|
HC ETHOSUXIMIDE-ZARONTIN
|
Facility
IP
|
$80.43
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
63001373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Cash Price |
$49.87
|
| Rate for Payer: Cigna All Commercial |
$69.41
|
| Rate for Payer: CORVEL All Commercial |
$74.80
|
| Rate for Payer: Coventry All Commercial |
$70.78
|
| Rate for Payer: Encore All Commercial |
$74.03
|
| Rate for Payer: Frontpath All Commercial |
$73.99
|
| Rate for Payer: Humana ChoiceCare |
$69.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.38
|
| Rate for Payer: PHCS All Commercial |
$60.32
|
| Rate for Payer: PHP All Commercial |
$61.00
|
| Rate for Payer: Sagamore Health Network All Products |
$62.09
|
| Rate for Payer: Signature Care EPO |
$66.75
|
| Rate for Payer: Signature Care PPO |
$70.78
|
| Rate for Payer: United Healthcare Commercial |
$63.38
|
|
|
HC ETHOSUXIMIDE-ZARONTIN
|
Facility
OP
|
$80.43
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
63001373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Aetna Commercial |
$67.88
|
| Rate for Payer: Aetna Medicare |
$26.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.20
|
| Rate for Payer: Cash Price |
$49.87
|
| Rate for Payer: Cash Price |
$49.87
|
| Rate for Payer: Centivo All Commercial |
$41.02
|
| Rate for Payer: Cigna All Commercial |
$69.41
|
| Rate for Payer: CORVEL All Commercial |
$74.80
|
| Rate for Payer: Coventry All Commercial |
$70.78
|
| Rate for Payer: Encore All Commercial |
$74.03
|
| Rate for Payer: Frontpath All Commercial |
$73.99
|
| Rate for Payer: Humana ChoiceCare |
$69.46
|
| Rate for Payer: Humana Medicare |
$41.02
|
| Rate for Payer: Lucent All Commercial |
$41.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.38
|
| Rate for Payer: Managed Health Services Medicaid |
$16.34
|
| Rate for Payer: MDWise Medicaid |
$16.34
|
| Rate for Payer: PHCS All Commercial |
$60.32
|
| Rate for Payer: PHP All Commercial |
$61.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.37
|
| Rate for Payer: Sagamore Health Network All Products |
$62.09
|
| Rate for Payer: Signature Care EPO |
$66.75
|
| Rate for Payer: Signature Care PPO |
$70.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.36
|
| Rate for Payer: United Healthcare Commercial |
$63.38
|
| Rate for Payer: United Healthcare Medicare |
$26.54
|
|
|
HC EVACUATOR SILICONE 100CC
|
Facility
OP
|
$28.91
|
|
| Hospital Charge Code |
41602079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.49
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Centivo All Commercial |
$14.74
|
| Rate for Payer: Cigna All Commercial |
$24.95
|
| Rate for Payer: CORVEL All Commercial |
$26.89
|
| Rate for Payer: Coventry All Commercial |
$25.44
|
| Rate for Payer: Encore All Commercial |
$26.61
|
| Rate for Payer: Frontpath All Commercial |
$26.60
|
| Rate for Payer: Humana ChoiceCare |
$24.97
|
| Rate for Payer: Humana Medicare |
$14.74
|
| Rate for Payer: Lucent All Commercial |
$14.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.68
|
| Rate for Payer: PHP All Commercial |
$21.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.27
|
| Rate for Payer: Sagamore Health Network All Products |
$22.32
|
| Rate for Payer: Signature Care EPO |
$24.00
|
| Rate for Payer: Signature Care PPO |
$25.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.57
|
| Rate for Payer: United Healthcare Commercial |
$22.78
|
| Rate for Payer: United Healthcare Medicare |
$9.54
|
|
|
HC EVACUATOR SILICONE 100CC
|
Facility
IP
|
$28.91
|
|
| Hospital Charge Code |
41602079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cigna All Commercial |
$24.95
|
| Rate for Payer: CORVEL All Commercial |
$26.89
|
| Rate for Payer: Coventry All Commercial |
$25.44
|
| Rate for Payer: Encore All Commercial |
$26.61
|
| Rate for Payer: Frontpath All Commercial |
$26.60
|
| Rate for Payer: Humana ChoiceCare |
$24.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.02
|
| Rate for Payer: PHCS All Commercial |
$21.68
|
| Rate for Payer: PHP All Commercial |
$21.93
|
| Rate for Payer: Sagamore Health Network All Products |
$22.32
|
| Rate for Payer: Signature Care EPO |
$24.00
|
| Rate for Payer: Signature Care PPO |
$25.44
|
| Rate for Payer: United Healthcare Commercial |
$22.78
|
|
|
HC EVAL ALT COMM DEVICE-30 MIN-SP
|
Facility
IP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01748033
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.69
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| 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 |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
|
|
HC EVAL ALT COMM DEVICE-30 MIN-SP
|
Facility
OP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01748033
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.12
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Centivo All Commercial |
$212.31
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$212.31
|
| Rate for Payer: Lucent All Commercial |
$212.31
|
| 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: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
| Rate for Payer: United Healthcare Medicare |
$137.38
|
|
|
HC EVAL ALT COMM DEVICE-45 MIN-SP
|
Facility
OP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01748034
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.12
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Centivo All Commercial |
$212.31
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$212.31
|
| Rate for Payer: Lucent All Commercial |
$212.31
|
| 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: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
| Rate for Payer: United Healthcare Medicare |
$137.38
|
|
|
HC EVAL ALT COMM DEVICE-45 MIN-SP
|
Facility
IP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01748034
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.69
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| 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 |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
|
|
HC EVAL ALT COMM DEVICE-60 MIN-SP
|
Facility
OP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01748035
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.12
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Centivo All Commercial |
$212.31
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$212.31
|
| Rate for Payer: Lucent All Commercial |
$212.31
|
| 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: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
| Rate for Payer: United Healthcare Medicare |
$137.38
|
|
|
HC EVAL ALT COMM DEVICE-60 MIN-SP
|
Facility
IP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01748035
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.69
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| 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 |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
|
|
HC EVAL ALT COMM DEVICE - SP
|
Facility
IP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01749050
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.69
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| 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 |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
|
|
HC EVAL ALT COMM DEVICE - SP
|
Facility
OP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
01749050
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.12
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Centivo All Commercial |
$212.31
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$212.31
|
| Rate for Payer: Lucent All Commercial |
$212.31
|
| 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: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
| Rate for Payer: United Healthcare Medicare |
$137.38
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 15 MIN
|
Facility
OP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01743524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$146.67 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$375.12
|
| Rate for Payer: Aetna Medicare |
$146.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$255.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.34
|
| Rate for Payer: Cash Price |
$275.56
|
| Rate for Payer: Centivo All Commercial |
$226.67
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.90
|
| Rate for Payer: Humana ChoiceCare |
$383.88
|
| Rate for Payer: Humana Medicare |
$226.67
|
| Rate for Payer: Lucent All Commercial |
$226.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.01
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.34
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$377.79
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
| Rate for Payer: United Healthcare Medicare |
$146.67
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 15 MIN
|
Facility
IP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01743524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$333.34 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$384.01
|
| Rate for Payer: Cash Price |
$275.56
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.90
|
| Rate for Payer: Humana ChoiceCare |
$383.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.01
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 30 MIN
|
Facility
OP
|
$398.31
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01745524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$131.44 |
| Max. Negotiated Rate |
$370.43 |
| Rate for Payer: Aetna Commercial |
$336.17
|
| Rate for Payer: Aetna Medicare |
$131.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.59
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Centivo All Commercial |
$203.14
|
| Rate for Payer: Cigna All Commercial |
$343.74
|
| Rate for Payer: CORVEL All Commercial |
$370.43
|
| Rate for Payer: Coventry All Commercial |
$350.51
|
| Rate for Payer: Encore All Commercial |
$366.64
|
| Rate for Payer: Frontpath All Commercial |
$366.45
|
| Rate for Payer: Humana ChoiceCare |
$344.02
|
| Rate for Payer: Humana Medicare |
$203.14
|
| Rate for Payer: Lucent All Commercial |
$203.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.48
|
| Rate for Payer: PHCS All Commercial |
$298.73
|
| Rate for Payer: PHP All Commercial |
$302.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.34
|
| Rate for Payer: Sagamore Health Network All Products |
$307.50
|
| Rate for Payer: Signature Care EPO |
$330.60
|
| Rate for Payer: Signature Care PPO |
$350.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.56
|
| Rate for Payer: United Healthcare Commercial |
$313.87
|
| Rate for Payer: United Healthcare Medicare |
$131.44
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 30 MIN
|
Facility
IP
|
$398.31
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01745524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$370.43 |
| Rate for Payer: Aetna Commercial |
$344.14
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna All Commercial |
$343.74
|
| Rate for Payer: CORVEL All Commercial |
$370.43
|
| Rate for Payer: Coventry All Commercial |
$350.51
|
| Rate for Payer: Encore All Commercial |
$366.64
|
| Rate for Payer: Frontpath All Commercial |
$366.45
|
| Rate for Payer: Humana ChoiceCare |
$344.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.48
|
| Rate for Payer: PHCS All Commercial |
$298.73
|
| Rate for Payer: PHP All Commercial |
$302.08
|
| Rate for Payer: Sagamore Health Network All Products |
$307.50
|
| Rate for Payer: Signature Care EPO |
$330.60
|
| Rate for Payer: Signature Care PPO |
$350.51
|
| Rate for Payer: United Healthcare Commercial |
$313.87
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 45 MIN
|
Facility
IP
|
$424.73
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01744524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$318.55 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$366.96
|
| Rate for Payer: Cash Price |
$263.33
|
| Rate for Payer: Cigna All Commercial |
$366.54
|
| Rate for Payer: CORVEL All Commercial |
$395.00
|
| Rate for Payer: Coventry All Commercial |
$373.76
|
| Rate for Payer: Encore All Commercial |
$390.96
|
| Rate for Payer: Frontpath All Commercial |
$390.75
|
| Rate for Payer: Humana ChoiceCare |
$366.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.26
|
| Rate for Payer: PHCS All Commercial |
$318.55
|
| Rate for Payer: PHP All Commercial |
$322.11
|
| Rate for Payer: Sagamore Health Network All Products |
$327.89
|
| Rate for Payer: Signature Care EPO |
$352.52
|
| Rate for Payer: Signature Care PPO |
$373.76
|
| Rate for Payer: United Healthcare Commercial |
$334.69
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 45 MIN
|
Facility
OP
|
$424.73
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01744524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$358.47
|
| Rate for Payer: Aetna Medicare |
$140.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.18
|
| Rate for Payer: Cash Price |
$263.33
|
| Rate for Payer: Centivo All Commercial |
$216.61
|
| Rate for Payer: Cigna All Commercial |
$366.54
|
| Rate for Payer: CORVEL All Commercial |
$395.00
|
| Rate for Payer: Coventry All Commercial |
$373.76
|
| Rate for Payer: Encore All Commercial |
$390.96
|
| Rate for Payer: Frontpath All Commercial |
$390.75
|
| Rate for Payer: Humana ChoiceCare |
$366.84
|
| Rate for Payer: Humana Medicare |
$216.61
|
| Rate for Payer: Lucent All Commercial |
$216.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.26
|
| Rate for Payer: PHCS All Commercial |
$318.55
|
| Rate for Payer: PHP All Commercial |
$322.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.64
|
| Rate for Payer: Sagamore Health Network All Products |
$327.89
|
| Rate for Payer: Signature Care EPO |
$352.52
|
| Rate for Payer: Signature Care PPO |
$373.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.02
|
| Rate for Payer: United Healthcare Commercial |
$334.69
|
| Rate for Payer: United Healthcare Medicare |
$140.16
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 60 MIN
|
Facility
IP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01742524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$333.34 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$384.01
|
| Rate for Payer: Cash Price |
$275.56
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.90
|
| Rate for Payer: Humana ChoiceCare |
$383.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.01
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE 60 MIN
|
Facility
OP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01742524
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$146.67 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$375.12
|
| Rate for Payer: Aetna Medicare |
$146.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$255.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.34
|
| Rate for Payer: Cash Price |
$275.56
|
| Rate for Payer: Centivo All Commercial |
$226.67
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.90
|
| Rate for Payer: Humana ChoiceCare |
$383.88
|
| Rate for Payer: Humana Medicare |
$226.67
|
| Rate for Payer: Lucent All Commercial |
$226.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.01
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.34
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$377.79
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
| Rate for Payer: United Healthcare Medicare |
$146.67
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE - SP
|
Facility
IP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01749070
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$333.34 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$384.01
|
| Rate for Payer: Cash Price |
$275.56
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.90
|
| Rate for Payer: Humana ChoiceCare |
$383.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.01
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE - SP
|
Facility
OP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
01749070
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$146.67 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$375.12
|
| Rate for Payer: Aetna Medicare |
$146.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$255.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.34
|
| Rate for Payer: Cash Price |
$275.56
|
| Rate for Payer: Centivo All Commercial |
$226.67
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.90
|
| Rate for Payer: Humana ChoiceCare |
$383.88
|
| Rate for Payer: Humana Medicare |
$226.67
|
| Rate for Payer: Lucent All Commercial |
$226.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.01
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.34
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$377.79
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
| Rate for Payer: United Healthcare Medicare |
$146.67
|
|
|
HC EVAL SPEECH SOUND LANG COMPREHEN 15 MIN
|
Facility
IP
|
$456.71
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
01743523
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$342.53 |
| Max. Negotiated Rate |
$424.74 |
| Rate for Payer: Aetna Commercial |
$394.59
|
| Rate for Payer: Cash Price |
$283.16
|
| Rate for Payer: Cigna All Commercial |
$394.14
|
| Rate for Payer: CORVEL All Commercial |
$424.74
|
| Rate for Payer: Coventry All Commercial |
$401.90
|
| Rate for Payer: Encore All Commercial |
$420.40
|
| Rate for Payer: Frontpath All Commercial |
$420.17
|
| Rate for Payer: Humana ChoiceCare |
$394.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$411.03
|
| Rate for Payer: PHCS All Commercial |
$342.53
|
| Rate for Payer: PHP All Commercial |
$346.37
|
| Rate for Payer: Sagamore Health Network All Products |
$352.58
|
| Rate for Payer: Signature Care EPO |
$379.07
|
| Rate for Payer: Signature Care PPO |
$401.90
|
| Rate for Payer: United Healthcare Commercial |
$359.88
|
|
|
HC EVAL SPEECH SOUND LANG COMPREHEN 15 MIN
|
Facility
OP
|
$456.71
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
01743523
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$150.71 |
| Max. Negotiated Rate |
$424.74 |
| Rate for Payer: Aetna Commercial |
$385.46
|
| Rate for Payer: Aetna Medicare |
$150.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$262.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$285.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.78
|
| Rate for Payer: Cash Price |
$283.16
|
| Rate for Payer: Centivo All Commercial |
$232.92
|
| Rate for Payer: Cigna All Commercial |
$394.14
|
| Rate for Payer: CORVEL All Commercial |
$424.74
|
| Rate for Payer: Coventry All Commercial |
$401.90
|
| Rate for Payer: Encore All Commercial |
$420.40
|
| Rate for Payer: Frontpath All Commercial |
$420.17
|
| Rate for Payer: Humana ChoiceCare |
$394.46
|
| Rate for Payer: Humana Medicare |
$232.92
|
| Rate for Payer: Lucent All Commercial |
$232.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$411.03
|
| Rate for Payer: PHCS All Commercial |
$342.53
|
| Rate for Payer: PHP All Commercial |
$346.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.11
|
| Rate for Payer: Sagamore Health Network All Products |
$352.58
|
| Rate for Payer: Signature Care EPO |
$379.07
|
| Rate for Payer: Signature Care PPO |
$401.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$388.20
|
| Rate for Payer: United Healthcare Commercial |
$359.88
|
| Rate for Payer: United Healthcare Medicare |
$150.71
|
|
|
HC EVAL SPEECH SOUND LANG COMPREHEN 30 MIN
|
Facility
OP
|
$414.99
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
01744523
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$385.94 |
| Rate for Payer: Aetna Commercial |
$350.25
|
| Rate for Payer: Aetna Medicare |
$136.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$238.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.64
|
| Rate for Payer: Cash Price |
$257.29
|
| Rate for Payer: Centivo All Commercial |
$211.64
|
| Rate for Payer: Cigna All Commercial |
$358.13
|
| Rate for Payer: CORVEL All Commercial |
$385.94
|
| Rate for Payer: Coventry All Commercial |
$365.19
|
| Rate for Payer: Encore All Commercial |
$382.00
|
| Rate for Payer: Frontpath All Commercial |
$381.79
|
| Rate for Payer: Humana ChoiceCare |
$358.42
|
| Rate for Payer: Humana Medicare |
$211.64
|
| Rate for Payer: Lucent All Commercial |
$211.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.49
|
| Rate for Payer: PHCS All Commercial |
$311.24
|
| Rate for Payer: PHP All Commercial |
$314.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.84
|
| Rate for Payer: Sagamore Health Network All Products |
$320.37
|
| Rate for Payer: Signature Care EPO |
$344.44
|
| Rate for Payer: Signature Care PPO |
$365.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.74
|
| Rate for Payer: United Healthcare Commercial |
$327.01
|
| Rate for Payer: United Healthcare Medicare |
$136.95
|
|
