|
HC PT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
1728060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC PT PROSTHETIC TRAINJ 1ST ENC /15 MIN
|
Facility
|
OP
|
$152.10
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
1728065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$141.45 |
| Rate for Payer: Aetna Commercial |
$128.37
|
| Rate for Payer: Aetna Medicare |
$48.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.54
|
| Rate for Payer: Cash Price |
$91.26
|
| Rate for Payer: Cash Price |
$91.26
|
| Rate for Payer: Centivo All Commercial |
$82.74
|
| Rate for Payer: Cigna All Commercial |
$131.26
|
| Rate for Payer: CORVEL All Commercial |
$141.45
|
| Rate for Payer: Coventry All Commercial |
$133.85
|
| Rate for Payer: Encore All Commercial |
$140.01
|
| Rate for Payer: Frontpath All Commercial |
$139.93
|
| Rate for Payer: Humana ChoiceCare |
$131.37
|
| Rate for Payer: Humana Medicare |
$48.67
|
| Rate for Payer: Lucent All Commercial |
$82.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.89
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$114.08
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.32
|
| Rate for Payer: Sagamore Health Network All Products |
$117.42
|
| Rate for Payer: Signature Care EPO |
$126.24
|
| Rate for Payer: Signature Care PPO |
$133.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.28
|
| Rate for Payer: United Healthcare Commercial |
$119.85
|
| Rate for Payer: United Healthcare Medicare |
$48.67
|
|
|
HC PT PROSTHETIC TRAINJ 1ST ENC /15 MIN
|
Facility
|
IP
|
$152.10
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
1728065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$141.45 |
| Rate for Payer: Aetna Commercial |
$131.41
|
| Rate for Payer: Cash Price |
$91.26
|
| Rate for Payer: Cigna All Commercial |
$131.26
|
| Rate for Payer: CORVEL All Commercial |
$141.45
|
| Rate for Payer: Coventry All Commercial |
$133.85
|
| Rate for Payer: Encore All Commercial |
$140.01
|
| Rate for Payer: Frontpath All Commercial |
$139.93
|
| Rate for Payer: Humana ChoiceCare |
$131.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.89
|
| Rate for Payer: PHCS All Commercial |
$114.08
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Sagamore Health Network All Products |
$117.42
|
| Rate for Payer: Signature Care EPO |
$126.24
|
| Rate for Payer: Signature Care PPO |
$133.85
|
| Rate for Payer: United Healthcare Commercial |
$119.85
|
|
|
HC PT RE-EVAL EST PLAN CARE
|
Facility
|
IP
|
$406.37
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
1727164
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$304.78 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$351.10
|
| Rate for Payer: Cash Price |
$243.82
|
| Rate for Payer: Cigna All Commercial |
$350.70
|
| Rate for Payer: CORVEL All Commercial |
$377.92
|
| Rate for Payer: Coventry All Commercial |
$357.61
|
| Rate for Payer: Encore All Commercial |
$374.06
|
| Rate for Payer: Frontpath All Commercial |
$373.86
|
| Rate for Payer: Humana ChoiceCare |
$350.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$365.73
|
| Rate for Payer: PHCS All Commercial |
$304.78
|
| Rate for Payer: PHP All Commercial |
$308.19
|
| Rate for Payer: Sagamore Health Network All Products |
$313.72
|
| Rate for Payer: Signature Care EPO |
$337.29
|
| Rate for Payer: Signature Care PPO |
$357.61
|
| Rate for Payer: United Healthcare Commercial |
$320.22
|
|
|
HC PT RE-EVAL EST PLAN CARE
|
Facility
|
OP
|
$406.37
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
1727164
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: Aetna Medicare |
$130.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$233.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$254.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.04
|
| Rate for Payer: Cash Price |
$243.82
|
| Rate for Payer: Cash Price |
$243.82
|
| Rate for Payer: Centivo All Commercial |
$221.07
|
| Rate for Payer: Cigna All Commercial |
$350.70
|
| Rate for Payer: CORVEL All Commercial |
$377.92
|
| Rate for Payer: Coventry All Commercial |
$357.61
|
| Rate for Payer: Encore All Commercial |
$374.06
|
| Rate for Payer: Frontpath All Commercial |
$373.86
|
| Rate for Payer: Humana ChoiceCare |
$350.98
|
| Rate for Payer: Humana Medicare |
$130.04
|
| Rate for Payer: Lucent All Commercial |
$221.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$365.73
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$304.78
|
| Rate for Payer: PHP All Commercial |
$308.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.48
|
| Rate for Payer: Sagamore Health Network All Products |
$313.72
|
| Rate for Payer: Signature Care EPO |
$337.29
|
| Rate for Payer: Signature Care PPO |
$357.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$345.41
|
| Rate for Payer: United Healthcare Commercial |
$320.22
|
| Rate for Payer: United Healthcare Medicare |
$130.04
|
|
|
HC PTT
|
Facility
|
IP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$82.11
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.90
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
|
|
HC PTT
|
Facility
|
OP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Aetna Medicare |
$43.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.17
|
| Rate for Payer: Cash Price |
$82.11
|
| Rate for Payer: Cash Price |
$82.11
|
| Rate for Payer: Centivo All Commercial |
$74.45
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.90
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Humana Medicare |
$43.79
|
| Rate for Payer: Lucent All Commercial |
$74.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: Managed Health Services Medicaid |
$6.01
|
| Rate for Payer: MDWise Medicaid |
$6.01
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.37
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.32
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
| Rate for Payer: United Healthcare Medicare |
$43.79
|
|
|
HC PUDENDAL TRAY DISPOSABLE
|
Facility
|
OP
|
$41.63
|
|
| Hospital Charge Code |
41601183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$38.72 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.65
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Centivo All Commercial |
$22.65
|
| Rate for Payer: Cigna All Commercial |
$35.93
|
| Rate for Payer: CORVEL All Commercial |
$38.72
|
| Rate for Payer: Coventry All Commercial |
$36.63
|
| Rate for Payer: Encore All Commercial |
$38.32
|
| Rate for Payer: Frontpath All Commercial |
$38.30
|
| Rate for Payer: Humana ChoiceCare |
$35.96
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Lucent All Commercial |
$22.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.47
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$31.22
|
| Rate for Payer: PHP All Commercial |
$31.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.24
|
| Rate for Payer: Sagamore Health Network All Products |
$32.14
|
| Rate for Payer: Signature Care EPO |
$34.55
|
| Rate for Payer: Signature Care PPO |
$36.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.39
|
| Rate for Payer: United Healthcare Commercial |
$32.80
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
|
|
HC PUDENDAL TRAY DISPOSABLE
|
Facility
|
IP
|
$41.63
|
|
| Hospital Charge Code |
41601183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$38.72 |
| Rate for Payer: Aetna Commercial |
$35.97
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cigna All Commercial |
$35.93
|
| Rate for Payer: CORVEL All Commercial |
$38.72
|
| Rate for Payer: Coventry All Commercial |
$36.63
|
| Rate for Payer: Encore All Commercial |
$38.32
|
| Rate for Payer: Frontpath All Commercial |
$38.30
|
| Rate for Payer: Humana ChoiceCare |
$35.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.47
|
| Rate for Payer: PHCS All Commercial |
$31.22
|
| Rate for Payer: PHP All Commercial |
$31.57
|
| Rate for Payer: Sagamore Health Network All Products |
$32.14
|
| Rate for Payer: Signature Care EPO |
$34.55
|
| Rate for Payer: Signature Care PPO |
$36.63
|
| Rate for Payer: United Healthcare Commercial |
$32.80
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
IP
|
$898.79
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
1704726
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$674.09 |
| Max. Negotiated Rate |
$835.87 |
| Rate for Payer: Aetna Commercial |
$776.55
|
| Rate for Payer: Cash Price |
$539.27
|
| Rate for Payer: Cigna All Commercial |
$775.66
|
| Rate for Payer: CORVEL All Commercial |
$835.87
|
| Rate for Payer: Coventry All Commercial |
$790.94
|
| Rate for Payer: Encore All Commercial |
$827.34
|
| Rate for Payer: Frontpath All Commercial |
$826.89
|
| Rate for Payer: Humana ChoiceCare |
$776.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.91
|
| Rate for Payer: PHCS All Commercial |
$674.09
|
| Rate for Payer: PHP All Commercial |
$681.64
|
| Rate for Payer: Sagamore Health Network All Products |
$693.87
|
| Rate for Payer: Signature Care EPO |
$746.00
|
| Rate for Payer: Signature Care PPO |
$790.94
|
| Rate for Payer: United Healthcare Commercial |
$708.25
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
OP
|
$898.79
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
1704726
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$835.87 |
| Rate for Payer: Aetna Commercial |
$758.58
|
| Rate for Payer: Aetna Medicare |
$287.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$278.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$561.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$330.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$316.37
|
| Rate for Payer: Cash Price |
$539.27
|
| Rate for Payer: Cash Price |
$539.27
|
| Rate for Payer: Centivo All Commercial |
$488.94
|
| Rate for Payer: Cigna All Commercial |
$775.66
|
| Rate for Payer: CORVEL All Commercial |
$835.87
|
| Rate for Payer: Coventry All Commercial |
$790.94
|
| Rate for Payer: Encore All Commercial |
$827.34
|
| Rate for Payer: Frontpath All Commercial |
$826.89
|
| Rate for Payer: Humana ChoiceCare |
$776.28
|
| Rate for Payer: Humana Medicare |
$287.61
|
| Rate for Payer: Lucent All Commercial |
$488.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.91
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$674.09
|
| Rate for Payer: PHP All Commercial |
$681.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.53
|
| Rate for Payer: Sagamore Health Network All Products |
$693.87
|
| Rate for Payer: Signature Care EPO |
$746.00
|
| Rate for Payer: Signature Care PPO |
$790.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$763.97
|
| Rate for Payer: United Healthcare Commercial |
$708.25
|
| Rate for Payer: United Healthcare Medicare |
$287.61
|
|
|
HC PULMONARY STRESS TEST/SIMPLE
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
1604620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$206.61
|
| Rate for Payer: Aetna Medicare |
$78.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.17
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Centivo All Commercial |
$133.17
|
| Rate for Payer: Cigna All Commercial |
$211.26
|
| Rate for Payer: CORVEL All Commercial |
$227.66
|
| Rate for Payer: Coventry All Commercial |
$215.42
|
| Rate for Payer: Encore All Commercial |
$225.34
|
| Rate for Payer: Frontpath All Commercial |
$225.22
|
| Rate for Payer: Humana ChoiceCare |
$211.43
|
| Rate for Payer: Humana Medicare |
$78.34
|
| Rate for Payer: Lucent All Commercial |
$133.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.32
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$183.60
|
| Rate for Payer: PHP All Commercial |
$185.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.47
|
| Rate for Payer: Sagamore Health Network All Products |
$188.99
|
| Rate for Payer: Signature Care EPO |
$203.18
|
| Rate for Payer: Signature Care PPO |
$215.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.08
|
| Rate for Payer: United Healthcare Commercial |
$192.90
|
| Rate for Payer: United Healthcare Medicare |
$78.34
|
|
|
HC PULMONARY STRESS TEST/SIMPLE
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
1604620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$211.51
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cigna All Commercial |
$211.26
|
| Rate for Payer: CORVEL All Commercial |
$227.66
|
| Rate for Payer: Coventry All Commercial |
$215.42
|
| Rate for Payer: Encore All Commercial |
$225.34
|
| Rate for Payer: Frontpath All Commercial |
$225.22
|
| Rate for Payer: Humana ChoiceCare |
$211.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.32
|
| Rate for Payer: PHCS All Commercial |
$183.60
|
| Rate for Payer: PHP All Commercial |
$185.66
|
| Rate for Payer: Sagamore Health Network All Products |
$188.99
|
| Rate for Payer: Signature Care EPO |
$203.18
|
| Rate for Payer: Signature Care PPO |
$215.42
|
| Rate for Payer: United Healthcare Commercial |
$192.90
|
|
|
HC PULM REHAB WITH CONT OXIMTRY MNTR
|
Facility
|
OP
|
$350.28
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
1604626
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$295.64
|
| Rate for Payer: Aetna Medicare |
$112.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.30
|
| Rate for Payer: Cash Price |
$210.17
|
| Rate for Payer: Centivo All Commercial |
$190.55
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.25
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Humana Medicare |
$112.09
|
| Rate for Payer: Lucent All Commercial |
$190.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.61
|
| Rate for Payer: Sagamore Health Network All Products |
$270.42
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.74
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
| Rate for Payer: United Healthcare Medicare |
$112.09
|
|
|
HC PULM REHAB WITH CONT OXIMTRY MNTR
|
Facility
|
IP
|
$350.28
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
1604626
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$262.71 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$302.64
|
| Rate for Payer: Cash Price |
$210.17
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.25
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Sagamore Health Network All Products |
$270.42
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.25
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
OP
|
$350.28
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
1604625
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$295.64
|
| Rate for Payer: Aetna Medicare |
$112.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.30
|
| Rate for Payer: Cash Price |
$210.17
|
| Rate for Payer: Centivo All Commercial |
$190.55
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.25
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Humana Medicare |
$112.09
|
| Rate for Payer: Lucent All Commercial |
$190.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.61
|
| Rate for Payer: Sagamore Health Network All Products |
$270.42
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.74
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
| Rate for Payer: United Healthcare Medicare |
$112.09
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
IP
|
$350.28
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
1604625
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$262.71 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$302.64
|
| Rate for Payer: Cash Price |
$210.17
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.25
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Sagamore Health Network All Products |
$270.42
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.25
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
|
|
HC PULSE OXIMETRY NB SCREEN
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
1014760
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$33.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.34
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Centivo All Commercial |
$57.71
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$33.95
|
| Rate for Payer: Lucent All Commercial |
$57.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$33.95
|
|
|
HC PULSE OXIMETRY NB SCREEN
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
1014760
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC PYRUVIC ACID-BLOOD
|
Facility
|
OP
|
$99.07
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
63001671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$83.62
|
| Rate for Payer: Aetna Medicare |
$31.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.87
|
| Rate for Payer: Cash Price |
$59.44
|
| Rate for Payer: Cash Price |
$59.44
|
| Rate for Payer: Centivo All Commercial |
$53.89
|
| Rate for Payer: Cigna All Commercial |
$85.50
|
| Rate for Payer: CORVEL All Commercial |
$92.14
|
| Rate for Payer: Coventry All Commercial |
$87.18
|
| Rate for Payer: Encore All Commercial |
$91.19
|
| Rate for Payer: Frontpath All Commercial |
$91.14
|
| Rate for Payer: Humana ChoiceCare |
$85.57
|
| Rate for Payer: Humana Medicare |
$31.70
|
| Rate for Payer: Lucent All Commercial |
$53.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.16
|
| Rate for Payer: Managed Health Services Medicaid |
$14.48
|
| Rate for Payer: MDWise Medicaid |
$14.48
|
| Rate for Payer: PHCS All Commercial |
$74.30
|
| Rate for Payer: PHP All Commercial |
$75.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.64
|
| Rate for Payer: Sagamore Health Network All Products |
$76.48
|
| Rate for Payer: Signature Care EPO |
$82.23
|
| Rate for Payer: Signature Care PPO |
$87.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.21
|
| Rate for Payer: United Healthcare Commercial |
$78.07
|
| Rate for Payer: United Healthcare Medicare |
$31.70
|
|
|
HC PYRUVIC ACID-BLOOD
|
Facility
|
IP
|
$99.07
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
63001671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$85.60
|
| Rate for Payer: Cash Price |
$59.44
|
| Rate for Payer: Cigna All Commercial |
$85.50
|
| Rate for Payer: CORVEL All Commercial |
$92.14
|
| Rate for Payer: Coventry All Commercial |
$87.18
|
| Rate for Payer: Encore All Commercial |
$91.19
|
| Rate for Payer: Frontpath All Commercial |
$91.14
|
| Rate for Payer: Humana ChoiceCare |
$85.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.16
|
| Rate for Payer: PHCS All Commercial |
$74.30
|
| Rate for Payer: PHP All Commercial |
$75.13
|
| Rate for Payer: Sagamore Health Network All Products |
$76.48
|
| Rate for Payer: Signature Care EPO |
$82.23
|
| Rate for Payer: Signature Care PPO |
$87.18
|
| Rate for Payer: United Healthcare Commercial |
$78.07
|
|
|
HC QUANTIFERRON GOLD-TB
|
Facility
|
OP
|
$304.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
63001917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$97.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$61.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$61.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.03
|
| Rate for Payer: Cash Price |
$182.44
|
| Rate for Payer: Cash Price |
$182.44
|
| Rate for Payer: Centivo All Commercial |
$165.41
|
| Rate for Payer: Cigna All Commercial |
$262.40
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Humana Medicare |
$97.30
|
| Rate for Payer: Lucent All Commercial |
$165.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.65
|
| Rate for Payer: Managed Health Services Medicaid |
$61.98
|
| Rate for Payer: MDWise Medicaid |
$61.98
|
| Rate for Payer: PHCS All Commercial |
$228.04
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.58
|
| Rate for Payer: Sagamore Health Network All Products |
$234.73
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.45
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
| Rate for Payer: United Healthcare Medicare |
$97.30
|
|
|
HC QUANTIFERRON GOLD-TB
|
Facility
|
IP
|
$304.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
63001917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.04 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$262.71
|
| Rate for Payer: Cash Price |
$182.44
|
| Rate for Payer: Cigna All Commercial |
$262.40
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.65
|
| Rate for Payer: PHCS All Commercial |
$228.04
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Sagamore Health Network All Products |
$234.73
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
|
|
HC RA
|
Facility
|
IP
|
$127.83
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
63001281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.87 |
| Max. Negotiated Rate |
$118.88 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cigna All Commercial |
$110.32
|
| Rate for Payer: CORVEL All Commercial |
$118.88
|
| Rate for Payer: Coventry All Commercial |
$112.49
|
| Rate for Payer: Encore All Commercial |
$117.67
|
| Rate for Payer: Frontpath All Commercial |
$117.60
|
| Rate for Payer: Humana ChoiceCare |
$110.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.05
|
| Rate for Payer: PHCS All Commercial |
$95.87
|
| Rate for Payer: PHP All Commercial |
$96.95
|
| Rate for Payer: Sagamore Health Network All Products |
$98.68
|
| Rate for Payer: Signature Care EPO |
$106.10
|
| Rate for Payer: Signature Care PPO |
$112.49
|
| Rate for Payer: United Healthcare Commercial |
$100.73
|
|
|
HC RA
|
Facility
|
OP
|
$127.83
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
63001281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$118.88 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: Aetna Medicare |
$40.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.00
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Centivo All Commercial |
$69.54
|
| Rate for Payer: Cigna All Commercial |
$110.32
|
| Rate for Payer: CORVEL All Commercial |
$118.88
|
| Rate for Payer: Coventry All Commercial |
$112.49
|
| Rate for Payer: Encore All Commercial |
$117.67
|
| Rate for Payer: Frontpath All Commercial |
$117.60
|
| Rate for Payer: Humana ChoiceCare |
$110.41
|
| Rate for Payer: Humana Medicare |
$40.91
|
| Rate for Payer: Lucent All Commercial |
$69.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.05
|
| Rate for Payer: Managed Health Services Medicaid |
$6.14
|
| Rate for Payer: MDWise Medicaid |
$6.14
|
| Rate for Payer: PHCS All Commercial |
$95.87
|
| Rate for Payer: PHP All Commercial |
$96.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.85
|
| Rate for Payer: Sagamore Health Network All Products |
$98.68
|
| Rate for Payer: Signature Care EPO |
$106.10
|
| Rate for Payer: Signature Care PPO |
$112.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.66
|
| Rate for Payer: United Healthcare Commercial |
$100.73
|
| Rate for Payer: United Healthcare Medicare |
$40.91
|
|
