|
HC GLOVE ISOTONER LT/MED
|
Facility
OP
|
$31.57
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41601891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.46
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Centivo All Commercial |
$16.10
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Humana Medicare |
$16.10
|
| Rate for Payer: Lucent All Commercial |
$16.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.31
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.83
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
| Rate for Payer: United Healthcare Medicare |
$10.42
|
|
|
HC GLOVE ISOTONER LT/MED
|
Facility
IP
|
$31.57
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41601891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
|
|
HC GLOVE ISOTONER LT/SM
|
Facility
OP
|
$31.57
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41601889
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.46
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Centivo All Commercial |
$16.10
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Humana Medicare |
$16.10
|
| Rate for Payer: Lucent All Commercial |
$16.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.31
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.83
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
| Rate for Payer: United Healthcare Medicare |
$10.42
|
|
|
HC GLOVE ISOTONER LT/SM
|
Facility
IP
|
$31.57
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41601889
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
|
|
HC GLOVE ISOTONER RT/LG
|
Facility
IP
|
$41.79
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603872
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$36.11
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Cigna All Commercial |
$36.06
|
| Rate for Payer: CORVEL All Commercial |
$38.86
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.47
|
| Rate for Payer: Frontpath All Commercial |
$38.45
|
| Rate for Payer: Humana ChoiceCare |
$36.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.61
|
| Rate for Payer: PHCS All Commercial |
$31.34
|
| Rate for Payer: PHP All Commercial |
$31.69
|
| Rate for Payer: Sagamore Health Network All Products |
$32.26
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
|
|
HC GLOVE ISOTONER RT/LG
|
Facility
OP
|
$41.79
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603872
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Centivo All Commercial |
$21.31
|
| Rate for Payer: Cigna All Commercial |
$36.06
|
| Rate for Payer: CORVEL All Commercial |
$38.86
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.47
|
| Rate for Payer: Frontpath All Commercial |
$38.45
|
| Rate for Payer: Humana ChoiceCare |
$36.09
|
| Rate for Payer: Humana Medicare |
$21.31
|
| Rate for Payer: Lucent All Commercial |
$21.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.61
|
| Rate for Payer: PHCS All Commercial |
$31.34
|
| Rate for Payer: PHP All Commercial |
$31.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.26
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.52
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC GLOVE ISOTONER RT/MED
|
Facility
OP
|
$31.57
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41601890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.46
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Centivo All Commercial |
$16.10
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Humana Medicare |
$16.10
|
| Rate for Payer: Lucent All Commercial |
$16.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.31
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.83
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
| Rate for Payer: United Healthcare Medicare |
$10.42
|
|
|
HC GLOVE ISOTONER RT/MED
|
Facility
IP
|
$31.57
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41601890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
|
|
HC GLOVE ISOTONER RT/SM
|
Facility
IP
|
$41.79
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603874
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$36.11
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Cigna All Commercial |
$36.06
|
| Rate for Payer: CORVEL All Commercial |
$38.86
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.47
|
| Rate for Payer: Frontpath All Commercial |
$38.45
|
| Rate for Payer: Humana ChoiceCare |
$36.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.61
|
| Rate for Payer: PHCS All Commercial |
$31.34
|
| Rate for Payer: PHP All Commercial |
$31.69
|
| Rate for Payer: Sagamore Health Network All Products |
$32.26
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
|
|
HC GLOVE ISOTONER RT/SM
|
Facility
OP
|
$41.79
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603874
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Centivo All Commercial |
$21.31
|
| Rate for Payer: Cigna All Commercial |
$36.06
|
| Rate for Payer: CORVEL All Commercial |
$38.86
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.47
|
| Rate for Payer: Frontpath All Commercial |
$38.45
|
| Rate for Payer: Humana ChoiceCare |
$36.09
|
| Rate for Payer: Humana Medicare |
$21.31
|
| Rate for Payer: Lucent All Commercial |
$21.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.61
|
| Rate for Payer: PHCS All Commercial |
$31.34
|
| Rate for Payer: PHP All Commercial |
$31.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.26
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.52
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC GLUCOSE 24U
|
Facility
OP
|
$77.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$72.43 |
| Rate for Payer: Aetna Commercial |
$65.73
|
| Rate for Payer: Aetna Medicare |
$25.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.27
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Centivo All Commercial |
$39.72
|
| Rate for Payer: Cigna All Commercial |
$67.21
|
| Rate for Payer: CORVEL All Commercial |
$72.43
|
| Rate for Payer: Coventry All Commercial |
$68.53
|
| Rate for Payer: Encore All Commercial |
$71.69
|
| Rate for Payer: Frontpath All Commercial |
$71.65
|
| Rate for Payer: Humana ChoiceCare |
$67.26
|
| Rate for Payer: Humana Medicare |
$39.72
|
| Rate for Payer: Lucent All Commercial |
$39.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.09
|
| Rate for Payer: Managed Health Services Medicaid |
$3.93
|
| Rate for Payer: MDWise Medicaid |
$3.93
|
| Rate for Payer: PHCS All Commercial |
$58.41
|
| Rate for Payer: PHP All Commercial |
$59.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.37
|
| Rate for Payer: Sagamore Health Network All Products |
$60.12
|
| Rate for Payer: Signature Care EPO |
$64.64
|
| Rate for Payer: Signature Care PPO |
$68.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.20
|
| Rate for Payer: United Healthcare Commercial |
$61.37
|
| Rate for Payer: United Healthcare Medicare |
$25.70
|
|
|
HC GLUCOSE 24U
|
Facility
IP
|
$77.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.41 |
| Max. Negotiated Rate |
$72.43 |
| Rate for Payer: Aetna Commercial |
$67.29
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cigna All Commercial |
$67.21
|
| Rate for Payer: CORVEL All Commercial |
$72.43
|
| Rate for Payer: Coventry All Commercial |
$68.53
|
| Rate for Payer: Encore All Commercial |
$71.69
|
| Rate for Payer: Frontpath All Commercial |
$71.65
|
| Rate for Payer: Humana ChoiceCare |
$67.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.09
|
| Rate for Payer: PHCS All Commercial |
$58.41
|
| Rate for Payer: PHP All Commercial |
$59.06
|
| Rate for Payer: Sagamore Health Network All Products |
$60.12
|
| Rate for Payer: Signature Care EPO |
$64.64
|
| Rate for Payer: Signature Care PPO |
$68.53
|
| Rate for Payer: United Healthcare Commercial |
$61.37
|
|
|
HC GLUCOSE BF
|
Facility
IP
|
$113.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$98.39
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.22
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.22
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
|
|
HC GLUCOSE BF
|
Facility
OP
|
$113.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$96.12
|
| Rate for Payer: Aetna Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.34
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Centivo All Commercial |
$58.08
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.22
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Humana Medicare |
$58.08
|
| Rate for Payer: Lucent All Commercial |
$58.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: Managed Health Services Medicaid |
$3.93
|
| Rate for Payer: MDWise Medicaid |
$3.93
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.41
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.80
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
| Rate for Payer: United Healthcare Medicare |
$37.58
|
|
|
HC GLUCOSE BLOOD
|
Facility
OP
|
$44.88
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
63001095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$41.74 |
| Rate for Payer: Aetna Commercial |
$37.88
|
| Rate for Payer: Aetna Medicare |
$14.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.29
|
| Rate for Payer: Cash Price |
$27.83
|
| Rate for Payer: Cash Price |
$27.83
|
| Rate for Payer: Centivo All Commercial |
$22.89
|
| Rate for Payer: Cigna All Commercial |
$38.73
|
| Rate for Payer: CORVEL All Commercial |
$41.74
|
| Rate for Payer: Coventry All Commercial |
$39.49
|
| Rate for Payer: Encore All Commercial |
$41.31
|
| Rate for Payer: Frontpath All Commercial |
$41.29
|
| Rate for Payer: Humana ChoiceCare |
$38.76
|
| Rate for Payer: Humana Medicare |
$22.89
|
| Rate for Payer: Lucent All Commercial |
$22.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.39
|
| Rate for Payer: Managed Health Services Medicaid |
$3.93
|
| Rate for Payer: MDWise Medicaid |
$3.93
|
| Rate for Payer: PHCS All Commercial |
$33.66
|
| Rate for Payer: PHP All Commercial |
$34.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.50
|
| Rate for Payer: Sagamore Health Network All Products |
$34.65
|
| Rate for Payer: Signature Care EPO |
$37.25
|
| Rate for Payer: Signature Care PPO |
$39.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.15
|
| Rate for Payer: United Healthcare Commercial |
$35.37
|
| Rate for Payer: United Healthcare Medicare |
$14.81
|
|
|
HC GLUCOSE BLOOD
|
Facility
IP
|
$44.88
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
63001095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$41.74 |
| Rate for Payer: Aetna Commercial |
$38.78
|
| Rate for Payer: Cash Price |
$27.83
|
| Rate for Payer: Cigna All Commercial |
$38.73
|
| Rate for Payer: CORVEL All Commercial |
$41.74
|
| Rate for Payer: Coventry All Commercial |
$39.49
|
| Rate for Payer: Encore All Commercial |
$41.31
|
| Rate for Payer: Frontpath All Commercial |
$41.29
|
| Rate for Payer: Humana ChoiceCare |
$38.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.39
|
| Rate for Payer: PHCS All Commercial |
$33.66
|
| Rate for Payer: PHP All Commercial |
$34.04
|
| Rate for Payer: Sagamore Health Network All Products |
$34.65
|
| Rate for Payer: Signature Care EPO |
$37.25
|
| Rate for Payer: Signature Care PPO |
$39.49
|
| Rate for Payer: United Healthcare Commercial |
$35.37
|
|
|
HC GLUCOSE POST DOSE
|
Facility
IP
|
$71.81
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
63001134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$62.04
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.06
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: United Healthcare Commercial |
$56.58
|
|
|
HC GLUCOSE POST DOSE
|
Facility
OP
|
$71.81
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
63001134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.61
|
| Rate for Payer: Aetna Medicare |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Centivo All Commercial |
$36.62
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.06
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Humana Medicare |
$36.62
|
| Rate for Payer: Lucent All Commercial |
$36.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: MDWise Medicaid |
$4.75
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.01
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$56.58
|
| Rate for Payer: United Healthcare Medicare |
$23.70
|
|
|
HC GLUCOSE TOLER 2HR
|
Facility
IP
|
$35.34
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
63001136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Commercial |
$30.54
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cigna All Commercial |
$30.50
|
| Rate for Payer: CORVEL All Commercial |
$32.87
|
| Rate for Payer: Coventry All Commercial |
$31.10
|
| Rate for Payer: Encore All Commercial |
$32.53
|
| Rate for Payer: Frontpath All Commercial |
$32.52
|
| Rate for Payer: Humana ChoiceCare |
$30.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.81
|
| Rate for Payer: PHCS All Commercial |
$26.51
|
| Rate for Payer: PHP All Commercial |
$26.80
|
| Rate for Payer: Sagamore Health Network All Products |
$27.28
|
| Rate for Payer: Signature Care EPO |
$29.33
|
| Rate for Payer: Signature Care PPO |
$31.10
|
| Rate for Payer: United Healthcare Commercial |
$27.85
|
|
|
HC GLUCOSE TOLER 2HR
|
Facility
OP
|
$35.34
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
63001136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Commercial |
$29.83
|
| Rate for Payer: Aetna Medicare |
$11.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.83
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Centivo All Commercial |
$18.02
|
| Rate for Payer: Cigna All Commercial |
$30.50
|
| Rate for Payer: CORVEL All Commercial |
$32.87
|
| Rate for Payer: Coventry All Commercial |
$31.10
|
| Rate for Payer: Encore All Commercial |
$32.53
|
| Rate for Payer: Frontpath All Commercial |
$32.52
|
| Rate for Payer: Humana ChoiceCare |
$30.53
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Lucent All Commercial |
$18.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.81
|
| Rate for Payer: Managed Health Services Medicaid |
$3.92
|
| Rate for Payer: MDWise Medicaid |
$3.92
|
| Rate for Payer: PHCS All Commercial |
$26.51
|
| Rate for Payer: PHP All Commercial |
$26.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.78
|
| Rate for Payer: Sagamore Health Network All Products |
$27.28
|
| Rate for Payer: Signature Care EPO |
$29.33
|
| Rate for Payer: Signature Care PPO |
$31.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.04
|
| Rate for Payer: United Healthcare Commercial |
$27.85
|
| Rate for Payer: United Healthcare Medicare |
$11.66
|
|
|
HC GLUCOSE TOLER 3HR
|
Facility
IP
|
$35.34
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
63001137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Commercial |
$30.54
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cigna All Commercial |
$30.50
|
| Rate for Payer: CORVEL All Commercial |
$32.87
|
| Rate for Payer: Coventry All Commercial |
$31.10
|
| Rate for Payer: Encore All Commercial |
$32.53
|
| Rate for Payer: Frontpath All Commercial |
$32.52
|
| Rate for Payer: Humana ChoiceCare |
$30.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.81
|
| Rate for Payer: PHCS All Commercial |
$26.51
|
| Rate for Payer: PHP All Commercial |
$26.80
|
| Rate for Payer: Sagamore Health Network All Products |
$27.28
|
| Rate for Payer: Signature Care EPO |
$29.33
|
| Rate for Payer: Signature Care PPO |
$31.10
|
| Rate for Payer: United Healthcare Commercial |
$27.85
|
|
|
HC GLUCOSE TOLER 3HR
|
Facility
OP
|
$35.34
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
63001137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Commercial |
$29.83
|
| Rate for Payer: Aetna Medicare |
$11.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.83
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Centivo All Commercial |
$18.02
|
| Rate for Payer: Cigna All Commercial |
$30.50
|
| Rate for Payer: CORVEL All Commercial |
$32.87
|
| Rate for Payer: Coventry All Commercial |
$31.10
|
| Rate for Payer: Encore All Commercial |
$32.53
|
| Rate for Payer: Frontpath All Commercial |
$32.52
|
| Rate for Payer: Humana ChoiceCare |
$30.53
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Lucent All Commercial |
$18.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.81
|
| Rate for Payer: Managed Health Services Medicaid |
$3.92
|
| Rate for Payer: MDWise Medicaid |
$3.92
|
| Rate for Payer: PHCS All Commercial |
$26.51
|
| Rate for Payer: PHP All Commercial |
$26.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.78
|
| Rate for Payer: Sagamore Health Network All Products |
$27.28
|
| Rate for Payer: Signature Care EPO |
$29.33
|
| Rate for Payer: Signature Care PPO |
$31.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.04
|
| Rate for Payer: United Healthcare Commercial |
$27.85
|
| Rate for Payer: United Healthcare Medicare |
$11.66
|
|
|
HC GLUCOSE TOLER 4HR
|
Facility
IP
|
$32.08
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
63001138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cigna All Commercial |
$27.68
|
| Rate for Payer: CORVEL All Commercial |
$29.83
|
| Rate for Payer: Coventry All Commercial |
$28.23
|
| Rate for Payer: Encore All Commercial |
$29.53
|
| Rate for Payer: Frontpath All Commercial |
$29.51
|
| Rate for Payer: Humana ChoiceCare |
$27.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.87
|
| Rate for Payer: PHCS All Commercial |
$24.06
|
| Rate for Payer: PHP All Commercial |
$24.33
|
| Rate for Payer: Sagamore Health Network All Products |
$24.76
|
| Rate for Payer: Signature Care EPO |
$26.63
|
| Rate for Payer: Signature Care PPO |
$28.23
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
|
|
HC GLUCOSE TOLER 4HR
|
Facility
OP
|
$32.08
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
63001138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna Commercial |
$27.07
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.64
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Centivo All Commercial |
$16.36
|
| Rate for Payer: Cigna All Commercial |
$27.68
|
| Rate for Payer: CORVEL All Commercial |
$29.83
|
| Rate for Payer: Coventry All Commercial |
$28.23
|
| Rate for Payer: Encore All Commercial |
$29.53
|
| Rate for Payer: Frontpath All Commercial |
$29.51
|
| Rate for Payer: Humana ChoiceCare |
$27.71
|
| Rate for Payer: Humana Medicare |
$16.36
|
| Rate for Payer: Lucent All Commercial |
$16.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.87
|
| Rate for Payer: Managed Health Services Medicaid |
$3.92
|
| Rate for Payer: MDWise Medicaid |
$3.92
|
| Rate for Payer: PHCS All Commercial |
$24.06
|
| Rate for Payer: PHP All Commercial |
$24.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.51
|
| Rate for Payer: Sagamore Health Network All Products |
$24.76
|
| Rate for Payer: Signature Care EPO |
$26.63
|
| Rate for Payer: Signature Care PPO |
$28.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.27
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
|
|
HC GLUCOSE TOLERANCE 5HR SPE
|
Facility
OP
|
$35.34
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
63001139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Commercial |
$29.83
|
| Rate for Payer: Aetna Medicare |
$11.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.83
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Centivo All Commercial |
$18.02
|
| Rate for Payer: Cigna All Commercial |
$30.50
|
| Rate for Payer: CORVEL All Commercial |
$32.87
|
| Rate for Payer: Coventry All Commercial |
$31.10
|
| Rate for Payer: Encore All Commercial |
$32.53
|
| Rate for Payer: Frontpath All Commercial |
$32.52
|
| Rate for Payer: Humana ChoiceCare |
$30.53
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Lucent All Commercial |
$18.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.81
|
| Rate for Payer: Managed Health Services Medicaid |
$3.92
|
| Rate for Payer: MDWise Medicaid |
$3.92
|
| Rate for Payer: PHCS All Commercial |
$26.51
|
| Rate for Payer: PHP All Commercial |
$26.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.78
|
| Rate for Payer: Sagamore Health Network All Products |
$27.28
|
| Rate for Payer: Signature Care EPO |
$29.33
|
| Rate for Payer: Signature Care PPO |
$31.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.04
|
| Rate for Payer: United Healthcare Commercial |
$27.85
|
| Rate for Payer: United Healthcare Medicare |
$11.66
|
|
