|
HC OSMOLALITY (BLOOD)
|
Facility
|
IP
|
$139.13
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
63001121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$120.21
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Cigna All Commercial |
$120.07
|
| Rate for Payer: CORVEL All Commercial |
$129.39
|
| Rate for Payer: Coventry All Commercial |
$122.43
|
| Rate for Payer: Encore All Commercial |
$128.07
|
| Rate for Payer: Frontpath All Commercial |
$128.00
|
| Rate for Payer: Humana ChoiceCare |
$120.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.22
|
| Rate for Payer: PHCS All Commercial |
$104.35
|
| Rate for Payer: PHP All Commercial |
$105.52
|
| Rate for Payer: Sagamore Health Network All Products |
$107.41
|
| Rate for Payer: Signature Care EPO |
$115.48
|
| Rate for Payer: Signature Care PPO |
$122.43
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
|
|
HC OSMOLALITY URINE
|
Facility
|
IP
|
$134.51
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
63001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$125.09 |
| Rate for Payer: Aetna Commercial |
$116.22
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Cigna All Commercial |
$116.08
|
| Rate for Payer: CORVEL All Commercial |
$125.09
|
| Rate for Payer: Coventry All Commercial |
$118.37
|
| Rate for Payer: Encore All Commercial |
$123.82
|
| Rate for Payer: Frontpath All Commercial |
$123.75
|
| Rate for Payer: Humana ChoiceCare |
$116.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.06
|
| Rate for Payer: PHCS All Commercial |
$100.88
|
| Rate for Payer: PHP All Commercial |
$102.01
|
| Rate for Payer: Sagamore Health Network All Products |
$103.84
|
| Rate for Payer: Signature Care EPO |
$111.64
|
| Rate for Payer: Signature Care PPO |
$118.37
|
| Rate for Payer: United Healthcare Commercial |
$105.99
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$134.51
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
63001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$125.09 |
| Rate for Payer: Aetna Commercial |
$113.53
|
| Rate for Payer: Aetna Medicare |
$43.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$61.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.35
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Centivo All Commercial |
$73.17
|
| Rate for Payer: Cigna All Commercial |
$116.08
|
| Rate for Payer: CORVEL All Commercial |
$125.09
|
| Rate for Payer: Coventry All Commercial |
$118.37
|
| Rate for Payer: Encore All Commercial |
$123.82
|
| Rate for Payer: Frontpath All Commercial |
$123.75
|
| Rate for Payer: Humana ChoiceCare |
$116.18
|
| Rate for Payer: Humana Medicare |
$43.04
|
| Rate for Payer: Lucent All Commercial |
$73.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.06
|
| Rate for Payer: Managed Health Services Medicaid |
$6.82
|
| Rate for Payer: MDWise Medicaid |
$6.82
|
| Rate for Payer: PHCS All Commercial |
$100.88
|
| Rate for Payer: PHP All Commercial |
$102.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.46
|
| Rate for Payer: Sagamore Health Network All Products |
$103.84
|
| Rate for Payer: Signature Care EPO |
$111.64
|
| Rate for Payer: Signature Care PPO |
$118.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.33
|
| Rate for Payer: United Healthcare Commercial |
$105.99
|
| Rate for Payer: United Healthcare Medicare |
$43.04
|
|
|
HC OSTEOBOOST BONE FILLER 10CC
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,665.60
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
|
HC OSTEOBOOST BONE FILLER 10CC
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Medicare |
$1,728.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,101.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,987.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,900.80
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Centivo All Commercial |
$2,937.60
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Humana Medicare |
$1,728.00
|
| Rate for Payer: Lucent All Commercial |
$2,937.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,106.00
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,590.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
| Rate for Payer: United Healthcare Medicare |
$1,728.00
|
|
|
HC OSTOMY BAG 2.5
|
Facility
|
IP
|
$6.87
|
|
| Hospital Charge Code |
41601440
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Aetna Commercial |
$5.94
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna All Commercial |
$5.93
|
| Rate for Payer: CORVEL All Commercial |
$6.39
|
| Rate for Payer: Coventry All Commercial |
$6.05
|
| Rate for Payer: Encore All Commercial |
$6.32
|
| Rate for Payer: Frontpath All Commercial |
$6.32
|
| Rate for Payer: Humana ChoiceCare |
$5.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.18
|
| Rate for Payer: PHCS All Commercial |
$5.15
|
| Rate for Payer: PHP All Commercial |
$5.21
|
| Rate for Payer: Sagamore Health Network All Products |
$5.30
|
| Rate for Payer: Signature Care EPO |
$5.70
|
| Rate for Payer: Signature Care PPO |
$6.05
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
|
|
HC OSTOMY BAG 2.5
|
Facility
|
OP
|
$6.87
|
|
| Hospital Charge Code |
41601440
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$21.01 |
| Rate for Payer: Aetna Commercial |
$5.80
|
| Rate for Payer: Aetna Medicare |
$2.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.42
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Centivo All Commercial |
$3.74
|
| Rate for Payer: Cigna All Commercial |
$5.93
|
| Rate for Payer: CORVEL All Commercial |
$6.39
|
| Rate for Payer: Coventry All Commercial |
$6.05
|
| Rate for Payer: Encore All Commercial |
$6.32
|
| Rate for Payer: Frontpath All Commercial |
$6.32
|
| Rate for Payer: Humana ChoiceCare |
$5.93
|
| Rate for Payer: Humana Medicare |
$2.20
|
| Rate for Payer: Lucent All Commercial |
$3.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.18
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$5.15
|
| Rate for Payer: PHP All Commercial |
$5.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.68
|
| Rate for Payer: Sagamore Health Network All Products |
$5.30
|
| Rate for Payer: Signature Care EPO |
$5.70
|
| Rate for Payer: Signature Care PPO |
$6.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.84
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare |
$2.20
|
|
|
HC OSTOMY BELT LG
|
Facility
|
IP
|
$9.91
|
|
| Hospital Charge Code |
41601438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna Commercial |
$8.56
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cigna All Commercial |
$8.55
|
| Rate for Payer: CORVEL All Commercial |
$9.22
|
| Rate for Payer: Coventry All Commercial |
$8.72
|
| Rate for Payer: Encore All Commercial |
$9.12
|
| Rate for Payer: Frontpath All Commercial |
$9.12
|
| Rate for Payer: Humana ChoiceCare |
$8.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.92
|
| Rate for Payer: PHCS All Commercial |
$7.43
|
| Rate for Payer: PHP All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$7.65
|
| Rate for Payer: Signature Care EPO |
$8.23
|
| Rate for Payer: Signature Care PPO |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$7.81
|
|
|
HC OSTOMY BELT LG
|
Facility
|
OP
|
$9.91
|
|
| Hospital Charge Code |
41601438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$21.01 |
| Rate for Payer: Aetna Commercial |
$8.36
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.49
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$8.55
|
| Rate for Payer: CORVEL All Commercial |
$9.22
|
| Rate for Payer: Coventry All Commercial |
$8.72
|
| Rate for Payer: Encore All Commercial |
$9.12
|
| Rate for Payer: Frontpath All Commercial |
$9.12
|
| Rate for Payer: Humana ChoiceCare |
$8.56
|
| Rate for Payer: Humana Medicare |
$3.17
|
| Rate for Payer: Lucent All Commercial |
$5.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.92
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$7.43
|
| Rate for Payer: PHP All Commercial |
$7.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.86
|
| Rate for Payer: Sagamore Health Network All Products |
$7.65
|
| Rate for Payer: Signature Care EPO |
$8.23
|
| Rate for Payer: Signature Care PPO |
$8.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$7.81
|
| Rate for Payer: United Healthcare Medicare |
$3.17
|
|
|
HC OSTOMY BELT MED
|
Facility
|
IP
|
$9.91
|
|
| Hospital Charge Code |
41601439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna Commercial |
$8.56
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cigna All Commercial |
$8.55
|
| Rate for Payer: CORVEL All Commercial |
$9.22
|
| Rate for Payer: Coventry All Commercial |
$8.72
|
| Rate for Payer: Encore All Commercial |
$9.12
|
| Rate for Payer: Frontpath All Commercial |
$9.12
|
| Rate for Payer: Humana ChoiceCare |
$8.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.92
|
| Rate for Payer: PHCS All Commercial |
$7.43
|
| Rate for Payer: PHP All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$7.65
|
| Rate for Payer: Signature Care EPO |
$8.23
|
| Rate for Payer: Signature Care PPO |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$7.81
|
|
|
HC OSTOMY BELT MED
|
Facility
|
OP
|
$9.91
|
|
| Hospital Charge Code |
41601439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$21.01 |
| Rate for Payer: Aetna Commercial |
$8.36
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.49
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$8.55
|
| Rate for Payer: CORVEL All Commercial |
$9.22
|
| Rate for Payer: Coventry All Commercial |
$8.72
|
| Rate for Payer: Encore All Commercial |
$9.12
|
| Rate for Payer: Frontpath All Commercial |
$9.12
|
| Rate for Payer: Humana ChoiceCare |
$8.56
|
| Rate for Payer: Humana Medicare |
$3.17
|
| Rate for Payer: Lucent All Commercial |
$5.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.92
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$7.43
|
| Rate for Payer: PHP All Commercial |
$7.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.86
|
| Rate for Payer: Sagamore Health Network All Products |
$7.65
|
| Rate for Payer: Signature Care EPO |
$8.23
|
| Rate for Payer: Signature Care PPO |
$8.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$7.81
|
| Rate for Payer: United Healthcare Medicare |
$3.17
|
|
|
HC OSTOMY FLOATING FLANGE
|
Facility
|
IP
|
$5.12
|
|
| Hospital Charge Code |
41601408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna Commercial |
$4.42
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna All Commercial |
$4.42
|
| Rate for Payer: CORVEL All Commercial |
$4.76
|
| Rate for Payer: Coventry All Commercial |
$4.51
|
| Rate for Payer: Encore All Commercial |
$4.71
|
| Rate for Payer: Frontpath All Commercial |
$4.71
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.61
|
| Rate for Payer: PHCS All Commercial |
$3.84
|
| Rate for Payer: PHP All Commercial |
$3.88
|
| Rate for Payer: Sagamore Health Network All Products |
$3.95
|
| Rate for Payer: Signature Care EPO |
$4.25
|
| Rate for Payer: Signature Care PPO |
$4.51
|
| Rate for Payer: United Healthcare Commercial |
$4.03
|
|
|
HC OSTOMY FLOATING FLANGE
|
Facility
|
OP
|
$5.12
|
|
| Hospital Charge Code |
41601408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$4.32
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.80
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Centivo All Commercial |
$2.79
|
| Rate for Payer: Cigna All Commercial |
$4.42
|
| Rate for Payer: CORVEL All Commercial |
$4.76
|
| Rate for Payer: Coventry All Commercial |
$4.51
|
| Rate for Payer: Encore All Commercial |
$4.71
|
| Rate for Payer: Frontpath All Commercial |
$4.71
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Humana Medicare |
$1.64
|
| Rate for Payer: Lucent All Commercial |
$2.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.61
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3.84
|
| Rate for Payer: PHP All Commercial |
$3.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.00
|
| Rate for Payer: Sagamore Health Network All Products |
$3.95
|
| Rate for Payer: Signature Care EPO |
$4.25
|
| Rate for Payer: Signature Care PPO |
$4.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$4.03
|
| Rate for Payer: United Healthcare Medicare |
$1.64
|
|
|
HC OSTOMY IRRIG DRAIN-4
|
Facility
|
IP
|
$2.29
|
|
| Hospital Charge Code |
41601436
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna All Commercial |
$1.98
|
| Rate for Payer: CORVEL All Commercial |
$2.13
|
| Rate for Payer: Coventry All Commercial |
$2.02
|
| Rate for Payer: Encore All Commercial |
$2.11
|
| Rate for Payer: Frontpath All Commercial |
$2.11
|
| Rate for Payer: Humana ChoiceCare |
$1.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.06
|
| Rate for Payer: PHCS All Commercial |
$1.72
|
| Rate for Payer: PHP All Commercial |
$1.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1.77
|
| Rate for Payer: Signature Care EPO |
$1.90
|
| Rate for Payer: Signature Care PPO |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
|
HC OSTOMY IRRIG DRAIN-4
|
Facility
|
OP
|
$2.29
|
|
| Hospital Charge Code |
41601436
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$21.01 |
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.81
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Centivo All Commercial |
$1.25
|
| Rate for Payer: Cigna All Commercial |
$1.98
|
| Rate for Payer: CORVEL All Commercial |
$2.13
|
| Rate for Payer: Coventry All Commercial |
$2.02
|
| Rate for Payer: Encore All Commercial |
$2.11
|
| Rate for Payer: Frontpath All Commercial |
$2.11
|
| Rate for Payer: Humana ChoiceCare |
$1.98
|
| Rate for Payer: Humana Medicare |
$0.73
|
| Rate for Payer: Lucent All Commercial |
$1.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.06
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$1.72
|
| Rate for Payer: PHP All Commercial |
$1.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1.77
|
| Rate for Payer: Signature Care EPO |
$1.90
|
| Rate for Payer: Signature Care PPO |
$2.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$0.73
|
|
|
HC OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
IP
|
$514.59
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
1737167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$385.94 |
| Max. Negotiated Rate |
$478.57 |
| Rate for Payer: Aetna Commercial |
$444.61
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Cigna All Commercial |
$444.09
|
| Rate for Payer: CORVEL All Commercial |
$478.57
|
| Rate for Payer: Coventry All Commercial |
$452.84
|
| Rate for Payer: Encore All Commercial |
$473.68
|
| Rate for Payer: Frontpath All Commercial |
$473.42
|
| Rate for Payer: Humana ChoiceCare |
$444.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$463.13
|
| Rate for Payer: PHCS All Commercial |
$385.94
|
| Rate for Payer: PHP All Commercial |
$390.27
|
| Rate for Payer: Sagamore Health Network All Products |
$397.26
|
| Rate for Payer: Signature Care EPO |
$427.11
|
| Rate for Payer: Signature Care PPO |
$452.84
|
| Rate for Payer: United Healthcare Commercial |
$405.50
|
|
|
HC OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
OP
|
$514.59
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
1737167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$478.57 |
| Rate for Payer: Aetna Commercial |
$434.31
|
| Rate for Payer: Aetna Medicare |
$164.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$295.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$321.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$189.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.14
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Centivo All Commercial |
$279.94
|
| Rate for Payer: Cigna All Commercial |
$444.09
|
| Rate for Payer: CORVEL All Commercial |
$478.57
|
| Rate for Payer: Coventry All Commercial |
$452.84
|
| Rate for Payer: Encore All Commercial |
$473.68
|
| Rate for Payer: Frontpath All Commercial |
$473.42
|
| Rate for Payer: Humana ChoiceCare |
$444.45
|
| Rate for Payer: Humana Medicare |
$164.67
|
| Rate for Payer: Lucent All Commercial |
$279.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$463.13
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$385.94
|
| Rate for Payer: PHP All Commercial |
$390.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.69
|
| Rate for Payer: Sagamore Health Network All Products |
$397.26
|
| Rate for Payer: Signature Care EPO |
$427.11
|
| Rate for Payer: Signature Care PPO |
$452.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$437.40
|
| Rate for Payer: United Healthcare Commercial |
$405.50
|
| Rate for Payer: United Healthcare Medicare |
$164.67
|
|
|
HC OT EVAL LOW COMPLEX 30 MIN
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
1737165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$344.35
|
| Rate for Payer: Aetna Medicare |
$130.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$234.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.62
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Centivo All Commercial |
$221.95
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Humana Medicare |
$130.56
|
| Rate for Payer: Lucent All Commercial |
$221.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.12
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.80
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
| Rate for Payer: United Healthcare Medicare |
$130.56
|
|
|
HC OT EVAL LOW COMPLEX 30 MIN
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
1737165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$352.51
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
|
|
HC OT EVAL MOD COMPLEX 45 MIN
|
Facility
|
IP
|
$483.48
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
1737166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$362.61 |
| Max. Negotiated Rate |
$449.64 |
| Rate for Payer: Aetna Commercial |
$417.73
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cigna All Commercial |
$417.24
|
| Rate for Payer: CORVEL All Commercial |
$449.64
|
| Rate for Payer: Coventry All Commercial |
$425.46
|
| Rate for Payer: Encore All Commercial |
$445.04
|
| Rate for Payer: Frontpath All Commercial |
$444.80
|
| Rate for Payer: Humana ChoiceCare |
$417.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.13
|
| Rate for Payer: PHCS All Commercial |
$362.61
|
| Rate for Payer: PHP All Commercial |
$366.67
|
| Rate for Payer: Sagamore Health Network All Products |
$373.25
|
| Rate for Payer: Signature Care EPO |
$401.29
|
| Rate for Payer: Signature Care PPO |
$425.46
|
| Rate for Payer: United Healthcare Commercial |
$380.98
|
|
|
HC OT EVAL MOD COMPLEX 45 MIN
|
Facility
|
OP
|
$483.48
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
1737166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$449.64 |
| Rate for Payer: Aetna Commercial |
$408.06
|
| Rate for Payer: Aetna Medicare |
$154.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$149.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$277.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$177.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.18
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Centivo All Commercial |
$263.01
|
| Rate for Payer: Cigna All Commercial |
$417.24
|
| Rate for Payer: CORVEL All Commercial |
$449.64
|
| Rate for Payer: Coventry All Commercial |
$425.46
|
| Rate for Payer: Encore All Commercial |
$445.04
|
| Rate for Payer: Frontpath All Commercial |
$444.80
|
| Rate for Payer: Humana ChoiceCare |
$417.58
|
| Rate for Payer: Humana Medicare |
$154.71
|
| Rate for Payer: Lucent All Commercial |
$263.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.13
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$362.61
|
| Rate for Payer: PHP All Commercial |
$366.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.56
|
| Rate for Payer: Sagamore Health Network All Products |
$373.25
|
| Rate for Payer: Signature Care EPO |
$401.29
|
| Rate for Payer: Signature Care PPO |
$425.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.96
|
| Rate for Payer: United Healthcare Commercial |
$380.98
|
| Rate for Payer: United Healthcare Medicare |
$154.71
|
|
|
HC OT ORTHC/PROSTC MGMT SBSQ ENC /15 MIN
|
Facility
|
OP
|
$143.02
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
1738049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.34
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Centivo All Commercial |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$45.77
|
| Rate for Payer: Lucent All Commercial |
$77.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
|
HC OT ORTHC/PROSTC MGMT SBSQ ENC /15 MIN
|
Facility
|
IP
|
$143.02
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
1738049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC OT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
|
IP
|
$143.02
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
1738050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC OT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
|
OP
|
$143.02
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
1738050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.34
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Centivo All Commercial |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$45.77
|
| Rate for Payer: Lucent All Commercial |
$77.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
