|
HC INDIV THERAPY-45 MIN-SP
|
Facility
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748056
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.89
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Centivo All Commercial |
$161.42
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$161.42
|
| Rate for Payer: Lucent All Commercial |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$104.45
|
|
|
HC INDIV THERAPY-45 MIN-SP
|
Facility
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748056
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-60 MIN-SP
|
Facility
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748057
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-60 MIN-SP
|
Facility
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748057
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.89
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Centivo All Commercial |
$161.42
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$161.42
|
| Rate for Payer: Lucent All Commercial |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$104.45
|
|
|
HC INDIV THERAPY-75 MIN-SP
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748058
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC INDIV THERAPY-75 MIN-SP
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748058
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC INDIV THERAPY-90 MIN-SP
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748059
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC INDIV THERAPY-90 MIN-SP
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748059
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC INDIV THERAPY - SP
|
Facility
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01742507
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.89
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Centivo All Commercial |
$161.42
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$161.42
|
| Rate for Payer: Lucent All Commercial |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$104.45
|
|
|
HC INDIV THERAPY - SP
|
Facility
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01742507
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDUSTRIAL COMPLETE PFT
|
Facility
OP
|
$715.49
|
|
| Hospital Charge Code |
01706005
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$665.40 |
| Rate for Payer: Aetna Commercial |
$603.87
|
| Rate for Payer: Aetna Medicare |
$236.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$236.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$410.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$447.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$271.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$259.72
|
| Rate for Payer: Cash Price |
$443.60
|
| Rate for Payer: Cash Price |
$443.60
|
| Rate for Payer: Centivo All Commercial |
$364.90
|
| Rate for Payer: Cigna All Commercial |
$617.47
|
| Rate for Payer: CORVEL All Commercial |
$665.40
|
| Rate for Payer: Coventry All Commercial |
$629.63
|
| Rate for Payer: Encore All Commercial |
$658.61
|
| Rate for Payer: Frontpath All Commercial |
$658.25
|
| Rate for Payer: Humana ChoiceCare |
$617.97
|
| Rate for Payer: Humana Medicare |
$364.90
|
| Rate for Payer: Lucent All Commercial |
$364.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$643.94
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$536.62
|
| Rate for Payer: PHP All Commercial |
$542.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$279.04
|
| Rate for Payer: Sagamore Health Network All Products |
$552.36
|
| Rate for Payer: Signature Care EPO |
$593.86
|
| Rate for Payer: Signature Care PPO |
$629.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$608.17
|
| Rate for Payer: United Healthcare Commercial |
$563.81
|
| Rate for Payer: United Healthcare Medicare |
$236.11
|
|
|
HC INDUSTRIAL COMPLETE PFT
|
Facility
IP
|
$715.49
|
|
| Hospital Charge Code |
01706005
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$536.62 |
| Max. Negotiated Rate |
$665.40 |
| Rate for Payer: Aetna Commercial |
$618.18
|
| Rate for Payer: Cash Price |
$443.60
|
| Rate for Payer: Cigna All Commercial |
$617.47
|
| Rate for Payer: CORVEL All Commercial |
$665.40
|
| Rate for Payer: Coventry All Commercial |
$629.63
|
| Rate for Payer: Encore All Commercial |
$658.61
|
| Rate for Payer: Frontpath All Commercial |
$658.25
|
| Rate for Payer: Humana ChoiceCare |
$617.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$643.94
|
| Rate for Payer: PHCS All Commercial |
$536.62
|
| Rate for Payer: PHP All Commercial |
$542.63
|
| Rate for Payer: Sagamore Health Network All Products |
$552.36
|
| Rate for Payer: Signature Care EPO |
$593.86
|
| Rate for Payer: Signature Care PPO |
$629.63
|
| Rate for Payer: United Healthcare Commercial |
$563.81
|
|
|
HC INDUSTRIAL PRE/POST PFT
|
Facility
IP
|
$264.31
|
|
| Hospital Charge Code |
01706006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$245.81 |
| Rate for Payer: Aetna Commercial |
$228.37
|
| Rate for Payer: Cash Price |
$163.87
|
| Rate for Payer: Cigna All Commercial |
$228.10
|
| Rate for Payer: CORVEL All Commercial |
$245.81
|
| Rate for Payer: Coventry All Commercial |
$232.60
|
| Rate for Payer: Encore All Commercial |
$243.30
|
| Rate for Payer: Frontpath All Commercial |
$243.17
|
| Rate for Payer: Humana ChoiceCare |
$228.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.88
|
| Rate for Payer: PHCS All Commercial |
$198.23
|
| Rate for Payer: PHP All Commercial |
$200.45
|
| Rate for Payer: Sagamore Health Network All Products |
$204.05
|
| Rate for Payer: Signature Care EPO |
$219.38
|
| Rate for Payer: Signature Care PPO |
$232.60
|
| Rate for Payer: United Healthcare Commercial |
$208.28
|
|
|
HC INDUSTRIAL PRE/POST PFT
|
Facility
OP
|
$264.31
|
|
| Hospital Charge Code |
01706006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$245.81 |
| Rate for Payer: Aetna Commercial |
$223.08
|
| Rate for Payer: Aetna Medicare |
$87.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$151.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.95
|
| Rate for Payer: Cash Price |
$163.87
|
| Rate for Payer: Cash Price |
$163.87
|
| Rate for Payer: Centivo All Commercial |
$134.80
|
| Rate for Payer: Cigna All Commercial |
$228.10
|
| Rate for Payer: CORVEL All Commercial |
$245.81
|
| Rate for Payer: Coventry All Commercial |
$232.60
|
| Rate for Payer: Encore All Commercial |
$243.30
|
| Rate for Payer: Frontpath All Commercial |
$243.17
|
| Rate for Payer: Humana ChoiceCare |
$228.29
|
| Rate for Payer: Humana Medicare |
$134.80
|
| Rate for Payer: Lucent All Commercial |
$134.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.88
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$198.23
|
| Rate for Payer: PHP All Commercial |
$200.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.08
|
| Rate for Payer: Sagamore Health Network All Products |
$204.05
|
| Rate for Payer: Signature Care EPO |
$219.38
|
| Rate for Payer: Signature Care PPO |
$232.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$224.67
|
| Rate for Payer: United Healthcare Commercial |
$208.28
|
| Rate for Payer: United Healthcare Medicare |
$87.22
|
|
|
HC INDUSTRIAL SCREEN PFT
|
Facility
OP
|
$116.17
|
|
| Hospital Charge Code |
01706007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$186.46 |
| Rate for Payer: Aetna Commercial |
$98.05
|
| Rate for Payer: Aetna Medicare |
$38.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.17
|
| Rate for Payer: Cash Price |
$72.02
|
| Rate for Payer: Cash Price |
$72.02
|
| Rate for Payer: Centivo All Commercial |
$59.25
|
| Rate for Payer: Cigna All Commercial |
$100.25
|
| Rate for Payer: CORVEL All Commercial |
$108.04
|
| Rate for Payer: Coventry All Commercial |
$102.23
|
| Rate for Payer: Encore All Commercial |
$106.93
|
| Rate for Payer: Frontpath All Commercial |
$106.87
|
| Rate for Payer: Humana ChoiceCare |
$100.33
|
| Rate for Payer: Humana Medicare |
$59.25
|
| Rate for Payer: Lucent All Commercial |
$59.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.55
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$87.13
|
| Rate for Payer: PHP All Commercial |
$88.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.31
|
| Rate for Payer: Sagamore Health Network All Products |
$89.68
|
| Rate for Payer: Signature Care EPO |
$96.42
|
| Rate for Payer: Signature Care PPO |
$102.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.74
|
| Rate for Payer: United Healthcare Commercial |
$91.54
|
| Rate for Payer: United Healthcare Medicare |
$38.34
|
|
|
HC INDUSTRIAL SCREEN PFT
|
Facility
IP
|
$116.17
|
|
| Hospital Charge Code |
01706007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$87.13 |
| Max. Negotiated Rate |
$108.04 |
| Rate for Payer: Aetna Commercial |
$100.37
|
| Rate for Payer: Cash Price |
$72.02
|
| Rate for Payer: Cigna All Commercial |
$100.25
|
| Rate for Payer: CORVEL All Commercial |
$108.04
|
| Rate for Payer: Coventry All Commercial |
$102.23
|
| Rate for Payer: Encore All Commercial |
$106.93
|
| Rate for Payer: Frontpath All Commercial |
$106.87
|
| Rate for Payer: Humana ChoiceCare |
$100.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.55
|
| Rate for Payer: PHCS All Commercial |
$87.13
|
| Rate for Payer: PHP All Commercial |
$88.10
|
| Rate for Payer: Sagamore Health Network All Products |
$89.68
|
| Rate for Payer: Signature Care EPO |
$96.42
|
| Rate for Payer: Signature Care PPO |
$102.23
|
| Rate for Payer: United Healthcare Commercial |
$91.54
|
|
|
HC INFLATION SYRINGE
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
41602098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$177.24
|
| Rate for Payer: Aetna Medicare |
$69.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.23
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Centivo All Commercial |
$107.10
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.30
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Humana Medicare |
$107.10
|
| Rate for Payer: Lucent All Commercial |
$107.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.90
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
|
|
HC INFLATION SYRINGE
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
41602098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.30
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
|
|
HC INFLIXIMAB AND ANTI-INFLIXIMAB ANTIBODY, DOSEASSURE IFX-B
|
Facility
OP
|
$161.16
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63044051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$149.88 |
| Rate for Payer: Aetna Commercial |
$136.02
|
| Rate for Payer: Aetna Medicare |
$53.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.50
|
| Rate for Payer: Cash Price |
$99.92
|
| Rate for Payer: Cash Price |
$99.92
|
| Rate for Payer: Centivo All Commercial |
$82.19
|
| Rate for Payer: Cigna All Commercial |
$139.08
|
| Rate for Payer: CORVEL All Commercial |
$149.88
|
| Rate for Payer: Coventry All Commercial |
$141.82
|
| Rate for Payer: Encore All Commercial |
$148.35
|
| Rate for Payer: Frontpath All Commercial |
$148.27
|
| Rate for Payer: Humana ChoiceCare |
$139.19
|
| Rate for Payer: Humana Medicare |
$82.19
|
| Rate for Payer: Lucent All Commercial |
$82.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.04
|
| Rate for Payer: Managed Health Services Medicaid |
$12.16
|
| Rate for Payer: MDWise Medicaid |
$12.16
|
| Rate for Payer: PHCS All Commercial |
$120.87
|
| Rate for Payer: PHP All Commercial |
$122.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.85
|
| Rate for Payer: Sagamore Health Network All Products |
$124.42
|
| Rate for Payer: Signature Care EPO |
$133.76
|
| Rate for Payer: Signature Care PPO |
$141.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.99
|
| Rate for Payer: United Healthcare Commercial |
$126.99
|
| Rate for Payer: United Healthcare Medicare |
$53.18
|
|
|
HC INFLIXIMAB AND ANTI-INFLIXIMAB ANTIBODY, DOSEASSURE IFX-B
|
Facility
IP
|
$161.16
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63044051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.87 |
| Max. Negotiated Rate |
$149.88 |
| Rate for Payer: Aetna Commercial |
$139.24
|
| Rate for Payer: Cash Price |
$99.92
|
| Rate for Payer: Cigna All Commercial |
$139.08
|
| Rate for Payer: CORVEL All Commercial |
$149.88
|
| Rate for Payer: Coventry All Commercial |
$141.82
|
| Rate for Payer: Encore All Commercial |
$148.35
|
| Rate for Payer: Frontpath All Commercial |
$148.27
|
| Rate for Payer: Humana ChoiceCare |
$139.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.04
|
| Rate for Payer: PHCS All Commercial |
$120.87
|
| Rate for Payer: PHP All Commercial |
$122.22
|
| Rate for Payer: Sagamore Health Network All Products |
$124.42
|
| Rate for Payer: Signature Care EPO |
$133.76
|
| Rate for Payer: Signature Care PPO |
$141.82
|
| Rate for Payer: United Healthcare Commercial |
$126.99
|
|
|
HC INFLIXIMAB AND ANTI-INFLIXIMAB ANTIBODY, DOSEASSUR IFX
|
Facility
IP
|
$371.06
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63044050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$278.29 |
| Max. Negotiated Rate |
$345.08 |
| Rate for Payer: Aetna Commercial |
$320.59
|
| Rate for Payer: Cash Price |
$230.05
|
| Rate for Payer: Cigna All Commercial |
$320.22
|
| Rate for Payer: CORVEL All Commercial |
$345.08
|
| Rate for Payer: Coventry All Commercial |
$326.53
|
| Rate for Payer: Encore All Commercial |
$341.56
|
| Rate for Payer: Frontpath All Commercial |
$341.37
|
| Rate for Payer: Humana ChoiceCare |
$320.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.95
|
| Rate for Payer: PHCS All Commercial |
$278.29
|
| Rate for Payer: PHP All Commercial |
$281.41
|
| Rate for Payer: Sagamore Health Network All Products |
$286.45
|
| Rate for Payer: Signature Care EPO |
$307.98
|
| Rate for Payer: Signature Care PPO |
$326.53
|
| Rate for Payer: United Healthcare Commercial |
$292.39
|
|
|
HC INFLIXIMAB AND ANTI-INFLIXIMAB ANTIBODY, DOSEASSUR IFX
|
Facility
OP
|
$371.06
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63044050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$345.08 |
| Rate for Payer: Aetna Commercial |
$313.17
|
| Rate for Payer: Aetna Medicare |
$122.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$213.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.69
|
| Rate for Payer: Cash Price |
$230.05
|
| Rate for Payer: Cash Price |
$230.05
|
| Rate for Payer: Centivo All Commercial |
$189.24
|
| Rate for Payer: Cigna All Commercial |
$320.22
|
| Rate for Payer: CORVEL All Commercial |
$345.08
|
| Rate for Payer: Coventry All Commercial |
$326.53
|
| Rate for Payer: Encore All Commercial |
$341.56
|
| Rate for Payer: Frontpath All Commercial |
$341.37
|
| Rate for Payer: Humana ChoiceCare |
$320.48
|
| Rate for Payer: Humana Medicare |
$189.24
|
| Rate for Payer: Lucent All Commercial |
$189.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.95
|
| Rate for Payer: Managed Health Services Medicaid |
$18.64
|
| Rate for Payer: MDWise Medicaid |
$18.64
|
| Rate for Payer: PHCS All Commercial |
$278.29
|
| Rate for Payer: PHP All Commercial |
$281.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.71
|
| Rate for Payer: Sagamore Health Network All Products |
$286.45
|
| Rate for Payer: Signature Care EPO |
$307.98
|
| Rate for Payer: Signature Care PPO |
$326.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$315.40
|
| Rate for Payer: United Healthcare Commercial |
$292.39
|
| Rate for Payer: United Healthcare Medicare |
$122.45
|
|
|
HC INFLUENZA A
|
Facility
OP
|
$64.85
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
63002032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$54.73
|
| Rate for Payer: Aetna Medicare |
$21.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.54
|
| Rate for Payer: Cash Price |
$40.21
|
| Rate for Payer: Cash Price |
$40.21
|
| Rate for Payer: Centivo All Commercial |
$33.07
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.70
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Humana Medicare |
$33.07
|
| Rate for Payer: Lucent All Commercial |
$33.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: Managed Health Services Medicaid |
$8.29
|
| Rate for Payer: MDWise Medicaid |
$8.29
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.29
|
| Rate for Payer: Sagamore Health Network All Products |
$50.07
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.12
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
| Rate for Payer: United Healthcare Medicare |
$21.40
|
|
|
HC INFLUENZA A
|
Facility
IP
|
$64.85
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
63002032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$56.03
|
| Rate for Payer: Cash Price |
$40.21
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.70
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Sagamore Health Network All Products |
$50.07
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
|
|
HC INFLUENZA A/B
|
Facility
OP
|
$384.85
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
63087502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$357.91 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$95.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.70
|
| Rate for Payer: Cash Price |
$238.61
|
| Rate for Payer: Cash Price |
$238.61
|
| Rate for Payer: Centivo All Commercial |
$196.27
|
| Rate for Payer: Cigna All Commercial |
$332.12
|
| Rate for Payer: CORVEL All Commercial |
$357.91
|
| Rate for Payer: Coventry All Commercial |
$338.66
|
| Rate for Payer: Encore All Commercial |
$354.25
|
| Rate for Payer: Frontpath All Commercial |
$354.06
|
| Rate for Payer: Humana ChoiceCare |
$332.39
|
| Rate for Payer: Humana Medicare |
$196.27
|
| Rate for Payer: Lucent All Commercial |
$196.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.36
|
| Rate for Payer: Managed Health Services Medicaid |
$95.80
|
| Rate for Payer: MDWise Medicaid |
$95.80
|
| Rate for Payer: PHCS All Commercial |
$288.63
|
| Rate for Payer: PHP All Commercial |
$291.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.09
|
| Rate for Payer: Sagamore Health Network All Products |
$297.10
|
| Rate for Payer: Signature Care EPO |
$319.42
|
| Rate for Payer: Signature Care PPO |
$338.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.12
|
| Rate for Payer: United Healthcare Commercial |
$303.26
|
| Rate for Payer: United Healthcare Medicare |
$127.00
|
|
