|
HC GAIT TRAINING/15 MIN-PT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
01728036
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC GAIT TRAINING/15 MIN-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
01728036
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC GASTRIC EMPTYING
|
Facility
IP
|
$2,092.86
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
01638453
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,569.64 |
| Max. Negotiated Rate |
$1,946.36 |
| Rate for Payer: Aetna Commercial |
$1,808.23
|
| Rate for Payer: Cash Price |
$1,297.57
|
| Rate for Payer: Cigna All Commercial |
$1,806.14
|
| Rate for Payer: CORVEL All Commercial |
$1,946.36
|
| Rate for Payer: Coventry All Commercial |
$1,841.71
|
| Rate for Payer: Encore All Commercial |
$1,926.47
|
| Rate for Payer: Frontpath All Commercial |
$1,925.43
|
| Rate for Payer: Humana ChoiceCare |
$1,807.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,883.57
|
| Rate for Payer: PHCS All Commercial |
$1,569.64
|
| Rate for Payer: PHP All Commercial |
$1,587.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,615.69
|
| Rate for Payer: Signature Care EPO |
$1,737.07
|
| Rate for Payer: Signature Care PPO |
$1,841.71
|
| Rate for Payer: United Healthcare Commercial |
$1,649.17
|
|
|
HC GASTRIC EMPTYING
|
Facility
OP
|
$2,092.86
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
01638453
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$690.64 |
| Max. Negotiated Rate |
$1,946.36 |
| Rate for Payer: Aetna Commercial |
$1,766.37
|
| Rate for Payer: Aetna Medicare |
$690.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$690.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,201.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,308.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$840.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$794.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$759.71
|
| Rate for Payer: Cash Price |
$1,297.57
|
| Rate for Payer: Cash Price |
$1,297.57
|
| Rate for Payer: Centivo All Commercial |
$1,067.36
|
| Rate for Payer: Cigna All Commercial |
$1,806.14
|
| Rate for Payer: CORVEL All Commercial |
$1,946.36
|
| Rate for Payer: Coventry All Commercial |
$1,841.71
|
| Rate for Payer: Encore All Commercial |
$1,926.47
|
| Rate for Payer: Frontpath All Commercial |
$1,925.43
|
| Rate for Payer: Humana ChoiceCare |
$1,807.60
|
| Rate for Payer: Humana Medicare |
$1,067.36
|
| Rate for Payer: Lucent All Commercial |
$1,067.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,883.57
|
| Rate for Payer: Managed Health Services Medicaid |
$840.18
|
| Rate for Payer: MDWise Medicaid |
$840.18
|
| Rate for Payer: PHCS All Commercial |
$1,569.64
|
| Rate for Payer: PHP All Commercial |
$1,587.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$816.21
|
| Rate for Payer: Sagamore Health Network All Products |
$1,615.69
|
| Rate for Payer: Signature Care EPO |
$1,737.07
|
| Rate for Payer: Signature Care PPO |
$1,841.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,778.93
|
| Rate for Payer: United Healthcare Commercial |
$1,649.17
|
| Rate for Payer: United Healthcare Medicare |
$690.64
|
|
|
HC GASTRIN
|
Facility
OP
|
$220.09
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
63001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$204.68 |
| Rate for Payer: Aetna Commercial |
$185.75
|
| Rate for Payer: Aetna Medicare |
$72.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$126.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$137.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.89
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Centivo All Commercial |
$112.24
|
| Rate for Payer: Cigna All Commercial |
$189.93
|
| Rate for Payer: CORVEL All Commercial |
$204.68
|
| Rate for Payer: Coventry All Commercial |
$193.68
|
| Rate for Payer: Encore All Commercial |
$202.59
|
| Rate for Payer: Frontpath All Commercial |
$202.48
|
| Rate for Payer: Humana ChoiceCare |
$190.09
|
| Rate for Payer: Humana Medicare |
$112.24
|
| Rate for Payer: Lucent All Commercial |
$112.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.08
|
| Rate for Payer: Managed Health Services Medicaid |
$17.63
|
| Rate for Payer: MDWise Medicaid |
$17.63
|
| Rate for Payer: PHCS All Commercial |
$165.06
|
| Rate for Payer: PHP All Commercial |
$166.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.83
|
| Rate for Payer: Sagamore Health Network All Products |
$169.91
|
| Rate for Payer: Signature Care EPO |
$182.67
|
| Rate for Payer: Signature Care PPO |
$193.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.07
|
| Rate for Payer: United Healthcare Commercial |
$173.43
|
| Rate for Payer: United Healthcare Medicare |
$72.63
|
|
|
HC GASTRIN
|
Facility
IP
|
$220.09
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
63001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.06 |
| Max. Negotiated Rate |
$204.68 |
| Rate for Payer: Aetna Commercial |
$190.15
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna All Commercial |
$189.93
|
| Rate for Payer: CORVEL All Commercial |
$204.68
|
| Rate for Payer: Coventry All Commercial |
$193.68
|
| Rate for Payer: Encore All Commercial |
$202.59
|
| Rate for Payer: Frontpath All Commercial |
$202.48
|
| Rate for Payer: Humana ChoiceCare |
$190.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.08
|
| Rate for Payer: PHCS All Commercial |
$165.06
|
| Rate for Payer: PHP All Commercial |
$166.91
|
| Rate for Payer: Sagamore Health Network All Products |
$169.91
|
| Rate for Payer: Signature Care EPO |
$182.67
|
| Rate for Payer: Signature Care PPO |
$193.68
|
| Rate for Payer: United Healthcare Commercial |
$173.43
|
|
|
HC GASTROCCULT
|
Facility
OP
|
$71.53
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
63001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$66.53 |
| Rate for Payer: Aetna Commercial |
$60.37
|
| Rate for Payer: Aetna Medicare |
$23.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.97
|
| Rate for Payer: Cash Price |
$44.35
|
| Rate for Payer: Cash Price |
$44.35
|
| Rate for Payer: Centivo All Commercial |
$36.48
|
| Rate for Payer: Cigna All Commercial |
$61.73
|
| Rate for Payer: CORVEL All Commercial |
$66.53
|
| Rate for Payer: Coventry All Commercial |
$62.95
|
| Rate for Payer: Encore All Commercial |
$65.85
|
| Rate for Payer: Frontpath All Commercial |
$65.81
|
| Rate for Payer: Humana ChoiceCare |
$61.78
|
| Rate for Payer: Humana Medicare |
$36.48
|
| Rate for Payer: Lucent All Commercial |
$36.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.38
|
| Rate for Payer: Managed Health Services Medicaid |
$4.43
|
| Rate for Payer: MDWise Medicaid |
$4.43
|
| Rate for Payer: PHCS All Commercial |
$53.65
|
| Rate for Payer: PHP All Commercial |
$54.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.90
|
| Rate for Payer: Sagamore Health Network All Products |
$55.22
|
| Rate for Payer: Signature Care EPO |
$59.37
|
| Rate for Payer: Signature Care PPO |
$62.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.80
|
| Rate for Payer: United Healthcare Commercial |
$56.37
|
| Rate for Payer: United Healthcare Medicare |
$23.61
|
|
|
HC GASTROCCULT
|
Facility
IP
|
$71.53
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
63001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.65 |
| Max. Negotiated Rate |
$66.53 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: Cash Price |
$44.35
|
| Rate for Payer: Cigna All Commercial |
$61.73
|
| Rate for Payer: CORVEL All Commercial |
$66.53
|
| Rate for Payer: Coventry All Commercial |
$62.95
|
| Rate for Payer: Encore All Commercial |
$65.85
|
| Rate for Payer: Frontpath All Commercial |
$65.81
|
| Rate for Payer: Humana ChoiceCare |
$61.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.38
|
| Rate for Payer: PHCS All Commercial |
$53.65
|
| Rate for Payer: PHP All Commercial |
$54.25
|
| Rate for Payer: Sagamore Health Network All Products |
$55.22
|
| Rate for Payer: Signature Care EPO |
$59.37
|
| Rate for Payer: Signature Care PPO |
$62.95
|
| Rate for Payer: United Healthcare Commercial |
$56.37
|
|
|
HC GASTROGRAFIN 12X120ML
|
Facility
OP
|
$113.75
|
|
| Hospital Charge Code |
41602207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.54 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$96.00
|
| Rate for Payer: Aetna Medicare |
$37.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.29
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Centivo All Commercial |
$58.01
|
| Rate for Payer: Cigna All Commercial |
$98.17
|
| Rate for Payer: CORVEL All Commercial |
$105.79
|
| Rate for Payer: Coventry All Commercial |
$100.10
|
| Rate for Payer: Encore All Commercial |
$104.71
|
| Rate for Payer: Frontpath All Commercial |
$104.65
|
| Rate for Payer: Humana ChoiceCare |
$98.25
|
| Rate for Payer: Humana Medicare |
$58.01
|
| Rate for Payer: Lucent All Commercial |
$58.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$85.31
|
| Rate for Payer: PHP All Commercial |
$86.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.36
|
| Rate for Payer: Sagamore Health Network All Products |
$87.82
|
| Rate for Payer: Signature Care EPO |
$94.41
|
| Rate for Payer: Signature Care PPO |
$100.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.69
|
| Rate for Payer: United Healthcare Commercial |
$89.64
|
| Rate for Payer: United Healthcare Medicare |
$37.54
|
|
|
HC GASTROGRAFIN 12X120ML
|
Facility
IP
|
$113.75
|
|
| Hospital Charge Code |
41602207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.31 |
| Max. Negotiated Rate |
$105.79 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cigna All Commercial |
$98.17
|
| Rate for Payer: CORVEL All Commercial |
$105.79
|
| Rate for Payer: Coventry All Commercial |
$100.10
|
| Rate for Payer: Encore All Commercial |
$104.71
|
| Rate for Payer: Frontpath All Commercial |
$104.65
|
| Rate for Payer: Humana ChoiceCare |
$98.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.38
|
| Rate for Payer: PHCS All Commercial |
$85.31
|
| Rate for Payer: PHP All Commercial |
$86.27
|
| Rate for Payer: Sagamore Health Network All Products |
$87.82
|
| Rate for Payer: Signature Care EPO |
$94.41
|
| Rate for Payer: Signature Care PPO |
$100.10
|
| Rate for Payer: United Healthcare Commercial |
$89.64
|
|
|
HC GASTROINTESTINAL PROFILE, STOOL, PCR
|
Facility
OP
|
$1,081.93
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
63044048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$357.04 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Aetna Commercial |
$913.15
|
| Rate for Payer: Aetna Medicare |
$357.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$621.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$676.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$416.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$410.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$392.74
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Centivo All Commercial |
$551.79
|
| Rate for Payer: Cigna All Commercial |
$933.71
|
| Rate for Payer: CORVEL All Commercial |
$1,006.20
|
| Rate for Payer: Coventry All Commercial |
$952.10
|
| Rate for Payer: Encore All Commercial |
$995.92
|
| Rate for Payer: Frontpath All Commercial |
$995.38
|
| Rate for Payer: Humana ChoiceCare |
$934.47
|
| Rate for Payer: Humana Medicare |
$551.79
|
| Rate for Payer: Lucent All Commercial |
$551.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$973.74
|
| Rate for Payer: Managed Health Services Medicaid |
$416.78
|
| Rate for Payer: MDWise Medicaid |
$416.78
|
| Rate for Payer: PHCS All Commercial |
$811.45
|
| Rate for Payer: PHP All Commercial |
$820.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$421.95
|
| Rate for Payer: Sagamore Health Network All Products |
$835.25
|
| Rate for Payer: Signature Care EPO |
$898.01
|
| Rate for Payer: Signature Care PPO |
$952.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$919.64
|
| Rate for Payer: United Healthcare Commercial |
$852.56
|
| Rate for Payer: United Healthcare Medicare |
$357.04
|
|
|
HC GASTROINTESTINAL PROFILE, STOOL, PCR
|
Facility
IP
|
$1,081.93
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
63044048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$811.45 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Aetna Commercial |
$934.79
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cigna All Commercial |
$933.71
|
| Rate for Payer: CORVEL All Commercial |
$1,006.20
|
| Rate for Payer: Coventry All Commercial |
$952.10
|
| Rate for Payer: Encore All Commercial |
$995.92
|
| Rate for Payer: Frontpath All Commercial |
$995.38
|
| Rate for Payer: Humana ChoiceCare |
$934.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$973.74
|
| Rate for Payer: PHCS All Commercial |
$811.45
|
| Rate for Payer: PHP All Commercial |
$820.54
|
| Rate for Payer: Sagamore Health Network All Products |
$835.25
|
| Rate for Payer: Signature Care EPO |
$898.01
|
| Rate for Payer: Signature Care PPO |
$952.10
|
| Rate for Payer: United Healthcare Commercial |
$852.56
|
|
|
HC GATED HEART STUDY-SINGLE STUDY
|
Facility
OP
|
$2,285.85
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
01638452
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$501.38 |
| Max. Negotiated Rate |
$2,125.84 |
| Rate for Payer: Aetna Commercial |
$1,929.26
|
| Rate for Payer: Aetna Medicare |
$754.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$754.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,312.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,428.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$501.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$867.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$829.76
|
| Rate for Payer: Cash Price |
$1,417.23
|
| Rate for Payer: Cash Price |
$1,417.23
|
| Rate for Payer: Centivo All Commercial |
$1,165.78
|
| Rate for Payer: Cigna All Commercial |
$1,972.69
|
| Rate for Payer: CORVEL All Commercial |
$2,125.84
|
| Rate for Payer: Coventry All Commercial |
$2,011.55
|
| Rate for Payer: Encore All Commercial |
$2,104.13
|
| Rate for Payer: Frontpath All Commercial |
$2,102.98
|
| Rate for Payer: Humana ChoiceCare |
$1,974.29
|
| Rate for Payer: Humana Medicare |
$1,165.78
|
| Rate for Payer: Lucent All Commercial |
$1,165.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,057.27
|
| Rate for Payer: Managed Health Services Medicaid |
$501.38
|
| Rate for Payer: MDWise Medicaid |
$501.38
|
| Rate for Payer: PHCS All Commercial |
$1,714.39
|
| Rate for Payer: PHP All Commercial |
$1,733.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$891.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,764.68
|
| Rate for Payer: Signature Care EPO |
$1,897.26
|
| Rate for Payer: Signature Care PPO |
$2,011.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,942.97
|
| Rate for Payer: United Healthcare Commercial |
$1,801.25
|
| Rate for Payer: United Healthcare Medicare |
$754.33
|
|
|
HC GATED HEART STUDY-SINGLE STUDY
|
Facility
IP
|
$2,285.85
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
01638452
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,714.39 |
| Max. Negotiated Rate |
$2,125.84 |
| Rate for Payer: Aetna Commercial |
$1,974.97
|
| Rate for Payer: Cash Price |
$1,417.23
|
| Rate for Payer: Cigna All Commercial |
$1,972.69
|
| Rate for Payer: CORVEL All Commercial |
$2,125.84
|
| Rate for Payer: Coventry All Commercial |
$2,011.55
|
| Rate for Payer: Encore All Commercial |
$2,104.13
|
| Rate for Payer: Frontpath All Commercial |
$2,102.98
|
| Rate for Payer: Humana ChoiceCare |
$1,974.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,057.27
|
| Rate for Payer: PHCS All Commercial |
$1,714.39
|
| Rate for Payer: PHP All Commercial |
$1,733.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,764.68
|
| Rate for Payer: Signature Care EPO |
$1,897.26
|
| Rate for Payer: Signature Care PPO |
$2,011.55
|
| Rate for Payer: United Healthcare Commercial |
$1,801.25
|
|
|
HC GCATH 7F ACU PRO 60CM CSIC 130
|
Facility
OP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$775.42
|
| Rate for Payer: Aetna Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$527.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$574.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$348.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$333.51
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Centivo All Commercial |
$468.56
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Humana Medicare |
$468.56
|
| Rate for Payer: Lucent All Commercial |
$468.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.31
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$780.94
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
| Rate for Payer: United Healthcare Medicare |
$303.19
|
|
|
HC GCATH 7F ACU PRO 60CM CSIC 130
|
Facility
IP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.06 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$793.80
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
|
|
HC GCATH 7F ACU PRO 60CM CSIC 90
|
Facility
OP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$775.42
|
| Rate for Payer: Aetna Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$527.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$574.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$348.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$333.51
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Centivo All Commercial |
$468.56
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Humana Medicare |
$468.56
|
| Rate for Payer: Lucent All Commercial |
$468.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.31
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$780.94
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
| Rate for Payer: United Healthcare Medicare |
$303.19
|
|
|
HC GCATH 7F ACU PRO 60CM CSIC 90
|
Facility
IP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.06 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$793.80
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
|
|
HC GCATH 7F ACU PRO 69CM CSIC 130
|
Facility
OP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$775.42
|
| Rate for Payer: Aetna Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$527.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$574.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$348.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$333.51
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Centivo All Commercial |
$468.56
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Humana Medicare |
$468.56
|
| Rate for Payer: Lucent All Commercial |
$468.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.31
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$780.94
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
| Rate for Payer: United Healthcare Medicare |
$303.19
|
|
|
HC GCATH 7F ACU PRO 69CM CSIC 130
|
Facility
IP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.06 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$793.80
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
|
|
HC GCATH 7F ACU PRO 69CM CSIC 90
|
Facility
OP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$775.42
|
| Rate for Payer: Aetna Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$303.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$527.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$574.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$348.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$333.51
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Centivo All Commercial |
$468.56
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Humana Medicare |
$468.56
|
| Rate for Payer: Lucent All Commercial |
$468.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.31
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$780.94
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
| Rate for Payer: United Healthcare Medicare |
$303.19
|
|
|
HC GCATH 7F ACU PRO 69CM CSIC 90
|
Facility
IP
|
$918.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.06 |
| Max. Negotiated Rate |
$854.44 |
| Rate for Payer: Aetna Commercial |
$793.80
|
| Rate for Payer: Cash Price |
$569.63
|
| Rate for Payer: Cigna All Commercial |
$792.88
|
| Rate for Payer: CORVEL All Commercial |
$854.44
|
| Rate for Payer: Coventry All Commercial |
$808.50
|
| Rate for Payer: Encore All Commercial |
$845.71
|
| Rate for Payer: Frontpath All Commercial |
$845.25
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$826.88
|
| Rate for Payer: PHCS All Commercial |
$689.06
|
| Rate for Payer: PHP All Commercial |
$696.78
|
| Rate for Payer: Sagamore Health Network All Products |
$709.28
|
| Rate for Payer: Signature Care EPO |
$762.56
|
| Rate for Payer: Signature Care PPO |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$723.98
|
|
|
HC GCATH 9F ACU PRO 45CM CSA6
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
|
HC GCATH 9F ACU PRO 45CM CSA6
|
Facility
OP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,566.68
|
| Rate for Payer: Aetna Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.82
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Centivo All Commercial |
$946.69
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Humana Medicare |
$946.69
|
| Rate for Payer: Lucent All Commercial |
$946.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$723.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.81
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
| Rate for Payer: United Healthcare Medicare |
$612.56
|
|
|
HC GCATH 9F ACU PRO 45CM CSEH
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
