|
HC NETTLE IGE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC NETTLE IGE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC NEUROMUSCLE RE-ED/15 MIN-OT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
01738041
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC NEUROMUSCLE RE-ED/15 MIN-OT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
01738041
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| 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 |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC NEUROMUSCLE RE-ED/15 MIN-PT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
01728055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC NEUROMUSCLE RE-ED/15 MIN-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
01728055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| 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 |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC NEURONAL NUCLEAR IGG AB (HU & RI)
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC NEURONAL NUCLEAR IGG AB (HU & RI)
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC NEURONAL NUCLEAR IGG AB TITER - IFA
|
Facility
OP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$184.87
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.51
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Centivo All Commercial |
$111.71
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Humana Medicare |
$111.71
|
| Rate for Payer: Lucent All Commercial |
$111.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.42
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.18
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
| Rate for Payer: United Healthcare Medicare |
$72.28
|
|
|
HC NEURONAL NUCLEAR IGG AB TITER - IFA
|
Facility
IP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.28 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
|
|
HC NEWBORN CARE
|
Facility
IP
|
$1,060.80
|
|
| Hospital Charge Code |
10010028
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$5,584.50 |
| Rate for Payer: Aetna Commercial |
$916.53
|
| Rate for Payer: Aetna Medicare |
$3,285.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,285.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,777.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,613.50
|
| Rate for Payer: Cash Price |
$657.70
|
| Rate for Payer: Cash Price |
$657.70
|
| Rate for Payer: Centivo All Commercial |
$3,613.50
|
| Rate for Payer: Cigna All Commercial |
$915.47
|
| Rate for Payer: CORVEL All Commercial |
$986.54
|
| Rate for Payer: Coventry All Commercial |
$933.50
|
| Rate for Payer: Encore All Commercial |
$976.47
|
| Rate for Payer: Frontpath All Commercial |
$975.94
|
| Rate for Payer: Humana ChoiceCare |
$916.21
|
| Rate for Payer: Humana Medicare |
$3,285.00
|
| Rate for Payer: Lucent All Commercial |
$5,584.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$954.72
|
| Rate for Payer: PHCS All Commercial |
$795.60
|
| Rate for Payer: PHP All Commercial |
$804.51
|
| Rate for Payer: Sagamore Health Network All Products |
$818.94
|
| Rate for Payer: Signature Care EPO |
$880.46
|
| Rate for Payer: Signature Care PPO |
$933.50
|
| Rate for Payer: United Healthcare Commercial |
$835.91
|
| Rate for Payer: United Healthcare Medicare |
$3,285.00
|
|
|
HC NEWBORN HEARING AEP SCR AUDITORY POTENTIAL
|
Facility
IP
|
$344.76
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
01012650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$258.57 |
| Max. Negotiated Rate |
$320.63 |
| Rate for Payer: Aetna Commercial |
$297.87
|
| Rate for Payer: Cash Price |
$213.75
|
| Rate for Payer: Cigna All Commercial |
$297.53
|
| Rate for Payer: CORVEL All Commercial |
$320.63
|
| Rate for Payer: Coventry All Commercial |
$303.39
|
| Rate for Payer: Encore All Commercial |
$317.35
|
| Rate for Payer: Frontpath All Commercial |
$317.18
|
| Rate for Payer: Humana ChoiceCare |
$297.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$310.28
|
| Rate for Payer: PHCS All Commercial |
$258.57
|
| Rate for Payer: PHP All Commercial |
$261.47
|
| Rate for Payer: Sagamore Health Network All Products |
$266.15
|
| Rate for Payer: Signature Care EPO |
$286.15
|
| Rate for Payer: Signature Care PPO |
$303.39
|
| Rate for Payer: United Healthcare Commercial |
$271.67
|
|
|
HC NEWBORN HEARING AEP SCR AUDITORY POTENTIAL
|
Facility
OP
|
$344.76
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
01012650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$113.77 |
| Max. Negotiated Rate |
$320.63 |
| Rate for Payer: Aetna Commercial |
$290.98
|
| Rate for Payer: Aetna Medicare |
$113.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$198.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.15
|
| Rate for Payer: Cash Price |
$213.75
|
| Rate for Payer: Cash Price |
$213.75
|
| Rate for Payer: Centivo All Commercial |
$175.83
|
| Rate for Payer: Cigna All Commercial |
$297.53
|
| Rate for Payer: CORVEL All Commercial |
$320.63
|
| Rate for Payer: Coventry All Commercial |
$303.39
|
| Rate for Payer: Encore All Commercial |
$317.35
|
| Rate for Payer: Frontpath All Commercial |
$317.18
|
| Rate for Payer: Humana ChoiceCare |
$297.77
|
| Rate for Payer: Humana Medicare |
$175.83
|
| Rate for Payer: Lucent All Commercial |
$175.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$310.28
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$258.57
|
| Rate for Payer: PHP All Commercial |
$261.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.46
|
| Rate for Payer: Sagamore Health Network All Products |
$266.15
|
| Rate for Payer: Signature Care EPO |
$286.15
|
| Rate for Payer: Signature Care PPO |
$303.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$293.05
|
| Rate for Payer: United Healthcare Commercial |
$271.67
|
| Rate for Payer: United Healthcare Medicare |
$113.77
|
|
|
HC NEWBORN RESUSCITATION
|
Facility
IP
|
$1,310.70
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
01709440
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$983.02 |
| Max. Negotiated Rate |
$1,218.95 |
| Rate for Payer: Aetna Commercial |
$1,132.44
|
| Rate for Payer: Cash Price |
$812.63
|
| Rate for Payer: Cigna All Commercial |
$1,131.13
|
| Rate for Payer: CORVEL All Commercial |
$1,218.95
|
| Rate for Payer: Coventry All Commercial |
$1,153.42
|
| Rate for Payer: Encore All Commercial |
$1,206.50
|
| Rate for Payer: Frontpath All Commercial |
$1,205.84
|
| Rate for Payer: Humana ChoiceCare |
$1,132.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,179.63
|
| Rate for Payer: PHCS All Commercial |
$983.02
|
| Rate for Payer: PHP All Commercial |
$994.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,011.86
|
| Rate for Payer: Signature Care EPO |
$1,087.88
|
| Rate for Payer: Signature Care PPO |
$1,153.42
|
| Rate for Payer: United Healthcare Commercial |
$1,032.83
|
|
|
HC NEWBORN RESUSCITATION
|
Facility
OP
|
$1,310.70
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
01709440
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$432.53 |
| Max. Negotiated Rate |
$1,218.95 |
| Rate for Payer: Aetna Commercial |
$1,106.23
|
| Rate for Payer: Aetna Medicare |
$432.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$432.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$752.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$819.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$497.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$475.78
|
| Rate for Payer: Cash Price |
$812.63
|
| Rate for Payer: Cash Price |
$812.63
|
| Rate for Payer: Centivo All Commercial |
$668.46
|
| Rate for Payer: Cigna All Commercial |
$1,131.13
|
| Rate for Payer: CORVEL All Commercial |
$1,218.95
|
| Rate for Payer: Coventry All Commercial |
$1,153.42
|
| Rate for Payer: Encore All Commercial |
$1,206.50
|
| Rate for Payer: Frontpath All Commercial |
$1,205.84
|
| Rate for Payer: Humana ChoiceCare |
$1,132.05
|
| Rate for Payer: Humana Medicare |
$668.46
|
| Rate for Payer: Lucent All Commercial |
$668.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,179.63
|
| Rate for Payer: Managed Health Services Medicaid |
$648.65
|
| Rate for Payer: MDWise Medicaid |
$648.65
|
| Rate for Payer: PHCS All Commercial |
$983.02
|
| Rate for Payer: PHP All Commercial |
$994.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$511.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,011.86
|
| Rate for Payer: Signature Care EPO |
$1,087.88
|
| Rate for Payer: Signature Care PPO |
$1,153.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,114.10
|
| Rate for Payer: United Healthcare Commercial |
$1,032.83
|
| Rate for Payer: United Healthcare Medicare |
$432.53
|
|
|
HC NEWBORN SCREEN (PKU)
|
Facility
OP
|
$214.60
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
63001653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$199.58 |
| Rate for Payer: Aetna Commercial |
$181.12
|
| Rate for Payer: Aetna Medicare |
$70.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$123.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.90
|
| Rate for Payer: Cash Price |
$133.05
|
| Rate for Payer: Cash Price |
$133.05
|
| Rate for Payer: Centivo All Commercial |
$109.44
|
| Rate for Payer: Cigna All Commercial |
$185.20
|
| Rate for Payer: CORVEL All Commercial |
$199.58
|
| Rate for Payer: Coventry All Commercial |
$188.85
|
| Rate for Payer: Encore All Commercial |
$197.54
|
| Rate for Payer: Frontpath All Commercial |
$197.43
|
| Rate for Payer: Humana ChoiceCare |
$185.35
|
| Rate for Payer: Humana Medicare |
$109.44
|
| Rate for Payer: Lucent All Commercial |
$109.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.14
|
| Rate for Payer: Managed Health Services Medicaid |
$5.50
|
| Rate for Payer: MDWise Medicaid |
$5.50
|
| Rate for Payer: PHCS All Commercial |
$160.95
|
| Rate for Payer: PHP All Commercial |
$162.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.69
|
| Rate for Payer: Sagamore Health Network All Products |
$165.67
|
| Rate for Payer: Signature Care EPO |
$178.12
|
| Rate for Payer: Signature Care PPO |
$188.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.41
|
| Rate for Payer: United Healthcare Commercial |
$169.10
|
| Rate for Payer: United Healthcare Medicare |
$70.82
|
|
|
HC NEWBORN SCREEN (PKU)
|
Facility
IP
|
$214.60
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
63001653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.95 |
| Max. Negotiated Rate |
$199.58 |
| Rate for Payer: Aetna Commercial |
$185.41
|
| Rate for Payer: Cash Price |
$133.05
|
| Rate for Payer: Cigna All Commercial |
$185.20
|
| Rate for Payer: CORVEL All Commercial |
$199.58
|
| Rate for Payer: Coventry All Commercial |
$188.85
|
| Rate for Payer: Encore All Commercial |
$197.54
|
| Rate for Payer: Frontpath All Commercial |
$197.43
|
| Rate for Payer: Humana ChoiceCare |
$185.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.14
|
| Rate for Payer: PHCS All Commercial |
$160.95
|
| Rate for Payer: PHP All Commercial |
$162.75
|
| Rate for Payer: Sagamore Health Network All Products |
$165.67
|
| Rate for Payer: Signature Care EPO |
$178.12
|
| Rate for Payer: Signature Care PPO |
$188.85
|
| Rate for Payer: United Healthcare Commercial |
$169.10
|
|
|
HC NEXTRA HAMMERTOE CORR SYS 3.5 SS
|
Facility
OP
|
$5,054.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,700.59 |
| Rate for Payer: Aetna Commercial |
$4,265.91
|
| Rate for Payer: Aetna Medicare |
$1,667.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,667.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,902.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,159.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,918.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,834.75
|
| Rate for Payer: Cash Price |
$3,133.73
|
| Rate for Payer: Cash Price |
$3,133.73
|
| Rate for Payer: Centivo All Commercial |
$2,577.74
|
| Rate for Payer: Cigna All Commercial |
$4,361.95
|
| Rate for Payer: CORVEL All Commercial |
$4,700.59
|
| Rate for Payer: Coventry All Commercial |
$4,447.87
|
| Rate for Payer: Encore All Commercial |
$4,652.58
|
| Rate for Payer: Frontpath All Commercial |
$4,650.05
|
| Rate for Payer: Humana ChoiceCare |
$4,365.49
|
| Rate for Payer: Humana Medicare |
$2,577.74
|
| Rate for Payer: Lucent All Commercial |
$2,577.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,548.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,790.80
|
| Rate for Payer: PHP All Commercial |
$3,833.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,971.22
|
| Rate for Payer: Sagamore Health Network All Products |
$3,902.00
|
| Rate for Payer: Signature Care EPO |
$4,195.15
|
| Rate for Payer: Signature Care PPO |
$4,447.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,296.24
|
| Rate for Payer: United Healthcare Commercial |
$3,982.87
|
| Rate for Payer: United Healthcare Medicare |
$1,667.95
|
|
|
HC NEXTRA HAMMERTOE CORR SYS 3.5 SS
|
Facility
IP
|
$5,054.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,790.80 |
| Max. Negotiated Rate |
$4,700.59 |
| Rate for Payer: Aetna Commercial |
$4,367.00
|
| Rate for Payer: Cash Price |
$3,133.73
|
| Rate for Payer: Cigna All Commercial |
$4,361.95
|
| Rate for Payer: CORVEL All Commercial |
$4,700.59
|
| Rate for Payer: Coventry All Commercial |
$4,447.87
|
| Rate for Payer: Encore All Commercial |
$4,652.58
|
| Rate for Payer: Frontpath All Commercial |
$4,650.05
|
| Rate for Payer: Humana ChoiceCare |
$4,365.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,548.96
|
| Rate for Payer: PHCS All Commercial |
$3,790.80
|
| Rate for Payer: PHP All Commercial |
$3,833.26
|
| Rate for Payer: Sagamore Health Network All Products |
$3,902.00
|
| Rate for Payer: Signature Care EPO |
$4,195.15
|
| Rate for Payer: Signature Care PPO |
$4,447.87
|
| Rate for Payer: United Healthcare Commercial |
$3,982.87
|
|
|
HC NEXTRA HAMMERTOE IMPLANT 3.5 SS
|
Facility
IP
|
$3,693.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.20 |
| Max. Negotiated Rate |
$3,435.05 |
| Rate for Payer: Aetna Commercial |
$3,191.27
|
| Rate for Payer: Cash Price |
$2,290.03
|
| Rate for Payer: Cigna All Commercial |
$3,187.58
|
| Rate for Payer: CORVEL All Commercial |
$3,435.05
|
| Rate for Payer: Coventry All Commercial |
$3,250.37
|
| Rate for Payer: Encore All Commercial |
$3,399.96
|
| Rate for Payer: Frontpath All Commercial |
$3,398.11
|
| Rate for Payer: Humana ChoiceCare |
$3,190.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,324.24
|
| Rate for Payer: PHCS All Commercial |
$2,770.20
|
| Rate for Payer: PHP All Commercial |
$2,801.23
|
| Rate for Payer: Sagamore Health Network All Products |
$2,851.46
|
| Rate for Payer: Signature Care EPO |
$3,065.69
|
| Rate for Payer: Signature Care PPO |
$3,250.37
|
| Rate for Payer: United Healthcare Commercial |
$2,910.56
|
|
|
HC NEXTRA HAMMERTOE IMPLANT 3.5 SS
|
Facility
OP
|
$3,693.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,435.05 |
| Rate for Payer: Aetna Commercial |
$3,117.40
|
| Rate for Payer: Aetna Medicare |
$1,218.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,218.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,121.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,308.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,401.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,340.78
|
| Rate for Payer: Cash Price |
$2,290.03
|
| Rate for Payer: Cash Price |
$2,290.03
|
| Rate for Payer: Centivo All Commercial |
$1,883.74
|
| Rate for Payer: Cigna All Commercial |
$3,187.58
|
| Rate for Payer: CORVEL All Commercial |
$3,435.05
|
| Rate for Payer: Coventry All Commercial |
$3,250.37
|
| Rate for Payer: Encore All Commercial |
$3,399.96
|
| Rate for Payer: Frontpath All Commercial |
$3,398.11
|
| Rate for Payer: Humana ChoiceCare |
$3,190.16
|
| Rate for Payer: Humana Medicare |
$1,883.74
|
| Rate for Payer: Lucent All Commercial |
$1,883.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,324.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,770.20
|
| Rate for Payer: PHP All Commercial |
$2,801.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,440.50
|
| Rate for Payer: Sagamore Health Network All Products |
$2,851.46
|
| Rate for Payer: Signature Care EPO |
$3,065.69
|
| Rate for Payer: Signature Care PPO |
$3,250.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,139.56
|
| Rate for Payer: United Healthcare Commercial |
$2,910.56
|
| Rate for Payer: United Healthcare Medicare |
$1,218.89
|
|
|
HC NFCT DS BV&VAGINITIS AMP PRB
|
Facility
IP
|
$398.50
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
63000352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$298.88 |
| Max. Negotiated Rate |
$370.60 |
| Rate for Payer: Aetna Commercial |
$344.30
|
| Rate for Payer: Cash Price |
$247.07
|
| Rate for Payer: Cigna All Commercial |
$343.91
|
| Rate for Payer: CORVEL All Commercial |
$370.60
|
| Rate for Payer: Coventry All Commercial |
$350.68
|
| Rate for Payer: Encore All Commercial |
$366.82
|
| Rate for Payer: Frontpath All Commercial |
$366.62
|
| Rate for Payer: Humana ChoiceCare |
$344.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.65
|
| Rate for Payer: PHCS All Commercial |
$298.88
|
| Rate for Payer: PHP All Commercial |
$302.22
|
| Rate for Payer: Sagamore Health Network All Products |
$307.64
|
| Rate for Payer: Signature Care EPO |
$330.76
|
| Rate for Payer: Signature Care PPO |
$350.68
|
| Rate for Payer: United Healthcare Commercial |
$314.02
|
|
|
HC NFCT DS BV&VAGINITIS AMP PRB
|
Facility
OP
|
$398.50
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
63000352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.50 |
| Max. Negotiated Rate |
$370.60 |
| Rate for Payer: Aetna Commercial |
$336.33
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.66
|
| Rate for Payer: Cash Price |
$247.07
|
| Rate for Payer: Centivo All Commercial |
$203.24
|
| Rate for Payer: Cigna All Commercial |
$343.91
|
| Rate for Payer: CORVEL All Commercial |
$370.60
|
| Rate for Payer: Coventry All Commercial |
$350.68
|
| Rate for Payer: Encore All Commercial |
$366.82
|
| Rate for Payer: Frontpath All Commercial |
$366.62
|
| Rate for Payer: Humana ChoiceCare |
$344.18
|
| Rate for Payer: Humana Medicare |
$203.24
|
| Rate for Payer: Lucent All Commercial |
$203.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.65
|
| Rate for Payer: PHCS All Commercial |
$298.88
|
| Rate for Payer: PHP All Commercial |
$302.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.42
|
| Rate for Payer: Sagamore Health Network All Products |
$307.64
|
| Rate for Payer: Signature Care EPO |
$330.76
|
| Rate for Payer: Signature Care PPO |
$350.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.72
|
| Rate for Payer: United Healthcare Commercial |
$314.02
|
| Rate for Payer: United Healthcare Medicare |
$131.50
|
|
|
HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR
|
Facility
OP
|
$491.09
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
63081596
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$456.71 |
| Rate for Payer: Aetna Commercial |
$414.48
|
| Rate for Payer: Aetna Medicare |
$162.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$162.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$282.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$306.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$186.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.27
|
| Rate for Payer: Cash Price |
$304.48
|
| Rate for Payer: Centivo All Commercial |
$250.46
|
| Rate for Payer: Cigna All Commercial |
$423.81
|
| Rate for Payer: CORVEL All Commercial |
$456.71
|
| Rate for Payer: Coventry All Commercial |
$432.16
|
| Rate for Payer: Encore All Commercial |
$452.05
|
| Rate for Payer: Frontpath All Commercial |
$451.80
|
| Rate for Payer: Humana ChoiceCare |
$424.15
|
| Rate for Payer: Humana Medicare |
$250.46
|
| Rate for Payer: Lucent All Commercial |
$250.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.98
|
| Rate for Payer: PHCS All Commercial |
$368.32
|
| Rate for Payer: PHP All Commercial |
$372.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.52
|
| Rate for Payer: Sagamore Health Network All Products |
$379.12
|
| Rate for Payer: Signature Care EPO |
$407.60
|
| Rate for Payer: Signature Care PPO |
$432.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$417.43
|
| Rate for Payer: United Healthcare Commercial |
$386.98
|
| Rate for Payer: United Healthcare Medicare |
$162.06
|
|
|
HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR
|
Facility
IP
|
$491.09
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
63081596
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$368.32 |
| Max. Negotiated Rate |
$456.71 |
| Rate for Payer: Aetna Commercial |
$424.30
|
| Rate for Payer: Cash Price |
$304.48
|
| Rate for Payer: Cigna All Commercial |
$423.81
|
| Rate for Payer: CORVEL All Commercial |
$456.71
|
| Rate for Payer: Coventry All Commercial |
$432.16
|
| Rate for Payer: Encore All Commercial |
$452.05
|
| Rate for Payer: Frontpath All Commercial |
$451.80
|
| Rate for Payer: Humana ChoiceCare |
$424.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.98
|
| Rate for Payer: PHCS All Commercial |
$368.32
|
| Rate for Payer: PHP All Commercial |
$372.44
|
| Rate for Payer: Sagamore Health Network All Products |
$379.12
|
| Rate for Payer: Signature Care EPO |
$407.60
|
| Rate for Payer: Signature Care PPO |
$432.16
|
| Rate for Payer: United Healthcare Commercial |
$386.98
|
|
