|
HC EVALUATION OF SPEECH FLUENCY 60 MIN
|
Facility
|
IP
|
$462.23
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
01742521
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$346.68 |
| Max. Negotiated Rate |
$429.88 |
| Rate for Payer: Aetna Commercial |
$399.37
|
| Rate for Payer: Cash Price |
$286.59
|
| Rate for Payer: Cigna All Commercial |
$398.91
|
| Rate for Payer: CORVEL All Commercial |
$429.88
|
| Rate for Payer: Coventry All Commercial |
$406.77
|
| Rate for Payer: Encore All Commercial |
$425.49
|
| Rate for Payer: Frontpath All Commercial |
$425.25
|
| Rate for Payer: Humana ChoiceCare |
$399.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.01
|
| Rate for Payer: PHCS All Commercial |
$346.68
|
| Rate for Payer: PHP All Commercial |
$350.56
|
| Rate for Payer: Sagamore Health Network All Products |
$356.84
|
| Rate for Payer: Signature Care EPO |
$383.65
|
| Rate for Payer: Signature Care PPO |
$406.77
|
| Rate for Payer: United Healthcare Commercial |
$364.24
|
|
|
HC EVALUATION OF SPEECH FLUENCY 60 MIN
|
Facility
|
OP
|
$462.23
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
01742521
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$152.54 |
| Max. Negotiated Rate |
$429.88 |
| Rate for Payer: Aetna Commercial |
$390.12
|
| Rate for Payer: Aetna Medicare |
$152.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$265.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.79
|
| Rate for Payer: Cash Price |
$286.59
|
| Rate for Payer: Centivo All Commercial |
$235.74
|
| Rate for Payer: Cigna All Commercial |
$398.91
|
| Rate for Payer: CORVEL All Commercial |
$429.88
|
| Rate for Payer: Coventry All Commercial |
$406.77
|
| Rate for Payer: Encore All Commercial |
$425.49
|
| Rate for Payer: Frontpath All Commercial |
$425.25
|
| Rate for Payer: Humana ChoiceCare |
$399.23
|
| Rate for Payer: Humana Medicare |
$235.74
|
| Rate for Payer: Lucent All Commercial |
$235.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.01
|
| Rate for Payer: PHCS All Commercial |
$346.68
|
| Rate for Payer: PHP All Commercial |
$350.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.27
|
| Rate for Payer: Sagamore Health Network All Products |
$356.84
|
| Rate for Payer: Signature Care EPO |
$383.65
|
| Rate for Payer: Signature Care PPO |
$406.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.90
|
| Rate for Payer: United Healthcare Commercial |
$364.24
|
| Rate for Payer: United Healthcare Medicare |
$152.54
|
|
|
HC EVALUATION OF SPEECH FLUENCY - SP
|
Facility
|
IP
|
$462.23
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
01747521
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$346.68 |
| Max. Negotiated Rate |
$429.88 |
| Rate for Payer: Aetna Commercial |
$399.37
|
| Rate for Payer: Cash Price |
$286.59
|
| Rate for Payer: Cigna All Commercial |
$398.91
|
| Rate for Payer: CORVEL All Commercial |
$429.88
|
| Rate for Payer: Coventry All Commercial |
$406.77
|
| Rate for Payer: Encore All Commercial |
$425.49
|
| Rate for Payer: Frontpath All Commercial |
$425.25
|
| Rate for Payer: Humana ChoiceCare |
$399.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.01
|
| Rate for Payer: PHCS All Commercial |
$346.68
|
| Rate for Payer: PHP All Commercial |
$350.56
|
| Rate for Payer: Sagamore Health Network All Products |
$356.84
|
| Rate for Payer: Signature Care EPO |
$383.65
|
| Rate for Payer: Signature Care PPO |
$406.77
|
| Rate for Payer: United Healthcare Commercial |
$364.24
|
|
|
HC EVALUATION OF SPEECH FLUENCY - SP
|
Facility
|
OP
|
$462.23
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
01747521
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$152.54 |
| Max. Negotiated Rate |
$429.88 |
| Rate for Payer: Aetna Commercial |
$390.12
|
| Rate for Payer: Aetna Medicare |
$152.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$265.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.79
|
| Rate for Payer: Cash Price |
$286.59
|
| Rate for Payer: Centivo All Commercial |
$235.74
|
| Rate for Payer: Cigna All Commercial |
$398.91
|
| Rate for Payer: CORVEL All Commercial |
$429.88
|
| Rate for Payer: Coventry All Commercial |
$406.77
|
| Rate for Payer: Encore All Commercial |
$425.49
|
| Rate for Payer: Frontpath All Commercial |
$425.25
|
| Rate for Payer: Humana ChoiceCare |
$399.23
|
| Rate for Payer: Humana Medicare |
$235.74
|
| Rate for Payer: Lucent All Commercial |
$235.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.01
|
| Rate for Payer: PHCS All Commercial |
$346.68
|
| Rate for Payer: PHP All Commercial |
$350.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.27
|
| Rate for Payer: Sagamore Health Network All Products |
$356.84
|
| Rate for Payer: Signature Care EPO |
$383.65
|
| Rate for Payer: Signature Care PPO |
$406.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.90
|
| Rate for Payer: United Healthcare Commercial |
$364.24
|
| Rate for Payer: United Healthcare Medicare |
$152.54
|
|
|
HC EVEROLIMUS
|
Facility
|
IP
|
$220.65
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
63001002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$190.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna All Commercial |
$190.42
|
| Rate for Payer: CORVEL All Commercial |
$205.20
|
| Rate for Payer: Coventry All Commercial |
$194.17
|
| Rate for Payer: Encore All Commercial |
$203.11
|
| Rate for Payer: Frontpath All Commercial |
$202.99
|
| Rate for Payer: Humana ChoiceCare |
$190.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.58
|
| Rate for Payer: PHCS All Commercial |
$165.48
|
| Rate for Payer: PHP All Commercial |
$167.34
|
| Rate for Payer: Sagamore Health Network All Products |
$170.34
|
| Rate for Payer: Signature Care EPO |
$183.14
|
| Rate for Payer: Signature Care PPO |
$194.17
|
| Rate for Payer: United Healthcare Commercial |
$173.87
|
|
|
HC EVEROLIMUS
|
Facility
|
OP
|
$220.65
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
63001002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$186.23
|
| Rate for Payer: Aetna Medicare |
$72.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$126.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$137.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.09
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Centivo All Commercial |
$112.53
|
| Rate for Payer: Cigna All Commercial |
$190.42
|
| Rate for Payer: CORVEL All Commercial |
$205.20
|
| Rate for Payer: Coventry All Commercial |
$194.17
|
| Rate for Payer: Encore All Commercial |
$203.11
|
| Rate for Payer: Frontpath All Commercial |
$202.99
|
| Rate for Payer: Humana ChoiceCare |
$190.57
|
| Rate for Payer: Humana Medicare |
$112.53
|
| Rate for Payer: Lucent All Commercial |
$112.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.58
|
| Rate for Payer: Managed Health Services Medicaid |
$13.73
|
| Rate for Payer: MDWise Medicaid |
$13.73
|
| Rate for Payer: PHCS All Commercial |
$165.48
|
| Rate for Payer: PHP All Commercial |
$167.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.05
|
| Rate for Payer: Sagamore Health Network All Products |
$170.34
|
| Rate for Payer: Signature Care EPO |
$183.14
|
| Rate for Payer: Signature Care PPO |
$194.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.55
|
| Rate for Payer: United Healthcare Commercial |
$173.87
|
| Rate for Payer: United Healthcare Medicare |
$72.81
|
|
|
HC EXFUSE PUTTY 1
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna Commercial |
$864.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna All Commercial |
$863.00
|
| Rate for Payer: CORVEL All Commercial |
$930.00
|
| Rate for Payer: Coventry All Commercial |
$880.00
|
| Rate for Payer: Encore All Commercial |
$920.50
|
| Rate for Payer: Frontpath All Commercial |
$920.00
|
| Rate for Payer: Humana ChoiceCare |
$863.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.00
|
| Rate for Payer: PHCS All Commercial |
$750.00
|
| Rate for Payer: PHP All Commercial |
$758.40
|
| Rate for Payer: Sagamore Health Network All Products |
$772.00
|
| Rate for Payer: Signature Care EPO |
$830.00
|
| Rate for Payer: Signature Care PPO |
$880.00
|
| Rate for Payer: United Healthcare Commercial |
$788.00
|
|
|
HC EXFUSE PUTTY 1
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna Commercial |
$844.00
|
| Rate for Payer: Aetna Medicare |
$330.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$574.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$625.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$379.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Centivo All Commercial |
$510.00
|
| Rate for Payer: Cigna All Commercial |
$863.00
|
| Rate for Payer: CORVEL All Commercial |
$930.00
|
| Rate for Payer: Coventry All Commercial |
$880.00
|
| Rate for Payer: Encore All Commercial |
$920.50
|
| Rate for Payer: Frontpath All Commercial |
$920.00
|
| Rate for Payer: Humana ChoiceCare |
$863.70
|
| Rate for Payer: Humana Medicare |
$510.00
|
| Rate for Payer: Lucent All Commercial |
$510.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$750.00
|
| Rate for Payer: PHP All Commercial |
$758.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.00
|
| Rate for Payer: Sagamore Health Network All Products |
$772.00
|
| Rate for Payer: Signature Care EPO |
$830.00
|
| Rate for Payer: Signature Care PPO |
$880.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$850.00
|
| Rate for Payer: United Healthcare Commercial |
$788.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
|
|
HC EXFUSE PUTTY 10
|
Facility
|
IP
|
$3,528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.00 |
| Max. Negotiated Rate |
$3,281.04 |
| Rate for Payer: Aetna Commercial |
$3,048.19
|
| Rate for Payer: Cash Price |
$2,187.36
|
| Rate for Payer: Cigna All Commercial |
$3,044.66
|
| Rate for Payer: CORVEL All Commercial |
$3,281.04
|
| Rate for Payer: Coventry All Commercial |
$3,104.64
|
| Rate for Payer: Encore All Commercial |
$3,247.52
|
| Rate for Payer: Frontpath All Commercial |
$3,245.76
|
| Rate for Payer: Humana ChoiceCare |
$3,047.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,175.20
|
| Rate for Payer: PHCS All Commercial |
$2,646.00
|
| Rate for Payer: PHP All Commercial |
$2,675.64
|
| Rate for Payer: Sagamore Health Network All Products |
$2,723.62
|
| Rate for Payer: Signature Care EPO |
$2,928.24
|
| Rate for Payer: Signature Care PPO |
$3,104.64
|
| Rate for Payer: United Healthcare Commercial |
$2,780.06
|
|
|
HC EXFUSE PUTTY 10
|
Facility
|
OP
|
$3,528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,281.04 |
| Rate for Payer: Aetna Commercial |
$2,977.63
|
| Rate for Payer: Aetna Medicare |
$1,164.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,164.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,026.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,205.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,338.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,280.66
|
| Rate for Payer: Cash Price |
$2,187.36
|
| Rate for Payer: Cash Price |
$2,187.36
|
| Rate for Payer: Centivo All Commercial |
$1,799.28
|
| Rate for Payer: Cigna All Commercial |
$3,044.66
|
| Rate for Payer: CORVEL All Commercial |
$3,281.04
|
| Rate for Payer: Coventry All Commercial |
$3,104.64
|
| Rate for Payer: Encore All Commercial |
$3,247.52
|
| Rate for Payer: Frontpath All Commercial |
$3,245.76
|
| Rate for Payer: Humana ChoiceCare |
$3,047.13
|
| Rate for Payer: Humana Medicare |
$1,799.28
|
| Rate for Payer: Lucent All Commercial |
$1,799.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,175.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,646.00
|
| Rate for Payer: PHP All Commercial |
$2,675.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,375.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,723.62
|
| Rate for Payer: Signature Care EPO |
$2,928.24
|
| Rate for Payer: Signature Care PPO |
$3,104.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,998.80
|
| Rate for Payer: United Healthcare Commercial |
$2,780.06
|
| Rate for Payer: United Healthcare Medicare |
$1,164.24
|
|
|
HC EXFUSE PUTTY 5
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,075.76 |
| Rate for Payer: Aetna Commercial |
$1,883.81
|
| Rate for Payer: Aetna Medicare |
$736.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$736.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,281.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,395.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$847.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$810.22
|
| Rate for Payer: Cash Price |
$1,383.84
|
| Rate for Payer: Cash Price |
$1,383.84
|
| Rate for Payer: Centivo All Commercial |
$1,138.32
|
| Rate for Payer: Cigna All Commercial |
$1,926.22
|
| Rate for Payer: CORVEL All Commercial |
$2,075.76
|
| Rate for Payer: Coventry All Commercial |
$1,964.16
|
| Rate for Payer: Encore All Commercial |
$2,054.56
|
| Rate for Payer: Frontpath All Commercial |
$2,053.44
|
| Rate for Payer: Humana ChoiceCare |
$1,927.78
|
| Rate for Payer: Humana Medicare |
$1,138.32
|
| Rate for Payer: Lucent All Commercial |
$1,138.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,008.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,674.00
|
| Rate for Payer: PHP All Commercial |
$1,692.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$870.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,723.10
|
| Rate for Payer: Signature Care EPO |
$1,852.56
|
| Rate for Payer: Signature Care PPO |
$1,964.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,897.20
|
| Rate for Payer: United Healthcare Commercial |
$1,758.82
|
| Rate for Payer: United Healthcare Medicare |
$736.56
|
|
|
HC EXFUSE PUTTY 5
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$2,075.76 |
| Rate for Payer: Aetna Commercial |
$1,928.45
|
| Rate for Payer: Cash Price |
$1,383.84
|
| Rate for Payer: Cigna All Commercial |
$1,926.22
|
| Rate for Payer: CORVEL All Commercial |
$2,075.76
|
| Rate for Payer: Coventry All Commercial |
$1,964.16
|
| Rate for Payer: Encore All Commercial |
$2,054.56
|
| Rate for Payer: Frontpath All Commercial |
$2,053.44
|
| Rate for Payer: Humana ChoiceCare |
$1,927.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,008.80
|
| Rate for Payer: PHCS All Commercial |
$1,674.00
|
| Rate for Payer: PHP All Commercial |
$1,692.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,723.10
|
| Rate for Payer: Signature Care EPO |
$1,852.56
|
| Rate for Payer: Signature Care PPO |
$1,964.16
|
| Rate for Payer: United Healthcare Commercial |
$1,758.82
|
|
|
HC EXT ECG MONIT/REPRT 12-48 HRS
|
Facility
|
IP
|
$1,628.06
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
01505069
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$1,221.05 |
| Max. Negotiated Rate |
$1,514.10 |
| Rate for Payer: Aetna Commercial |
$1,406.65
|
| Rate for Payer: Cash Price |
$1,009.40
|
| Rate for Payer: Cigna All Commercial |
$1,405.02
|
| Rate for Payer: CORVEL All Commercial |
$1,514.10
|
| Rate for Payer: Coventry All Commercial |
$1,432.70
|
| Rate for Payer: Encore All Commercial |
$1,498.63
|
| Rate for Payer: Frontpath All Commercial |
$1,497.82
|
| Rate for Payer: Humana ChoiceCare |
$1,406.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,465.26
|
| Rate for Payer: PHCS All Commercial |
$1,221.05
|
| Rate for Payer: PHP All Commercial |
$1,234.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,256.86
|
| Rate for Payer: Signature Care EPO |
$1,351.29
|
| Rate for Payer: Signature Care PPO |
$1,432.70
|
| Rate for Payer: United Healthcare Commercial |
$1,282.91
|
|
|
HC EXT ECG MONIT/REPRT 12-48 HRS
|
Facility
|
OP
|
$1,628.06
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
01505069
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$537.26 |
| Max. Negotiated Rate |
$1,514.10 |
| Rate for Payer: Aetna Commercial |
$1,374.09
|
| Rate for Payer: Aetna Medicare |
$537.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$935.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,017.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$563.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$617.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$590.99
|
| Rate for Payer: Cash Price |
$1,009.40
|
| Rate for Payer: Cash Price |
$1,009.40
|
| Rate for Payer: Centivo All Commercial |
$830.31
|
| Rate for Payer: Cigna All Commercial |
$1,405.02
|
| Rate for Payer: CORVEL All Commercial |
$1,514.10
|
| Rate for Payer: Coventry All Commercial |
$1,432.70
|
| Rate for Payer: Encore All Commercial |
$1,498.63
|
| Rate for Payer: Frontpath All Commercial |
$1,497.82
|
| Rate for Payer: Humana ChoiceCare |
$1,406.16
|
| Rate for Payer: Humana Medicare |
$830.31
|
| Rate for Payer: Lucent All Commercial |
$830.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,465.26
|
| Rate for Payer: Managed Health Services Medicaid |
$563.90
|
| Rate for Payer: MDWise Medicaid |
$563.90
|
| Rate for Payer: PHCS All Commercial |
$1,221.05
|
| Rate for Payer: PHP All Commercial |
$1,234.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$634.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,256.86
|
| Rate for Payer: Signature Care EPO |
$1,351.29
|
| Rate for Payer: Signature Care PPO |
$1,432.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,383.85
|
| Rate for Payer: United Healthcare Commercial |
$1,282.91
|
| Rate for Payer: United Healthcare Medicare |
$537.26
|
|
|
HC EXTENDED RECOVERY INITIAL HOUR
|
Facility
|
OP
|
$1,201.16
|
|
| Hospital Charge Code |
61171001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$396.38 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,013.78
|
| Rate for Payer: Aetna Medicare |
$396.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$396.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$689.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$401.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$436.02
|
| Rate for Payer: Cash Price |
$744.72
|
| Rate for Payer: Cash Price |
$744.72
|
| Rate for Payer: Centivo All Commercial |
$612.59
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Humana Medicare |
$612.59
|
| Rate for Payer: Lucent All Commercial |
$612.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.05
|
| Rate for Payer: Managed Health Services Medicaid |
$401.86
|
| Rate for Payer: MDWise Medicaid |
$401.86
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.45
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.99
|
| Rate for Payer: United Healthcare Commercial |
$946.52
|
| Rate for Payer: United Healthcare Medicare |
$396.38
|
|
|
HC EXTENDED RECOVERY INITIAL HOUR
|
Facility
|
IP
|
$1,201.16
|
|
| Hospital Charge Code |
61171001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$900.87 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,037.80
|
| Rate for Payer: Cash Price |
$744.72
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.05
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: United Healthcare Commercial |
$946.52
|
|
|
HC EXTENDED RECOVERY SUBSEQUENT <24
|
Facility
|
IP
|
$19.27
|
|
| Hospital Charge Code |
61171002
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC EXTENDED RECOVERY SUBSEQUENT <24
|
Facility
|
OP
|
$19.27
|
|
| Hospital Charge Code |
61171002
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$401.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.99
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$401.86
|
| Rate for Payer: MDWise Medicaid |
$401.86
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC EXTENDED RECOVERY SUBSEQUENT >24
|
Facility
|
OP
|
$68.50
|
|
| Hospital Charge Code |
61171003
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$57.82
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$401.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.87
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Centivo All Commercial |
$34.94
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.71
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.06
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.17
|
| Rate for Payer: Humana Medicare |
$34.94
|
| Rate for Payer: Lucent All Commercial |
$34.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: Managed Health Services Medicaid |
$401.86
|
| Rate for Payer: MDWise Medicaid |
$401.86
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.72
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.86
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.23
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare |
$22.61
|
|
|
HC EXTENDED RECOVERY SUBSEQUENT >24
|
Facility
|
IP
|
$68.50
|
|
| Hospital Charge Code |
61171003
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$63.71 |
| Rate for Payer: Aetna Commercial |
$59.19
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.71
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.06
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.86
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$1,314.82
|
|
| Hospital Charge Code |
01229412
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$433.89 |
| Max. Negotiated Rate |
$1,222.78 |
| Rate for Payer: Aetna Commercial |
$1,109.71
|
| Rate for Payer: Aetna Medicare |
$433.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$433.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$755.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$821.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$492.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$498.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$477.28
|
| Rate for Payer: Cash Price |
$815.19
|
| Rate for Payer: Cash Price |
$815.19
|
| Rate for Payer: Centivo All Commercial |
$670.56
|
| Rate for Payer: Cigna All Commercial |
$1,134.69
|
| Rate for Payer: CORVEL All Commercial |
$1,222.78
|
| Rate for Payer: Coventry All Commercial |
$1,157.04
|
| Rate for Payer: Encore All Commercial |
$1,210.29
|
| Rate for Payer: Frontpath All Commercial |
$1,209.64
|
| Rate for Payer: Humana ChoiceCare |
$1,135.61
|
| Rate for Payer: Humana Medicare |
$670.56
|
| Rate for Payer: Lucent All Commercial |
$670.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,183.34
|
| Rate for Payer: Managed Health Services Medicaid |
$492.69
|
| Rate for Payer: MDWise Medicaid |
$492.69
|
| Rate for Payer: PHCS All Commercial |
$986.12
|
| Rate for Payer: PHP All Commercial |
$997.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$512.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,015.04
|
| Rate for Payer: Signature Care EPO |
$1,091.30
|
| Rate for Payer: Signature Care PPO |
$1,157.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,117.60
|
| Rate for Payer: United Healthcare Commercial |
$1,036.08
|
| Rate for Payer: United Healthcare Medicare |
$433.89
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$1,314.82
|
|
| Hospital Charge Code |
01229412
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$986.12 |
| Max. Negotiated Rate |
$1,222.78 |
| Rate for Payer: Aetna Commercial |
$1,136.01
|
| Rate for Payer: Cash Price |
$815.19
|
| Rate for Payer: Cigna All Commercial |
$1,134.69
|
| Rate for Payer: CORVEL All Commercial |
$1,222.78
|
| Rate for Payer: Coventry All Commercial |
$1,157.04
|
| Rate for Payer: Encore All Commercial |
$1,210.29
|
| Rate for Payer: Frontpath All Commercial |
$1,209.64
|
| Rate for Payer: Humana ChoiceCare |
$1,135.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,183.34
|
| Rate for Payer: PHCS All Commercial |
$986.12
|
| Rate for Payer: PHP All Commercial |
$997.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,015.04
|
| Rate for Payer: Signature Care EPO |
$1,091.30
|
| Rate for Payer: Signature Care PPO |
$1,157.04
|
| Rate for Payer: United Healthcare Commercial |
$1,036.08
|
|
|
HC EXTRACTABLE NUC AG
|
Facility
|
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
|
|
HC EXTRACTABLE NUC AG
|
Facility
|
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.48
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Centivo All Commercial |
$79.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$79.35
|
| Rate for Payer: Lucent All Commercial |
$79.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
| Rate for Payer: United Healthcare Medicare |
$51.34
|
|
|
HC EXTRACTOR VACUUM
|
Facility
|
OP
|
$224.07
|
|
| Hospital Charge Code |
41603542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$208.39 |
| Rate for Payer: Aetna Commercial |
$189.12
|
| Rate for Payer: Aetna Medicare |
$73.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.34
|
| Rate for Payer: Cash Price |
$138.92
|
| Rate for Payer: Cash Price |
$138.92
|
| Rate for Payer: Centivo All Commercial |
$114.28
|
| Rate for Payer: Cigna All Commercial |
$193.37
|
| Rate for Payer: CORVEL All Commercial |
$208.39
|
| Rate for Payer: Coventry All Commercial |
$197.18
|
| Rate for Payer: Encore All Commercial |
$206.26
|
| Rate for Payer: Frontpath All Commercial |
$206.14
|
| Rate for Payer: Humana ChoiceCare |
$193.53
|
| Rate for Payer: Humana Medicare |
$114.28
|
| Rate for Payer: Lucent All Commercial |
$114.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$168.05
|
| Rate for Payer: PHP All Commercial |
$169.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.39
|
| Rate for Payer: Sagamore Health Network All Products |
$172.98
|
| Rate for Payer: Signature Care EPO |
$185.98
|
| Rate for Payer: Signature Care PPO |
$197.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$190.46
|
| Rate for Payer: United Healthcare Commercial |
$176.57
|
| Rate for Payer: United Healthcare Medicare |
$73.94
|
|
