|
HC EVAL SPEECH SOUND LANG COMPREHEN - SP
|
Facility
|
IP
|
$456.71
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
1749075
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$342.53 |
| Max. Negotiated Rate |
$424.74 |
| Rate for Payer: Aetna Commercial |
$394.60
|
| Rate for Payer: Cash Price |
$274.03
|
| Rate for Payer: Cigna All Commercial |
$394.14
|
| Rate for Payer: CORVEL All Commercial |
$424.74
|
| Rate for Payer: Coventry All Commercial |
$401.90
|
| Rate for Payer: Encore All Commercial |
$420.40
|
| Rate for Payer: Frontpath All Commercial |
$420.17
|
| Rate for Payer: Humana ChoiceCare |
$394.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$411.04
|
| Rate for Payer: PHCS All Commercial |
$342.53
|
| Rate for Payer: PHP All Commercial |
$346.37
|
| Rate for Payer: Sagamore Health Network All Products |
$352.58
|
| Rate for Payer: Signature Care EPO |
$379.07
|
| Rate for Payer: Signature Care PPO |
$401.90
|
| Rate for Payer: United Healthcare Commercial |
$359.89
|
|
|
HC EVAL SP GEN DEVICE/INITL HR-SP
|
Facility
|
IP
|
$416.30
|
|
|
Service Code
|
CPT 92607 GN
|
| Hospital Charge Code |
1748037
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.68
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
|
|
HC EVAL SP GEN DEVICE/INITL HR-SP
|
Facility
|
OP
|
$416.30
|
|
|
Service Code
|
CPT 92607 GN
|
| Hospital Charge Code |
1748037
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Centivo All Commercial |
$226.47
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
HC EVALUATE SPEECH PRODUCTION 60 MIN
|
Facility
|
IP
|
$444.45
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
1742522
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$333.34 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$384.00
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.89
|
| Rate for Payer: Humana ChoiceCare |
$383.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.00
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.89
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
|
|
HC EVALUATE SPEECH PRODUCTION 60 MIN
|
Facility
|
OP
|
$444.45
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
1742522
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$375.12
|
| Rate for Payer: Aetna Medicare |
$142.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$255.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.45
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Centivo All Commercial |
$241.78
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.89
|
| Rate for Payer: Humana ChoiceCare |
$383.87
|
| Rate for Payer: Humana Medicare |
$142.22
|
| Rate for Payer: Lucent All Commercial |
$241.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.34
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.89
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$377.78
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
| Rate for Payer: United Healthcare Medicare |
$142.22
|
|
|
HC EVALUATE SPEECH PRODUCTION - SP
|
Facility
|
IP
|
$449.08
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
1749072
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$336.81 |
| Max. Negotiated Rate |
$417.64 |
| Rate for Payer: Aetna Commercial |
$388.01
|
| Rate for Payer: Cash Price |
$269.45
|
| Rate for Payer: Cigna All Commercial |
$387.56
|
| Rate for Payer: CORVEL All Commercial |
$417.64
|
| Rate for Payer: Coventry All Commercial |
$395.19
|
| Rate for Payer: Encore All Commercial |
$413.38
|
| Rate for Payer: Frontpath All Commercial |
$413.15
|
| Rate for Payer: Humana ChoiceCare |
$387.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.17
|
| Rate for Payer: PHCS All Commercial |
$336.81
|
| Rate for Payer: PHP All Commercial |
$340.58
|
| Rate for Payer: Sagamore Health Network All Products |
$346.69
|
| Rate for Payer: Signature Care EPO |
$372.74
|
| Rate for Payer: Signature Care PPO |
$395.19
|
| Rate for Payer: United Healthcare Commercial |
$353.88
|
|
|
HC EVALUATE SPEECH PRODUCTION - SP
|
Facility
|
OP
|
$449.08
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
1749072
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$417.64 |
| Rate for Payer: Aetna Commercial |
$379.02
|
| Rate for Payer: Aetna Medicare |
$143.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$257.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$280.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.08
|
| Rate for Payer: Cash Price |
$269.45
|
| Rate for Payer: Cash Price |
$269.45
|
| Rate for Payer: Centivo All Commercial |
$244.30
|
| Rate for Payer: Cigna All Commercial |
$387.56
|
| Rate for Payer: CORVEL All Commercial |
$417.64
|
| Rate for Payer: Coventry All Commercial |
$395.19
|
| Rate for Payer: Encore All Commercial |
$413.38
|
| Rate for Payer: Frontpath All Commercial |
$413.15
|
| Rate for Payer: Humana ChoiceCare |
$387.87
|
| Rate for Payer: Humana Medicare |
$143.71
|
| Rate for Payer: Lucent All Commercial |
$244.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.17
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$336.81
|
| Rate for Payer: PHP All Commercial |
$340.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.14
|
| Rate for Payer: Sagamore Health Network All Products |
$346.69
|
| Rate for Payer: Signature Care EPO |
$372.74
|
| Rate for Payer: Signature Care PPO |
$395.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$381.72
|
| Rate for Payer: United Healthcare Commercial |
$353.88
|
| Rate for Payer: United Healthcare Medicare |
$143.71
|
|
|
HC EVALUATION OF SPEECH FLUENCY - SP
|
Facility
|
IP
|
$462.23
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
1747521
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$346.67 |
| Max. Negotiated Rate |
$429.87 |
| Rate for Payer: Aetna Commercial |
$399.37
|
| Rate for Payer: Cash Price |
$277.34
|
| Rate for Payer: Cigna All Commercial |
$398.90
|
| Rate for Payer: CORVEL All Commercial |
$429.87
|
| Rate for Payer: Coventry All Commercial |
$406.76
|
| Rate for Payer: Encore All Commercial |
$425.48
|
| Rate for Payer: Frontpath All Commercial |
$425.25
|
| Rate for Payer: Humana ChoiceCare |
$399.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.01
|
| Rate for Payer: PHCS All Commercial |
$346.67
|
| Rate for Payer: PHP All Commercial |
$350.56
|
| Rate for Payer: Sagamore Health Network All Products |
$356.84
|
| Rate for Payer: Signature Care EPO |
$383.65
|
| Rate for Payer: Signature Care PPO |
$406.76
|
| Rate for Payer: United Healthcare Commercial |
$364.24
|
|
|
HC EVALUATION OF SPEECH FLUENCY - SP
|
Facility
|
OP
|
$462.23
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
1747521
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$429.87 |
| Rate for Payer: Aetna Commercial |
$390.12
|
| Rate for Payer: Aetna Medicare |
$147.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$265.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.70
|
| Rate for Payer: Cash Price |
$277.34
|
| Rate for Payer: Cash Price |
$277.34
|
| Rate for Payer: Centivo All Commercial |
$251.45
|
| Rate for Payer: Cigna All Commercial |
$398.90
|
| Rate for Payer: CORVEL All Commercial |
$429.87
|
| Rate for Payer: Coventry All Commercial |
$406.76
|
| Rate for Payer: Encore All Commercial |
$425.48
|
| Rate for Payer: Frontpath All Commercial |
$425.25
|
| Rate for Payer: Humana ChoiceCare |
$399.23
|
| Rate for Payer: Humana Medicare |
$147.91
|
| Rate for Payer: Lucent All Commercial |
$251.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.01
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$346.67
|
| Rate for Payer: PHP All Commercial |
$350.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.27
|
| Rate for Payer: Sagamore Health Network All Products |
$356.84
|
| Rate for Payer: Signature Care EPO |
$383.65
|
| Rate for Payer: Signature Care PPO |
$406.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.90
|
| Rate for Payer: United Healthcare Commercial |
$364.24
|
| Rate for Payer: United Healthcare Medicare |
$147.91
|
|
|
HC EXCHANGE NEPHROSTOMY CATH
|
Facility
|
IP
|
$5,252.27
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
1610435
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,939.20 |
| Max. Negotiated Rate |
$4,884.61 |
| Rate for Payer: Aetna Commercial |
$4,537.96
|
| Rate for Payer: Cash Price |
$3,151.36
|
| Rate for Payer: Cigna All Commercial |
$4,532.71
|
| Rate for Payer: CORVEL All Commercial |
$4,884.61
|
| Rate for Payer: Coventry All Commercial |
$4,622.00
|
| Rate for Payer: Encore All Commercial |
$4,834.71
|
| Rate for Payer: Frontpath All Commercial |
$4,832.09
|
| Rate for Payer: Humana ChoiceCare |
$4,536.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,727.04
|
| Rate for Payer: PHCS All Commercial |
$3,939.20
|
| Rate for Payer: PHP All Commercial |
$3,983.32
|
| Rate for Payer: Sagamore Health Network All Products |
$4,054.75
|
| Rate for Payer: Signature Care EPO |
$4,359.38
|
| Rate for Payer: Signature Care PPO |
$4,622.00
|
| Rate for Payer: United Healthcare Commercial |
$4,138.79
|
|
|
HC EXCHANGE NEPHROSTOMY CATH
|
Facility
|
OP
|
$5,252.27
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
1610435
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.57 |
| Max. Negotiated Rate |
$4,884.61 |
| Rate for Payer: Aetna Commercial |
$4,432.92
|
| Rate for Payer: Aetna Medicare |
$1,680.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$488.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,628.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,016.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,283.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$488.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,932.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,848.80
|
| Rate for Payer: Cash Price |
$3,151.36
|
| Rate for Payer: Cash Price |
$3,151.36
|
| Rate for Payer: Centivo All Commercial |
$2,857.23
|
| Rate for Payer: Cigna All Commercial |
$4,532.71
|
| Rate for Payer: CORVEL All Commercial |
$4,884.61
|
| Rate for Payer: Coventry All Commercial |
$4,622.00
|
| Rate for Payer: Encore All Commercial |
$4,834.71
|
| Rate for Payer: Frontpath All Commercial |
$4,832.09
|
| Rate for Payer: Humana ChoiceCare |
$4,536.39
|
| Rate for Payer: Humana Medicare |
$1,680.73
|
| Rate for Payer: Lucent All Commercial |
$2,857.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,727.04
|
| Rate for Payer: Managed Health Services Medicaid |
$488.57
|
| Rate for Payer: MDWise Medicaid |
$488.57
|
| Rate for Payer: PHCS All Commercial |
$3,939.20
|
| Rate for Payer: PHP All Commercial |
$3,983.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,048.39
|
| Rate for Payer: Sagamore Health Network All Products |
$4,054.75
|
| Rate for Payer: Signature Care EPO |
$4,359.38
|
| Rate for Payer: Signature Care PPO |
$4,622.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,464.43
|
| Rate for Payer: United Healthcare Commercial |
$4,138.79
|
| Rate for Payer: United Healthcare Medicare |
$1,680.73
|
|
|
HC EXT ECG MONIT/REPRT 12-48 HRS
|
Facility
|
IP
|
$1,628.06
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
1505069
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$1,221.05 |
| Max. Negotiated Rate |
$1,514.10 |
| Rate for Payer: Aetna Commercial |
$1,406.64
|
| Rate for Payer: Cash Price |
$976.84
|
| Rate for Payer: Cigna All Commercial |
$1,405.02
|
| Rate for Payer: CORVEL All Commercial |
$1,514.10
|
| Rate for Payer: Coventry All Commercial |
$1,432.69
|
| Rate for Payer: Encore All Commercial |
$1,498.63
|
| Rate for Payer: Frontpath All Commercial |
$1,497.82
|
| Rate for Payer: Humana ChoiceCare |
$1,406.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,465.25
|
| Rate for Payer: PHCS All Commercial |
$1,221.05
|
| Rate for Payer: PHP All Commercial |
$1,234.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,256.86
|
| Rate for Payer: Signature Care EPO |
$1,351.29
|
| Rate for Payer: Signature Care PPO |
$1,432.69
|
| Rate for Payer: United Healthcare Commercial |
$1,282.91
|
|
|
HC EXT ECG MONIT/REPRT 12-48 HRS
|
Facility
|
OP
|
$1,628.06
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
1505069
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$1,514.10 |
| Rate for Payer: Aetna Commercial |
$1,374.08
|
| Rate for Payer: Aetna Medicare |
$520.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$144.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$504.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$934.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,017.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$144.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$599.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$573.08
|
| Rate for Payer: Cash Price |
$976.84
|
| Rate for Payer: Cash Price |
$976.84
|
| Rate for Payer: Centivo All Commercial |
$885.66
|
| Rate for Payer: Cigna All Commercial |
$1,405.02
|
| Rate for Payer: CORVEL All Commercial |
$1,514.10
|
| Rate for Payer: Coventry All Commercial |
$1,432.69
|
| Rate for Payer: Encore All Commercial |
$1,498.63
|
| Rate for Payer: Frontpath All Commercial |
$1,497.82
|
| Rate for Payer: Humana ChoiceCare |
$1,406.16
|
| Rate for Payer: Humana Medicare |
$520.98
|
| Rate for Payer: Lucent All Commercial |
$885.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,465.25
|
| Rate for Payer: Managed Health Services Medicaid |
$144.59
|
| Rate for Payer: MDWise Medicaid |
$144.59
|
| Rate for Payer: PHCS All Commercial |
$1,221.05
|
| Rate for Payer: PHP All Commercial |
$1,234.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$634.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,256.86
|
| Rate for Payer: Signature Care EPO |
$1,351.29
|
| Rate for Payer: Signature Care PPO |
$1,432.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,383.85
|
| Rate for Payer: United Healthcare Commercial |
$1,282.91
|
| Rate for Payer: United Healthcare Medicare |
$520.98
|
|
|
HC EXTENDED RECOVERY INITIAL HOUR
|
Facility
|
IP
|
$1,201.16
|
|
| Hospital Charge Code |
61171001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$900.87 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,037.80
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.04
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: United Healthcare Commercial |
$946.51
|
|
|
HC EXTENDED RECOVERY INITIAL HOUR
|
Facility
|
OP
|
$1,201.16
|
|
| Hospital Charge Code |
61171001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,013.78
|
| Rate for Payer: Aetna Medicare |
$384.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$103.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$372.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$689.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$103.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.81
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Centivo All Commercial |
$653.43
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Humana Medicare |
$384.37
|
| Rate for Payer: Lucent All Commercial |
$653.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.04
|
| Rate for Payer: Managed Health Services Medicaid |
$103.04
|
| Rate for Payer: MDWise Medicaid |
$103.04
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.45
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.99
|
| Rate for Payer: United Healthcare Commercial |
$946.51
|
| Rate for Payer: United Healthcare Medicare |
$384.37
|
|
|
HC EXTENDED RECOVERY SUBSEQUENT <24
|
Facility
|
IP
|
$19.27
|
|
| Hospital Charge Code |
61171002
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC EXTENDED RECOVERY SUBSEQUENT <24
|
Facility
|
OP
|
$19.27
|
|
| Hospital Charge Code |
61171002
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$103.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$103.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Centivo All Commercial |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$6.17
|
| Rate for Payer: Lucent All Commercial |
$10.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$103.04
|
| Rate for Payer: MDWise Medicaid |
$103.04
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.17
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$1,314.82
|
|
| Hospital Charge Code |
1229412
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$986.12 |
| Max. Negotiated Rate |
$1,222.78 |
| Rate for Payer: Aetna Commercial |
$1,136.00
|
| Rate for Payer: Cash Price |
$788.89
|
| Rate for Payer: Cigna All Commercial |
$1,134.69
|
| Rate for Payer: CORVEL All Commercial |
$1,222.78
|
| Rate for Payer: Coventry All Commercial |
$1,157.04
|
| Rate for Payer: Encore All Commercial |
$1,210.29
|
| Rate for Payer: Frontpath All Commercial |
$1,209.63
|
| Rate for Payer: Humana ChoiceCare |
$1,135.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,183.34
|
| Rate for Payer: PHCS All Commercial |
$986.12
|
| Rate for Payer: PHP All Commercial |
$997.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,015.04
|
| Rate for Payer: Signature Care EPO |
$1,091.30
|
| Rate for Payer: Signature Care PPO |
$1,157.04
|
| Rate for Payer: United Healthcare Commercial |
$1,036.08
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$1,314.82
|
|
| Hospital Charge Code |
1229412
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$1,222.78 |
| Rate for Payer: Aetna Commercial |
$1,109.71
|
| Rate for Payer: Aetna Medicare |
$420.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$126.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$407.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$755.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$821.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$126.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$483.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$462.82
|
| Rate for Payer: Cash Price |
$788.89
|
| Rate for Payer: Cash Price |
$788.89
|
| Rate for Payer: Centivo All Commercial |
$715.26
|
| Rate for Payer: Cigna All Commercial |
$1,134.69
|
| Rate for Payer: CORVEL All Commercial |
$1,222.78
|
| Rate for Payer: Coventry All Commercial |
$1,157.04
|
| Rate for Payer: Encore All Commercial |
$1,210.29
|
| Rate for Payer: Frontpath All Commercial |
$1,209.63
|
| Rate for Payer: Humana ChoiceCare |
$1,135.61
|
| Rate for Payer: Humana Medicare |
$420.74
|
| Rate for Payer: Lucent All Commercial |
$715.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,183.34
|
| Rate for Payer: Managed Health Services Medicaid |
$126.33
|
| Rate for Payer: MDWise Medicaid |
$126.33
|
| Rate for Payer: PHCS All Commercial |
$986.12
|
| Rate for Payer: PHP All Commercial |
$997.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$512.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,015.04
|
| Rate for Payer: Signature Care EPO |
$1,091.30
|
| Rate for Payer: Signature Care PPO |
$1,157.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,117.60
|
| Rate for Payer: United Healthcare Commercial |
$1,036.08
|
| Rate for Payer: United Healthcare Medicare |
$420.74
|
|
|
HC EXTRACTABLE NUC AG
|
Facility
|
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.60
|
|
|
HC EXTRACTABLE NUC AG
|
Facility
|
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$49.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.77
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Centivo All Commercial |
$84.64
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$49.79
|
| Rate for Payer: Lucent All Commercial |
$84.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.60
|
| Rate for Payer: United Healthcare Medicare |
$49.79
|
|
|
HC EXTRACTOR VACUUM
|
Facility
|
IP
|
$359.94
|
|
| Hospital Charge Code |
41603542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.95 |
| Max. Negotiated Rate |
$334.74 |
| Rate for Payer: Aetna Commercial |
$310.99
|
| Rate for Payer: Cash Price |
$215.96
|
| Rate for Payer: Cigna All Commercial |
$310.63
|
| Rate for Payer: CORVEL All Commercial |
$334.74
|
| Rate for Payer: Coventry All Commercial |
$316.75
|
| Rate for Payer: Encore All Commercial |
$331.32
|
| Rate for Payer: Frontpath All Commercial |
$331.14
|
| Rate for Payer: Humana ChoiceCare |
$310.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$323.95
|
| Rate for Payer: PHCS All Commercial |
$269.95
|
| Rate for Payer: PHP All Commercial |
$272.98
|
| Rate for Payer: Sagamore Health Network All Products |
$277.87
|
| Rate for Payer: Signature Care EPO |
$298.75
|
| Rate for Payer: Signature Care PPO |
$316.75
|
| Rate for Payer: United Healthcare Commercial |
$283.63
|
|
|
HC EXTRACTOR VACUUM
|
Facility
|
OP
|
$359.94
|
|
| Hospital Charge Code |
41603542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$334.74 |
| Rate for Payer: Aetna Commercial |
$303.79
|
| Rate for Payer: Aetna Medicare |
$115.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$206.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.70
|
| Rate for Payer: Cash Price |
$215.96
|
| Rate for Payer: Cash Price |
$215.96
|
| Rate for Payer: Centivo All Commercial |
$195.81
|
| Rate for Payer: Cigna All Commercial |
$310.63
|
| Rate for Payer: CORVEL All Commercial |
$334.74
|
| Rate for Payer: Coventry All Commercial |
$316.75
|
| Rate for Payer: Encore All Commercial |
$331.32
|
| Rate for Payer: Frontpath All Commercial |
$331.14
|
| Rate for Payer: Humana ChoiceCare |
$310.88
|
| Rate for Payer: Humana Medicare |
$115.18
|
| Rate for Payer: Lucent All Commercial |
$195.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$323.95
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$269.95
|
| Rate for Payer: PHP All Commercial |
$272.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.38
|
| Rate for Payer: Sagamore Health Network All Products |
$277.87
|
| Rate for Payer: Signature Care EPO |
$298.75
|
| Rate for Payer: Signature Care PPO |
$316.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$305.95
|
| Rate for Payer: United Healthcare Commercial |
$283.63
|
| Rate for Payer: United Healthcare Medicare |
$115.18
|
|
|
HC EYE BURR - DISPOSABLE
|
Facility
|
OP
|
$92.02
|
|
| Hospital Charge Code |
41601387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna Commercial |
$77.66
|
| Rate for Payer: Aetna Medicare |
$29.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.39
|
| Rate for Payer: Cash Price |
$55.21
|
| Rate for Payer: Cash Price |
$55.21
|
| Rate for Payer: Centivo All Commercial |
$50.06
|
| Rate for Payer: Cigna All Commercial |
$79.41
|
| Rate for Payer: CORVEL All Commercial |
$85.58
|
| Rate for Payer: Coventry All Commercial |
$80.98
|
| Rate for Payer: Encore All Commercial |
$84.70
|
| Rate for Payer: Frontpath All Commercial |
$84.66
|
| Rate for Payer: Humana ChoiceCare |
$79.48
|
| Rate for Payer: Humana Medicare |
$29.45
|
| Rate for Payer: Lucent All Commercial |
$50.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.82
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$69.02
|
| Rate for Payer: PHP All Commercial |
$69.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.89
|
| Rate for Payer: Sagamore Health Network All Products |
$71.04
|
| Rate for Payer: Signature Care EPO |
$76.38
|
| Rate for Payer: Signature Care PPO |
$80.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.22
|
| Rate for Payer: United Healthcare Commercial |
$72.51
|
| Rate for Payer: United Healthcare Medicare |
$29.45
|
|
|
HC EYE BURR - DISPOSABLE
|
Facility
|
IP
|
$92.02
|
|
| Hospital Charge Code |
41601387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.02 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna Commercial |
$79.51
|
| Rate for Payer: Cash Price |
$55.21
|
| Rate for Payer: Cigna All Commercial |
$79.41
|
| Rate for Payer: CORVEL All Commercial |
$85.58
|
| Rate for Payer: Coventry All Commercial |
$80.98
|
| Rate for Payer: Encore All Commercial |
$84.70
|
| Rate for Payer: Frontpath All Commercial |
$84.66
|
| Rate for Payer: Humana ChoiceCare |
$79.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.82
|
| Rate for Payer: PHCS All Commercial |
$69.02
|
| Rate for Payer: PHP All Commercial |
$69.79
|
| Rate for Payer: Sagamore Health Network All Products |
$71.04
|
| Rate for Payer: Signature Care EPO |
$76.38
|
| Rate for Payer: Signature Care PPO |
$80.98
|
| Rate for Payer: United Healthcare Commercial |
$72.51
|
|
