|
HC PET IMAGE W/CT FULL BODY IN
|
Facility
IP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 PI
|
| Hospital Charge Code |
01639004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$7,383.73 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,506.06
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
|
|
HC PET IMAGE W/CT FULL BODY IN
|
Facility
OP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 PI
|
| Hospital Charge Code |
01639004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,248.84 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,309.16
|
| Rate for Payer: Aetna Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,653.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,154.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,736.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,573.73
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Centivo All Commercial |
$5,020.94
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Humana Medicare |
$5,020.94
|
| Rate for Payer: Lucent All Commercial |
$5,020.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,839.54
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,368.23
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
| Rate for Payer: United Healthcare Medicare |
$3,248.84
|
|
|
HC PET IMAGEW/CT FULL BODY ST
|
Facility
IP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 PS
|
| Hospital Charge Code |
01639003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$7,383.73 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,506.06
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
|
|
HC PET IMAGEW/CT FULL BODY ST
|
Facility
OP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 PS
|
| Hospital Charge Code |
01639003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,248.84 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,309.16
|
| Rate for Payer: Aetna Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,653.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,154.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,736.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,573.73
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Centivo All Commercial |
$5,020.94
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Humana Medicare |
$5,020.94
|
| Rate for Payer: Lucent All Commercial |
$5,020.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,839.54
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,368.23
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
| Rate for Payer: United Healthcare Medicare |
$3,248.84
|
|
|
HC PET IMAGE W/CT LMTD
|
Facility
IP
|
$7,201.53
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
01639006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,401.14 |
| Max. Negotiated Rate |
$6,697.42 |
| Rate for Payer: Aetna Commercial |
$6,222.12
|
| Rate for Payer: Cash Price |
$4,464.95
|
| Rate for Payer: Cigna All Commercial |
$6,214.92
|
| Rate for Payer: CORVEL All Commercial |
$6,697.42
|
| Rate for Payer: Coventry All Commercial |
$6,337.34
|
| Rate for Payer: Encore All Commercial |
$6,629.01
|
| Rate for Payer: Frontpath All Commercial |
$6,625.40
|
| Rate for Payer: Humana ChoiceCare |
$6,219.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,481.37
|
| Rate for Payer: PHCS All Commercial |
$5,401.14
|
| Rate for Payer: PHP All Commercial |
$5,461.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,559.58
|
| Rate for Payer: Signature Care EPO |
$5,977.27
|
| Rate for Payer: Signature Care PPO |
$6,337.34
|
| Rate for Payer: United Healthcare Commercial |
$5,674.80
|
|
|
HC PET IMAGE W/CT LMTD
|
Facility
OP
|
$7,201.53
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
01639006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$6,697.42 |
| Rate for Payer: Aetna Commercial |
$6,078.09
|
| Rate for Payer: Aetna Medicare |
$2,376.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,376.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,135.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,501.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3,033.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,732.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,614.15
|
| Rate for Payer: Cash Price |
$4,464.95
|
| Rate for Payer: Cash Price |
$4,464.95
|
| Rate for Payer: Centivo All Commercial |
$3,672.78
|
| Rate for Payer: Cigna All Commercial |
$6,214.92
|
| Rate for Payer: CORVEL All Commercial |
$6,697.42
|
| Rate for Payer: Coventry All Commercial |
$6,337.34
|
| Rate for Payer: Encore All Commercial |
$6,629.01
|
| Rate for Payer: Frontpath All Commercial |
$6,625.40
|
| Rate for Payer: Humana ChoiceCare |
$6,219.96
|
| Rate for Payer: Humana Medicare |
$3,672.78
|
| Rate for Payer: Lucent All Commercial |
$3,672.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,481.37
|
| Rate for Payer: Managed Health Services Medicaid |
$3,033.23
|
| Rate for Payer: MDWise Medicaid |
$3,033.23
|
| Rate for Payer: PHCS All Commercial |
$5,401.14
|
| Rate for Payer: PHP All Commercial |
$5,461.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,808.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,559.58
|
| Rate for Payer: Signature Care EPO |
$5,977.27
|
| Rate for Payer: Signature Care PPO |
$6,337.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,121.30
|
| Rate for Payer: United Healthcare Commercial |
$5,674.80
|
| Rate for Payer: United Healthcare Medicare |
$2,376.50
|
|
|
HC PET IMAGE W/CT NOPR SKULL M/THGH IN
|
Facility
IP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 Q0,PI
|
| Hospital Charge Code |
01639011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$6,640.28 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,649.60
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
|
|
HC PET IMAGE W/CT NOPR SKULL M/THGH IN
|
Facility
OP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 Q0,PI
|
| Hospital Charge Code |
01639011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,921.72 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,472.52
|
| Rate for Payer: Aetna Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,084.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,534.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,359.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,213.89
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Centivo All Commercial |
$4,515.39
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Humana Medicare |
$4,515.39
|
| Rate for Payer: Lucent All Commercial |
$4,515.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,452.94
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,525.65
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
| Rate for Payer: United Healthcare Medicare |
$2,921.72
|
|
|
HC PET IMAGE W/CT NOPR SKULL M/THGH ST
|
Facility
OP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 Q0,PS
|
| Hospital Charge Code |
01639010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,921.72 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,472.52
|
| Rate for Payer: Aetna Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,084.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,534.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,359.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,213.89
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Centivo All Commercial |
$4,515.39
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Humana Medicare |
$4,515.39
|
| Rate for Payer: Lucent All Commercial |
$4,515.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,452.94
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,525.65
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
| Rate for Payer: United Healthcare Medicare |
$2,921.72
|
|
|
HC PET IMAGE W/CT NOPR SKULL M/THGH ST
|
Facility
IP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 Q0,PS
|
| Hospital Charge Code |
01639010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$6,640.28 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,649.60
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
|
|
HC PET IMAGE W/CT NOPR WB INITIAL
|
Facility
OP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 Q0,PI
|
| Hospital Charge Code |
01639008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,248.84 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,309.16
|
| Rate for Payer: Aetna Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,653.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,154.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,736.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,573.73
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Centivo All Commercial |
$5,020.94
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Humana Medicare |
$5,020.94
|
| Rate for Payer: Lucent All Commercial |
$5,020.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,839.54
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,368.23
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
| Rate for Payer: United Healthcare Medicare |
$3,248.84
|
|
|
HC PET IMAGE W/CT NOPR WB INITIAL
|
Facility
IP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 Q0,PI
|
| Hospital Charge Code |
01639008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$7,383.73 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,506.06
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
|
|
HC PET IMAGE W/CT SKULL-THIGH IN
|
Facility
IP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 PI
|
| Hospital Charge Code |
01639005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$6,640.28 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,649.60
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
|
|
HC PET IMAGE W/CT SKULL-THIGH IN
|
Facility
OP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 PI
|
| Hospital Charge Code |
01639005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,921.72 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,472.52
|
| Rate for Payer: Aetna Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,084.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,534.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,359.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,213.89
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Centivo All Commercial |
$4,515.39
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Humana Medicare |
$4,515.39
|
| Rate for Payer: Lucent All Commercial |
$4,515.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,452.94
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,525.65
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
| Rate for Payer: United Healthcare Medicare |
$2,921.72
|
|
|
HC PET IMAGE W/CT SKULL-THIGH ST
|
Facility
OP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 PS
|
| Hospital Charge Code |
01639002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,921.72 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,472.52
|
| Rate for Payer: Aetna Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,921.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,084.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,534.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,359.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,213.89
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Centivo All Commercial |
$4,515.39
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Humana Medicare |
$4,515.39
|
| Rate for Payer: Lucent All Commercial |
$4,515.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,452.94
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,525.65
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
| Rate for Payer: United Healthcare Medicare |
$2,921.72
|
|
|
HC PET IMAGE W/CT SKULL-THIGH ST
|
Facility
IP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 PS
|
| Hospital Charge Code |
01639002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$6,640.28 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,649.60
|
| Rate for Payer: Cash Price |
$5,489.30
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.41
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.28
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
|
|
HC PET IMAGING W/CT NOPR WB STAGING
|
Facility
OP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 Q0,PS
|
| Hospital Charge Code |
01639009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,248.84 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,309.16
|
| Rate for Payer: Aetna Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,248.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,653.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,154.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,736.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,573.73
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Centivo All Commercial |
$5,020.94
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Humana Medicare |
$5,020.94
|
| Rate for Payer: Lucent All Commercial |
$5,020.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,839.54
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,368.23
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
| Rate for Payer: United Healthcare Medicare |
$3,248.84
|
|
|
HC PET IMAGING W/CT NOPR WB STAGING
|
Facility
IP
|
$9,844.98
|
|
|
Service Code
|
CPT 78816 Q0,PS
|
| Hospital Charge Code |
01639009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$7,383.73 |
| Max. Negotiated Rate |
$9,155.83 |
| Rate for Payer: Aetna Commercial |
$8,506.06
|
| Rate for Payer: Cash Price |
$6,103.89
|
| Rate for Payer: Cigna All Commercial |
$8,496.22
|
| Rate for Payer: CORVEL All Commercial |
$9,155.83
|
| Rate for Payer: Coventry All Commercial |
$8,663.58
|
| Rate for Payer: Encore All Commercial |
$9,062.30
|
| Rate for Payer: Frontpath All Commercial |
$9,057.38
|
| Rate for Payer: Humana ChoiceCare |
$8,503.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,860.48
|
| Rate for Payer: PHCS All Commercial |
$7,383.73
|
| Rate for Payer: PHP All Commercial |
$7,466.43
|
| Rate for Payer: Sagamore Health Network All Products |
$7,600.32
|
| Rate for Payer: Signature Care EPO |
$8,171.33
|
| Rate for Payer: Signature Care PPO |
$8,663.58
|
| Rate for Payer: United Healthcare Commercial |
$7,757.84
|
|
|
HC PFT SPIROMETRY
|
Facility
OP
|
$364.48
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
01706489
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$120.28 |
| Max. Negotiated Rate |
$338.96 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$120.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$209.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$227.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$138.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$132.31
|
| Rate for Payer: Cash Price |
$225.98
|
| Rate for Payer: Cash Price |
$225.98
|
| Rate for Payer: Centivo All Commercial |
$185.88
|
| Rate for Payer: Cigna All Commercial |
$314.54
|
| Rate for Payer: CORVEL All Commercial |
$338.96
|
| Rate for Payer: Coventry All Commercial |
$320.74
|
| Rate for Payer: Encore All Commercial |
$335.50
|
| Rate for Payer: Frontpath All Commercial |
$335.32
|
| Rate for Payer: Humana ChoiceCare |
$314.80
|
| Rate for Payer: Humana Medicare |
$185.88
|
| Rate for Payer: Lucent All Commercial |
$185.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.03
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$273.36
|
| Rate for Payer: PHP All Commercial |
$276.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.15
|
| Rate for Payer: Sagamore Health Network All Products |
$281.38
|
| Rate for Payer: Signature Care EPO |
$302.52
|
| Rate for Payer: Signature Care PPO |
$320.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$309.81
|
| Rate for Payer: United Healthcare Commercial |
$287.21
|
| Rate for Payer: United Healthcare Medicare |
$120.28
|
|
|
HC PFT SPIROMETRY
|
Facility
IP
|
$364.48
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
01706489
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$273.36 |
| Max. Negotiated Rate |
$338.96 |
| Rate for Payer: Aetna Commercial |
$314.91
|
| Rate for Payer: Cash Price |
$225.98
|
| Rate for Payer: Cigna All Commercial |
$314.54
|
| Rate for Payer: CORVEL All Commercial |
$338.96
|
| Rate for Payer: Coventry All Commercial |
$320.74
|
| Rate for Payer: Encore All Commercial |
$335.50
|
| Rate for Payer: Frontpath All Commercial |
$335.32
|
| Rate for Payer: Humana ChoiceCare |
$314.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.03
|
| Rate for Payer: PHCS All Commercial |
$273.36
|
| Rate for Payer: PHP All Commercial |
$276.42
|
| Rate for Payer: Sagamore Health Network All Products |
$281.38
|
| Rate for Payer: Signature Care EPO |
$302.52
|
| Rate for Payer: Signature Care PPO |
$320.74
|
| Rate for Payer: United Healthcare Commercial |
$287.21
|
|
|
HC P GUIDE WIRE KIT
|
Facility
OP
|
$2,225.00
|
|
| Hospital Charge Code |
41608183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,069.25 |
| Rate for Payer: Aetna Commercial |
$1,877.90
|
| Rate for Payer: Aetna Medicare |
$734.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$734.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,277.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,390.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$844.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$807.68
|
| Rate for Payer: Cash Price |
$1,379.50
|
| Rate for Payer: Cash Price |
$1,379.50
|
| Rate for Payer: Centivo All Commercial |
$1,134.75
|
| Rate for Payer: Cigna All Commercial |
$1,920.18
|
| Rate for Payer: CORVEL All Commercial |
$2,069.25
|
| Rate for Payer: Coventry All Commercial |
$1,958.00
|
| Rate for Payer: Encore All Commercial |
$2,048.11
|
| Rate for Payer: Frontpath All Commercial |
$2,047.00
|
| Rate for Payer: Humana ChoiceCare |
$1,921.73
|
| Rate for Payer: Humana Medicare |
$1,134.75
|
| Rate for Payer: Lucent All Commercial |
$1,134.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,668.75
|
| Rate for Payer: PHP All Commercial |
$1,687.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$867.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.70
|
| Rate for Payer: Signature Care EPO |
$1,846.75
|
| Rate for Payer: Signature Care PPO |
$1,958.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,891.25
|
| Rate for Payer: United Healthcare Commercial |
$1,753.30
|
| Rate for Payer: United Healthcare Medicare |
$734.25
|
|
|
HC P GUIDE WIRE KIT
|
Facility
IP
|
$2,225.00
|
|
| Hospital Charge Code |
41608183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$2,069.25 |
| Rate for Payer: Aetna Commercial |
$1,922.40
|
| Rate for Payer: Cash Price |
$1,379.50
|
| Rate for Payer: Cigna All Commercial |
$1,920.18
|
| Rate for Payer: CORVEL All Commercial |
$2,069.25
|
| Rate for Payer: Coventry All Commercial |
$1,958.00
|
| Rate for Payer: Encore All Commercial |
$2,048.11
|
| Rate for Payer: Frontpath All Commercial |
$2,047.00
|
| Rate for Payer: Humana ChoiceCare |
$1,921.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.50
|
| Rate for Payer: PHCS All Commercial |
$1,668.75
|
| Rate for Payer: PHP All Commercial |
$1,687.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.70
|
| Rate for Payer: Signature Care EPO |
$1,846.75
|
| Rate for Payer: Signature Care PPO |
$1,958.00
|
| Rate for Payer: United Healthcare Commercial |
$1,753.30
|
|
|
HC PHARYNX OR LARYNX W FLUORO
|
Facility
OP
|
$420.96
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
01610370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.92 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna Commercial |
$355.29
|
| Rate for Payer: Aetna Medicare |
$138.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$178.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.81
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Centivo All Commercial |
$214.69
|
| Rate for Payer: Cigna All Commercial |
$363.29
|
| Rate for Payer: CORVEL All Commercial |
$391.50
|
| Rate for Payer: Coventry All Commercial |
$370.45
|
| Rate for Payer: Encore All Commercial |
$387.50
|
| Rate for Payer: Frontpath All Commercial |
$387.29
|
| Rate for Payer: Humana ChoiceCare |
$363.59
|
| Rate for Payer: Humana Medicare |
$214.69
|
| Rate for Payer: Lucent All Commercial |
$214.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.87
|
| Rate for Payer: Managed Health Services Medicaid |
$178.39
|
| Rate for Payer: MDWise Medicaid |
$178.39
|
| Rate for Payer: PHCS All Commercial |
$315.72
|
| Rate for Payer: PHP All Commercial |
$319.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.18
|
| Rate for Payer: Sagamore Health Network All Products |
$324.98
|
| Rate for Payer: Signature Care EPO |
$349.40
|
| Rate for Payer: Signature Care PPO |
$370.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.82
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
| Rate for Payer: United Healthcare Medicare |
$138.92
|
|
|
HC PHARYNX OR LARYNX W FLUORO
|
Facility
IP
|
$420.96
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
01610370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.72 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna Commercial |
$363.71
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna All Commercial |
$363.29
|
| Rate for Payer: CORVEL All Commercial |
$391.50
|
| Rate for Payer: Coventry All Commercial |
$370.45
|
| Rate for Payer: Encore All Commercial |
$387.50
|
| Rate for Payer: Frontpath All Commercial |
$387.29
|
| Rate for Payer: Humana ChoiceCare |
$363.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.87
|
| Rate for Payer: PHCS All Commercial |
$315.72
|
| Rate for Payer: PHP All Commercial |
$319.26
|
| Rate for Payer: Sagamore Health Network All Products |
$324.98
|
| Rate for Payer: Signature Care EPO |
$349.40
|
| Rate for Payer: Signature Care PPO |
$370.45
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
|
|
HC PH-BLOOD
|
Facility
OP
|
$95.07
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
63001112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$88.42 |
| Rate for Payer: Aetna Commercial |
$80.24
|
| Rate for Payer: Aetna Medicare |
$31.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.51
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Centivo All Commercial |
$48.49
|
| Rate for Payer: Cigna All Commercial |
$82.05
|
| Rate for Payer: CORVEL All Commercial |
$88.42
|
| Rate for Payer: Coventry All Commercial |
$83.67
|
| Rate for Payer: Encore All Commercial |
$87.52
|
| Rate for Payer: Frontpath All Commercial |
$87.47
|
| Rate for Payer: Humana ChoiceCare |
$82.12
|
| Rate for Payer: Humana Medicare |
$48.49
|
| Rate for Payer: Lucent All Commercial |
$48.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.57
|
| Rate for Payer: Managed Health Services Medicaid |
$11.00
|
| Rate for Payer: MDWise Medicaid |
$11.00
|
| Rate for Payer: PHCS All Commercial |
$71.31
|
| Rate for Payer: PHP All Commercial |
$72.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.08
|
| Rate for Payer: Sagamore Health Network All Products |
$73.40
|
| Rate for Payer: Signature Care EPO |
$78.91
|
| Rate for Payer: Signature Care PPO |
$83.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.81
|
| Rate for Payer: United Healthcare Commercial |
$74.92
|
| Rate for Payer: United Healthcare Medicare |
$31.37
|
|
