44 |
| Rate for Payer: Aetna Commercial |
$2,014.21
|
| Rate for Payer: Aetna Medicare |
$787.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$787.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,370.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,491.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$905.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$866.30
|
| Rate for Payer: Cash Price |
$1,479.63
|
| Rate for Payer: Cash Price |
$1,479.63
|
| Rate for Payer: Centivo All Commercial |
$1,217.12
|
| Rate for Payer: Cigna All Commercial |
$2,059.55
|
| Rate for Payer: CORVEL All Commercial |
$2,219.44
|
| Rate for Payer: Coventry All Commercial |
$2,100.12
|
| Rate for Payer: Encore All Commercial |
$2,196.77
|
| Rate for Payer: Frontpath All Commercial |
$2,195.58
|
| Rate for Payer: Humana ChoiceCare |
$2,061.22
|
| Rate for Payer: Humana Medicare |
$1,217.12
|
| Rate for Payer: Lucent All Commercial |
$1,217.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,147.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,789.88
|
| Rate for Payer: PHP All Commercial |
$1,809.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$930.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,842.38
|
| Rate for Payer: Signature Care EPO |
$1,980.80
|
| Rate for Payer: Signature Care PPO |
$2,100.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,028.52
|
| Rate for Payer: United Healthcare Commercial |
$1,880.56
|
| Rate for Payer: United Healthcare Medicare |
$787.54
|
|
|
HC ELECTRODE HF 45 D NEEDLE
|
Facility
IP
|
$2,386.50
|
|
| Hospital Charge Code |
41603277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,789.88 |
| Max. Negotiated Rate |
$2,219.44 |
| Rate for Payer: Aetna Commercial |
$2,061.94
|
| Rate for Payer: Cash Price |
$1,479.63
|
| Rate for Payer: Cigna All Commercial |
$2,059.55
|
| Rate for Payer: CORVEL All Commercial |
$2,219.44
|
| Rate for Payer: Coventry All Commercial |
$2,100.12
|
| Rate for Payer: Encore All Commercial |
$2,196.77
|
| Rate for Payer: Frontpath All Commercial |
$2,195.58
|
| Rate for Payer: Humana ChoiceCare |
$2,061.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,147.85
|
| Rate for Payer: PHCS All Commercial |
$1,789.88
|
| Rate for Payer: PHP All Commercial |
$1,809.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,842.38
|
| Rate for Payer: Signature Care EPO |
$1,980.80
|
| Rate for Payer: Signature Care PPO |
$2,100.12
|
| Rate for Payer: United Healthcare Commercial |
$1,880.56
|
|
|
HC ELECTRODE LOOP 15X12
|
Facility
IP
|
$76.57
|
|
| Hospital Charge Code |
41608234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$71.21 |
| Rate for Payer: Aetna Commercial |
$66.16
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cigna All Commercial |
$66.08
|
| Rate for Payer: CORVEL All Commercial |
$71.21
|
| Rate for Payer: Coventry All Commercial |
$67.38
|
| Rate for Payer: Encore All Commercial |
$70.48
|
| Rate for Payer: Frontpath All Commercial |
$70.44
|
| Rate for Payer: Humana ChoiceCare |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.91
|
| Rate for Payer: PHCS All Commercial |
$57.43
|
| Rate for Payer: PHP All Commercial |
$58.07
|
| Rate for Payer: Sagamore Health Network All Products |
$59.11
|
| Rate for Payer: Signature Care EPO |
$63.55
|
| Rate for Payer: Signature Care PPO |
$67.38
|
| Rate for Payer: United Healthcare Commercial |
$60.34
|
|
|
HC ELECTRODE LOOP 15X12
|
Facility
OP
|
$76.57
|
|
| Hospital Charge Code |
41608234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$64.63
|
| Rate for Payer: Aetna Medicare |
$25.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.79
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Centivo All Commercial |
$39.05
|
| Rate for Payer: Cigna All Commercial |
$66.08
|
| Rate for Payer: CORVEL All Commercial |
$71.21
|
| Rate for Payer: Coventry All Commercial |
$67.38
|
| Rate for Payer: Encore All Commercial |
$70.48
|
| Rate for Payer: Frontpath All Commercial |
$70.44
|
| Rate for Payer: Humana ChoiceCare |
$66.13
|
| Rate for Payer: Humana Medicare |
$39.05
|
| Rate for Payer: Lucent All Commercial |
$39.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$57.43
|
| Rate for Payer: PHP All Commercial |
$58.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.86
|
| Rate for Payer: Sagamore Health Network All Products |
$59.11
|
| Rate for Payer: Signature Care EPO |
$63.55
|
| Rate for Payer: Signature Care PPO |
$67.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.08
|
| Rate for Payer: United Healthcare Commercial |
$60.34
|
| Rate for Payer: United Healthcare Medicare |
$25.27
|
|
|
HC ELECTRODE LOOP 20X15
|
Facility
IP
|
$76.57
|
|
| Hospital Charge Code |
41608235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$71.21 |
| Rate for Payer: Aetna Commercial |
$66.16
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cigna All Commercial |
$66.08
|
| Rate for Payer: CORVEL All Commercial |
$71.21
|
| Rate for Payer: Coventry All Commercial |
$67.38
|
| Rate for Payer: Encore All Commercial |
$70.48
|
| Rate for Payer: Frontpath All Commercial |
$70.44
|
| Rate for Payer: Humana ChoiceCare |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.91
|
| Rate for Payer: PHCS All Commercial |
$57.43
|
| Rate for Payer: PHP All Commercial |
$58.07
|
| Rate for Payer: Sagamore Health Network All Products |
$59.11
|
| Rate for Payer: Signature Care EPO |
$63.55
|
| Rate for Payer: Signature Care PPO |
$67.38
|
| Rate for Payer: United Healthcare Commercial |
$60.34
|
|
