|
HC SPINAL FLUID CELL CT
|
Facility
|
OP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$134.39 |
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Aetna Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.87
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$78.61
|
| Rate for Payer: Cigna All Commercial |
$124.71
|
| Rate for Payer: CORVEL All Commercial |
$134.39
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.81
|
| Rate for Payer: Humana Medicare |
$46.24
|
| Rate for Payer: Lucent All Commercial |
$78.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: Managed Health Services Medicaid |
$4.72
|
| Rate for Payer: MDWise Medicaid |
$4.72
|
| Rate for Payer: PHCS All Commercial |
$108.38
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.36
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.94
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.83
|
| Rate for Payer: United Healthcare Commercial |
$113.87
|
| Rate for Payer: United Healthcare Medicare |
$46.24
|
|
|
HC SPINAL FLUID CELL CT
|
Facility
|
IP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$134.39 |
| Rate for Payer: Aetna Commercial |
$124.86
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$124.71
|
| Rate for Payer: CORVEL All Commercial |
$134.39
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: PHCS All Commercial |
$108.38
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.94
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: United Healthcare Commercial |
$113.87
|
|
|
HC SPINAL FLUID GLUCOSE
|
Facility
|
IP
|
$113.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$98.39
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.21
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.21
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
|
|
HC SPINAL FLUID GLUCOSE
|
Facility
|
OP
|
$113.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$96.11
|
| Rate for Payer: Aetna Medicare |
$36.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.09
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Centivo All Commercial |
$61.95
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.21
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Humana Medicare |
$36.44
|
| Rate for Payer: Lucent All Commercial |
$61.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: Managed Health Services Medicaid |
$3.93
|
| Rate for Payer: MDWise Medicaid |
$3.93
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.41
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.80
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
| Rate for Payer: United Healthcare Medicare |
$36.44
|
|
|
HC SPINAL FLUID PROTEIN
|
Facility
|
OP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$104.61
|
| Rate for Payer: Aetna Medicare |
$39.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.63
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Centivo All Commercial |
$67.42
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Humana Medicare |
$39.66
|
| Rate for Payer: Lucent All Commercial |
$67.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: Managed Health Services Medicaid |
$4.00
|
| Rate for Payer: MDWise Medicaid |
$4.00
|
| Rate for Payer: PHCS All Commercial |
$92.95
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.34
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.35
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
| Rate for Payer: United Healthcare Medicare |
$39.66
|
|
|
HC SPINAL FLUID PROTEIN
|
Facility
|
IP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: PHCS All Commercial |
$92.95
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
|
|
HC SPLINT BASEBALL DEROYAL LARGE
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601427
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Aetna Commercial |
$10.23
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cigna All Commercial |
$10.22
|
| Rate for Payer: CORVEL All Commercial |
$11.01
|
| Rate for Payer: Coventry All Commercial |
$10.42
|
| Rate for Payer: Encore All Commercial |
$10.90
|
| Rate for Payer: Frontpath All Commercial |
$10.89
|
| Rate for Payer: Humana ChoiceCare |
$10.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.66
|
| Rate for Payer: PHCS All Commercial |
$8.88
|
| Rate for Payer: PHP All Commercial |
$8.98
|
| Rate for Payer: Sagamore Health Network All Products |
$9.14
|
| Rate for Payer: Signature Care EPO |
$9.83
|
| Rate for Payer: Signature Care PPO |
$10.42
|
| Rate for Payer: United Healthcare Commercial |
$9.33
|
|
|
HC SPLINT BASEBALL DEROYAL LARGE
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601427
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.17
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Centivo All Commercial |
$6.44
|
| Rate for Payer: Cigna All Commercial |
$10.22
|
| Rate for Payer: CORVEL All Commercial |
$11.01
|
| Rate for Payer: Coventry All Commercial |
$10.42
|
| Rate for Payer: Encore All Commercial |
$10.90
|
| Rate for Payer: Frontpath All Commercial |
$10.89
|
| Rate for Payer: Humana ChoiceCare |
$10.23
|
| Rate for Payer: Humana Medicare |
$3.79
|
| Rate for Payer: Lucent All Commercial |
$6.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.66
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$8.88
|
| Rate for Payer: PHP All Commercial |
$8.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.62
|
| Rate for Payer: Sagamore Health Network All Products |
$9.14
|
| Rate for Payer: Signature Care EPO |
$9.83
|
| Rate for Payer: Signature Care PPO |
$10.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.06
|
| Rate for Payer: United Healthcare Commercial |
$9.33
|
| Rate for Payer: United Healthcare Medicare |
$3.79
|
|
|
HC SPLINT BASEBALL DEROYAL MEDIUM
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601426
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Aetna Commercial |
$10.23
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cigna All Commercial |
$10.22
|
| Rate for Payer: CORVEL All Commercial |
$11.01
|
| Rate for Payer: Coventry All Commercial |
$10.42
|
| Rate for Payer: Encore All Commercial |
$10.90
|
| Rate for Payer: Frontpath All Commercial |
$10.89
|
| Rate for Payer: Humana ChoiceCare |
$10.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.66
|
| Rate for Payer: PHCS All Commercial |
$8.88
|
| Rate for Payer: PHP All Commercial |
$8.98
|
| Rate for Payer: Sagamore Health Network All Products |
$9.14
|
| Rate for Payer: Signature Care EPO |
$9.83
|
| Rate for Payer: Signature Care PPO |
$10.42
|
| Rate for Payer: United Healthcare Commercial |
$9.33
|
|
|
HC SPLINT BASEBALL DEROYAL MEDIUM
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601426
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.17
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Centivo All Commercial |
$6.44
|
| Rate for Payer: Cigna All Commercial |
$10.22
|
| Rate for Payer: CORVEL All Commercial |
$11.01
|
| Rate for Payer: Coventry All Commercial |
$10.42
|
| Rate for Payer: Encore All Commercial |
$10.90
|
| Rate for Payer: Frontpath All Commercial |
$10.89
|
| Rate for Payer: Humana ChoiceCare |
$10.23
|
| Rate for Payer: Humana Medicare |
$3.79
|
| Rate for Payer: Lucent All Commercial |
$6.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.66
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$8.88
|
| Rate for Payer: PHP All Commercial |
$8.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.62
|
| Rate for Payer: Sagamore Health Network All Products |
$9.14
|
| Rate for Payer: Signature Care EPO |
$9.83
|
| Rate for Payer: Signature Care PPO |
$10.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.06
|
| Rate for Payer: United Healthcare Commercial |
$9.33
|
| Rate for Payer: United Healthcare Medicare |
$3.79
|
|
|
HC SPLINT FINGER 4 PRONG LARGE
|
Facility
|
OP
|
$6.06
|
|
| Hospital Charge Code |
41601829
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna Commercial |
$5.11
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.13
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Centivo All Commercial |
$3.30
|
| Rate for Payer: Cigna All Commercial |
$5.23
|
| Rate for Payer: CORVEL All Commercial |
$5.64
|
| Rate for Payer: Coventry All Commercial |
$5.33
|
| Rate for Payer: Encore All Commercial |
$5.58
|
| Rate for Payer: Frontpath All Commercial |
$5.58
|
| Rate for Payer: Humana ChoiceCare |
$5.23
|
| Rate for Payer: Humana Medicare |
$1.94
|
| Rate for Payer: Lucent All Commercial |
$3.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.45
|
| Rate for Payer: PHCS All Commercial |
$4.54
|
| Rate for Payer: PHP All Commercial |
$4.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4.68
|
| Rate for Payer: Signature Care EPO |
$5.03
|
| Rate for Payer: Signature Care PPO |
$5.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.15
|
| Rate for Payer: United Healthcare Commercial |
$4.78
|
| Rate for Payer: United Healthcare Medicare |
$1.94
|
|
|
HC SPLINT FINGER 4 PRONG LARGE
|
Facility
|
IP
|
$6.06
|
|
| Hospital Charge Code |
41601829
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cigna All Commercial |
$5.23
|
| Rate for Payer: CORVEL All Commercial |
$5.64
|
| Rate for Payer: Coventry All Commercial |
$5.33
|
| Rate for Payer: Encore All Commercial |
$5.58
|
| Rate for Payer: Frontpath All Commercial |
$5.58
|
| Rate for Payer: Humana ChoiceCare |
$5.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.45
|
| Rate for Payer: PHCS All Commercial |
$4.54
|
| Rate for Payer: PHP All Commercial |
$4.60
|
| Rate for Payer: Sagamore Health Network All Products |
$4.68
|
| Rate for Payer: Signature Care EPO |
$5.03
|
| Rate for Payer: Signature Care PPO |
$5.33
|
| Rate for Payer: United Healthcare Commercial |
$4.78
|
|
|
HC SPLINT FINGER 4 PRONG MEDIUM
|
Facility
|
OP
|
$5.80
|
|
| Hospital Charge Code |
41601830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.04
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Centivo All Commercial |
$3.16
|
| Rate for Payer: Cigna All Commercial |
$5.01
|
| Rate for Payer: CORVEL All Commercial |
$5.39
|
| Rate for Payer: Coventry All Commercial |
$5.10
|
| Rate for Payer: Encore All Commercial |
$5.34
|
| Rate for Payer: Frontpath All Commercial |
$5.34
|
| Rate for Payer: Humana ChoiceCare |
$5.01
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Lucent All Commercial |
$3.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$4.35
|
| Rate for Payer: PHP All Commercial |
$4.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.26
|
| Rate for Payer: Sagamore Health Network All Products |
$4.48
|
| Rate for Payer: Signature Care EPO |
$4.81
|
| Rate for Payer: Signature Care PPO |
$5.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.93
|
| Rate for Payer: United Healthcare Commercial |
$4.57
|
| Rate for Payer: United Healthcare Medicare |
$1.86
|
|
|
HC SPLINT FINGER 4 PRONG MEDIUM
|
Facility
|
IP
|
$5.80
|
|
| Hospital Charge Code |
41601830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cigna All Commercial |
$5.01
|
| Rate for Payer: CORVEL All Commercial |
$5.39
|
| Rate for Payer: Coventry All Commercial |
$5.10
|
| Rate for Payer: Encore All Commercial |
$5.34
|
| Rate for Payer: Frontpath All Commercial |
$5.34
|
| Rate for Payer: Humana ChoiceCare |
$5.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$4.35
|
| Rate for Payer: PHP All Commercial |
$4.40
|
| Rate for Payer: Sagamore Health Network All Products |
$4.48
|
| Rate for Payer: Signature Care EPO |
$4.81
|
| Rate for Payer: Signature Care PPO |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$4.57
|
|
|
HC SPLINT FINGER 4 PRONG SM
|
Facility
|
IP
|
$3.17
|
|
| Hospital Charge Code |
41603085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna All Commercial |
$2.74
|
| Rate for Payer: CORVEL All Commercial |
$2.95
|
| Rate for Payer: Coventry All Commercial |
$2.79
|
| Rate for Payer: Encore All Commercial |
$2.92
|
| Rate for Payer: Frontpath All Commercial |
$2.92
|
| Rate for Payer: Humana ChoiceCare |
$2.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.85
|
| Rate for Payer: PHCS All Commercial |
$2.38
|
| Rate for Payer: PHP All Commercial |
$2.40
|
| Rate for Payer: Sagamore Health Network All Products |
$2.45
|
| Rate for Payer: Signature Care EPO |
$2.63
|
| Rate for Payer: Signature Care PPO |
$2.79
|
| Rate for Payer: United Healthcare Commercial |
$2.50
|
|
|
HC SPLINT FINGER 4 PRONG SM
|
Facility
|
OP
|
$3.17
|
|
| Hospital Charge Code |
41603085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Centivo All Commercial |
$1.72
|
| Rate for Payer: Cigna All Commercial |
$2.74
|
| Rate for Payer: CORVEL All Commercial |
$2.95
|
| Rate for Payer: Coventry All Commercial |
$2.79
|
| Rate for Payer: Encore All Commercial |
$2.92
|
| Rate for Payer: Frontpath All Commercial |
$2.92
|
| Rate for Payer: Humana ChoiceCare |
$2.74
|
| Rate for Payer: Humana Medicare |
$1.01
|
| Rate for Payer: Lucent All Commercial |
$1.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.85
|
| Rate for Payer: PHCS All Commercial |
$2.38
|
| Rate for Payer: PHP All Commercial |
$2.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2.45
|
| Rate for Payer: Signature Care EPO |
$2.63
|
| Rate for Payer: Signature Care PPO |
$2.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.69
|
| Rate for Payer: United Healthcare Commercial |
$2.50
|
| Rate for Payer: United Healthcare Medicare |
$1.01
|
|
|
HC SPLINT FINGER FOAM 3 INCH
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna All Commercial |
$4.05
|
| Rate for Payer: CORVEL All Commercial |
$4.36
|
| Rate for Payer: Coventry All Commercial |
$4.13
|
| Rate for Payer: Encore All Commercial |
$4.32
|
| Rate for Payer: Frontpath All Commercial |
$4.31
|
| Rate for Payer: Humana ChoiceCare |
$4.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.22
|
| Rate for Payer: PHCS All Commercial |
$3.52
|
| Rate for Payer: PHP All Commercial |
$3.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.62
|
| Rate for Payer: Signature Care EPO |
$3.89
|
| Rate for Payer: Signature Care PPO |
$4.13
|
| Rate for Payer: United Healthcare Commercial |
$3.70
|
|
|
HC SPLINT FINGER FOAM 3 INCH
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.65
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Centivo All Commercial |
$2.55
|
| Rate for Payer: Cigna All Commercial |
$4.05
|
| Rate for Payer: CORVEL All Commercial |
$4.36
|
| Rate for Payer: Coventry All Commercial |
$4.13
|
| Rate for Payer: Encore All Commercial |
$4.32
|
| Rate for Payer: Frontpath All Commercial |
$4.31
|
| Rate for Payer: Humana ChoiceCare |
$4.05
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Lucent All Commercial |
$2.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.22
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$3.52
|
| Rate for Payer: PHP All Commercial |
$3.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3.62
|
| Rate for Payer: Signature Care EPO |
$3.89
|
| Rate for Payer: Signature Care PPO |
$4.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.99
|
| Rate for Payer: United Healthcare Commercial |
$3.70
|
| Rate for Payer: United Healthcare Medicare |
$1.50
|
|
|
HC SPLINT FINGER FOAM 6 INCH
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601095
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna All Commercial |
$4.05
|
| Rate for Payer: CORVEL All Commercial |
$4.36
|
| Rate for Payer: Coventry All Commercial |
$4.13
|
| Rate for Payer: Encore All Commercial |
$4.32
|
| Rate for Payer: Frontpath All Commercial |
$4.31
|
| Rate for Payer: Humana ChoiceCare |
$4.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.22
|
| Rate for Payer: PHCS All Commercial |
$3.52
|
| Rate for Payer: PHP All Commercial |
$3.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.62
|
| Rate for Payer: Signature Care EPO |
$3.89
|
| Rate for Payer: Signature Care PPO |
$4.13
|
| Rate for Payer: United Healthcare Commercial |
$3.70
|
|
|
HC SPLINT FINGER FOAM 6 INCH
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601095
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.65
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Centivo All Commercial |
$2.55
|
| Rate for Payer: Cigna All Commercial |
$4.05
|
| Rate for Payer: CORVEL All Commercial |
$4.36
|
| Rate for Payer: Coventry All Commercial |
$4.13
|
| Rate for Payer: Encore All Commercial |
$4.32
|
| Rate for Payer: Frontpath All Commercial |
$4.31
|
| Rate for Payer: Humana ChoiceCare |
$4.05
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Lucent All Commercial |
$2.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.22
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$3.52
|
| Rate for Payer: PHP All Commercial |
$3.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3.62
|
| Rate for Payer: Signature Care EPO |
$3.89
|
| Rate for Payer: Signature Care PPO |
$4.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.99
|
| Rate for Payer: United Healthcare Commercial |
$3.70
|
| Rate for Payer: United Healthcare Medicare |
$1.50
|
|
|
HC SPLINT FINGER FOAM MED
|
Facility
|
OP
|
$6.17
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601428
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$5.21
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.17
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Centivo All Commercial |
$3.36
|
| Rate for Payer: Cigna All Commercial |
$5.32
|
| Rate for Payer: CORVEL All Commercial |
$5.74
|
| Rate for Payer: Coventry All Commercial |
$5.43
|
| Rate for Payer: Encore All Commercial |
$5.68
|
| Rate for Payer: Frontpath All Commercial |
$5.68
|
| Rate for Payer: Humana ChoiceCare |
$5.33
|
| Rate for Payer: Humana Medicare |
$1.97
|
| Rate for Payer: Lucent All Commercial |
$3.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.55
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$4.63
|
| Rate for Payer: PHP All Commercial |
$4.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.41
|
| Rate for Payer: Sagamore Health Network All Products |
$4.76
|
| Rate for Payer: Signature Care EPO |
$5.12
|
| Rate for Payer: Signature Care PPO |
$5.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.24
|
| Rate for Payer: United Healthcare Commercial |
$4.86
|
| Rate for Payer: United Healthcare Medicare |
$1.97
|
|
|
HC SPLINT FINGER FOAM MED
|
Facility
|
IP
|
$6.17
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601428
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.33
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna All Commercial |
$5.32
|
| Rate for Payer: CORVEL All Commercial |
$5.74
|
| Rate for Payer: Coventry All Commercial |
$5.43
|
| Rate for Payer: Encore All Commercial |
$5.68
|
| Rate for Payer: Frontpath All Commercial |
$5.68
|
| Rate for Payer: Humana ChoiceCare |
$5.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.55
|
| Rate for Payer: PHCS All Commercial |
$4.63
|
| Rate for Payer: PHP All Commercial |
$4.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4.76
|
| Rate for Payer: Signature Care EPO |
$5.12
|
| Rate for Payer: Signature Care PPO |
$5.43
|
| Rate for Payer: United Healthcare Commercial |
$4.86
|
|
|
HC SPLINT FINGER FOAM XLG
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601096
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$1.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.74
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Centivo All Commercial |
$2.69
|
| Rate for Payer: Cigna All Commercial |
$4.26
|
| Rate for Payer: CORVEL All Commercial |
$4.59
|
| Rate for Payer: Coventry All Commercial |
$4.35
|
| Rate for Payer: Encore All Commercial |
$4.55
|
| Rate for Payer: Frontpath All Commercial |
$4.54
|
| Rate for Payer: Humana ChoiceCare |
$4.27
|
| Rate for Payer: Humana Medicare |
$1.58
|
| Rate for Payer: Lucent All Commercial |
$2.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.45
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$3.71
|
| Rate for Payer: PHP All Commercial |
$3.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.93
|
| Rate for Payer: Sagamore Health Network All Products |
$3.81
|
| Rate for Payer: Signature Care EPO |
$4.10
|
| Rate for Payer: Signature Care PPO |
$4.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$3.89
|
| Rate for Payer: United Healthcare Medicare |
$1.58
|
|
|
HC SPLINT FINGER FOAM XLG
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601096
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cigna All Commercial |
$4.26
|
| Rate for Payer: CORVEL All Commercial |
$4.59
|
| Rate for Payer: Coventry All Commercial |
$4.35
|
| Rate for Payer: Encore All Commercial |
$4.55
|
| Rate for Payer: Frontpath All Commercial |
$4.54
|
| Rate for Payer: Humana ChoiceCare |
$4.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.45
|
| Rate for Payer: PHCS All Commercial |
$3.71
|
| Rate for Payer: PHP All Commercial |
$3.75
|
| Rate for Payer: Sagamore Health Network All Products |
$3.81
|
| Rate for Payer: Signature Care EPO |
$4.10
|
| Rate for Payer: Signature Care PPO |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$3.89
|
|
|
HC SPLINT; FINGER L 2 STATIC-OT
|
Facility
|
IP
|
$291.72
|
|
|
Service Code
|
CPT 29130 GO,F1
|
| Hospital Charge Code |
11738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$218.79 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna Commercial |
$252.05
|
| Rate for Payer: Cash Price |
$175.03
|
| Rate for Payer: Cigna All Commercial |
$251.75
|
| Rate for Payer: CORVEL All Commercial |
$271.30
|
| Rate for Payer: Coventry All Commercial |
$256.71
|
| Rate for Payer: Encore All Commercial |
$268.53
|
| Rate for Payer: Frontpath All Commercial |
$268.38
|
| Rate for Payer: Humana ChoiceCare |
$251.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$262.55
|
| Rate for Payer: PHCS All Commercial |
$218.79
|
| Rate for Payer: PHP All Commercial |
$221.24
|
| Rate for Payer: Sagamore Health Network All Products |
$225.21
|
| Rate for Payer: Signature Care EPO |
$242.13
|
| Rate for Payer: Signature Care PPO |
$256.71
|
| Rate for Payer: United Healthcare Commercial |
$229.88
|
|
