|
HC OR ORTHO LEVEL 4 INITIAL 15 MIN
|
Facility
IP
|
$4,413.77
|
|
| Hospital Charge Code |
01206664
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,310.33 |
| Max. Negotiated Rate |
$4,104.81 |
| Rate for Payer: Aetna Commercial |
$3,813.50
|
| Rate for Payer: Cash Price |
$2,736.54
|
| Rate for Payer: Cigna All Commercial |
$3,809.09
|
| Rate for Payer: CORVEL All Commercial |
$4,104.81
|
| Rate for Payer: Coventry All Commercial |
$3,884.12
|
| Rate for Payer: Encore All Commercial |
$4,062.88
|
| Rate for Payer: Frontpath All Commercial |
$4,060.67
|
| Rate for Payer: Humana ChoiceCare |
$3,812.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,972.40
|
| Rate for Payer: PHCS All Commercial |
$3,310.33
|
| Rate for Payer: PHP All Commercial |
$3,347.41
|
| Rate for Payer: Sagamore Health Network All Products |
$3,407.43
|
| Rate for Payer: Signature Care EPO |
$3,663.43
|
| Rate for Payer: Signature Care PPO |
$3,884.12
|
| Rate for Payer: United Healthcare Commercial |
$3,478.05
|
|
|
HC OSMOLALITY (BLOOD)
|
Facility
IP
|
$139.13
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
63001121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$120.21
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Cigna All Commercial |
$120.07
|
| Rate for Payer: CORVEL All Commercial |
$129.39
|
| Rate for Payer: Coventry All Commercial |
$122.43
|
| Rate for Payer: Encore All Commercial |
$128.07
|
| Rate for Payer: Frontpath All Commercial |
$128.00
|
| Rate for Payer: Humana ChoiceCare |
$120.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.22
|
| Rate for Payer: PHCS All Commercial |
$104.35
|
| Rate for Payer: PHP All Commercial |
$105.51
|
| Rate for Payer: Sagamore Health Network All Products |
$107.41
|
| Rate for Payer: Signature Care EPO |
$115.48
|
| Rate for Payer: Signature Care PPO |
$122.43
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
|
|
HC OSMOLALITY (BLOOD)
|
Facility
OP
|
$139.13
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
63001121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$117.42
|
| Rate for Payer: Aetna Medicare |
$45.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Centivo All Commercial |
$70.96
|
| Rate for Payer: Cigna All Commercial |
$120.07
|
| Rate for Payer: CORVEL All Commercial |
$129.39
|
| Rate for Payer: Coventry All Commercial |
$122.43
|
| Rate for Payer: Encore All Commercial |
$128.07
|
| Rate for Payer: Frontpath All Commercial |
$128.00
|
| Rate for Payer: Humana ChoiceCare |
$120.16
|
| Rate for Payer: Humana Medicare |
$70.96
|
| Rate for Payer: Lucent All Commercial |
$70.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.22
|
| Rate for Payer: Managed Health Services Medicaid |
$6.61
|
| Rate for Payer: MDWise Medicaid |
$6.61
|
| Rate for Payer: PHCS All Commercial |
$104.35
|
| Rate for Payer: PHP All Commercial |
$105.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.26
|
| Rate for Payer: Sagamore Health Network All Products |
$107.41
|
| Rate for Payer: Signature Care EPO |
$115.48
|
| Rate for Payer: Signature Care PPO |
$122.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.26
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
| Rate for Payer: United Healthcare Medicare |
$45.91
|
|
|
HC OSMOLALITY URINE
|
Facility
IP
|
$134.51
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
63001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$125.09 |
| Rate for Payer: Aetna Commercial |
$116.21
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna All Commercial |
$116.08
|
| Rate for Payer: CORVEL All Commercial |
$125.09
|
| Rate for Payer: Coventry All Commercial |
$118.37
|
| Rate for Payer: Encore All Commercial |
$123.81
|
| Rate for Payer: Frontpath All Commercial |
$123.75
|
| Rate for Payer: Humana ChoiceCare |
$116.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.06
|
| Rate for Payer: PHCS All Commercial |
$100.88
|
| Rate for Payer: PHP All Commercial |
$102.01
|
| Rate for Payer: Sagamore Health Network All Products |
$103.84
|
| Rate for Payer: Signature Care EPO |
$111.64
|
| Rate for Payer: Signature Care PPO |
$118.37
|
| Rate for Payer: United Healthcare Commercial |
$105.99
|
|
|
HC OSMOLALITY URINE
|
Facility
OP
|
$134.51
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
63001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$125.09 |
| Rate for Payer: Aetna Commercial |
$113.52
|
| Rate for Payer: Aetna Medicare |
$44.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.83
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Centivo All Commercial |
$68.60
|
| Rate for Payer: Cigna All Commercial |
$116.08
|
| Rate for Payer: CORVEL All Commercial |
$125.09
|
| Rate for Payer: Coventry All Commercial |
$118.37
|
| Rate for Payer: Encore All Commercial |
$123.81
|
| Rate for Payer: Frontpath All Commercial |
$123.75
|
| Rate for Payer: Humana ChoiceCare |
$116.17
|
| Rate for Payer: Humana Medicare |
$68.60
|
| Rate for Payer: Lucent All Commercial |
$68.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.06
|
| Rate for Payer: Managed Health Services Medicaid |
$6.82
|
| Rate for Payer: MDWise Medicaid |
$6.82
|
| Rate for Payer: PHCS All Commercial |
$100.88
|
| Rate for Payer: PHP All Commercial |
$102.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.46
|
| Rate for Payer: Sagamore Health Network All Products |
$103.84
|
| Rate for Payer: Signature Care EPO |
$111.64
|
| Rate for Payer: Signature Care PPO |
$118.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.33
|
| Rate for Payer: United Healthcare Commercial |
$105.99
|
| Rate for Payer: United Healthcare Medicare |
$44.39
|
|
|
HC OSTEOBOOST BONE FILLER 10CC
|
Facility
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Medicare |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,101.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,049.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,960.20
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$2,754.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Humana Medicare |
$2,754.00
|
| Rate for Payer: Lucent All Commercial |
$2,754.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,106.00
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,590.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
| Rate for Payer: United Healthcare Medicare |
$1,782.00
|
|
|
HC OSTEOBOOST BONE FILLER 10CC
|
Facility
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,665.60
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
|
HC OSTOMY BAG 2.5
|
Facility
OP
|
$9.51
|
|
| Hospital Charge Code |
41601440
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$3.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.45
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Centivo All Commercial |
$4.85
|
| Rate for Payer: Cigna All Commercial |
$8.21
|
| Rate for Payer: CORVEL All Commercial |
$8.84
|
| Rate for Payer: Coventry All Commercial |
$8.37
|
| Rate for Payer: Encore All Commercial |
$8.75
|
| Rate for Payer: Frontpath All Commercial |
$8.75
|
| Rate for Payer: Humana ChoiceCare |
$8.21
|
| Rate for Payer: Humana Medicare |
$4.85
|
| Rate for Payer: Lucent All Commercial |
$4.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.56
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$7.13
|
| Rate for Payer: PHP All Commercial |
$7.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.71
|
| Rate for Payer: Sagamore Health Network All Products |
$7.34
|
| Rate for Payer: Signature Care EPO |
$7.89
|
| Rate for Payer: Signature Care PPO |
$8.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$7.49
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
|
|
HC OSTOMY BAG 2.5
|
Facility
IP
|
$9.51
|
|
| Hospital Charge Code |
41601440
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna All Commercial |
$8.21
|
| Rate for Payer: CORVEL All Commercial |
$8.84
|
| Rate for Payer: Coventry All Commercial |
$8.37
|
| Rate for Payer: Encore All Commercial |
$8.75
|
| Rate for Payer: Frontpath All Commercial |
$8.75
|
| Rate for Payer: Humana ChoiceCare |
$8.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.56
|
| Rate for Payer: PHCS All Commercial |
$7.13
|
| Rate for Payer: PHP All Commercial |
$7.21
|
| Rate for Payer: Sagamore Health Network All Products |
$7.34
|
| Rate for Payer: Signature Care EPO |
$7.89
|
| Rate for Payer: Signature Care PPO |
$8.37
|
| Rate for Payer: United Healthcare Commercial |
$7.49
|
|
|
HC OSTOMY BAGS 1 3/4
|
Facility
IP
|
$10.63
|
|
| Hospital Charge Code |
41602242
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Cigna All Commercial |
$9.17
|
| Rate for Payer: CORVEL All Commercial |
$9.89
|
| Rate for Payer: Coventry All Commercial |
$9.35
|
| Rate for Payer: Encore All Commercial |
$9.78
|
| Rate for Payer: Frontpath All Commercial |
$9.78
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.57
|
| Rate for Payer: PHCS All Commercial |
$7.97
|
| Rate for Payer: PHP All Commercial |
$8.06
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.82
|
| Rate for Payer: Signature Care PPO |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
|
|
HC OSTOMY BAGS 1 3/4
|
Facility
OP
|
$10.63
|
|
| Hospital Charge Code |
41602242
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$8.97
|
| Rate for Payer: Aetna Medicare |
$3.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.86
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Centivo All Commercial |
$5.42
|
| Rate for Payer: Cigna All Commercial |
$9.17
|
| Rate for Payer: CORVEL All Commercial |
$9.89
|
| Rate for Payer: Coventry All Commercial |
$9.35
|
| Rate for Payer: Encore All Commercial |
$9.78
|
| Rate for Payer: Frontpath All Commercial |
$9.78
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Humana Medicare |
$5.42
|
| Rate for Payer: Lucent All Commercial |
$5.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.57
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$7.97
|
| Rate for Payer: PHP All Commercial |
$8.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.15
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.82
|
| Rate for Payer: Signature Care PPO |
$9.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.04
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
| Rate for Payer: United Healthcare Medicare |
$3.51
|
|
|
HC OSTOMY BELT LG
|
Facility
OP
|
$19.28
|
|
| Hospital Charge Code |
41601438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.64
|
| Rate for Payer: CORVEL All Commercial |
$17.93
|
| Rate for Payer: Coventry All Commercial |
$16.97
|
| Rate for Payer: Encore All Commercial |
$17.75
|
| Rate for Payer: Frontpath All Commercial |
$17.74
|
| Rate for Payer: Humana ChoiceCare |
$16.65
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.35
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$14.46
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$16.00
|
| Rate for Payer: Signature Care PPO |
$16.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.39
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC OSTOMY BELT LG
|
Facility
IP
|
$19.28
|
|
| Hospital Charge Code |
41601438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna Commercial |
$16.66
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.64
|
| Rate for Payer: CORVEL All Commercial |
$17.93
|
| Rate for Payer: Coventry All Commercial |
$16.97
|
| Rate for Payer: Encore All Commercial |
$17.75
|
| Rate for Payer: Frontpath All Commercial |
$17.74
|
| Rate for Payer: Humana ChoiceCare |
$16.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.35
|
| Rate for Payer: PHCS All Commercial |
$14.46
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$16.00
|
| Rate for Payer: Signature Care PPO |
$16.97
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
|
|
HC OSTOMY BELT MED
|
Facility
OP
|
$19.28
|
|
| Hospital Charge Code |
41601439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.64
|
| Rate for Payer: CORVEL All Commercial |
$17.93
|
| Rate for Payer: Coventry All Commercial |
$16.97
|
| Rate for Payer: Encore All Commercial |
$17.75
|
| Rate for Payer: Frontpath All Commercial |
$17.74
|
| Rate for Payer: Humana ChoiceCare |
$16.65
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.35
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$14.46
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$16.00
|
| Rate for Payer: Signature Care PPO |
$16.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.39
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC OSTOMY BELT MED
|
Facility
IP
|
$19.28
|
|
| Hospital Charge Code |
41601439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna Commercial |
$16.66
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.64
|
| Rate for Payer: CORVEL All Commercial |
$17.93
|
| Rate for Payer: Coventry All Commercial |
$16.97
|
| Rate for Payer: Encore All Commercial |
$17.75
|
| Rate for Payer: Frontpath All Commercial |
$17.74
|
| Rate for Payer: Humana ChoiceCare |
$16.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.35
|
| Rate for Payer: PHCS All Commercial |
$14.46
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$16.00
|
| Rate for Payer: Signature Care PPO |
$16.97
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
|
|
HC OSTOMY FLOATING FLANGE
|
Facility
OP
|
$51.31
|
|
| Hospital Charge Code |
41601408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$43.31
|
| Rate for Payer: Aetna Medicare |
$16.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.63
|
| Rate for Payer: Cash Price |
$31.81
|
| Rate for Payer: Cash Price |
$31.81
|
| Rate for Payer: Centivo All Commercial |
$26.17
|
| Rate for Payer: Cigna All Commercial |
$44.28
|
| Rate for Payer: CORVEL All Commercial |
$47.72
|
| Rate for Payer: Coventry All Commercial |
$45.15
|
| Rate for Payer: Encore All Commercial |
$47.23
|
| Rate for Payer: Frontpath All Commercial |
$47.21
|
| Rate for Payer: Humana ChoiceCare |
$44.32
|
| Rate for Payer: Humana Medicare |
$26.17
|
| Rate for Payer: Lucent All Commercial |
$26.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$38.48
|
| Rate for Payer: PHP All Commercial |
$38.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.01
|
| Rate for Payer: Sagamore Health Network All Products |
$39.61
|
| Rate for Payer: Signature Care EPO |
$42.59
|
| Rate for Payer: Signature Care PPO |
$45.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$40.43
|
| Rate for Payer: United Healthcare Medicare |
$16.93
|
|
|
HC OSTOMY FLOATING FLANGE
|
Facility
IP
|
$51.31
|
|
| Hospital Charge Code |
41601408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$47.72 |
| Rate for Payer: Aetna Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$31.81
|
| Rate for Payer: Cigna All Commercial |
$44.28
|
| Rate for Payer: CORVEL All Commercial |
$47.72
|
| Rate for Payer: Coventry All Commercial |
$45.15
|
| Rate for Payer: Encore All Commercial |
$47.23
|
| Rate for Payer: Frontpath All Commercial |
$47.21
|
| Rate for Payer: Humana ChoiceCare |
$44.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.18
|
| Rate for Payer: PHCS All Commercial |
$38.48
|
| Rate for Payer: PHP All Commercial |
$38.91
|
| Rate for Payer: Sagamore Health Network All Products |
$39.61
|
| Rate for Payer: Signature Care EPO |
$42.59
|
| Rate for Payer: Signature Care PPO |
$45.15
|
| Rate for Payer: United Healthcare Commercial |
$40.43
|
|
|
HC OSTOMY IRRIG DRAIN-4
|
Facility
IP
|
$17.90
|
|
| Hospital Charge Code |
41601436
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna All Commercial |
$15.45
|
| Rate for Payer: CORVEL All Commercial |
$16.65
|
| Rate for Payer: Coventry All Commercial |
$15.75
|
| Rate for Payer: Encore All Commercial |
$16.48
|
| Rate for Payer: Frontpath All Commercial |
$16.47
|
| Rate for Payer: Humana ChoiceCare |
$15.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.11
|
| Rate for Payer: PHCS All Commercial |
$13.42
|
| Rate for Payer: PHP All Commercial |
$13.58
|
| Rate for Payer: Sagamore Health Network All Products |
$13.82
|
| Rate for Payer: Signature Care EPO |
$14.86
|
| Rate for Payer: Signature Care PPO |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$14.11
|
|
|
HC OSTOMY IRRIG DRAIN-4
|
Facility
OP
|
$17.90
|
|
| Hospital Charge Code |
41601436
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Medicare |
$5.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.50
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Centivo All Commercial |
$9.13
|
| Rate for Payer: Cigna All Commercial |
$15.45
|
| Rate for Payer: CORVEL All Commercial |
$16.65
|
| Rate for Payer: Coventry All Commercial |
$15.75
|
| Rate for Payer: Encore All Commercial |
$16.48
|
| Rate for Payer: Frontpath All Commercial |
$16.47
|
| Rate for Payer: Humana ChoiceCare |
$15.46
|
| Rate for Payer: Humana Medicare |
$9.13
|
| Rate for Payer: Lucent All Commercial |
$9.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.11
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$13.42
|
| Rate for Payer: PHP All Commercial |
$13.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.98
|
| Rate for Payer: Sagamore Health Network All Products |
$13.82
|
| Rate for Payer: Signature Care EPO |
$14.86
|
| Rate for Payer: Signature Care PPO |
$15.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.22
|
| Rate for Payer: United Healthcare Commercial |
$14.11
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
|
|
HC OSTOMY POUCH 4 IN
|
Facility
IP
|
$21.90
|
|
| Hospital Charge Code |
41601410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cigna All Commercial |
$18.90
|
| Rate for Payer: CORVEL All Commercial |
$20.37
|
| Rate for Payer: Coventry All Commercial |
$19.27
|
| Rate for Payer: Encore All Commercial |
$20.16
|
| Rate for Payer: Frontpath All Commercial |
$20.15
|
| Rate for Payer: Humana ChoiceCare |
$18.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.71
|
| Rate for Payer: PHCS All Commercial |
$16.42
|
| Rate for Payer: PHP All Commercial |
$16.61
|
| Rate for Payer: Sagamore Health Network All Products |
$16.91
|
| Rate for Payer: Signature Care EPO |
$18.18
|
| Rate for Payer: Signature Care PPO |
$19.27
|
| Rate for Payer: United Healthcare Commercial |
$17.26
|
|
|
HC OSTOMY POUCH 4 IN
|
Facility
OP
|
$21.90
|
|
| Hospital Charge Code |
41601410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna Medicare |
$7.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.95
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Centivo All Commercial |
$11.17
|
| Rate for Payer: Cigna All Commercial |
$18.90
|
| Rate for Payer: CORVEL All Commercial |
$20.37
|
| Rate for Payer: Coventry All Commercial |
$19.27
|
| Rate for Payer: Encore All Commercial |
$20.16
|
| Rate for Payer: Frontpath All Commercial |
$20.15
|
| Rate for Payer: Humana ChoiceCare |
$18.92
|
| Rate for Payer: Humana Medicare |
$11.17
|
| Rate for Payer: Lucent All Commercial |
$11.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.71
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$16.42
|
| Rate for Payer: PHP All Commercial |
$16.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.54
|
| Rate for Payer: Sagamore Health Network All Products |
$16.91
|
| Rate for Payer: Signature Care EPO |
$18.18
|
| Rate for Payer: Signature Care PPO |
$19.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.62
|
| Rate for Payer: United Healthcare Commercial |
$17.26
|
| Rate for Payer: United Healthcare Medicare |
$7.23
|
|
|
HC OT EVAL HIGH COMPLEX 60 MIN
|
Facility
OP
|
$514.59
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
01737167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$169.81 |
| Max. Negotiated Rate |
$478.57 |
| Rate for Payer: Aetna Commercial |
$434.31
|
| Rate for Payer: Aetna Medicare |
$169.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$295.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$321.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$195.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.80
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Centivo All Commercial |
$262.44
|
| Rate for Payer: Cigna All Commercial |
$444.09
|
| Rate for Payer: CORVEL All Commercial |
$478.57
|
| Rate for Payer: Coventry All Commercial |
$452.84
|
| Rate for Payer: Encore All Commercial |
$473.68
|
| Rate for Payer: Frontpath All Commercial |
$473.42
|
| Rate for Payer: Humana ChoiceCare |
$444.45
|
| Rate for Payer: Humana Medicare |
$262.44
|
| Rate for Payer: Lucent All Commercial |
$262.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$463.13
|
| Rate for Payer: PHCS All Commercial |
$385.94
|
| Rate for Payer: PHP All Commercial |
$390.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.69
|
| Rate for Payer: Sagamore Health Network All Products |
$397.26
|
| Rate for Payer: Signature Care EPO |
$427.11
|
| Rate for Payer: Signature Care PPO |
$452.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$437.40
|
| Rate for Payer: United Healthcare Commercial |
$405.50
|
| Rate for Payer: United Healthcare Medicare |
$169.81
|
|
|
HC OT EVAL HIGH COMPLEX 60 MIN
|
Facility
IP
|
$514.59
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
01737167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$385.94 |
| Max. Negotiated Rate |
$478.57 |
| Rate for Payer: Aetna Commercial |
$444.61
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cigna All Commercial |
$444.09
|
| Rate for Payer: CORVEL All Commercial |
$478.57
|
| Rate for Payer: Coventry All Commercial |
$452.84
|
| Rate for Payer: Encore All Commercial |
$473.68
|
| Rate for Payer: Frontpath All Commercial |
$473.42
|
| Rate for Payer: Humana ChoiceCare |
$444.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$463.13
|
| Rate for Payer: PHCS All Commercial |
$385.94
|
| Rate for Payer: PHP All Commercial |
$390.27
|
| Rate for Payer: Sagamore Health Network All Products |
$397.26
|
| Rate for Payer: Signature Care EPO |
$427.11
|
| Rate for Payer: Signature Care PPO |
$452.84
|
| Rate for Payer: United Healthcare Commercial |
$405.50
|
|
|
HC OT EVAL LOW COMPLEX 30 MIN
|
Facility
IP
|
$408.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
01737165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$352.51
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
|
|
HC OT EVAL LOW COMPLEX 30 MIN
|
Facility
OP
|
$408.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
01737165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$344.35
|
| Rate for Payer: Aetna Medicare |
$134.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$234.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.10
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Centivo All Commercial |
$208.08
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Humana Medicare |
$208.08
|
| Rate for Payer: Lucent All Commercial |
$208.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.12
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.80
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
| Rate for Payer: United Healthcare Medicare |
$134.64
|
|
