|
HC OTI RIA PRO2 MINIR BTE HA MON
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603686
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,110.00
|
| Rate for Payer: Aetna Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,435.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,562.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$948.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$907.50
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Centivo All Commercial |
$1,275.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Humana Medicare |
$1,275.00
|
| Rate for Payer: Lucent All Commercial |
$1,275.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
| Rate for Payer: United Healthcare Medicare |
$825.00
|
|
|
HC OT ORTHC/PROSTC MGMT SBSQ ENC /15 MIN
|
Facility
IP
|
$143.02
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
01738049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC OT ORTHC/PROSTC MGMT SBSQ ENC /15 MIN
|
Facility
OP
|
$143.02
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
01738049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.92
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Centivo All Commercial |
$72.94
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$72.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
|
|
HC OT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
IP
|
$143.02
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
01738050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC OT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
OP
|
$143.02
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
01738050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.92
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Centivo All Commercial |
$72.94
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$72.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
|
|
HC OT RE-EVAL EST PLAN CARE
|
Facility
OP
|
$295.80
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
01737168
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$275.09 |
| Rate for Payer: Aetna Commercial |
$249.66
|
| Rate for Payer: Aetna Medicare |
$97.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$169.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$184.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.38
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Centivo All Commercial |
$150.86
|
| Rate for Payer: Cigna All Commercial |
$255.28
|
| Rate for Payer: CORVEL All Commercial |
$275.09
|
| Rate for Payer: Coventry All Commercial |
$260.30
|
| Rate for Payer: Encore All Commercial |
$272.28
|
| Rate for Payer: Frontpath All Commercial |
$272.14
|
| Rate for Payer: Humana ChoiceCare |
$255.48
|
| Rate for Payer: Humana Medicare |
$150.86
|
| Rate for Payer: Lucent All Commercial |
$150.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.22
|
| Rate for Payer: PHCS All Commercial |
$221.85
|
| Rate for Payer: PHP All Commercial |
$224.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.36
|
| Rate for Payer: Sagamore Health Network All Products |
$228.36
|
| Rate for Payer: Signature Care EPO |
$245.51
|
| Rate for Payer: Signature Care PPO |
$260.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$251.43
|
| Rate for Payer: United Healthcare Commercial |
$233.09
|
| Rate for Payer: United Healthcare Medicare |
$97.61
|
|
|
HC OT RE-EVAL EST PLAN CARE
|
Facility
IP
|
$295.80
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
01737168
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$221.85 |
| Max. Negotiated Rate |
$275.09 |
| Rate for Payer: Aetna Commercial |
$255.57
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Cigna All Commercial |
$255.28
|
| Rate for Payer: CORVEL All Commercial |
$275.09
|
| Rate for Payer: Coventry All Commercial |
$260.30
|
| Rate for Payer: Encore All Commercial |
$272.28
|
| Rate for Payer: Frontpath All Commercial |
$272.14
|
| Rate for Payer: Humana ChoiceCare |
$255.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.22
|
| Rate for Payer: PHCS All Commercial |
$221.85
|
| Rate for Payer: PHP All Commercial |
$224.33
|
| Rate for Payer: Sagamore Health Network All Products |
$228.36
|
| Rate for Payer: Signature Care EPO |
$245.51
|
| Rate for Payer: Signature Care PPO |
$260.30
|
| Rate for Payer: United Healthcare Commercial |
$233.09
|
|
|
HC OVERTUBE ESOPHAGEAL GUARDUS STD
|
Facility
OP
|
$800.00
|
|
| Hospital Charge Code |
41602173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC OVERTUBE ESOPHAGEAL GUARDUS STD
|
Facility
IP
|
$800.00
|
|
| Hospital Charge Code |
41602173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC OXALATE
|
Facility
IP
|
$225.63
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
63001647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.23 |
| Max. Negotiated Rate |
$209.84 |
| Rate for Payer: Cigna All Commercial |
$194.72
|
| Rate for Payer: Aetna Commercial |
$194.95
|
| Rate for Payer: Cash Price |
$139.89
|
| Rate for Payer: CORVEL All Commercial |
$209.84
|
| Rate for Payer: Coventry All Commercial |
$198.56
|
| Rate for Payer: Encore All Commercial |
$207.70
|
| Rate for Payer: Frontpath All Commercial |
$207.58
|
| Rate for Payer: Humana ChoiceCare |
$194.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.07
|
| Rate for Payer: PHCS All Commercial |
$169.23
|
| Rate for Payer: PHP All Commercial |
$171.12
|
| Rate for Payer: Sagamore Health Network All Products |
$174.19
|
| Rate for Payer: Signature Care EPO |
$187.28
|
| Rate for Payer: Signature Care PPO |
$198.56
|
| Rate for Payer: United Healthcare Commercial |
$177.80
|
|
|
HC OXALATE
|
Facility
OP
|
$225.63
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
63001647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$209.84 |
| Rate for Payer: Aetna Commercial |
$190.44
|
| Rate for Payer: Aetna Medicare |
$74.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$129.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.91
|
| Rate for Payer: Cash Price |
$139.89
|
| Rate for Payer: Cash Price |
$139.89
|
| Rate for Payer: Centivo All Commercial |
$115.07
|
| Rate for Payer: Cigna All Commercial |
$194.72
|
| Rate for Payer: CORVEL All Commercial |
$209.84
|
| Rate for Payer: Coventry All Commercial |
$198.56
|
| Rate for Payer: Encore All Commercial |
$207.70
|
| Rate for Payer: Frontpath All Commercial |
$207.58
|
| Rate for Payer: Humana ChoiceCare |
$194.88
|
| Rate for Payer: Humana Medicare |
$115.07
|
| Rate for Payer: Lucent All Commercial |
$115.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.07
|
| Rate for Payer: Managed Health Services Medicaid |
$14.45
|
| Rate for Payer: MDWise Medicaid |
$14.45
|
| Rate for Payer: PHCS All Commercial |
$169.23
|
| Rate for Payer: PHP All Commercial |
$171.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$174.19
|
| Rate for Payer: Signature Care EPO |
$187.28
|
| Rate for Payer: Signature Care PPO |
$198.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.79
|
| Rate for Payer: United Healthcare Commercial |
$177.80
|
| Rate for Payer: United Healthcare Medicare |
$74.46
|
|
|
HC OXALATE:CREATININE RATIO, RANDOM URINE
|
Facility
OP
|
$41.13
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.71
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.93
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Centivo All Commercial |
$20.97
|
| Rate for Payer: Cigna All Commercial |
$35.49
|
| Rate for Payer: CORVEL All Commercial |
$38.25
|
| Rate for Payer: Coventry All Commercial |
$36.19
|
| Rate for Payer: Encore All Commercial |
$37.86
|
| Rate for Payer: Frontpath All Commercial |
$37.84
|
| Rate for Payer: Humana ChoiceCare |
$35.52
|
| Rate for Payer: Humana Medicare |
$20.97
|
| Rate for Payer: Lucent All Commercial |
$20.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.01
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$30.84
|
| Rate for Payer: PHP All Commercial |
$31.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.04
|
| Rate for Payer: Sagamore Health Network All Products |
$31.75
|
| Rate for Payer: Signature Care EPO |
$34.13
|
| Rate for Payer: Signature Care PPO |
$36.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.96
|
| Rate for Payer: United Healthcare Commercial |
$32.41
|
| Rate for Payer: United Healthcare Medicare |
$13.57
|
|
|
HC OXALATE:CREATININE RATIO, RANDOM URINE
|
Facility
IP
|
$41.13
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna All Commercial |
$35.49
|
| Rate for Payer: CORVEL All Commercial |
$38.25
|
| Rate for Payer: Coventry All Commercial |
$36.19
|
| Rate for Payer: Encore All Commercial |
$37.86
|
| Rate for Payer: Frontpath All Commercial |
$37.84
|
| Rate for Payer: Humana ChoiceCare |
$35.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.01
|
| Rate for Payer: PHCS All Commercial |
$30.84
|
| Rate for Payer: PHP All Commercial |
$31.19
|
| Rate for Payer: Sagamore Health Network All Products |
$31.75
|
| Rate for Payer: Signature Care EPO |
$34.13
|
| Rate for Payer: Signature Care PPO |
$36.19
|
| Rate for Payer: United Healthcare Commercial |
$32.41
|
|
|
HC OXALATE:CREATININE RATIO, RANDOM URINE-B
|
Facility
OP
|
$41.13
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
63044072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.71
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.93
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Centivo All Commercial |
$20.97
|
| Rate for Payer: Cigna All Commercial |
$35.49
|
| Rate for Payer: CORVEL All Commercial |
$38.25
|
| Rate for Payer: Coventry All Commercial |
$36.19
|
| Rate for Payer: Encore All Commercial |
$37.86
|
| Rate for Payer: Frontpath All Commercial |
$37.84
|
| Rate for Payer: Humana ChoiceCare |
$35.52
|
| Rate for Payer: Humana Medicare |
$20.97
|
| Rate for Payer: Lucent All Commercial |
$20.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.01
|
| Rate for Payer: Managed Health Services Medicaid |
$14.45
|
| Rate for Payer: MDWise Medicaid |
$14.45
|
| Rate for Payer: PHCS All Commercial |
$30.84
|
| Rate for Payer: PHP All Commercial |
$31.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.04
|
| Rate for Payer: Sagamore Health Network All Products |
$31.75
|
| Rate for Payer: Signature Care EPO |
$34.13
|
| Rate for Payer: Signature Care PPO |
$36.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.96
|
| Rate for Payer: United Healthcare Commercial |
$32.41
|
| Rate for Payer: United Healthcare Medicare |
$13.57
|
|
|
HC OXALATE:CREATININE RATIO, RANDOM URINE-B
|
Facility
IP
|
$41.13
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
63044072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna All Commercial |
$35.49
|
| Rate for Payer: CORVEL All Commercial |
$38.25
|
| Rate for Payer: Coventry All Commercial |
$36.19
|
| Rate for Payer: Encore All Commercial |
$37.86
|
| Rate for Payer: Frontpath All Commercial |
$37.84
|
| Rate for Payer: Humana ChoiceCare |
$35.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.01
|
| Rate for Payer: PHCS All Commercial |
$30.84
|
| Rate for Payer: PHP All Commercial |
$31.19
|
| Rate for Payer: Sagamore Health Network All Products |
$31.75
|
| Rate for Payer: Signature Care EPO |
$34.13
|
| Rate for Payer: Signature Care PPO |
$36.19
|
| Rate for Payer: United Healthcare Commercial |
$32.41
|
|
|
HC OXIMETER CONTINIOUS
|
Facility
IP
|
$289.55
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
01014762
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$217.16 |
| Max. Negotiated Rate |
$269.28 |
| Rate for Payer: Aetna Commercial |
$250.17
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cigna All Commercial |
$249.88
|
| Rate for Payer: CORVEL All Commercial |
$269.28
|
| Rate for Payer: Coventry All Commercial |
$254.80
|
| Rate for Payer: Encore All Commercial |
$266.53
|
| Rate for Payer: Frontpath All Commercial |
$266.38
|
| Rate for Payer: Humana ChoiceCare |
$250.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.59
|
| Rate for Payer: PHCS All Commercial |
$217.16
|
| Rate for Payer: PHP All Commercial |
$219.59
|
| Rate for Payer: Sagamore Health Network All Products |
$223.53
|
| Rate for Payer: Signature Care EPO |
$240.32
|
| Rate for Payer: Signature Care PPO |
$254.80
|
| Rate for Payer: United Healthcare Commercial |
$228.16
|
|
|
HC OXIMETER CONTINIOUS
|
Facility
OP
|
$289.55
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
01014762
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$269.28 |
| Rate for Payer: Aetna Commercial |
$244.38
|
| Rate for Payer: Aetna Medicare |
$95.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$166.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$181.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$109.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.11
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Centivo All Commercial |
$147.67
|
| Rate for Payer: Cigna All Commercial |
$249.88
|
| Rate for Payer: CORVEL All Commercial |
$269.28
|
| Rate for Payer: Coventry All Commercial |
$254.80
|
| Rate for Payer: Encore All Commercial |
$266.53
|
| Rate for Payer: Frontpath All Commercial |
$266.38
|
| Rate for Payer: Humana ChoiceCare |
$250.08
|
| Rate for Payer: Humana Medicare |
$147.67
|
| Rate for Payer: Lucent All Commercial |
$147.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.59
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$217.16
|
| Rate for Payer: PHP All Commercial |
$219.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.92
|
| Rate for Payer: Sagamore Health Network All Products |
$223.53
|
| Rate for Payer: Signature Care EPO |
$240.32
|
| Rate for Payer: Signature Care PPO |
$254.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$246.12
|
| Rate for Payer: United Healthcare Commercial |
$228.16
|
| Rate for Payer: United Healthcare Medicare |
$95.55
|
|
|
HC OXIMETER MULTI DETERMINATION
|
Facility
OP
|
$303.80
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
01014761
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Aetna Commercial |
$256.40
|
| Rate for Payer: Aetna Medicare |
$100.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$174.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.28
|
| Rate for Payer: Cash Price |
$188.35
|
| Rate for Payer: Cash Price |
$188.35
|
| Rate for Payer: Centivo All Commercial |
$154.94
|
| Rate for Payer: Cigna All Commercial |
$262.18
|
| Rate for Payer: CORVEL All Commercial |
$282.53
|
| Rate for Payer: Coventry All Commercial |
$267.34
|
| Rate for Payer: Encore All Commercial |
$279.64
|
| Rate for Payer: Frontpath All Commercial |
$279.49
|
| Rate for Payer: Humana ChoiceCare |
$262.39
|
| Rate for Payer: Humana Medicare |
$154.94
|
| Rate for Payer: Lucent All Commercial |
$154.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.42
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$227.85
|
| Rate for Payer: PHP All Commercial |
$230.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.48
|
| Rate for Payer: Sagamore Health Network All Products |
$234.53
|
| Rate for Payer: Signature Care EPO |
$252.15
|
| Rate for Payer: Signature Care PPO |
$267.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.23
|
| Rate for Payer: United Healthcare Commercial |
$239.39
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
|
|
HC OXIMETER MULTI DETERMINATION
|
Facility
OP
|
$277.44
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
01704761
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$91.56 |
| Max. Negotiated Rate |
$258.02 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Medicare |
$91.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$159.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$173.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.71
|
| Rate for Payer: Cash Price |
$172.01
|
| Rate for Payer: Cash Price |
$172.01
|
| Rate for Payer: Centivo All Commercial |
$141.49
|
| Rate for Payer: Cigna All Commercial |
$239.43
|
| Rate for Payer: CORVEL All Commercial |
$258.02
|
| Rate for Payer: Coventry All Commercial |
$244.15
|
| Rate for Payer: Encore All Commercial |
$255.38
|
| Rate for Payer: Frontpath All Commercial |
$255.24
|
| Rate for Payer: Humana ChoiceCare |
$239.62
|
| Rate for Payer: Humana Medicare |
$141.49
|
| Rate for Payer: Lucent All Commercial |
$141.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.70
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$208.08
|
| Rate for Payer: PHP All Commercial |
$210.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.20
|
| Rate for Payer: Sagamore Health Network All Products |
$214.18
|
| Rate for Payer: Signature Care EPO |
$230.28
|
| Rate for Payer: Signature Care PPO |
$244.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$235.82
|
| Rate for Payer: United Healthcare Commercial |
$218.62
|
| Rate for Payer: United Healthcare Medicare |
$91.56
|
|
|
HC OXIMETER MULTI DETERMINATION
|
Facility
IP
|
$277.44
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
01704761
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$208.08 |
| Max. Negotiated Rate |
$258.02 |
| Rate for Payer: Aetna Commercial |
$239.71
|
| Rate for Payer: Cash Price |
$172.01
|
| Rate for Payer: Cigna All Commercial |
$239.43
|
| Rate for Payer: CORVEL All Commercial |
$258.02
|
| Rate for Payer: Coventry All Commercial |
$244.15
|
| Rate for Payer: Encore All Commercial |
$255.38
|
| Rate for Payer: Frontpath All Commercial |
$255.24
|
| Rate for Payer: Humana ChoiceCare |
$239.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.70
|
| Rate for Payer: PHCS All Commercial |
$208.08
|
| Rate for Payer: PHP All Commercial |
$210.41
|
| Rate for Payer: Sagamore Health Network All Products |
$214.18
|
| Rate for Payer: Signature Care EPO |
$230.28
|
| Rate for Payer: Signature Care PPO |
$244.15
|
| Rate for Payer: United Healthcare Commercial |
$218.62
|
|
|
HC OXIMETER MULTI DETERMINATION
|
Facility
IP
|
$303.80
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
01014761
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$227.85 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Aetna Commercial |
$262.48
|
| Rate for Payer: Cash Price |
$188.35
|
| Rate for Payer: Cigna All Commercial |
$262.18
|
| Rate for Payer: CORVEL All Commercial |
$282.53
|
| Rate for Payer: Coventry All Commercial |
$267.34
|
| Rate for Payer: Encore All Commercial |
$279.64
|
| Rate for Payer: Frontpath All Commercial |
$279.49
|
| Rate for Payer: Humana ChoiceCare |
$262.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.42
|
| Rate for Payer: PHCS All Commercial |
$227.85
|
| Rate for Payer: PHP All Commercial |
$230.40
|
| Rate for Payer: Sagamore Health Network All Products |
$234.53
|
| Rate for Payer: Signature Care EPO |
$252.15
|
| Rate for Payer: Signature Care PPO |
$267.34
|
| Rate for Payer: United Healthcare Commercial |
$239.39
|
|
|
HC OXIMETER OVERNIGHT
|
Facility
OP
|
$296.38
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
01701408
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$275.63 |
| Rate for Payer: Aetna Commercial |
$250.15
|
| Rate for Payer: Aetna Medicare |
$97.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$170.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.59
|
| Rate for Payer: Cash Price |
$183.76
|
| Rate for Payer: Cash Price |
$183.76
|
| Rate for Payer: Centivo All Commercial |
$151.15
|
| Rate for Payer: Cigna All Commercial |
$255.78
|
| Rate for Payer: CORVEL All Commercial |
$275.63
|
| Rate for Payer: Coventry All Commercial |
$260.82
|
| Rate for Payer: Encore All Commercial |
$272.82
|
| Rate for Payer: Frontpath All Commercial |
$272.67
|
| Rate for Payer: Humana ChoiceCare |
$255.98
|
| Rate for Payer: Humana Medicare |
$151.15
|
| Rate for Payer: Lucent All Commercial |
$151.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.74
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$222.29
|
| Rate for Payer: PHP All Commercial |
$224.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.59
|
| Rate for Payer: Sagamore Health Network All Products |
$228.81
|
| Rate for Payer: Signature Care EPO |
$246.00
|
| Rate for Payer: Signature Care PPO |
$260.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$251.92
|
| Rate for Payer: United Healthcare Commercial |
$233.55
|
| Rate for Payer: United Healthcare Medicare |
$97.81
|
|
|
HC OXIMETER OVERNIGHT
|
Facility
IP
|
$296.38
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
01701408
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$222.29 |
| Max. Negotiated Rate |
$275.63 |
| Rate for Payer: Aetna Commercial |
$256.07
|
| Rate for Payer: Cash Price |
$183.76
|
| Rate for Payer: Cigna All Commercial |
$255.78
|
| Rate for Payer: CORVEL All Commercial |
$275.63
|
| Rate for Payer: Coventry All Commercial |
$260.82
|
| Rate for Payer: Encore All Commercial |
$272.82
|
| Rate for Payer: Frontpath All Commercial |
$272.67
|
| Rate for Payer: Humana ChoiceCare |
$255.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.74
|
| Rate for Payer: PHCS All Commercial |
$222.29
|
| Rate for Payer: PHP All Commercial |
$224.78
|
| Rate for Payer: Sagamore Health Network All Products |
$228.81
|
| Rate for Payer: Signature Care EPO |
$246.00
|
| Rate for Payer: Signature Care PPO |
$260.82
|
| Rate for Payer: United Healthcare Commercial |
$233.55
|
|
|
HC OXIMETER SINGLE
|
Facility
IP
|
$94.20
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
01706011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$87.60 |
| Rate for Payer: Aetna Commercial |
$81.39
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cigna All Commercial |
$81.29
|
| Rate for Payer: CORVEL All Commercial |
$87.60
|
| Rate for Payer: Coventry All Commercial |
$82.89
|
| Rate for Payer: Encore All Commercial |
$86.71
|
| Rate for Payer: Frontpath All Commercial |
$86.66
|
| Rate for Payer: Humana ChoiceCare |
$81.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.78
|
| Rate for Payer: PHCS All Commercial |
$70.65
|
| Rate for Payer: PHP All Commercial |
$71.44
|
| Rate for Payer: Sagamore Health Network All Products |
$72.72
|
| Rate for Payer: Signature Care EPO |
$78.18
|
| Rate for Payer: Signature Care PPO |
$82.89
|
| Rate for Payer: United Healthcare Commercial |
$74.23
|
|
|
HC OXIMETER SINGLE
|
Facility
OP
|
$94.20
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
01706011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$186.46 |
| Rate for Payer: Aetna Commercial |
$79.50
|
| Rate for Payer: Aetna Medicare |
$31.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.19
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Centivo All Commercial |
$48.04
|
| Rate for Payer: Cigna All Commercial |
$81.29
|
| Rate for Payer: CORVEL All Commercial |
$87.60
|
| Rate for Payer: Coventry All Commercial |
$82.89
|
| Rate for Payer: Encore All Commercial |
$86.71
|
| Rate for Payer: Frontpath All Commercial |
$86.66
|
| Rate for Payer: Humana ChoiceCare |
$81.36
|
| Rate for Payer: Humana Medicare |
$48.04
|
| Rate for Payer: Lucent All Commercial |
$48.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.78
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$70.65
|
| Rate for Payer: PHP All Commercial |
$71.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.74
|
| Rate for Payer: Sagamore Health Network All Products |
$72.72
|
| Rate for Payer: Signature Care EPO |
$78.18
|
| Rate for Payer: Signature Care PPO |
$82.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.07
|
| Rate for Payer: United Healthcare Commercial |
$74.23
|
| Rate for Payer: United Healthcare Medicare |
$31.09
|
|
