|
HC COCCIDIODES AB - CF
|
Facility
|
IP
|
$88.08
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
63001934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$81.91 |
| Rate for Payer: Aetna Commercial |
$76.10
|
| Rate for Payer: Cash Price |
$52.85
|
| Rate for Payer: Cigna All Commercial |
$76.01
|
| Rate for Payer: CORVEL All Commercial |
$81.91
|
| Rate for Payer: Coventry All Commercial |
$77.51
|
| Rate for Payer: Encore All Commercial |
$81.08
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$76.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.27
|
| Rate for Payer: PHCS All Commercial |
$66.06
|
| Rate for Payer: PHP All Commercial |
$66.80
|
| Rate for Payer: Sagamore Health Network All Products |
$68.00
|
| Rate for Payer: Signature Care EPO |
$73.11
|
| Rate for Payer: Signature Care PPO |
$77.51
|
| Rate for Payer: United Healthcare Commercial |
$69.41
|
|
|
HC COCCIDIODES AB - CF
|
Facility
|
OP
|
$88.08
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
63001934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$81.91 |
| Rate for Payer: Aetna Commercial |
$74.34
|
| Rate for Payer: Aetna Medicare |
$28.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.00
|
| Rate for Payer: Cash Price |
$52.85
|
| Rate for Payer: Cash Price |
$52.85
|
| Rate for Payer: Centivo All Commercial |
$47.92
|
| Rate for Payer: Cigna All Commercial |
$76.01
|
| Rate for Payer: CORVEL All Commercial |
$81.91
|
| Rate for Payer: Coventry All Commercial |
$77.51
|
| Rate for Payer: Encore All Commercial |
$81.08
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$76.07
|
| Rate for Payer: Humana Medicare |
$28.19
|
| Rate for Payer: Lucent All Commercial |
$47.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.27
|
| Rate for Payer: Managed Health Services Medicaid |
$11.47
|
| Rate for Payer: MDWise Medicaid |
$11.47
|
| Rate for Payer: PHCS All Commercial |
$66.06
|
| Rate for Payer: PHP All Commercial |
$66.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.35
|
| Rate for Payer: Sagamore Health Network All Products |
$68.00
|
| Rate for Payer: Signature Care EPO |
$73.11
|
| Rate for Payer: Signature Care PPO |
$77.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.87
|
| Rate for Payer: United Healthcare Commercial |
$69.41
|
| Rate for Payer: United Healthcare Medicare |
$28.19
|
|
|
HC COGNITIVE PERF EVAL STND - OT
|
Facility
|
IP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GO
|
| Hospital Charge Code |
1732006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.68
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
|
|
HC COGNITIVE PERF EVAL STND - OT
|
Facility
|
OP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GO
|
| Hospital Charge Code |
1732006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Centivo All Commercial |
$226.47
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
HC COGNITIVE TEST BY HC PRO PER HOUR
|
Facility
|
OP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
1746125
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Centivo All Commercial |
$226.47
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
HC COGNITIVE TEST BY HC PRO PER HOUR
|
Facility
|
IP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
1746125
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.68
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
|
|
HC COLD AGGLUTININS
|
Facility
|
IP
|
$84.15
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
63001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.11 |
| Max. Negotiated Rate |
$78.26 |
| Rate for Payer: Aetna Commercial |
$72.71
|
| Rate for Payer: Cash Price |
$50.49
|
| Rate for Payer: Cigna All Commercial |
$72.62
|
| Rate for Payer: CORVEL All Commercial |
$78.26
|
| Rate for Payer: Coventry All Commercial |
$74.05
|
| Rate for Payer: Encore All Commercial |
$77.46
|
| Rate for Payer: Frontpath All Commercial |
$77.42
|
| Rate for Payer: Humana ChoiceCare |
$72.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.73
|
| Rate for Payer: PHCS All Commercial |
$63.11
|
| Rate for Payer: PHP All Commercial |
$63.82
|
| Rate for Payer: Sagamore Health Network All Products |
$64.96
|
| Rate for Payer: Signature Care EPO |
$69.84
|
| Rate for Payer: Signature Care PPO |
$74.05
|
| Rate for Payer: United Healthcare Commercial |
$66.31
|
|
|
HC COLD AGGLUTININS
|
Facility
|
OP
|
$84.15
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
63001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$78.26 |
| Rate for Payer: Aetna Commercial |
$71.02
|
| Rate for Payer: Aetna Medicare |
$26.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.62
|
| Rate for Payer: Cash Price |
$50.49
|
| Rate for Payer: Cash Price |
$50.49
|
| Rate for Payer: Centivo All Commercial |
$45.78
|
| Rate for Payer: Cigna All Commercial |
$72.62
|
| Rate for Payer: CORVEL All Commercial |
$78.26
|
| Rate for Payer: Coventry All Commercial |
$74.05
|
| Rate for Payer: Encore All Commercial |
$77.46
|
| Rate for Payer: Frontpath All Commercial |
$77.42
|
| Rate for Payer: Humana ChoiceCare |
$72.68
|
| Rate for Payer: Humana Medicare |
$26.93
|
| Rate for Payer: Lucent All Commercial |
$45.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.73
|
| Rate for Payer: Managed Health Services Medicaid |
$8.07
|
| Rate for Payer: MDWise Medicaid |
$8.07
|
| Rate for Payer: PHCS All Commercial |
$63.11
|
| Rate for Payer: PHP All Commercial |
$63.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.82
|
| Rate for Payer: Sagamore Health Network All Products |
$64.96
|
| Rate for Payer: Signature Care EPO |
$69.84
|
| Rate for Payer: Signature Care PPO |
$74.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.53
|
| Rate for Payer: United Healthcare Commercial |
$66.31
|
| Rate for Payer: United Healthcare Medicare |
$26.93
|
|
|
HC COLONY COUNT
|
Facility
|
IP
|
$74.05
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
63001075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.54 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Aetna Commercial |
$63.98
|
| Rate for Payer: Cash Price |
$44.43
|
| Rate for Payer: Cigna All Commercial |
$63.91
|
| Rate for Payer: CORVEL All Commercial |
$68.87
|
| Rate for Payer: Coventry All Commercial |
$65.16
|
| Rate for Payer: Encore All Commercial |
$68.16
|
| Rate for Payer: Frontpath All Commercial |
$68.13
|
| Rate for Payer: Humana ChoiceCare |
$63.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.64
|
| Rate for Payer: PHCS All Commercial |
$55.54
|
| Rate for Payer: PHP All Commercial |
$56.16
|
| Rate for Payer: Sagamore Health Network All Products |
$57.17
|
| Rate for Payer: Signature Care EPO |
$61.46
|
| Rate for Payer: Signature Care PPO |
$65.16
|
| Rate for Payer: United Healthcare Commercial |
$58.35
|
|
|
HC COLONY COUNT
|
Facility
|
OP
|
$74.05
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
63001075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Aetna Commercial |
$62.50
|
| Rate for Payer: Aetna Medicare |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$44.43
|
| Rate for Payer: Cash Price |
$44.43
|
| Rate for Payer: Centivo All Commercial |
$40.28
|
| Rate for Payer: Cigna All Commercial |
$63.91
|
| Rate for Payer: CORVEL All Commercial |
$68.87
|
| Rate for Payer: Coventry All Commercial |
$65.16
|
| Rate for Payer: Encore All Commercial |
$68.16
|
| Rate for Payer: Frontpath All Commercial |
$68.13
|
| Rate for Payer: Humana ChoiceCare |
$63.96
|
| Rate for Payer: Humana Medicare |
$23.70
|
| Rate for Payer: Lucent All Commercial |
$40.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.64
|
| Rate for Payer: Managed Health Services Medicaid |
$8.07
|
| Rate for Payer: MDWise Medicaid |
$8.07
|
| Rate for Payer: PHCS All Commercial |
$55.54
|
| Rate for Payer: PHP All Commercial |
$56.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.88
|
| Rate for Payer: Sagamore Health Network All Products |
$57.17
|
| Rate for Payer: Signature Care EPO |
$61.46
|
| Rate for Payer: Signature Care PPO |
$65.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.94
|
| Rate for Payer: United Healthcare Commercial |
$58.35
|
| Rate for Payer: United Healthcare Medicare |
$23.70
|
|
|
HC COLOR FLOW DOPPLER
|
Facility
|
OP
|
$629.34
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
863325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$195.10 |
| Max. Negotiated Rate |
$585.29 |
| Rate for Payer: Aetna Commercial |
$531.16
|
| Rate for Payer: Aetna Medicare |
$201.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$361.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$231.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$221.53
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Centivo All Commercial |
$342.36
|
| Rate for Payer: Cigna All Commercial |
$543.12
|
| Rate for Payer: CORVEL All Commercial |
$585.29
|
| Rate for Payer: Coventry All Commercial |
$553.82
|
| Rate for Payer: Encore All Commercial |
$579.31
|
| Rate for Payer: Frontpath All Commercial |
$578.99
|
| Rate for Payer: Humana ChoiceCare |
$543.56
|
| Rate for Payer: Humana Medicare |
$201.39
|
| Rate for Payer: Lucent All Commercial |
$342.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.41
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$472.00
|
| Rate for Payer: PHP All Commercial |
$477.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.44
|
| Rate for Payer: Sagamore Health Network All Products |
$485.85
|
| Rate for Payer: Signature Care EPO |
$522.35
|
| Rate for Payer: Signature Care PPO |
$553.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$534.94
|
| Rate for Payer: United Healthcare Commercial |
$495.92
|
| Rate for Payer: United Healthcare Medicare |
$201.39
|
|
|
HC COLOR FLOW DOPPLER
|
Facility
|
IP
|
$629.34
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
863325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$585.29 |
| Rate for Payer: Aetna Commercial |
$543.75
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cigna All Commercial |
$543.12
|
| Rate for Payer: CORVEL All Commercial |
$585.29
|
| Rate for Payer: Coventry All Commercial |
$553.82
|
| Rate for Payer: Encore All Commercial |
$579.31
|
| Rate for Payer: Frontpath All Commercial |
$578.99
|
| Rate for Payer: Humana ChoiceCare |
$543.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.41
|
| Rate for Payer: PHCS All Commercial |
$472.00
|
| Rate for Payer: PHP All Commercial |
$477.29
|
| Rate for Payer: Sagamore Health Network All Products |
$485.85
|
| Rate for Payer: Signature Care EPO |
$522.35
|
| Rate for Payer: Signature Care PPO |
$553.82
|
| Rate for Payer: United Healthcare Commercial |
$495.92
|
|
|
HC COLOR FLOW DOPPLER- LIMITED
|
Facility
|
OP
|
$629.85
|
|
|
Service Code
|
CPT 93325 52
|
| Hospital Charge Code |
864325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna Commercial |
$531.59
|
| Rate for Payer: Aetna Medicare |
$201.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$361.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$231.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$221.71
|
| Rate for Payer: Cash Price |
$377.91
|
| Rate for Payer: Cash Price |
$377.91
|
| Rate for Payer: Centivo All Commercial |
$342.64
|
| Rate for Payer: Cigna All Commercial |
$543.56
|
| Rate for Payer: CORVEL All Commercial |
$585.76
|
| Rate for Payer: Coventry All Commercial |
$554.27
|
| Rate for Payer: Encore All Commercial |
$579.78
|
| Rate for Payer: Frontpath All Commercial |
$579.46
|
| Rate for Payer: Humana ChoiceCare |
$544.00
|
| Rate for Payer: Humana Medicare |
$201.55
|
| Rate for Payer: Lucent All Commercial |
$342.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.87
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$472.39
|
| Rate for Payer: PHP All Commercial |
$477.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.64
|
| Rate for Payer: Sagamore Health Network All Products |
$486.24
|
| Rate for Payer: Signature Care EPO |
$522.78
|
| Rate for Payer: Signature Care PPO |
$554.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$535.37
|
| Rate for Payer: United Healthcare Commercial |
$496.32
|
| Rate for Payer: United Healthcare Medicare |
$201.55
|
|
|
HC COLOR FLOW DOPPLER- LIMITED
|
Facility
|
IP
|
$629.85
|
|
|
Service Code
|
CPT 93325 52
|
| Hospital Charge Code |
864325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$472.39 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna Commercial |
$544.19
|
| Rate for Payer: Cash Price |
$377.91
|
| Rate for Payer: Cigna All Commercial |
$543.56
|
| Rate for Payer: CORVEL All Commercial |
$585.76
|
| Rate for Payer: Coventry All Commercial |
$554.27
|
| Rate for Payer: Encore All Commercial |
$579.78
|
| Rate for Payer: Frontpath All Commercial |
$579.46
|
| Rate for Payer: Humana ChoiceCare |
$544.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.87
|
| Rate for Payer: PHCS All Commercial |
$472.39
|
| Rate for Payer: PHP All Commercial |
$477.68
|
| Rate for Payer: Sagamore Health Network All Products |
$486.24
|
| Rate for Payer: Signature Care EPO |
$522.78
|
| Rate for Payer: Signature Care PPO |
$554.27
|
| Rate for Payer: United Healthcare Commercial |
$496.32
|
|
|
HC COMM/WORK REINT/JOB ANAL/15-OT
|
Facility
|
OP
|
$226.78
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
1738010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$210.91 |
| Rate for Payer: Aetna Commercial |
$191.40
|
| Rate for Payer: Aetna Medicare |
$72.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$130.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.83
|
| Rate for Payer: Cash Price |
$136.07
|
| Rate for Payer: Cash Price |
$136.07
|
| Rate for Payer: Centivo All Commercial |
$123.37
|
| Rate for Payer: Cigna All Commercial |
$195.71
|
| Rate for Payer: CORVEL All Commercial |
$210.91
|
| Rate for Payer: Coventry All Commercial |
$199.57
|
| Rate for Payer: Encore All Commercial |
$208.75
|
| Rate for Payer: Frontpath All Commercial |
$208.64
|
| Rate for Payer: Humana ChoiceCare |
$195.87
|
| Rate for Payer: Humana Medicare |
$72.57
|
| Rate for Payer: Lucent All Commercial |
$123.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.10
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$170.09
|
| Rate for Payer: PHP All Commercial |
$171.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.44
|
| Rate for Payer: Sagamore Health Network All Products |
$175.07
|
| Rate for Payer: Signature Care EPO |
$188.23
|
| Rate for Payer: Signature Care PPO |
$199.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$192.76
|
| Rate for Payer: United Healthcare Commercial |
$178.70
|
| Rate for Payer: United Healthcare Medicare |
$72.57
|
|
|
HC COMM/WORK REINT/JOB ANAL/15-OT
|
Facility
|
IP
|
$226.78
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
1738010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$210.91 |
| Rate for Payer: Aetna Commercial |
$195.94
|
| Rate for Payer: Cash Price |
$136.07
|
| Rate for Payer: Cigna All Commercial |
$195.71
|
| Rate for Payer: CORVEL All Commercial |
$210.91
|
| Rate for Payer: Coventry All Commercial |
$199.57
|
| Rate for Payer: Encore All Commercial |
$208.75
|
| Rate for Payer: Frontpath All Commercial |
$208.64
|
| Rate for Payer: Humana ChoiceCare |
$195.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.10
|
| Rate for Payer: PHCS All Commercial |
$170.09
|
| Rate for Payer: PHP All Commercial |
$171.99
|
| Rate for Payer: Sagamore Health Network All Products |
$175.07
|
| Rate for Payer: Signature Care EPO |
$188.23
|
| Rate for Payer: Signature Care PPO |
$199.57
|
| Rate for Payer: United Healthcare Commercial |
$178.70
|
|
|
HC COMPATIBILITY-ELECTRONIC
|
Facility
|
OP
|
$214.30
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
63001128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna Commercial |
$180.87
|
| Rate for Payer: Aetna Medicare |
$68.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$149.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$98.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$149.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.43
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Centivo All Commercial |
$116.58
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.58
|
| Rate for Payer: Encore All Commercial |
$197.26
|
| Rate for Payer: Frontpath All Commercial |
$197.16
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Humana Medicare |
$68.58
|
| Rate for Payer: Lucent All Commercial |
$116.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.87
|
| Rate for Payer: Managed Health Services Medicaid |
$149.16
|
| Rate for Payer: MDWise Medicaid |
$149.16
|
| Rate for Payer: PHCS All Commercial |
$160.72
|
| Rate for Payer: PHP All Commercial |
$162.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.58
|
| Rate for Payer: Sagamore Health Network All Products |
$165.44
|
| Rate for Payer: Signature Care EPO |
$177.87
|
| Rate for Payer: Signature Care PPO |
$188.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.16
|
| Rate for Payer: United Healthcare Commercial |
$168.87
|
| Rate for Payer: United Healthcare Medicare |
$68.58
|
|
|
HC COMPATIBILITY-ELECTRONIC
|
Facility
|
IP
|
$214.30
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
63001128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna Commercial |
$185.16
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.58
|
| Rate for Payer: Encore All Commercial |
$197.26
|
| Rate for Payer: Frontpath All Commercial |
$197.16
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.87
|
| Rate for Payer: PHCS All Commercial |
$160.72
|
| Rate for Payer: PHP All Commercial |
$162.53
|
| Rate for Payer: Sagamore Health Network All Products |
$165.44
|
| Rate for Payer: Signature Care EPO |
$177.87
|
| Rate for Payer: Signature Care PPO |
$188.58
|
| Rate for Payer: United Healthcare Commercial |
$168.87
|
|
|
HC COMPLEMENT C1Q
|
Facility
|
OP
|
$79.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: Aetna Medicare |
$25.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.95
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Centivo All Commercial |
$43.19
|
| Rate for Payer: Cigna All Commercial |
$68.52
|
| Rate for Payer: CORVEL All Commercial |
$73.84
|
| Rate for Payer: Coventry All Commercial |
$69.87
|
| Rate for Payer: Encore All Commercial |
$73.09
|
| Rate for Payer: Frontpath All Commercial |
$73.05
|
| Rate for Payer: Humana ChoiceCare |
$68.58
|
| Rate for Payer: Humana Medicare |
$25.41
|
| Rate for Payer: Lucent All Commercial |
$43.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.46
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$59.55
|
| Rate for Payer: PHP All Commercial |
$60.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.97
|
| Rate for Payer: Sagamore Health Network All Products |
$61.30
|
| Rate for Payer: Signature Care EPO |
$65.90
|
| Rate for Payer: Signature Care PPO |
$69.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.49
|
| Rate for Payer: United Healthcare Commercial |
$62.57
|
| Rate for Payer: United Healthcare Medicare |
$25.41
|
|
|
HC COMPLEMENT C1Q
|
Facility
|
IP
|
$79.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna Commercial |
$68.60
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cigna All Commercial |
$68.52
|
| Rate for Payer: CORVEL All Commercial |
$73.84
|
| Rate for Payer: Coventry All Commercial |
$69.87
|
| Rate for Payer: Encore All Commercial |
$73.09
|
| Rate for Payer: Frontpath All Commercial |
$73.05
|
| Rate for Payer: Humana ChoiceCare |
$68.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.46
|
| Rate for Payer: PHCS All Commercial |
$59.55
|
| Rate for Payer: PHP All Commercial |
$60.22
|
| Rate for Payer: Sagamore Health Network All Products |
$61.30
|
| Rate for Payer: Signature Care EPO |
$65.90
|
| Rate for Payer: Signature Care PPO |
$69.87
|
| Rate for Payer: United Healthcare Commercial |
$62.57
|
|
|
HC COMPLEMENT C3
|
Facility
|
OP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: Aetna Medicare |
$20.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.45
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Centivo All Commercial |
$34.70
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.32
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Humana Medicare |
$20.41
|
| Rate for Payer: Lucent All Commercial |
$34.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.88
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.22
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
| Rate for Payer: United Healthcare Medicare |
$20.41
|
|
|
HC COMPLEMENT C3
|
Facility
|
IP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$55.11
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.32
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
|
|
HC COMPLEMENT C4
|
Facility
|
OP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: Aetna Medicare |
$20.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.45
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Centivo All Commercial |
$34.70
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.32
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Humana Medicare |
$20.41
|
| Rate for Payer: Lucent All Commercial |
$34.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.88
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.22
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
| Rate for Payer: United Healthcare Medicare |
$20.41
|
|
|
HC COMPLEMENT C4
|
Facility
|
IP
|
$63.79
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
63001332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$55.11
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cigna All Commercial |
$55.05
|
| Rate for Payer: CORVEL All Commercial |
$59.32
|
| Rate for Payer: Coventry All Commercial |
$56.14
|
| Rate for Payer: Encore All Commercial |
$58.72
|
| Rate for Payer: Frontpath All Commercial |
$58.69
|
| Rate for Payer: Humana ChoiceCare |
$55.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.41
|
| Rate for Payer: PHCS All Commercial |
$47.84
|
| Rate for Payer: PHP All Commercial |
$48.38
|
| Rate for Payer: Sagamore Health Network All Products |
$49.25
|
| Rate for Payer: Signature Care EPO |
$52.95
|
| Rate for Payer: Signature Care PPO |
$56.14
|
| Rate for Payer: United Healthcare Commercial |
$50.27
|
|
|
HC COMPLEX STAIN-O&P
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
63002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
|
