|
HC NEEDLE STIM ULTRA 22G 2 INCH
|
Facility
IP
|
$78.91
|
|
| Hospital Charge Code |
41606634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.18 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna Commercial |
$68.18
|
| Rate for Payer: Cash Price |
$48.92
|
| Rate for Payer: Cigna All Commercial |
$68.10
|
| Rate for Payer: CORVEL All Commercial |
$73.39
|
| Rate for Payer: Coventry All Commercial |
$69.44
|
| Rate for Payer: Encore All Commercial |
$72.64
|
| Rate for Payer: Frontpath All Commercial |
$72.60
|
| Rate for Payer: Humana ChoiceCare |
$68.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.02
|
| Rate for Payer: PHCS All Commercial |
$59.18
|
| Rate for Payer: PHP All Commercial |
$59.85
|
| Rate for Payer: Sagamore Health Network All Products |
$60.92
|
| Rate for Payer: Signature Care EPO |
$65.50
|
| Rate for Payer: Signature Care PPO |
$69.44
|
| Rate for Payer: United Healthcare Commercial |
$62.18
|
|
|
HC NEEDLE STIMUPLEX 21G 4 INCH
|
Facility
IP
|
$92.04
|
|
| Hospital Charge Code |
41601083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: Aetna Commercial |
$79.52
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$79.43
|
| Rate for Payer: CORVEL All Commercial |
$85.60
|
| Rate for Payer: Coventry All Commercial |
$81.00
|
| Rate for Payer: Encore All Commercial |
$84.72
|
| Rate for Payer: Frontpath All Commercial |
$84.68
|
| Rate for Payer: Humana ChoiceCare |
$79.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$69.03
|
| Rate for Payer: PHP All Commercial |
$69.80
|
| Rate for Payer: Sagamore Health Network All Products |
$71.05
|
| Rate for Payer: Signature Care EPO |
$76.39
|
| Rate for Payer: Signature Care PPO |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$72.53
|
|
|
HC NEEDLE STIMUPLEX 21G 4 INCH
|
Facility
OP
|
$92.04
|
|
| Hospital Charge Code |
41601083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: Aetna Medicare |
$30.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.41
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$46.94
|
| Rate for Payer: Cigna All Commercial |
$79.43
|
| Rate for Payer: CORVEL All Commercial |
$85.60
|
| Rate for Payer: Coventry All Commercial |
$81.00
|
| Rate for Payer: Encore All Commercial |
$84.72
|
| Rate for Payer: Frontpath All Commercial |
$84.68
|
| Rate for Payer: Humana ChoiceCare |
$79.49
|
| Rate for Payer: Humana Medicare |
$46.94
|
| Rate for Payer: Lucent All Commercial |
$46.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$69.03
|
| Rate for Payer: PHP All Commercial |
$69.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.90
|
| Rate for Payer: Sagamore Health Network All Products |
$71.05
|
| Rate for Payer: Signature Care EPO |
$76.39
|
| Rate for Payer: Signature Care PPO |
$81.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.23
|
| Rate for Payer: United Healthcare Commercial |
$72.53
|
| Rate for Payer: United Healthcare Medicare |
$30.37
|
|
|
HC NEEDLE STIMUPLEX 22G 2 INCH
|
Facility
OP
|
$64.42
|
|
| Hospital Charge Code |
41601084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$54.37
|
| Rate for Payer: Aetna Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.38
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Centivo All Commercial |
$32.85
|
| Rate for Payer: Cigna All Commercial |
$55.59
|
| Rate for Payer: CORVEL All Commercial |
$59.91
|
| Rate for Payer: Coventry All Commercial |
$56.69
|
| Rate for Payer: Encore All Commercial |
$59.30
|
| Rate for Payer: Frontpath All Commercial |
$59.27
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Humana Medicare |
$32.85
|
| Rate for Payer: Lucent All Commercial |
$32.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$48.32
|
| Rate for Payer: PHP All Commercial |
$48.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.12
|
| Rate for Payer: Sagamore Health Network All Products |
$49.73
|
| Rate for Payer: Signature Care EPO |
$53.47
|
| Rate for Payer: Signature Care PPO |
$56.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.76
|
| Rate for Payer: United Healthcare Commercial |
$50.76
|
| Rate for Payer: United Healthcare Medicare |
$21.26
|
|
|
HC NEEDLE STIMUPLEX 22G 2 INCH
|
Facility
IP
|
$64.42
|
|
| Hospital Charge Code |
41601084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$59.91 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cigna All Commercial |
$55.59
|
| Rate for Payer: CORVEL All Commercial |
$59.91
|
| Rate for Payer: Coventry All Commercial |
$56.69
|
| Rate for Payer: Encore All Commercial |
$59.30
|
| Rate for Payer: Frontpath All Commercial |
$59.27
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.98
|
| Rate for Payer: PHCS All Commercial |
$48.32
|
| Rate for Payer: PHP All Commercial |
$48.86
|
| Rate for Payer: Sagamore Health Network All Products |
$49.73
|
| Rate for Payer: Signature Care EPO |
$53.47
|
| Rate for Payer: Signature Care PPO |
$56.69
|
| Rate for Payer: United Healthcare Commercial |
$50.76
|
|
|
HC NEEDLE TUOHY 20X3.5
|
Facility
IP
|
$70.71
|
|
| Hospital Charge Code |
41607083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.03 |
| Max. Negotiated Rate |
$65.76 |
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Cash Price |
$43.84
|
| Rate for Payer: Cigna All Commercial |
$61.02
|
| Rate for Payer: CORVEL All Commercial |
$65.76
|
| Rate for Payer: Coventry All Commercial |
$62.22
|
| Rate for Payer: Encore All Commercial |
$65.09
|
| Rate for Payer: Frontpath All Commercial |
$65.05
|
| Rate for Payer: Humana ChoiceCare |
$61.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.64
|
| Rate for Payer: PHCS All Commercial |
$53.03
|
| Rate for Payer: PHP All Commercial |
$53.63
|
| Rate for Payer: Sagamore Health Network All Products |
$54.59
|
| Rate for Payer: Signature Care EPO |
$58.69
|
| Rate for Payer: Signature Care PPO |
$62.22
|
| Rate for Payer: United Healthcare Commercial |
$55.72
|
|
|
HC NEEDLE TUOHY 20X3.5
|
Facility
OP
|
$70.71
|
|
| Hospital Charge Code |
41607083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: Aetna Medicare |
$23.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.67
|
| Rate for Payer: Cash Price |
$43.84
|
| Rate for Payer: Cash Price |
$43.84
|
| Rate for Payer: Centivo All Commercial |
$36.06
|
| Rate for Payer: Cigna All Commercial |
$61.02
|
| Rate for Payer: CORVEL All Commercial |
$65.76
|
| Rate for Payer: Coventry All Commercial |
$62.22
|
| Rate for Payer: Encore All Commercial |
$65.09
|
| Rate for Payer: Frontpath All Commercial |
$65.05
|
| Rate for Payer: Humana ChoiceCare |
$61.07
|
| Rate for Payer: Humana Medicare |
$36.06
|
| Rate for Payer: Lucent All Commercial |
$36.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$53.03
|
| Rate for Payer: PHP All Commercial |
$53.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.58
|
| Rate for Payer: Sagamore Health Network All Products |
$54.59
|
| Rate for Payer: Signature Care EPO |
$58.69
|
| Rate for Payer: Signature Care PPO |
$62.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.10
|
| Rate for Payer: United Healthcare Commercial |
$55.72
|
| Rate for Payer: United Healthcare Medicare |
$23.33
|
|
|
HC NEEDLE TUOHY 20X6
|
Facility
OP
|
$61.61
|
|
| Hospital Charge Code |
41607093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Aetna Medicare |
$20.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.36
|
| Rate for Payer: Cash Price |
$38.20
|
| Rate for Payer: Cash Price |
$38.20
|
| Rate for Payer: Centivo All Commercial |
$31.42
|
| Rate for Payer: Cigna All Commercial |
$53.17
|
| Rate for Payer: CORVEL All Commercial |
$57.30
|
| Rate for Payer: Coventry All Commercial |
$54.22
|
| Rate for Payer: Encore All Commercial |
$56.71
|
| Rate for Payer: Frontpath All Commercial |
$56.68
|
| Rate for Payer: Humana ChoiceCare |
$53.21
|
| Rate for Payer: Humana Medicare |
$31.42
|
| Rate for Payer: Lucent All Commercial |
$31.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$46.21
|
| Rate for Payer: PHP All Commercial |
$46.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.03
|
| Rate for Payer: Sagamore Health Network All Products |
$47.56
|
| Rate for Payer: Signature Care EPO |
$51.14
|
| Rate for Payer: Signature Care PPO |
$54.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.37
|
| Rate for Payer: United Healthcare Commercial |
$48.55
|
| Rate for Payer: United Healthcare Medicare |
$20.33
|
|
|
HC NEEDLE TUOHY 20X6
|
Facility
IP
|
$61.61
|
|
| Hospital Charge Code |
41607093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$53.23
|
| Rate for Payer: Cash Price |
$38.20
|
| Rate for Payer: Cigna All Commercial |
$53.17
|
| Rate for Payer: CORVEL All Commercial |
$57.30
|
| Rate for Payer: Coventry All Commercial |
$54.22
|
| Rate for Payer: Encore All Commercial |
$56.71
|
| Rate for Payer: Frontpath All Commercial |
$56.68
|
| Rate for Payer: Humana ChoiceCare |
$53.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.45
|
| Rate for Payer: PHCS All Commercial |
$46.21
|
| Rate for Payer: PHP All Commercial |
$46.73
|
| Rate for Payer: Sagamore Health Network All Products |
$47.56
|
| Rate for Payer: Signature Care EPO |
$51.14
|
| Rate for Payer: Signature Care PPO |
$54.22
|
| Rate for Payer: United Healthcare Commercial |
$48.55
|
|
|
HC NEEDLE WHITACRE 25G X 3 1/2 IN
|
Facility
IP
|
$52.02
|
|
| Hospital Charge Code |
41602305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Cigna All Commercial |
$44.89
|
| Rate for Payer: CORVEL All Commercial |
$48.38
|
| Rate for Payer: Coventry All Commercial |
$45.78
|
| Rate for Payer: Encore All Commercial |
$47.88
|
| Rate for Payer: Frontpath All Commercial |
$47.86
|
| Rate for Payer: Humana ChoiceCare |
$44.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.82
|
| Rate for Payer: PHCS All Commercial |
$39.02
|
| Rate for Payer: PHP All Commercial |
$39.45
|
| Rate for Payer: Sagamore Health Network All Products |
$40.16
|
| Rate for Payer: Signature Care EPO |
$43.18
|
| Rate for Payer: Signature Care PPO |
$45.78
|
| Rate for Payer: United Healthcare Commercial |
$40.99
|
|
|
HC NEEDLE WHITACRE 25G X 3 1/2 IN
|
Facility
OP
|
$52.02
|
|
| Hospital Charge Code |
41602305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: Aetna Medicare |
$17.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.88
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Centivo All Commercial |
$26.53
|
| Rate for Payer: Cigna All Commercial |
$44.89
|
| Rate for Payer: CORVEL All Commercial |
$48.38
|
| Rate for Payer: Coventry All Commercial |
$45.78
|
| Rate for Payer: Encore All Commercial |
$47.88
|
| Rate for Payer: Frontpath All Commercial |
$47.86
|
| Rate for Payer: Humana ChoiceCare |
$44.93
|
| Rate for Payer: Humana Medicare |
$26.53
|
| Rate for Payer: Lucent All Commercial |
$26.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$39.02
|
| Rate for Payer: PHP All Commercial |
$39.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.29
|
| Rate for Payer: Sagamore Health Network All Products |
$40.16
|
| Rate for Payer: Signature Care EPO |
$43.18
|
| Rate for Payer: Signature Care PPO |
$45.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.22
|
| Rate for Payer: United Healthcare Commercial |
$40.99
|
| Rate for Payer: United Healthcare Medicare |
$17.17
|
|
|
HC NEG PRESS WOUND TX < 50 CM
|
Facility
IP
|
$250.93
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
01897605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.20 |
| Max. Negotiated Rate |
$233.37 |
| Rate for Payer: Aetna Commercial |
$216.80
|
| Rate for Payer: Cash Price |
$155.58
|
| Rate for Payer: Cigna All Commercial |
$216.55
|
| Rate for Payer: CORVEL All Commercial |
$233.37
|
| Rate for Payer: Coventry All Commercial |
$220.82
|
| Rate for Payer: Encore All Commercial |
$230.98
|
| Rate for Payer: Frontpath All Commercial |
$230.86
|
| Rate for Payer: Humana ChoiceCare |
$216.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.84
|
| Rate for Payer: PHCS All Commercial |
$188.20
|
| Rate for Payer: PHP All Commercial |
$190.31
|
| Rate for Payer: Sagamore Health Network All Products |
$193.72
|
| Rate for Payer: Signature Care EPO |
$208.27
|
| Rate for Payer: Signature Care PPO |
$220.82
|
| Rate for Payer: United Healthcare Commercial |
$197.73
|
|
|
HC NEG PRESS WOUND TX < 50 CM
|
Facility
OP
|
$250.93
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
01897605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$381.15 |
| Rate for Payer: Aetna Commercial |
$211.79
|
| Rate for Payer: Aetna Medicare |
$82.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$156.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$381.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.09
|
| Rate for Payer: Cash Price |
$155.58
|
| Rate for Payer: Cash Price |
$155.58
|
| Rate for Payer: Centivo All Commercial |
$127.97
|
| Rate for Payer: Cigna All Commercial |
$216.55
|
| Rate for Payer: CORVEL All Commercial |
$233.37
|
| Rate for Payer: Coventry All Commercial |
$220.82
|
| Rate for Payer: Encore All Commercial |
$230.98
|
| Rate for Payer: Frontpath All Commercial |
$230.86
|
| Rate for Payer: Humana ChoiceCare |
$216.73
|
| Rate for Payer: Humana Medicare |
$127.97
|
| Rate for Payer: Lucent All Commercial |
$127.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.84
|
| Rate for Payer: Managed Health Services Medicaid |
$381.15
|
| Rate for Payer: MDWise Medicaid |
$381.15
|
| Rate for Payer: PHCS All Commercial |
$188.20
|
| Rate for Payer: PHP All Commercial |
$190.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.86
|
| Rate for Payer: Sagamore Health Network All Products |
$193.72
|
| Rate for Payer: Signature Care EPO |
$208.27
|
| Rate for Payer: Signature Care PPO |
$220.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.29
|
| Rate for Payer: United Healthcare Commercial |
$197.73
|
| Rate for Payer: United Healthcare Medicare |
$82.81
|
|
|
HC NEG PRESS WOUND TX > 50 CM
|
Facility
IP
|
$302.60
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
01897606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.95 |
| Max. Negotiated Rate |
$281.42 |
| Rate for Payer: Aetna Commercial |
$261.45
|
| Rate for Payer: Cash Price |
$187.61
|
| Rate for Payer: Cigna All Commercial |
$261.15
|
| Rate for Payer: CORVEL All Commercial |
$281.42
|
| Rate for Payer: Coventry All Commercial |
$266.29
|
| Rate for Payer: Encore All Commercial |
$278.55
|
| Rate for Payer: Frontpath All Commercial |
$278.40
|
| Rate for Payer: Humana ChoiceCare |
$261.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$272.34
|
| Rate for Payer: PHCS All Commercial |
$226.95
|
| Rate for Payer: PHP All Commercial |
$229.49
|
| Rate for Payer: Sagamore Health Network All Products |
$233.61
|
| Rate for Payer: Signature Care EPO |
$251.16
|
| Rate for Payer: Signature Care PPO |
$266.29
|
| Rate for Payer: United Healthcare Commercial |
$238.45
|
|
|
HC NEG PRESS WOUND TX > 50 CM
|
Facility
OP
|
$302.60
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
01897606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.86 |
| Max. Negotiated Rate |
$381.15 |
| Rate for Payer: Aetna Commercial |
$255.40
|
| Rate for Payer: Aetna Medicare |
$99.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$173.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$381.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.85
|
| Rate for Payer: Cash Price |
$187.61
|
| Rate for Payer: Cash Price |
$187.61
|
| Rate for Payer: Centivo All Commercial |
$154.33
|
| Rate for Payer: Cigna All Commercial |
$261.15
|
| Rate for Payer: CORVEL All Commercial |
$281.42
|
| Rate for Payer: Coventry All Commercial |
$266.29
|
| Rate for Payer: Encore All Commercial |
$278.55
|
| Rate for Payer: Frontpath All Commercial |
$278.40
|
| Rate for Payer: Humana ChoiceCare |
$261.36
|
| Rate for Payer: Humana Medicare |
$154.33
|
| Rate for Payer: Lucent All Commercial |
$154.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$272.34
|
| Rate for Payer: Managed Health Services Medicaid |
$381.15
|
| Rate for Payer: MDWise Medicaid |
$381.15
|
| Rate for Payer: PHCS All Commercial |
$226.95
|
| Rate for Payer: PHP All Commercial |
$229.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.02
|
| Rate for Payer: Sagamore Health Network All Products |
$233.61
|
| Rate for Payer: Signature Care EPO |
$251.16
|
| Rate for Payer: Signature Care PPO |
$266.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$257.21
|
| Rate for Payer: United Healthcare Commercial |
$238.45
|
| Rate for Payer: United Healthcare Medicare |
$99.86
|
|
|
HC NEG PRESS WOUND TX < 50 CM PT
|
Facility
OP
|
$241.28
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
01727605
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$224.39 |
| Rate for Payer: Aetna Commercial |
$203.64
|
| Rate for Payer: Aetna Medicare |
$79.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$138.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.59
|
| Rate for Payer: Cash Price |
$149.59
|
| Rate for Payer: Centivo All Commercial |
$123.05
|
| Rate for Payer: Cigna All Commercial |
$208.23
|
| Rate for Payer: CORVEL All Commercial |
$224.39
|
| Rate for Payer: Coventry All Commercial |
$212.33
|
| Rate for Payer: Encore All Commercial |
$222.10
|
| Rate for Payer: Frontpath All Commercial |
$221.98
|
| Rate for Payer: Humana ChoiceCare |
$208.39
|
| Rate for Payer: Humana Medicare |
$123.05
|
| Rate for Payer: Lucent All Commercial |
$123.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.15
|
| Rate for Payer: PHCS All Commercial |
$180.96
|
| Rate for Payer: PHP All Commercial |
$182.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.10
|
| Rate for Payer: Sagamore Health Network All Products |
$186.27
|
| Rate for Payer: Signature Care EPO |
$200.26
|
| Rate for Payer: Signature Care PPO |
$212.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$205.09
|
| Rate for Payer: United Healthcare Commercial |
$190.13
|
| Rate for Payer: United Healthcare Medicare |
$79.62
|
|
|
HC NEG PRESS WOUND TX < 50 CM PT
|
Facility
IP
|
$241.28
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
01727605
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$224.39 |
| Rate for Payer: Aetna Commercial |
$208.47
|
| Rate for Payer: Cash Price |
$149.59
|
| Rate for Payer: Cigna All Commercial |
$208.23
|
| Rate for Payer: CORVEL All Commercial |
$224.39
|
| Rate for Payer: Coventry All Commercial |
$212.33
|
| Rate for Payer: Encore All Commercial |
$222.10
|
| Rate for Payer: Frontpath All Commercial |
$221.98
|
| Rate for Payer: Humana ChoiceCare |
$208.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.15
|
| Rate for Payer: PHCS All Commercial |
$180.96
|
| Rate for Payer: PHP All Commercial |
$182.99
|
| Rate for Payer: Sagamore Health Network All Products |
$186.27
|
| Rate for Payer: Signature Care EPO |
$200.26
|
| Rate for Payer: Signature Care PPO |
$212.33
|
| Rate for Payer: United Healthcare Commercial |
$190.13
|
|
|
HC NEG PRESS WOUND TX > 50 CM PT
|
Facility
OP
|
$290.97
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
01727606
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$96.02 |
| Max. Negotiated Rate |
$270.60 |
| Rate for Payer: Aetna Commercial |
$245.57
|
| Rate for Payer: Aetna Medicare |
$96.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$167.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$181.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.62
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Centivo All Commercial |
$148.39
|
| Rate for Payer: Cigna All Commercial |
$251.10
|
| Rate for Payer: CORVEL All Commercial |
$270.60
|
| Rate for Payer: Coventry All Commercial |
$256.05
|
| Rate for Payer: Encore All Commercial |
$267.83
|
| Rate for Payer: Frontpath All Commercial |
$267.69
|
| Rate for Payer: Humana ChoiceCare |
$251.31
|
| Rate for Payer: Humana Medicare |
$148.39
|
| Rate for Payer: Lucent All Commercial |
$148.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.87
|
| Rate for Payer: PHCS All Commercial |
$218.22
|
| Rate for Payer: PHP All Commercial |
$220.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.48
|
| Rate for Payer: Sagamore Health Network All Products |
$224.63
|
| Rate for Payer: Signature Care EPO |
$241.50
|
| Rate for Payer: Signature Care PPO |
$256.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$247.32
|
| Rate for Payer: United Healthcare Commercial |
$229.28
|
| Rate for Payer: United Healthcare Medicare |
$96.02
|
|
|
HC NEG PRESS WOUND TX > 50 CM PT
|
Facility
IP
|
$290.97
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
01727606
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$218.22 |
| Max. Negotiated Rate |
$270.60 |
| Rate for Payer: Aetna Commercial |
$251.39
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cigna All Commercial |
$251.10
|
| Rate for Payer: CORVEL All Commercial |
$270.60
|
| Rate for Payer: Coventry All Commercial |
$256.05
|
| Rate for Payer: Encore All Commercial |
$267.83
|
| Rate for Payer: Frontpath All Commercial |
$267.69
|
| Rate for Payer: Humana ChoiceCare |
$251.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.87
|
| Rate for Payer: PHCS All Commercial |
$218.22
|
| Rate for Payer: PHP All Commercial |
$220.67
|
| Rate for Payer: Sagamore Health Network All Products |
$224.63
|
| Rate for Payer: Signature Care EPO |
$241.50
|
| Rate for Payer: Signature Care PPO |
$256.05
|
| Rate for Payer: United Healthcare Commercial |
$229.28
|
|
|
HC NEPHELOMETRY ANALYTE EA
|
Facility
OP
|
$170.35
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$158.43 |
| Rate for Payer: Aetna Commercial |
$143.78
|
| Rate for Payer: Aetna Medicare |
$56.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.84
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Centivo All Commercial |
$86.88
|
| Rate for Payer: Cigna All Commercial |
$147.01
|
| Rate for Payer: CORVEL All Commercial |
$158.43
|
| Rate for Payer: Coventry All Commercial |
$149.91
|
| Rate for Payer: Encore All Commercial |
$156.81
|
| Rate for Payer: Frontpath All Commercial |
$156.72
|
| Rate for Payer: Humana ChoiceCare |
$147.13
|
| Rate for Payer: Humana Medicare |
$86.88
|
| Rate for Payer: Lucent All Commercial |
$86.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.32
|
| Rate for Payer: Managed Health Services Medicaid |
$13.60
|
| Rate for Payer: MDWise Medicaid |
$13.60
|
| Rate for Payer: PHCS All Commercial |
$127.76
|
| Rate for Payer: PHP All Commercial |
$129.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.44
|
| Rate for Payer: Sagamore Health Network All Products |
$131.51
|
| Rate for Payer: Signature Care EPO |
$141.39
|
| Rate for Payer: Signature Care PPO |
$149.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.80
|
| Rate for Payer: United Healthcare Commercial |
$134.24
|
| Rate for Payer: United Healthcare Medicare |
$56.22
|
|
|
HC NEPHELOMETRY ANALYTE EA
|
Facility
IP
|
$170.35
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$158.43 |
| Rate for Payer: Aetna Commercial |
$147.18
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Cigna All Commercial |
$147.01
|
| Rate for Payer: CORVEL All Commercial |
$158.43
|
| Rate for Payer: Coventry All Commercial |
$149.91
|
| Rate for Payer: Encore All Commercial |
$156.81
|
| Rate for Payer: Frontpath All Commercial |
$156.72
|
| Rate for Payer: Humana ChoiceCare |
$147.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.32
|
| Rate for Payer: PHCS All Commercial |
$127.76
|
| Rate for Payer: PHP All Commercial |
$129.19
|
| Rate for Payer: Sagamore Health Network All Products |
$131.51
|
| Rate for Payer: Signature Care EPO |
$141.39
|
| Rate for Payer: Signature Care PPO |
$149.91
|
| Rate for Payer: United Healthcare Commercial |
$134.24
|
|
|
HC NEPHELOMETRY EA ANALYTE
|
Facility
IP
|
$170.35
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001641
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$158.43 |
| Rate for Payer: Aetna Commercial |
$147.18
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Cigna All Commercial |
$147.01
|
| Rate for Payer: CORVEL All Commercial |
$158.43
|
| Rate for Payer: Coventry All Commercial |
$149.91
|
| Rate for Payer: Encore All Commercial |
$156.81
|
| Rate for Payer: Frontpath All Commercial |
$156.72
|
| Rate for Payer: Humana ChoiceCare |
$147.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.32
|
| Rate for Payer: PHCS All Commercial |
$127.76
|
| Rate for Payer: PHP All Commercial |
$129.19
|
| Rate for Payer: Sagamore Health Network All Products |
$131.51
|
| Rate for Payer: Signature Care EPO |
$141.39
|
| Rate for Payer: Signature Care PPO |
$149.91
|
| Rate for Payer: United Healthcare Commercial |
$134.24
|
|
|
HC NEPHELOMETRY EA ANALYTE
|
Facility
OP
|
$170.35
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001641
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$158.43 |
| Rate for Payer: Aetna Commercial |
$143.78
|
| Rate for Payer: Aetna Medicare |
$56.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.84
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Centivo All Commercial |
$86.88
|
| Rate for Payer: Cigna All Commercial |
$147.01
|
| Rate for Payer: CORVEL All Commercial |
$158.43
|
| Rate for Payer: Coventry All Commercial |
$149.91
|
| Rate for Payer: Encore All Commercial |
$156.81
|
| Rate for Payer: Frontpath All Commercial |
$156.72
|
| Rate for Payer: Humana ChoiceCare |
$147.13
|
| Rate for Payer: Humana Medicare |
$86.88
|
| Rate for Payer: Lucent All Commercial |
$86.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.32
|
| Rate for Payer: Managed Health Services Medicaid |
$13.60
|
| Rate for Payer: MDWise Medicaid |
$13.60
|
| Rate for Payer: PHCS All Commercial |
$127.76
|
| Rate for Payer: PHP All Commercial |
$129.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.44
|
| Rate for Payer: Sagamore Health Network All Products |
$131.51
|
| Rate for Payer: Signature Care EPO |
$141.39
|
| Rate for Payer: Signature Care PPO |
$149.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.80
|
| Rate for Payer: United Healthcare Commercial |
$134.24
|
| Rate for Payer: United Healthcare Medicare |
$56.22
|
|
|
HC NERVE STIMULATOR
|
Facility
OP
|
$396.90
|
|
| Hospital Charge Code |
41601963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$369.12 |
| Rate for Payer: Aetna Commercial |
$334.98
|
| Rate for Payer: Aetna Medicare |
$130.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$227.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.07
|
| Rate for Payer: Cash Price |
$246.08
|
| Rate for Payer: Cash Price |
$246.08
|
| Rate for Payer: Centivo All Commercial |
$202.42
|
| Rate for Payer: Cigna All Commercial |
$342.52
|
| Rate for Payer: CORVEL All Commercial |
$369.12
|
| Rate for Payer: Coventry All Commercial |
$349.27
|
| Rate for Payer: Encore All Commercial |
$365.35
|
| Rate for Payer: Frontpath All Commercial |
$365.15
|
| Rate for Payer: Humana ChoiceCare |
$342.80
|
| Rate for Payer: Humana Medicare |
$202.42
|
| Rate for Payer: Lucent All Commercial |
$202.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.21
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$297.68
|
| Rate for Payer: PHP All Commercial |
$301.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.79
|
| Rate for Payer: Sagamore Health Network All Products |
$306.41
|
| Rate for Payer: Signature Care EPO |
$329.43
|
| Rate for Payer: Signature Care PPO |
$349.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$337.36
|
| Rate for Payer: United Healthcare Commercial |
$312.76
|
| Rate for Payer: United Healthcare Medicare |
$130.98
|
|
|
HC NERVE STIMULATOR
|
Facility
IP
|
$396.90
|
|
| Hospital Charge Code |
41601963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.68 |
| Max. Negotiated Rate |
$369.12 |
| Rate for Payer: Aetna Commercial |
$342.92
|
| Rate for Payer: Cash Price |
$246.08
|
| Rate for Payer: Cigna All Commercial |
$342.52
|
| Rate for Payer: CORVEL All Commercial |
$369.12
|
| Rate for Payer: Coventry All Commercial |
$349.27
|
| Rate for Payer: Encore All Commercial |
$365.35
|
| Rate for Payer: Frontpath All Commercial |
$365.15
|
| Rate for Payer: Humana ChoiceCare |
$342.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.21
|
| Rate for Payer: PHCS All Commercial |
$297.68
|
| Rate for Payer: PHP All Commercial |
$301.01
|
| Rate for Payer: Sagamore Health Network All Products |
$306.41
|
| Rate for Payer: Signature Care EPO |
$329.43
|
| Rate for Payer: Signature Care PPO |
$349.27
|
| Rate for Payer: United Healthcare Commercial |
$312.76
|
|
