|
HC CT PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
1662194
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$149.54 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$962.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$149.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$149.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,107.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,059.17
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Centivo All Commercial |
$1,636.90
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$962.88
|
| Rate for Payer: Lucent All Commercial |
$1,636.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$149.54
|
| Rate for Payer: MDWise Medicaid |
$149.54
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$962.88
|
|
|
HC C TRACHOMATIS-AMP PROBE
|
Facility
|
OP
|
$138.74
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$129.03 |
| Rate for Payer: Aetna Commercial |
$117.10
|
| Rate for Payer: Aetna Medicare |
$44.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.84
|
| Rate for Payer: Cash Price |
$83.24
|
| Rate for Payer: Cash Price |
$83.24
|
| Rate for Payer: Centivo All Commercial |
$75.47
|
| Rate for Payer: Cigna All Commercial |
$119.73
|
| Rate for Payer: CORVEL All Commercial |
$129.03
|
| Rate for Payer: Coventry All Commercial |
$122.09
|
| Rate for Payer: Encore All Commercial |
$127.71
|
| Rate for Payer: Frontpath All Commercial |
$127.64
|
| Rate for Payer: Humana ChoiceCare |
$119.83
|
| Rate for Payer: Humana Medicare |
$44.40
|
| Rate for Payer: Lucent All Commercial |
$75.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.87
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$104.06
|
| Rate for Payer: PHP All Commercial |
$105.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.11
|
| Rate for Payer: Sagamore Health Network All Products |
$107.11
|
| Rate for Payer: Signature Care EPO |
$115.15
|
| Rate for Payer: Signature Care PPO |
$122.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.93
|
| Rate for Payer: United Healthcare Commercial |
$109.33
|
| Rate for Payer: United Healthcare Medicare |
$44.40
|
|
|
HC C TRACHOMATIS-AMP PROBE
|
Facility
|
IP
|
$138.74
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$129.03 |
| Rate for Payer: Aetna Commercial |
$119.87
|
| Rate for Payer: Cash Price |
$83.24
|
| Rate for Payer: Cigna All Commercial |
$119.73
|
| Rate for Payer: CORVEL All Commercial |
$129.03
|
| Rate for Payer: Coventry All Commercial |
$122.09
|
| Rate for Payer: Encore All Commercial |
$127.71
|
| Rate for Payer: Frontpath All Commercial |
$127.64
|
| Rate for Payer: Humana ChoiceCare |
$119.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.87
|
| Rate for Payer: PHCS All Commercial |
$104.06
|
| Rate for Payer: PHP All Commercial |
$105.22
|
| Rate for Payer: Sagamore Health Network All Products |
$107.11
|
| Rate for Payer: Signature Care EPO |
$115.15
|
| Rate for Payer: Signature Care PPO |
$122.09
|
| Rate for Payer: United Healthcare Commercial |
$109.33
|
|
|
HC CT THORACIC SPINE W/CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
1662129
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$124.02 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,170.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,274.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$124.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$124.02
|
| Rate for Payer: MDWise Medicaid |
$124.02
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$652.47
|
|
|
HC CT THORACIC SPINE W/CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
1662129
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT THORACIC SPINE W/O CONTRAST
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
1662149
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT THORACIC SPINE W/O CONTRAST
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
1662149
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$98.51 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$554.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$98.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$638.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$610.37
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Centivo All Commercial |
$943.30
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$554.88
|
| Rate for Payer: Lucent All Commercial |
$943.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$98.51
|
| Rate for Payer: MDWise Medicaid |
$98.51
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$554.88
|
|
|
HC CT THORACIC SPINE W/WO CONTRST
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
1662130
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$156.47 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$962.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$156.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$156.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,107.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,059.17
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Centivo All Commercial |
$1,636.90
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$962.88
|
| Rate for Payer: Lucent All Commercial |
$1,636.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$156.47
|
| Rate for Payer: MDWise Medicaid |
$156.47
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$962.88
|
|
|
HC CT THORACIC SPINE W/WO CONTRST
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
1662130
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CT UPPER EXT W/CONTRAST BI
|
Facility
|
OP
|
$2,856.00
|
|
|
Service Code
|
CPT 73201 50
|
| Hospital Charge Code |
21663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$2,656.08 |
| Rate for Payer: Aetna Commercial |
$2,410.46
|
| Rate for Payer: Aetna Medicare |
$913.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$885.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,051.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,005.31
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Centivo All Commercial |
$1,553.66
|
| Rate for Payer: Cigna All Commercial |
$2,464.73
|
| Rate for Payer: CORVEL All Commercial |
$2,656.08
|
| Rate for Payer: Coventry All Commercial |
$2,513.28
|
| Rate for Payer: Encore All Commercial |
$2,628.95
|
| Rate for Payer: Frontpath All Commercial |
$2,627.52
|
| Rate for Payer: Humana ChoiceCare |
$2,466.73
|
| Rate for Payer: Humana Medicare |
$913.92
|
| Rate for Payer: Lucent All Commercial |
$1,553.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,570.40
|
| Rate for Payer: Managed Health Services Medicaid |
$122.04
|
| Rate for Payer: MDWise Medicaid |
$122.04
|
| Rate for Payer: PHCS All Commercial |
$2,142.00
|
| Rate for Payer: PHP All Commercial |
$2,165.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,113.84
|
| Rate for Payer: Sagamore Health Network All Products |
$2,204.83
|
| Rate for Payer: Signature Care EPO |
$2,370.48
|
| Rate for Payer: Signature Care PPO |
$2,513.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,427.60
|
| Rate for Payer: United Healthcare Commercial |
$2,250.53
|
| Rate for Payer: United Healthcare Medicare |
$913.92
|
|
|
HC CT UPPER EXT W/CONTRAST BI
|
Facility
|
IP
|
$2,856.00
|
|
|
Service Code
|
CPT 73201 50
|
| Hospital Charge Code |
21663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,142.00 |
| Max. Negotiated Rate |
$2,656.08 |
| Rate for Payer: Aetna Commercial |
$2,467.58
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cigna All Commercial |
$2,464.73
|
| Rate for Payer: CORVEL All Commercial |
$2,656.08
|
| Rate for Payer: Coventry All Commercial |
$2,513.28
|
| Rate for Payer: Encore All Commercial |
$2,628.95
|
| Rate for Payer: Frontpath All Commercial |
$2,627.52
|
| Rate for Payer: Humana ChoiceCare |
$2,466.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,570.40
|
| Rate for Payer: PHCS All Commercial |
$2,142.00
|
| Rate for Payer: PHP All Commercial |
$2,165.99
|
| Rate for Payer: Sagamore Health Network All Products |
$2,204.83
|
| Rate for Payer: Signature Care EPO |
$2,370.48
|
| Rate for Payer: Signature Care PPO |
$2,513.28
|
| Rate for Payer: United Healthcare Commercial |
$2,250.53
|
|
|
HC CT UPPER EXT W/CONTRAST LT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
1663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$122.04
|
| Rate for Payer: MDWise Medicaid |
$122.04
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$652.47
|
|
|
HC CT UPPER EXT W/CONTRAST LT
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
1663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT UPPER EXT W/CONTRAST RT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
11663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$122.04
|
| Rate for Payer: MDWise Medicaid |
$122.04
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$652.47
|
|
|
HC CT UPPER EXT W/CONTRAST RT
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
11663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT UPPER EXT W/O CONTRAST BI
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 73200 50
|
| Hospital Charge Code |
21663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
|
|
HC CT UPPER EXT W/O CONTRAST BI
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 73200 50
|
| Hospital Charge Code |
21663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,152.20
|
| Rate for Payer: Aetna Medicare |
$816.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$790.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$938.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$897.60
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Centivo All Commercial |
$1,387.20
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Humana Medicare |
$816.00
|
| Rate for Payer: Lucent All Commercial |
$1,387.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: Managed Health Services Medicaid |
$97.76
|
| Rate for Payer: MDWise Medicaid |
$97.76
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,167.50
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
| Rate for Payer: United Healthcare Medicare |
$816.00
|
|
|
HC CT UPPER EXT W/O CONTRAST LT
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
1663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$554.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$638.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$610.37
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Centivo All Commercial |
$943.30
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$554.88
|
| Rate for Payer: Lucent All Commercial |
$943.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$97.76
|
| Rate for Payer: MDWise Medicaid |
$97.76
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$554.88
|
|
|
HC CT UPPER EXT W/O CONTRAST LT
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
1663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT UPPER EXT W/O CONTRAST RT
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
11663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$554.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$638.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$610.37
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Centivo All Commercial |
$943.30
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$554.88
|
| Rate for Payer: Lucent All Commercial |
$943.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$97.76
|
| Rate for Payer: MDWise Medicaid |
$97.76
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$554.88
|
|
|
HC CT UPPER EXT W/O CONTRAST RT
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
11663200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CUFF TOURNIQUET 18 IN
|
Facility
|
OP
|
$135.56
|
|
| Hospital Charge Code |
41601245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$126.07 |
| Rate for Payer: Aetna Commercial |
$114.41
|
| Rate for Payer: Aetna Medicare |
$43.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$84.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.72
|
| Rate for Payer: Cash Price |
$81.34
|
| Rate for Payer: Cash Price |
$81.34
|
| Rate for Payer: Centivo All Commercial |
$73.74
|
| Rate for Payer: Cigna All Commercial |
$116.99
|
| Rate for Payer: CORVEL All Commercial |
$126.07
|
| Rate for Payer: Coventry All Commercial |
$119.29
|
| Rate for Payer: Encore All Commercial |
$124.78
|
| Rate for Payer: Frontpath All Commercial |
$124.72
|
| Rate for Payer: Humana ChoiceCare |
$117.08
|
| Rate for Payer: Humana Medicare |
$43.38
|
| Rate for Payer: Lucent All Commercial |
$73.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$101.67
|
| Rate for Payer: PHP All Commercial |
$102.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.87
|
| Rate for Payer: Sagamore Health Network All Products |
$104.65
|
| Rate for Payer: Signature Care EPO |
$112.51
|
| Rate for Payer: Signature Care PPO |
$119.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.23
|
| Rate for Payer: United Healthcare Commercial |
$106.82
|
| Rate for Payer: United Healthcare Medicare |
$43.38
|
|
|
HC CUFF TOURNIQUET 18 IN
|
Facility
|
IP
|
$135.56
|
|
| Hospital Charge Code |
41601245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.67 |
| Max. Negotiated Rate |
$126.07 |
| Rate for Payer: Aetna Commercial |
$117.12
|
| Rate for Payer: Cash Price |
$81.34
|
| Rate for Payer: Cigna All Commercial |
$116.99
|
| Rate for Payer: CORVEL All Commercial |
$126.07
|
| Rate for Payer: Coventry All Commercial |
$119.29
|
| Rate for Payer: Encore All Commercial |
$124.78
|
| Rate for Payer: Frontpath All Commercial |
$124.72
|
| Rate for Payer: Humana ChoiceCare |
$117.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: PHCS All Commercial |
$101.67
|
| Rate for Payer: PHP All Commercial |
$102.81
|
| Rate for Payer: Sagamore Health Network All Products |
$104.65
|
| Rate for Payer: Signature Care EPO |
$112.51
|
| Rate for Payer: Signature Care PPO |
$119.29
|
| Rate for Payer: United Healthcare Commercial |
$106.82
|
|
|
HC CUFF TOURNIQUET 24 IN
|
Facility
|
IP
|
$151.03
|
|
| Hospital Charge Code |
41601247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.27 |
| Max. Negotiated Rate |
$140.46 |
| Rate for Payer: Aetna Commercial |
$130.49
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Cigna All Commercial |
$130.34
|
| Rate for Payer: CORVEL All Commercial |
$140.46
|
| Rate for Payer: Coventry All Commercial |
$132.91
|
| Rate for Payer: Encore All Commercial |
$139.02
|
| Rate for Payer: Frontpath All Commercial |
$138.95
|
| Rate for Payer: Humana ChoiceCare |
$130.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.93
|
| Rate for Payer: PHCS All Commercial |
$113.27
|
| Rate for Payer: PHP All Commercial |
$114.54
|
| Rate for Payer: Sagamore Health Network All Products |
$116.60
|
| Rate for Payer: Signature Care EPO |
$125.35
|
| Rate for Payer: Signature Care PPO |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$119.01
|
|
|
HC CUFF TOURNIQUET 24 IN
|
Facility
|
OP
|
$151.03
|
|
| Hospital Charge Code |
41601247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.46 |
| Rate for Payer: Aetna Commercial |
$127.47
|
| Rate for Payer: Aetna Medicare |
$48.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.16
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Centivo All Commercial |
$82.16
|
| Rate for Payer: Cigna All Commercial |
$130.34
|
| Rate for Payer: CORVEL All Commercial |
$140.46
|
| Rate for Payer: Coventry All Commercial |
$132.91
|
| Rate for Payer: Encore All Commercial |
$139.02
|
| Rate for Payer: Frontpath All Commercial |
$138.95
|
| Rate for Payer: Humana ChoiceCare |
$130.44
|
| Rate for Payer: Humana Medicare |
$48.33
|
| Rate for Payer: Lucent All Commercial |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.93
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$113.27
|
| Rate for Payer: PHP All Commercial |
$114.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.90
|
| Rate for Payer: Sagamore Health Network All Products |
$116.60
|
| Rate for Payer: Signature Care EPO |
$125.35
|
| Rate for Payer: Signature Care PPO |
$132.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.38
|
| Rate for Payer: United Healthcare Commercial |
$119.01
|
| Rate for Payer: United Healthcare Medicare |
$48.33
|
|
