|
HC INJECTION FOR CHOLANGIOGRAM EXIST ACCESS
|
Facility
IP
|
$736.03
|
|
| Hospital Charge Code |
01597531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.02 |
| Max. Negotiated Rate |
$684.51 |
| Rate for Payer: Aetna Commercial |
$635.93
|
| Rate for Payer: Cash Price |
$456.34
|
| Rate for Payer: Cigna All Commercial |
$635.20
|
| Rate for Payer: CORVEL All Commercial |
$684.51
|
| Rate for Payer: Coventry All Commercial |
$647.71
|
| Rate for Payer: Encore All Commercial |
$677.52
|
| Rate for Payer: Frontpath All Commercial |
$677.15
|
| Rate for Payer: Humana ChoiceCare |
$635.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.43
|
| Rate for Payer: PHCS All Commercial |
$552.02
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.91
|
| Rate for Payer: Signature Care PPO |
$647.71
|
| Rate for Payer: United Healthcare Commercial |
$579.99
|
|
|
HC INJECTION FOR CHOLANGIOGRAM EXIST ACCESS
|
Facility
OP
|
$736.03
|
|
| Hospital Charge Code |
01597531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.89 |
| Max. Negotiated Rate |
$684.51 |
| Rate for Payer: Aetna Commercial |
$621.21
|
| Rate for Payer: Aetna Medicare |
$242.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$422.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$460.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$279.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$267.18
|
| Rate for Payer: Cash Price |
$456.34
|
| Rate for Payer: Centivo All Commercial |
$375.38
|
| Rate for Payer: Cigna All Commercial |
$635.20
|
| Rate for Payer: CORVEL All Commercial |
$684.51
|
| Rate for Payer: Coventry All Commercial |
$647.71
|
| Rate for Payer: Encore All Commercial |
$677.52
|
| Rate for Payer: Frontpath All Commercial |
$677.15
|
| Rate for Payer: Humana ChoiceCare |
$635.71
|
| Rate for Payer: Humana Medicare |
$375.38
|
| Rate for Payer: Lucent All Commercial |
$375.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.43
|
| Rate for Payer: PHCS All Commercial |
$552.02
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$287.05
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.91
|
| Rate for Payer: Signature Care PPO |
$647.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$625.63
|
| Rate for Payer: United Healthcare Commercial |
$579.99
|
| Rate for Payer: United Healthcare Medicare |
$242.89
|
|
|
HC INJ ELBOW ARTHROGRAM BI
|
Facility
IP
|
$884.73
|
|
|
Service Code
|
CPT 24220 50
|
| Hospital Charge Code |
21614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.55 |
| Max. Negotiated Rate |
$822.80 |
| Rate for Payer: Aetna Commercial |
$764.40
|
| Rate for Payer: Cash Price |
$548.53
|
| Rate for Payer: Cigna All Commercial |
$763.52
|
| Rate for Payer: CORVEL All Commercial |
$822.80
|
| Rate for Payer: Coventry All Commercial |
$778.56
|
| Rate for Payer: Encore All Commercial |
$814.39
|
| Rate for Payer: Frontpath All Commercial |
$813.95
|
| Rate for Payer: Humana ChoiceCare |
$764.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.25
|
| Rate for Payer: PHCS All Commercial |
$663.55
|
| Rate for Payer: PHP All Commercial |
$670.98
|
| Rate for Payer: Sagamore Health Network All Products |
$683.01
|
| Rate for Payer: Signature Care EPO |
$734.32
|
| Rate for Payer: Signature Care PPO |
$778.56
|
| Rate for Payer: United Healthcare Commercial |
$697.17
|
|
|
HC INJ ELBOW ARTHROGRAM BI
|
Facility
OP
|
$884.73
|
|
|
Service Code
|
CPT 24220 50
|
| Hospital Charge Code |
21614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.96 |
| Max. Negotiated Rate |
$822.80 |
| Rate for Payer: Aetna Commercial |
$746.71
|
| Rate for Payer: Aetna Medicare |
$291.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$508.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$553.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$335.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.16
|
| Rate for Payer: Cash Price |
$548.53
|
| Rate for Payer: Centivo All Commercial |
$451.21
|
| Rate for Payer: Cigna All Commercial |
$763.52
|
| Rate for Payer: CORVEL All Commercial |
$822.80
|
| Rate for Payer: Coventry All Commercial |
$778.56
|
| Rate for Payer: Encore All Commercial |
$814.39
|
| Rate for Payer: Frontpath All Commercial |
$813.95
|
| Rate for Payer: Humana ChoiceCare |
$764.14
|
| Rate for Payer: Humana Medicare |
$451.21
|
| Rate for Payer: Lucent All Commercial |
$451.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.25
|
| Rate for Payer: PHCS All Commercial |
$663.55
|
| Rate for Payer: PHP All Commercial |
$670.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.04
|
| Rate for Payer: Sagamore Health Network All Products |
$683.01
|
| Rate for Payer: Signature Care EPO |
$734.32
|
| Rate for Payer: Signature Care PPO |
$778.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.02
|
| Rate for Payer: United Healthcare Commercial |
$697.17
|
| Rate for Payer: United Healthcare Medicare |
$291.96
|
|
|
HC INJ ELBOW ARTHROGRAM LT
|
Facility
OP
|
$589.82
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
01614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.64 |
| Max. Negotiated Rate |
$548.53 |
| Rate for Payer: Aetna Commercial |
$497.80
|
| Rate for Payer: Aetna Medicare |
$194.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$194.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$368.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$223.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$214.10
|
| Rate for Payer: Cash Price |
$365.69
|
| Rate for Payer: Cash Price |
$365.69
|
| Rate for Payer: Centivo All Commercial |
$300.81
|
| Rate for Payer: Cigna All Commercial |
$509.01
|
| Rate for Payer: CORVEL All Commercial |
$548.53
|
| Rate for Payer: Coventry All Commercial |
$519.04
|
| Rate for Payer: Encore All Commercial |
$542.92
|
| Rate for Payer: Frontpath All Commercial |
$542.63
|
| Rate for Payer: Humana ChoiceCare |
$509.42
|
| Rate for Payer: Humana Medicare |
$300.81
|
| Rate for Payer: Lucent All Commercial |
$300.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.83
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$442.36
|
| Rate for Payer: PHP All Commercial |
$447.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.03
|
| Rate for Payer: Sagamore Health Network All Products |
$455.34
|
| Rate for Payer: Signature Care EPO |
$489.55
|
| Rate for Payer: Signature Care PPO |
$519.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$501.34
|
| Rate for Payer: United Healthcare Commercial |
$464.77
|
| Rate for Payer: United Healthcare Medicare |
$194.64
|
|
|
HC INJ ELBOW ARTHROGRAM LT
|
Facility
IP
|
$589.82
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
01614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$442.36 |
| Max. Negotiated Rate |
$548.53 |
| Rate for Payer: Aetna Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$365.69
|
| Rate for Payer: Cigna All Commercial |
$509.01
|
| Rate for Payer: CORVEL All Commercial |
$548.53
|
| Rate for Payer: Coventry All Commercial |
$519.04
|
| Rate for Payer: Encore All Commercial |
$542.92
|
| Rate for Payer: Frontpath All Commercial |
$542.63
|
| Rate for Payer: Humana ChoiceCare |
$509.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.83
|
| Rate for Payer: PHCS All Commercial |
$442.36
|
| Rate for Payer: PHP All Commercial |
$447.32
|
| Rate for Payer: Sagamore Health Network All Products |
$455.34
|
| Rate for Payer: Signature Care EPO |
$489.55
|
| Rate for Payer: Signature Care PPO |
$519.04
|
| Rate for Payer: United Healthcare Commercial |
$464.77
|
|
|
HC INJ ELBOW ARTHROGRAM RT
|
Facility
IP
|
$589.82
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
11614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$442.36 |
| Max. Negotiated Rate |
$548.53 |
| Rate for Payer: Aetna Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$365.69
|
| Rate for Payer: Cigna All Commercial |
$509.01
|
| Rate for Payer: CORVEL All Commercial |
$548.53
|
| Rate for Payer: Coventry All Commercial |
$519.04
|
| Rate for Payer: Encore All Commercial |
$542.92
|
| Rate for Payer: Frontpath All Commercial |
$542.63
|
| Rate for Payer: Humana ChoiceCare |
$509.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.83
|
| Rate for Payer: PHCS All Commercial |
$442.36
|
| Rate for Payer: PHP All Commercial |
$447.32
|
| Rate for Payer: Sagamore Health Network All Products |
$455.34
|
| Rate for Payer: Signature Care EPO |
$489.55
|
| Rate for Payer: Signature Care PPO |
$519.04
|
| Rate for Payer: United Healthcare Commercial |
$464.77
|
|
|
HC INJ ELBOW ARTHROGRAM RT
|
Facility
OP
|
$589.82
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
11614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.64 |
| Max. Negotiated Rate |
$548.53 |
| Rate for Payer: Aetna Commercial |
$497.80
|
| Rate for Payer: Aetna Medicare |
$194.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$194.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$368.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$223.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$214.10
|
| Rate for Payer: Cash Price |
$365.69
|
| Rate for Payer: Cash Price |
$365.69
|
| Rate for Payer: Centivo All Commercial |
$300.81
|
| Rate for Payer: Cigna All Commercial |
$509.01
|
| Rate for Payer: CORVEL All Commercial |
$548.53
|
| Rate for Payer: Coventry All Commercial |
$519.04
|
| Rate for Payer: Encore All Commercial |
$542.92
|
| Rate for Payer: Frontpath All Commercial |
$542.63
|
| Rate for Payer: Humana ChoiceCare |
$509.42
|
| Rate for Payer: Humana Medicare |
$300.81
|
| Rate for Payer: Lucent All Commercial |
$300.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.83
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$442.36
|
| Rate for Payer: PHP All Commercial |
$447.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.03
|
| Rate for Payer: Sagamore Health Network All Products |
$455.34
|
| Rate for Payer: Signature Care EPO |
$489.55
|
| Rate for Payer: Signature Care PPO |
$519.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$501.34
|
| Rate for Payer: United Healthcare Commercial |
$464.77
|
| Rate for Payer: United Healthcare Medicare |
$194.64
|
|
|
HC INJ EPIDURAL BLOOD OR CLOT PATCH
|
Facility
IP
|
$2,033.33
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
01689117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$1,891.00 |
| Rate for Payer: Aetna Commercial |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,260.66
|
| Rate for Payer: Cigna All Commercial |
$1,754.76
|
| Rate for Payer: CORVEL All Commercial |
$1,891.00
|
| Rate for Payer: Coventry All Commercial |
$1,789.33
|
| Rate for Payer: Encore All Commercial |
$1,871.68
|
| Rate for Payer: Frontpath All Commercial |
$1,870.66
|
| Rate for Payer: Humana ChoiceCare |
$1,756.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,830.00
|
| Rate for Payer: PHCS All Commercial |
$1,525.00
|
| Rate for Payer: PHP All Commercial |
$1,542.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,569.73
|
| Rate for Payer: Signature Care EPO |
$1,687.66
|
| Rate for Payer: Signature Care PPO |
$1,789.33
|
| Rate for Payer: United Healthcare Commercial |
$1,602.26
|
|
|
HC INJ EPIDURAL BLOOD OR CLOT PATCH
|
Facility
OP
|
$2,033.33
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
01689117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$671.00 |
| Max. Negotiated Rate |
$1,891.00 |
| Rate for Payer: Aetna Commercial |
$1,716.13
|
| Rate for Payer: Aetna Medicare |
$671.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$671.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,167.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,271.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,242.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$771.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$738.10
|
| Rate for Payer: Cash Price |
$1,260.66
|
| Rate for Payer: Cash Price |
$1,260.66
|
| Rate for Payer: Centivo All Commercial |
$1,037.00
|
| Rate for Payer: Cigna All Commercial |
$1,754.76
|
| Rate for Payer: CORVEL All Commercial |
$1,891.00
|
| Rate for Payer: Coventry All Commercial |
$1,789.33
|
| Rate for Payer: Encore All Commercial |
$1,871.68
|
| Rate for Payer: Frontpath All Commercial |
$1,870.66
|
| Rate for Payer: Humana ChoiceCare |
$1,756.19
|
| Rate for Payer: Humana Medicare |
$1,037.00
|
| Rate for Payer: Lucent All Commercial |
$1,037.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,830.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,242.31
|
| Rate for Payer: MDWise Medicaid |
$1,242.31
|
| Rate for Payer: PHCS All Commercial |
$1,525.00
|
| Rate for Payer: PHP All Commercial |
$1,542.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$793.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,569.73
|
| Rate for Payer: Signature Care EPO |
$1,687.66
|
| Rate for Payer: Signature Care PPO |
$1,789.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,728.33
|
| Rate for Payer: United Healthcare Commercial |
$1,602.26
|
| Rate for Payer: United Healthcare Medicare |
$671.00
|
|
|
HC INJ HIP ARTHROGRAM BI
|
Facility
OP
|
$1,057.25
|
|
|
Service Code
|
CPT 27093 50
|
| Hospital Charge Code |
21617093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.89 |
| Max. Negotiated Rate |
$983.24 |
| Rate for Payer: Aetna Commercial |
$892.32
|
| Rate for Payer: Aetna Medicare |
$348.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$348.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$607.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$660.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$401.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.78
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Centivo All Commercial |
$539.20
|
| Rate for Payer: Cigna All Commercial |
$912.41
|
| Rate for Payer: CORVEL All Commercial |
$983.24
|
| Rate for Payer: Coventry All Commercial |
$930.38
|
| Rate for Payer: Encore All Commercial |
$973.20
|
| Rate for Payer: Frontpath All Commercial |
$972.67
|
| Rate for Payer: Humana ChoiceCare |
$913.15
|
| Rate for Payer: Humana Medicare |
$539.20
|
| Rate for Payer: Lucent All Commercial |
$539.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$951.53
|
| Rate for Payer: PHCS All Commercial |
$792.94
|
| Rate for Payer: PHP All Commercial |
$801.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$412.33
|
| Rate for Payer: Sagamore Health Network All Products |
$816.20
|
| Rate for Payer: Signature Care EPO |
$877.52
|
| Rate for Payer: Signature Care PPO |
$930.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$898.66
|
| Rate for Payer: United Healthcare Commercial |
$833.11
|
| Rate for Payer: United Healthcare Medicare |
$348.89
|
|
|
HC INJ HIP ARTHROGRAM BI
|
Facility
IP
|
$1,057.25
|
|
|
Service Code
|
CPT 27093 50
|
| Hospital Charge Code |
21617093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$983.24 |
| Rate for Payer: Aetna Commercial |
$913.46
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Cigna All Commercial |
$912.41
|
| Rate for Payer: CORVEL All Commercial |
$983.24
|
| Rate for Payer: Coventry All Commercial |
$930.38
|
| Rate for Payer: Encore All Commercial |
$973.20
|
| Rate for Payer: Frontpath All Commercial |
$972.67
|
| Rate for Payer: Humana ChoiceCare |
$913.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$951.53
|
| Rate for Payer: PHCS All Commercial |
$792.94
|
| Rate for Payer: PHP All Commercial |
$801.82
|
| Rate for Payer: Sagamore Health Network All Products |
$816.20
|
| Rate for Payer: Signature Care EPO |
$877.52
|
| Rate for Payer: Signature Care PPO |
$930.38
|
| Rate for Payer: United Healthcare Commercial |
$833.11
|
|
|
HC INJ HIP ARTHROGRAM LT
|
Facility
IP
|
$704.82
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
01617093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.62 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$608.96
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
|
|
HC INJ HIP ARTHROGRAM LT
|
Facility
OP
|
$704.82
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
01617093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.59 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$594.87
|
| Rate for Payer: Aetna Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$404.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.85
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Centivo All Commercial |
$359.46
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Humana Medicare |
$359.46
|
| Rate for Payer: Lucent All Commercial |
$359.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.88
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$599.10
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
| Rate for Payer: United Healthcare Medicare |
$232.59
|
|
|
HC INJ HIP ARTHROGRAM RT
|
Facility
OP
|
$704.82
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
11617093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.59 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$594.87
|
| Rate for Payer: Aetna Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$404.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.85
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Centivo All Commercial |
$359.46
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Humana Medicare |
$359.46
|
| Rate for Payer: Lucent All Commercial |
$359.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.88
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$599.10
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
| Rate for Payer: United Healthcare Medicare |
$232.59
|
|
|
HC INJ HIP ARTHROGRAM RT
|
Facility
IP
|
$704.82
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
11617093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.62 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$608.96
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
|
|
HC INJ HYSTEROSALPINGOGRAM
|
Facility
OP
|
$757.35
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
01618340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.93 |
| Max. Negotiated Rate |
$704.34 |
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna Medicare |
$249.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$249.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$434.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$473.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$287.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$274.92
|
| Rate for Payer: Cash Price |
$469.56
|
| Rate for Payer: Cash Price |
$469.56
|
| Rate for Payer: Centivo All Commercial |
$386.25
|
| Rate for Payer: Cigna All Commercial |
$653.59
|
| Rate for Payer: CORVEL All Commercial |
$704.34
|
| Rate for Payer: Coventry All Commercial |
$666.47
|
| Rate for Payer: Encore All Commercial |
$697.14
|
| Rate for Payer: Frontpath All Commercial |
$696.76
|
| Rate for Payer: Humana ChoiceCare |
$654.12
|
| Rate for Payer: Humana Medicare |
$386.25
|
| Rate for Payer: Lucent All Commercial |
$386.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$681.62
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$568.01
|
| Rate for Payer: PHP All Commercial |
$574.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$295.37
|
| Rate for Payer: Sagamore Health Network All Products |
$584.67
|
| Rate for Payer: Signature Care EPO |
$628.60
|
| Rate for Payer: Signature Care PPO |
$666.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$643.75
|
| Rate for Payer: United Healthcare Commercial |
$596.79
|
| Rate for Payer: United Healthcare Medicare |
$249.93
|
|
|
HC INJ HYSTEROSALPINGOGRAM
|
Facility
IP
|
$757.35
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
01618340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$568.01 |
| Max. Negotiated Rate |
$704.34 |
| Rate for Payer: Aetna Commercial |
$654.35
|
| Rate for Payer: Cash Price |
$469.56
|
| Rate for Payer: Cigna All Commercial |
$653.59
|
| Rate for Payer: CORVEL All Commercial |
$704.34
|
| Rate for Payer: Coventry All Commercial |
$666.47
|
| Rate for Payer: Encore All Commercial |
$697.14
|
| Rate for Payer: Frontpath All Commercial |
$696.76
|
| Rate for Payer: Humana ChoiceCare |
$654.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$681.62
|
| Rate for Payer: PHCS All Commercial |
$568.01
|
| Rate for Payer: PHP All Commercial |
$574.37
|
| Rate for Payer: Sagamore Health Network All Products |
$584.67
|
| Rate for Payer: Signature Care EPO |
$628.60
|
| Rate for Payer: Signature Care PPO |
$666.47
|
| Rate for Payer: United Healthcare Commercial |
$596.79
|
|
|
HC INJ INTESTINAL TUBE
|
Facility
OP
|
$1,261.72
|
|
| Hospital Charge Code |
01614799
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$416.37 |
| Max. Negotiated Rate |
$1,173.40 |
| Rate for Payer: Aetna Commercial |
$1,064.89
|
| Rate for Payer: Aetna Medicare |
$416.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$416.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$724.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$478.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$458.00
|
| Rate for Payer: Cash Price |
$782.27
|
| Rate for Payer: Centivo All Commercial |
$643.48
|
| Rate for Payer: Cigna All Commercial |
$1,088.86
|
| Rate for Payer: CORVEL All Commercial |
$1,173.40
|
| Rate for Payer: Coventry All Commercial |
$1,110.31
|
| Rate for Payer: Encore All Commercial |
$1,161.41
|
| Rate for Payer: Frontpath All Commercial |
$1,160.78
|
| Rate for Payer: Humana ChoiceCare |
$1,089.75
|
| Rate for Payer: Humana Medicare |
$643.48
|
| Rate for Payer: Lucent All Commercial |
$643.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,135.55
|
| Rate for Payer: PHCS All Commercial |
$946.29
|
| Rate for Payer: PHP All Commercial |
$956.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$492.07
|
| Rate for Payer: Sagamore Health Network All Products |
$974.05
|
| Rate for Payer: Signature Care EPO |
$1,047.23
|
| Rate for Payer: Signature Care PPO |
$1,110.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,072.46
|
| Rate for Payer: United Healthcare Commercial |
$994.24
|
| Rate for Payer: United Healthcare Medicare |
$416.37
|
|
|
HC INJ INTESTINAL TUBE
|
Facility
IP
|
$1,261.72
|
|
| Hospital Charge Code |
01614799
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.29 |
| Max. Negotiated Rate |
$1,173.40 |
| Rate for Payer: Aetna Commercial |
$1,090.13
|
| Rate for Payer: Cash Price |
$782.27
|
| Rate for Payer: Cigna All Commercial |
$1,088.86
|
| Rate for Payer: CORVEL All Commercial |
$1,173.40
|
| Rate for Payer: Coventry All Commercial |
$1,110.31
|
| Rate for Payer: Encore All Commercial |
$1,161.41
|
| Rate for Payer: Frontpath All Commercial |
$1,160.78
|
| Rate for Payer: Humana ChoiceCare |
$1,089.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,135.55
|
| Rate for Payer: PHCS All Commercial |
$946.29
|
| Rate for Payer: PHP All Commercial |
$956.89
|
| Rate for Payer: Sagamore Health Network All Products |
$974.05
|
| Rate for Payer: Signature Care EPO |
$1,047.23
|
| Rate for Payer: Signature Care PPO |
$1,110.31
|
| Rate for Payer: United Healthcare Commercial |
$994.24
|
|
|
HC INJ KNEE ARTHROGRAM BI
|
Facility
OP
|
$1,057.25
|
|
|
Service Code
|
CPT 27369 50
|
| Hospital Charge Code |
21617370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.89 |
| Max. Negotiated Rate |
$983.24 |
| Rate for Payer: Aetna Commercial |
$892.32
|
| Rate for Payer: Aetna Medicare |
$348.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$348.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$607.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$660.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$401.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.78
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Centivo All Commercial |
$539.20
|
| Rate for Payer: Cigna All Commercial |
$912.41
|
| Rate for Payer: CORVEL All Commercial |
$983.24
|
| Rate for Payer: Coventry All Commercial |
$930.38
|
| Rate for Payer: Encore All Commercial |
$973.20
|
| Rate for Payer: Frontpath All Commercial |
$972.67
|
| Rate for Payer: Humana ChoiceCare |
$913.15
|
| Rate for Payer: Humana Medicare |
$539.20
|
| Rate for Payer: Lucent All Commercial |
$539.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$951.53
|
| Rate for Payer: PHCS All Commercial |
$792.94
|
| Rate for Payer: PHP All Commercial |
$801.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$412.33
|
| Rate for Payer: Sagamore Health Network All Products |
$816.20
|
| Rate for Payer: Signature Care EPO |
$877.52
|
| Rate for Payer: Signature Care PPO |
$930.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$898.66
|
| Rate for Payer: United Healthcare Commercial |
$833.11
|
| Rate for Payer: United Healthcare Medicare |
$348.89
|
|
|
HC INJ KNEE ARTHROGRAM BI
|
Facility
IP
|
$1,057.25
|
|
|
Service Code
|
CPT 27369 50
|
| Hospital Charge Code |
21617370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$983.24 |
| Rate for Payer: Aetna Commercial |
$913.46
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Cigna All Commercial |
$912.41
|
| Rate for Payer: CORVEL All Commercial |
$983.24
|
| Rate for Payer: Coventry All Commercial |
$930.38
|
| Rate for Payer: Encore All Commercial |
$973.20
|
| Rate for Payer: Frontpath All Commercial |
$972.67
|
| Rate for Payer: Humana ChoiceCare |
$913.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$951.53
|
| Rate for Payer: PHCS All Commercial |
$792.94
|
| Rate for Payer: PHP All Commercial |
$801.82
|
| Rate for Payer: Sagamore Health Network All Products |
$816.20
|
| Rate for Payer: Signature Care EPO |
$877.52
|
| Rate for Payer: Signature Care PPO |
$930.38
|
| Rate for Payer: United Healthcare Commercial |
$833.11
|
|
|
HC INJ KNEE ARTHROGRAM LT
|
Facility
OP
|
$704.82
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
01617370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.59 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$594.87
|
| Rate for Payer: Aetna Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$404.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.85
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Centivo All Commercial |
$359.46
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Humana Medicare |
$359.46
|
| Rate for Payer: Lucent All Commercial |
$359.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.88
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$599.10
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
| Rate for Payer: United Healthcare Medicare |
$232.59
|
|
|
HC INJ KNEE ARTHROGRAM LT
|
Facility
IP
|
$704.82
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
01617370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.62 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$608.96
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
|
|
HC INJ KNEE ARTHROGRAM RT
|
Facility
OP
|
$704.82
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
11617370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.59 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$594.87
|
| Rate for Payer: Aetna Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$404.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.85
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Centivo All Commercial |
$359.46
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Humana Medicare |
$359.46
|
| Rate for Payer: Lucent All Commercial |
$359.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.88
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$599.10
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
| Rate for Payer: United Healthcare Medicare |
$232.59
|
|
