|
HC ELEC STIM (UNATTENDED)-OT
|
Facility
|
IP
|
$125.36
|
|
|
Service Code
|
CPT G0283 GO
|
| Hospital Charge Code |
1738018
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$94.02 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$108.31
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cigna All Commercial |
$108.19
|
| Rate for Payer: CORVEL All Commercial |
$116.58
|
| Rate for Payer: Coventry All Commercial |
$110.32
|
| Rate for Payer: Encore All Commercial |
$115.39
|
| Rate for Payer: Frontpath All Commercial |
$115.33
|
| Rate for Payer: Humana ChoiceCare |
$108.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.82
|
| Rate for Payer: PHCS All Commercial |
$94.02
|
| Rate for Payer: PHP All Commercial |
$95.07
|
| Rate for Payer: Sagamore Health Network All Products |
$96.78
|
| Rate for Payer: Signature Care EPO |
$104.05
|
| Rate for Payer: Signature Care PPO |
$110.32
|
| Rate for Payer: United Healthcare Commercial |
$98.78
|
|
|
HC ELECTRIC STIM UNATTENDED - PT
|
Facility
|
IP
|
$122.42
|
|
|
Service Code
|
CPT G0283 GP
|
| Hospital Charge Code |
1722005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.81 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: PHCS All Commercial |
$91.81
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
|
|
HC ELECTRIC STIM UNATTENDED - PT
|
Facility
|
OP
|
$122.42
|
|
|
Service Code
|
CPT 97014 GP
|
| Hospital Charge Code |
1722005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$103.32
|
| Rate for Payer: Aetna Medicare |
$39.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.09
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Centivo All Commercial |
$66.60
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Humana Medicare |
$39.17
|
| Rate for Payer: Lucent All Commercial |
$66.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$91.81
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.06
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
| Rate for Payer: United Healthcare Medicare |
$39.17
|
|
|
HC ELECTRIC STIM UNATTENDED - PT
|
Facility
|
IP
|
$122.42
|
|
|
Service Code
|
CPT 97014 GP
|
| Hospital Charge Code |
1722005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.81 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: PHCS All Commercial |
$91.81
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
|
|
HC ELECTRIC STIM UNATTENDED - PT
|
Facility
|
OP
|
$122.42
|
|
|
Service Code
|
CPT G0283 GP
|
| Hospital Charge Code |
1722005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$103.32
|
| Rate for Payer: Aetna Medicare |
$39.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.09
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Centivo All Commercial |
$66.60
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Humana Medicare |
$39.17
|
| Rate for Payer: Lucent All Commercial |
$66.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$91.81
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.06
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
| Rate for Payer: United Healthcare Medicare |
$39.17
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
IP
|
$323.10
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
1503215
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$242.32 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$279.16
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cigna All Commercial |
$278.84
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.33
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.33
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
OP
|
$323.10
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
1503215
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: Aetna Medicare |
$103.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$185.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.73
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Centivo All Commercial |
$175.77
|
| Rate for Payer: Cigna All Commercial |
$278.84
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.33
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Humana Medicare |
$103.39
|
| Rate for Payer: Lucent All Commercial |
$175.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: Managed Health Services Medicaid |
$34.97
|
| Rate for Payer: MDWise Medicaid |
$34.97
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.01
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$274.63
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare |
$103.39
|
|
|
HC ELECTROCARDIOGRAM PREVENTATIVE
|
Facility
|
IP
|
$323.10
|
|
|
Service Code
|
CPT G0404
|
| Hospital Charge Code |
1500367
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$242.32 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$279.16
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cigna All Commercial |
$278.84
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.33
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.33
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
HC ELECTROCARDIOGRAM PREVENTATIVE
|
Facility
|
OP
|
$323.10
|
|
|
Service Code
|
CPT G0404
|
| Hospital Charge Code |
1500367
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: Aetna Medicare |
$103.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$185.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.73
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Centivo All Commercial |
$175.77
|
| Rate for Payer: Cigna All Commercial |
$278.84
|
| Rate for Payer: CORVEL All Commercial |
$300.48
|
| Rate for Payer: Coventry All Commercial |
$284.33
|
| Rate for Payer: Encore All Commercial |
$297.41
|
| Rate for Payer: Frontpath All Commercial |
$297.25
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Humana Medicare |
$103.39
|
| Rate for Payer: Lucent All Commercial |
$175.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.79
|
| Rate for Payer: Managed Health Services Medicaid |
$34.97
|
| Rate for Payer: MDWise Medicaid |
$34.97
|
| Rate for Payer: PHCS All Commercial |
$242.32
|
| Rate for Payer: PHP All Commercial |
$245.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.01
|
| Rate for Payer: Sagamore Health Network All Products |
$249.43
|
| Rate for Payer: Signature Care EPO |
$268.17
|
| Rate for Payer: Signature Care PPO |
$284.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$274.63
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare |
$103.39
|
|
|
HC ELECTRODE LOOP SAFE T 10X10
|
Facility
|
OP
|
$140.81
|
|
| Hospital Charge Code |
41602552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Aetna Commercial |
$118.84
|
| Rate for Payer: Aetna Medicare |
$45.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.57
|
| Rate for Payer: Cash Price |
$84.49
|
| Rate for Payer: Cash Price |
$84.49
|
| Rate for Payer: Centivo All Commercial |
$76.60
|
| Rate for Payer: Cigna All Commercial |
$121.52
|
| Rate for Payer: CORVEL All Commercial |
$130.95
|
| Rate for Payer: Coventry All Commercial |
$123.91
|
| Rate for Payer: Encore All Commercial |
$129.62
|
| Rate for Payer: Frontpath All Commercial |
$129.55
|
| Rate for Payer: Humana ChoiceCare |
$121.62
|
| Rate for Payer: Humana Medicare |
$45.06
|
| Rate for Payer: Lucent All Commercial |
$76.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.73
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$105.61
|
| Rate for Payer: PHP All Commercial |
$106.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.92
|
| Rate for Payer: Sagamore Health Network All Products |
$108.71
|
| Rate for Payer: Signature Care EPO |
$116.87
|
| Rate for Payer: Signature Care PPO |
$123.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.69
|
| Rate for Payer: United Healthcare Commercial |
$110.96
|
| Rate for Payer: United Healthcare Medicare |
$45.06
|
|
|
HC ELECTRODE LOOP SAFE T 10X10
|
Facility
|
IP
|
$140.81
|
|
| Hospital Charge Code |
41602552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.61 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Cash Price |
$84.49
|
| Rate for Payer: Cigna All Commercial |
$121.52
|
| Rate for Payer: CORVEL All Commercial |
$130.95
|
| Rate for Payer: Coventry All Commercial |
$123.91
|
| Rate for Payer: Encore All Commercial |
$129.62
|
| Rate for Payer: Frontpath All Commercial |
$129.55
|
| Rate for Payer: Humana ChoiceCare |
$121.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.73
|
| Rate for Payer: PHCS All Commercial |
$105.61
|
| Rate for Payer: PHP All Commercial |
$106.79
|
| Rate for Payer: Sagamore Health Network All Products |
$108.71
|
| Rate for Payer: Signature Care EPO |
$116.87
|
| Rate for Payer: Signature Care PPO |
$123.91
|
| Rate for Payer: United Healthcare Commercial |
$110.96
|
|
|
HC ELECTRODE LOOP SAFE T 15X12
|
Facility
|
IP
|
$150.81
|
|
| Hospital Charge Code |
41602551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Aetna Commercial |
$130.30
|
| Rate for Payer: Cash Price |
$90.49
|
| Rate for Payer: Cigna All Commercial |
$130.15
|
| Rate for Payer: CORVEL All Commercial |
$140.25
|
| Rate for Payer: Coventry All Commercial |
$132.71
|
| Rate for Payer: Encore All Commercial |
$138.82
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Humana ChoiceCare |
$130.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.73
|
| Rate for Payer: PHCS All Commercial |
$113.11
|
| Rate for Payer: PHP All Commercial |
$114.37
|
| Rate for Payer: Sagamore Health Network All Products |
$116.43
|
| Rate for Payer: Signature Care EPO |
$125.17
|
| Rate for Payer: Signature Care PPO |
$132.71
|
| Rate for Payer: United Healthcare Commercial |
$118.84
|
|
|
HC ELECTRODE LOOP SAFE T 15X12
|
Facility
|
OP
|
$150.81
|
|
| Hospital Charge Code |
41602551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Aetna Commercial |
$127.28
|
| Rate for Payer: Aetna Medicare |
$48.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.09
|
| Rate for Payer: Cash Price |
$90.49
|
| Rate for Payer: Cash Price |
$90.49
|
| Rate for Payer: Centivo All Commercial |
$82.04
|
| Rate for Payer: Cigna All Commercial |
$130.15
|
| Rate for Payer: CORVEL All Commercial |
$140.25
|
| Rate for Payer: Coventry All Commercial |
$132.71
|
| Rate for Payer: Encore All Commercial |
$138.82
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Humana ChoiceCare |
$130.25
|
| Rate for Payer: Humana Medicare |
$48.26
|
| Rate for Payer: Lucent All Commercial |
$82.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.73
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$113.11
|
| Rate for Payer: PHP All Commercial |
$114.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.82
|
| Rate for Payer: Sagamore Health Network All Products |
$116.43
|
| Rate for Payer: Signature Care EPO |
$125.17
|
| Rate for Payer: Signature Care PPO |
$132.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.19
|
| Rate for Payer: United Healthcare Commercial |
$118.84
|
| Rate for Payer: United Healthcare Medicare |
$48.26
|
|
|
HC ELECTRODE LOOP SAFE T 20X15
|
Facility
|
OP
|
$137.59
|
|
| Hospital Charge Code |
41602550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$127.96 |
| Rate for Payer: Aetna Commercial |
$116.13
|
| Rate for Payer: Aetna Medicare |
$44.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.43
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Centivo All Commercial |
$74.85
|
| Rate for Payer: Cigna All Commercial |
$118.74
|
| Rate for Payer: CORVEL All Commercial |
$127.96
|
| Rate for Payer: Coventry All Commercial |
$121.08
|
| Rate for Payer: Encore All Commercial |
$126.65
|
| Rate for Payer: Frontpath All Commercial |
$126.58
|
| Rate for Payer: Humana ChoiceCare |
$118.84
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Lucent All Commercial |
$74.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.83
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$103.19
|
| Rate for Payer: PHP All Commercial |
$104.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.66
|
| Rate for Payer: Sagamore Health Network All Products |
$106.22
|
| Rate for Payer: Signature Care EPO |
$114.20
|
| Rate for Payer: Signature Care PPO |
$121.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.95
|
| Rate for Payer: United Healthcare Commercial |
$108.42
|
| Rate for Payer: United Healthcare Medicare |
$44.03
|
|
|
HC ELECTRODE LOOP SAFE T 20X15
|
Facility
|
IP
|
$137.59
|
|
| Hospital Charge Code |
41602550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$127.96 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cigna All Commercial |
$118.74
|
| Rate for Payer: CORVEL All Commercial |
$127.96
|
| Rate for Payer: Coventry All Commercial |
$121.08
|
| Rate for Payer: Encore All Commercial |
$126.65
|
| Rate for Payer: Frontpath All Commercial |
$126.58
|
| Rate for Payer: Humana ChoiceCare |
$118.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.83
|
| Rate for Payer: PHCS All Commercial |
$103.19
|
| Rate for Payer: PHP All Commercial |
$104.35
|
| Rate for Payer: Sagamore Health Network All Products |
$106.22
|
| Rate for Payer: Signature Care EPO |
$114.20
|
| Rate for Payer: Signature Care PPO |
$121.08
|
| Rate for Payer: United Healthcare Commercial |
$108.42
|
|
|
HC ELECTROLYTES PANEL
|
Facility
|
IP
|
$89.57
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
63001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.18 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Aetna Commercial |
$77.39
|
| Rate for Payer: Cash Price |
$53.74
|
| Rate for Payer: Cigna All Commercial |
$77.30
|
| Rate for Payer: CORVEL All Commercial |
$83.30
|
| Rate for Payer: Coventry All Commercial |
$78.82
|
| Rate for Payer: Encore All Commercial |
$82.45
|
| Rate for Payer: Frontpath All Commercial |
$82.40
|
| Rate for Payer: Humana ChoiceCare |
$77.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.61
|
| Rate for Payer: PHCS All Commercial |
$67.18
|
| Rate for Payer: PHP All Commercial |
$67.93
|
| Rate for Payer: Sagamore Health Network All Products |
$69.15
|
| Rate for Payer: Signature Care EPO |
$74.34
|
| Rate for Payer: Signature Care PPO |
$78.82
|
| Rate for Payer: United Healthcare Commercial |
$70.58
|
|
|
HC ELECTROLYTES PANEL
|
Facility
|
OP
|
$89.57
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
63001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Medicare |
$28.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.53
|
| Rate for Payer: Cash Price |
$53.74
|
| Rate for Payer: Cash Price |
$53.74
|
| Rate for Payer: Centivo All Commercial |
$48.73
|
| Rate for Payer: Cigna All Commercial |
$77.30
|
| Rate for Payer: CORVEL All Commercial |
$83.30
|
| Rate for Payer: Coventry All Commercial |
$78.82
|
| Rate for Payer: Encore All Commercial |
$82.45
|
| Rate for Payer: Frontpath All Commercial |
$82.40
|
| Rate for Payer: Humana ChoiceCare |
$77.36
|
| Rate for Payer: Humana Medicare |
$28.66
|
| Rate for Payer: Lucent All Commercial |
$48.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.61
|
| Rate for Payer: Managed Health Services Medicaid |
$7.01
|
| Rate for Payer: MDWise Medicaid |
$7.01
|
| Rate for Payer: PHCS All Commercial |
$67.18
|
| Rate for Payer: PHP All Commercial |
$67.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.93
|
| Rate for Payer: Sagamore Health Network All Products |
$69.15
|
| Rate for Payer: Signature Care EPO |
$74.34
|
| Rate for Payer: Signature Care PPO |
$78.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.13
|
| Rate for Payer: United Healthcare Commercial |
$70.58
|
| Rate for Payer: United Healthcare Medicare |
$28.66
|
|
|
HC ELECTROPHORESIS, PROTEIN, RANDOM URINE
|
Facility
|
OP
|
$93.80
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
63001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$87.23 |
| Rate for Payer: Aetna Commercial |
$79.17
|
| Rate for Payer: Aetna Medicare |
$30.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$61.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.02
|
| Rate for Payer: Cash Price |
$56.28
|
| Rate for Payer: Cash Price |
$56.28
|
| Rate for Payer: Centivo All Commercial |
$51.03
|
| Rate for Payer: Cigna All Commercial |
$80.95
|
| Rate for Payer: CORVEL All Commercial |
$87.23
|
| Rate for Payer: Coventry All Commercial |
$82.54
|
| Rate for Payer: Encore All Commercial |
$86.34
|
| Rate for Payer: Frontpath All Commercial |
$86.30
|
| Rate for Payer: Humana ChoiceCare |
$81.02
|
| Rate for Payer: Humana Medicare |
$30.02
|
| Rate for Payer: Lucent All Commercial |
$51.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.42
|
| Rate for Payer: Managed Health Services Medicaid |
$61.50
|
| Rate for Payer: MDWise Medicaid |
$61.50
|
| Rate for Payer: PHCS All Commercial |
$70.35
|
| Rate for Payer: PHP All Commercial |
$71.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.58
|
| Rate for Payer: Sagamore Health Network All Products |
$72.41
|
| Rate for Payer: Signature Care EPO |
$77.85
|
| Rate for Payer: Signature Care PPO |
$82.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.73
|
| Rate for Payer: United Healthcare Commercial |
$73.91
|
| Rate for Payer: United Healthcare Medicare |
$30.02
|
|
|
HC ELECTROPHORESIS, PROTEIN, RANDOM URINE
|
Facility
|
IP
|
$93.80
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
63001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$87.23 |
| Rate for Payer: Aetna Commercial |
$81.04
|
| Rate for Payer: Cash Price |
$56.28
|
| Rate for Payer: Cigna All Commercial |
$80.95
|
| Rate for Payer: CORVEL All Commercial |
$87.23
|
| Rate for Payer: Coventry All Commercial |
$82.54
|
| Rate for Payer: Encore All Commercial |
$86.34
|
| Rate for Payer: Frontpath All Commercial |
$86.30
|
| Rate for Payer: Humana ChoiceCare |
$81.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.42
|
| Rate for Payer: PHCS All Commercial |
$70.35
|
| Rate for Payer: PHP All Commercial |
$71.14
|
| Rate for Payer: Sagamore Health Network All Products |
$72.41
|
| Rate for Payer: Signature Care EPO |
$77.85
|
| Rate for Payer: Signature Care PPO |
$82.54
|
| Rate for Payer: United Healthcare Commercial |
$73.91
|
|
|
HC ELECTROPHORESIS, PROTEIN, SERUM
|
Facility
|
OP
|
$173.91
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
63001298
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$146.78
|
| Rate for Payer: Aetna Medicare |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.22
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$94.61
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Humana Medicare |
$55.65
|
| Rate for Payer: Lucent All Commercial |
$94.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: Managed Health Services Medicaid |
$10.74
|
| Rate for Payer: MDWise Medicaid |
$10.74
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.82
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.82
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
| Rate for Payer: United Healthcare Medicare |
$55.65
|
|
|
HC ELECTROPHORESIS, PROTEIN, SERUM
|
Facility
|
IP
|
$173.91
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
63001298
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$150.26
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
|
|
HC ENDOCATCH
|
Facility
|
IP
|
$476.98
|
|
| Hospital Charge Code |
41601057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.74 |
| Max. Negotiated Rate |
$443.59 |
| Rate for Payer: Aetna Commercial |
$412.11
|
| Rate for Payer: Cash Price |
$286.19
|
| Rate for Payer: Cigna All Commercial |
$411.63
|
| Rate for Payer: CORVEL All Commercial |
$443.59
|
| Rate for Payer: Coventry All Commercial |
$419.74
|
| Rate for Payer: Encore All Commercial |
$439.06
|
| Rate for Payer: Frontpath All Commercial |
$438.82
|
| Rate for Payer: Humana ChoiceCare |
$411.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.28
|
| Rate for Payer: PHCS All Commercial |
$357.74
|
| Rate for Payer: PHP All Commercial |
$361.74
|
| Rate for Payer: Sagamore Health Network All Products |
$368.23
|
| Rate for Payer: Signature Care EPO |
$395.89
|
| Rate for Payer: Signature Care PPO |
$419.74
|
| Rate for Payer: United Healthcare Commercial |
$375.86
|
|
|
HC ENDOCATCH
|
Facility
|
OP
|
$476.98
|
|
| Hospital Charge Code |
41601057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$443.59 |
| Rate for Payer: Aetna Commercial |
$402.57
|
| Rate for Payer: Aetna Medicare |
$152.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$273.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.90
|
| Rate for Payer: Cash Price |
$286.19
|
| Rate for Payer: Cash Price |
$286.19
|
| Rate for Payer: Centivo All Commercial |
$259.48
|
| Rate for Payer: Cigna All Commercial |
$411.63
|
| Rate for Payer: CORVEL All Commercial |
$443.59
|
| Rate for Payer: Coventry All Commercial |
$419.74
|
| Rate for Payer: Encore All Commercial |
$439.06
|
| Rate for Payer: Frontpath All Commercial |
$438.82
|
| Rate for Payer: Humana ChoiceCare |
$411.97
|
| Rate for Payer: Humana Medicare |
$152.63
|
| Rate for Payer: Lucent All Commercial |
$259.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$357.74
|
| Rate for Payer: PHP All Commercial |
$361.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.02
|
| Rate for Payer: Sagamore Health Network All Products |
$368.23
|
| Rate for Payer: Signature Care EPO |
$395.89
|
| Rate for Payer: Signature Care PPO |
$419.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.43
|
| Rate for Payer: United Healthcare Commercial |
$375.86
|
| Rate for Payer: United Healthcare Medicare |
$152.63
|
|
|
HC ENDO CLIP APPLIER 10MM COVIDIEN
|
Facility
|
OP
|
$686.77
|
|
| Hospital Charge Code |
41601006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$638.70 |
| Rate for Payer: Aetna Commercial |
$579.63
|
| Rate for Payer: Aetna Medicare |
$219.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$212.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$394.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$429.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$252.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$241.74
|
| Rate for Payer: Cash Price |
$412.06
|
| Rate for Payer: Cash Price |
$412.06
|
| Rate for Payer: Centivo All Commercial |
$373.60
|
| Rate for Payer: Cigna All Commercial |
$592.68
|
| Rate for Payer: CORVEL All Commercial |
$638.70
|
| Rate for Payer: Coventry All Commercial |
$604.36
|
| Rate for Payer: Encore All Commercial |
$632.17
|
| Rate for Payer: Frontpath All Commercial |
$631.83
|
| Rate for Payer: Humana ChoiceCare |
$593.16
|
| Rate for Payer: Humana Medicare |
$219.77
|
| Rate for Payer: Lucent All Commercial |
$373.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$618.09
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$515.08
|
| Rate for Payer: PHP All Commercial |
$520.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$267.84
|
| Rate for Payer: Sagamore Health Network All Products |
$530.19
|
| Rate for Payer: Signature Care EPO |
$570.02
|
| Rate for Payer: Signature Care PPO |
$604.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$583.75
|
| Rate for Payer: United Healthcare Commercial |
$541.17
|
| Rate for Payer: United Healthcare Medicare |
$219.77
|
|
|
HC ENDO CLIP APPLIER 10MM COVIDIEN
|
Facility
|
IP
|
$686.77
|
|
| Hospital Charge Code |
41601006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.08 |
| Max. Negotiated Rate |
$638.70 |
| Rate for Payer: Aetna Commercial |
$593.37
|
| Rate for Payer: Cash Price |
$412.06
|
| Rate for Payer: Cigna All Commercial |
$592.68
|
| Rate for Payer: CORVEL All Commercial |
$638.70
|
| Rate for Payer: Coventry All Commercial |
$604.36
|
| Rate for Payer: Encore All Commercial |
$632.17
|
| Rate for Payer: Frontpath All Commercial |
$631.83
|
| Rate for Payer: Humana ChoiceCare |
$593.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$618.09
|
| Rate for Payer: PHCS All Commercial |
$515.08
|
| Rate for Payer: PHP All Commercial |
$520.85
|
| Rate for Payer: Sagamore Health Network All Products |
$530.19
|
| Rate for Payer: Signature Care EPO |
$570.02
|
| Rate for Payer: Signature Care PPO |
$604.36
|
| Rate for Payer: United Healthcare Commercial |
$541.17
|
|
