|
HC PTH INTACT
|
Facility
OP
|
$391.04
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
63001133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$330.04
|
| Rate for Payer: Aetna Medicare |
$129.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$179.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$179.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.95
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Centivo All Commercial |
$199.43
|
| Rate for Payer: Cigna All Commercial |
$337.47
|
| Rate for Payer: CORVEL All Commercial |
$363.66
|
| Rate for Payer: Coventry All Commercial |
$344.11
|
| Rate for Payer: Encore All Commercial |
$359.95
|
| Rate for Payer: Frontpath All Commercial |
$359.75
|
| Rate for Payer: Humana ChoiceCare |
$337.74
|
| Rate for Payer: Humana Medicare |
$199.43
|
| Rate for Payer: Lucent All Commercial |
$199.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.93
|
| Rate for Payer: Managed Health Services Medicaid |
$41.28
|
| Rate for Payer: MDWise Medicaid |
$41.28
|
| Rate for Payer: PHCS All Commercial |
$293.28
|
| Rate for Payer: PHP All Commercial |
$296.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.50
|
| Rate for Payer: Sagamore Health Network All Products |
$301.88
|
| Rate for Payer: Signature Care EPO |
$324.56
|
| Rate for Payer: Signature Care PPO |
$344.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.38
|
| Rate for Payer: United Healthcare Commercial |
$308.14
|
| Rate for Payer: United Healthcare Medicare |
$129.04
|
|
|
HC PTH INTACT
|
Facility
IP
|
$391.04
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
63001133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$337.86
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cigna All Commercial |
$337.47
|
| Rate for Payer: CORVEL All Commercial |
$363.66
|
| Rate for Payer: Coventry All Commercial |
$344.11
|
| Rate for Payer: Encore All Commercial |
$359.95
|
| Rate for Payer: Frontpath All Commercial |
$359.75
|
| Rate for Payer: Humana ChoiceCare |
$337.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.93
|
| Rate for Payer: PHCS All Commercial |
$293.28
|
| Rate for Payer: PHP All Commercial |
$296.56
|
| Rate for Payer: Sagamore Health Network All Products |
$301.88
|
| Rate for Payer: Signature Care EPO |
$324.56
|
| Rate for Payer: Signature Care PPO |
$344.11
|
| Rate for Payer: United Healthcare Commercial |
$308.14
|
|
|
HC PT ORTHC/PROSTC MGMT SBSQ ENC /15 MIN
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97763 GP
|
| Hospital Charge Code |
01728094
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC PT ORTHC/PROSTC MGMT SBSQ ENC /15 MIN
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97763 GP
|
| Hospital Charge Code |
01728094
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC PT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
01728060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC PT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
01728060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC PT PROSTHETIC TRAINJ 1ST ENC /15 MIN
|
Facility
IP
|
$152.10
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
01728065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$141.46 |
| Rate for Payer: Aetna Commercial |
$131.42
|
| Rate for Payer: Cash Price |
$94.30
|
| Rate for Payer: Cigna All Commercial |
$131.26
|
| Rate for Payer: CORVEL All Commercial |
$141.46
|
| Rate for Payer: Coventry All Commercial |
$133.85
|
| Rate for Payer: Encore All Commercial |
$140.01
|
| Rate for Payer: Frontpath All Commercial |
$139.93
|
| Rate for Payer: Humana ChoiceCare |
$131.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.89
|
| Rate for Payer: PHCS All Commercial |
$114.08
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Sagamore Health Network All Products |
$117.42
|
| Rate for Payer: Signature Care EPO |
$126.24
|
| Rate for Payer: Signature Care PPO |
$133.85
|
| Rate for Payer: United Healthcare Commercial |
$119.86
|
|
|
HC PT PROSTHETIC TRAINJ 1ST ENC /15 MIN
|
Facility
OP
|
$152.10
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
01728065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.19 |
| Max. Negotiated Rate |
$141.46 |
| Rate for Payer: Aetna Commercial |
$128.37
|
| Rate for Payer: Aetna Medicare |
$50.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.21
|
| Rate for Payer: Cash Price |
$94.30
|
| Rate for Payer: Centivo All Commercial |
$77.57
|
| Rate for Payer: Cigna All Commercial |
$131.26
|
| Rate for Payer: CORVEL All Commercial |
$141.46
|
| Rate for Payer: Coventry All Commercial |
$133.85
|
| Rate for Payer: Encore All Commercial |
$140.01
|
| Rate for Payer: Frontpath All Commercial |
$139.93
|
| Rate for Payer: Humana ChoiceCare |
$131.37
|
| Rate for Payer: Humana Medicare |
$77.57
|
| Rate for Payer: Lucent All Commercial |
$77.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.89
|
| Rate for Payer: PHCS All Commercial |
$114.08
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.32
|
| Rate for Payer: Sagamore Health Network All Products |
$117.42
|
| Rate for Payer: Signature Care EPO |
$126.24
|
| Rate for Payer: Signature Care PPO |
$133.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.29
|
| Rate for Payer: United Healthcare Commercial |
$119.86
|
| Rate for Payer: United Healthcare Medicare |
$50.19
|
|
|
HC PT RE-EVAL EST PLAN CARE
|
Facility
IP
|
$406.37
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
01727164
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$304.78 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$351.10
|
| Rate for Payer: Cash Price |
$251.95
|
| Rate for Payer: Cigna All Commercial |
$350.70
|
| Rate for Payer: CORVEL All Commercial |
$377.92
|
| Rate for Payer: Coventry All Commercial |
$357.60
|
| Rate for Payer: Encore All Commercial |
$374.06
|
| Rate for Payer: Frontpath All Commercial |
$373.86
|
| Rate for Payer: Humana ChoiceCare |
$350.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$365.73
|
| Rate for Payer: PHCS All Commercial |
$304.78
|
| Rate for Payer: PHP All Commercial |
$308.19
|
| Rate for Payer: Sagamore Health Network All Products |
$313.72
|
| Rate for Payer: Signature Care EPO |
$337.29
|
| Rate for Payer: Signature Care PPO |
$357.60
|
| Rate for Payer: United Healthcare Commercial |
$320.22
|
|
|
HC PT RE-EVAL EST PLAN CARE
|
Facility
OP
|
$406.37
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
01727164
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$134.10 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$342.97
|
| Rate for Payer: Aetna Medicare |
$134.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$233.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$254.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$147.51
|
| Rate for Payer: Cash Price |
$251.95
|
| Rate for Payer: Centivo All Commercial |
$207.25
|
| Rate for Payer: Cigna All Commercial |
$350.70
|
| Rate for Payer: CORVEL All Commercial |
$377.92
|
| Rate for Payer: Coventry All Commercial |
$357.60
|
| Rate for Payer: Encore All Commercial |
$374.06
|
| Rate for Payer: Frontpath All Commercial |
$373.86
|
| Rate for Payer: Humana ChoiceCare |
$350.98
|
| Rate for Payer: Humana Medicare |
$207.25
|
| Rate for Payer: Lucent All Commercial |
$207.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$365.73
|
| Rate for Payer: PHCS All Commercial |
$304.78
|
| Rate for Payer: PHP All Commercial |
$308.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.48
|
| Rate for Payer: Sagamore Health Network All Products |
$313.72
|
| Rate for Payer: Signature Care EPO |
$337.29
|
| Rate for Payer: Signature Care PPO |
$357.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$345.41
|
| Rate for Payer: United Healthcare Commercial |
$320.22
|
| Rate for Payer: United Healthcare Medicare |
$134.10
|
|
|
HC PTT
|
Facility
IP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.91
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
|
|
HC PTT
|
Facility
OP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Aetna Medicare |
$45.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.68
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Centivo All Commercial |
$69.80
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.91
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Humana Medicare |
$69.80
|
| Rate for Payer: Lucent All Commercial |
$69.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: Managed Health Services Medicaid |
$6.01
|
| Rate for Payer: MDWise Medicaid |
$6.01
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.37
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.33
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
| Rate for Payer: United Healthcare Medicare |
$45.16
|
|
|
HC PUDENDAL TRAY DISPOSABLE
|
Facility
OP
|
$41.63
|
|
| Hospital Charge Code |
41601183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.11
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Centivo All Commercial |
$21.23
|
| Rate for Payer: Cigna All Commercial |
$35.93
|
| Rate for Payer: CORVEL All Commercial |
$38.72
|
| Rate for Payer: Coventry All Commercial |
$36.63
|
| Rate for Payer: Encore All Commercial |
$38.32
|
| Rate for Payer: Frontpath All Commercial |
$38.30
|
| Rate for Payer: Humana ChoiceCare |
$35.96
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Lucent All Commercial |
$21.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$31.22
|
| Rate for Payer: PHP All Commercial |
$31.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.24
|
| Rate for Payer: Sagamore Health Network All Products |
$32.14
|
| Rate for Payer: Signature Care EPO |
$34.55
|
| Rate for Payer: Signature Care PPO |
$36.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.39
|
| Rate for Payer: United Healthcare Commercial |
$32.80
|
| Rate for Payer: United Healthcare Medicare |
$13.74
|
|
|
HC PUDENDAL TRAY DISPOSABLE
|
Facility
IP
|
$41.63
|
|
| Hospital Charge Code |
41601183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$38.72 |
| Rate for Payer: Aetna Commercial |
$35.97
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cigna All Commercial |
$35.93
|
| Rate for Payer: CORVEL All Commercial |
$38.72
|
| Rate for Payer: Coventry All Commercial |
$36.63
|
| Rate for Payer: Encore All Commercial |
$38.32
|
| Rate for Payer: Frontpath All Commercial |
$38.30
|
| Rate for Payer: Humana ChoiceCare |
$35.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.47
|
| Rate for Payer: PHCS All Commercial |
$31.22
|
| Rate for Payer: PHP All Commercial |
$31.57
|
| Rate for Payer: Sagamore Health Network All Products |
$32.14
|
| Rate for Payer: Signature Care EPO |
$34.55
|
| Rate for Payer: Signature Care PPO |
$36.63
|
| Rate for Payer: United Healthcare Commercial |
$32.80
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP
|
Facility
OP
|
$898.79
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
01704726
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$835.88 |
| Rate for Payer: Aetna Commercial |
$758.58
|
| Rate for Payer: Aetna Medicare |
$296.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$296.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$516.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$561.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$341.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$326.26
|
| Rate for Payer: Cash Price |
$557.25
|
| Rate for Payer: Cash Price |
$557.25
|
| Rate for Payer: Centivo All Commercial |
$458.38
|
| Rate for Payer: Cigna All Commercial |
$775.66
|
| Rate for Payer: CORVEL All Commercial |
$835.88
|
| Rate for Payer: Coventry All Commercial |
$790.94
|
| Rate for Payer: Encore All Commercial |
$827.34
|
| Rate for Payer: Frontpath All Commercial |
$826.89
|
| Rate for Payer: Humana ChoiceCare |
$776.29
|
| Rate for Payer: Humana Medicare |
$458.38
|
| Rate for Payer: Lucent All Commercial |
$458.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.91
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$674.10
|
| Rate for Payer: PHP All Commercial |
$681.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.53
|
| Rate for Payer: Sagamore Health Network All Products |
$693.87
|
| Rate for Payer: Signature Care EPO |
$746.00
|
| Rate for Payer: Signature Care PPO |
$790.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$763.97
|
| Rate for Payer: United Healthcare Commercial |
$708.25
|
| Rate for Payer: United Healthcare Medicare |
$296.60
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP
|
Facility
IP
|
$898.79
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
01704726
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$674.10 |
| Max. Negotiated Rate |
$835.88 |
| Rate for Payer: Aetna Commercial |
$776.56
|
| Rate for Payer: Cash Price |
$557.25
|
| Rate for Payer: Cigna All Commercial |
$775.66
|
| Rate for Payer: CORVEL All Commercial |
$835.88
|
| Rate for Payer: Coventry All Commercial |
$790.94
|
| Rate for Payer: Encore All Commercial |
$827.34
|
| Rate for Payer: Frontpath All Commercial |
$826.89
|
| Rate for Payer: Humana ChoiceCare |
$776.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.91
|
| Rate for Payer: PHCS All Commercial |
$674.10
|
| Rate for Payer: PHP All Commercial |
$681.64
|
| Rate for Payer: Sagamore Health Network All Products |
$693.87
|
| Rate for Payer: Signature Care EPO |
$746.00
|
| Rate for Payer: Signature Care PPO |
$790.94
|
| Rate for Payer: United Healthcare Commercial |
$708.25
|
|
|
HC PULMONARY STRESS TEST/SIMPLE
|
Facility
IP
|
$244.80
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
01604620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$211.51
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cigna All Commercial |
$211.26
|
| Rate for Payer: CORVEL All Commercial |
$227.66
|
| Rate for Payer: Coventry All Commercial |
$215.42
|
| Rate for Payer: Encore All Commercial |
$225.34
|
| Rate for Payer: Frontpath All Commercial |
$225.22
|
| Rate for Payer: Humana ChoiceCare |
$211.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.32
|
| Rate for Payer: PHCS All Commercial |
$183.60
|
| Rate for Payer: PHP All Commercial |
$185.66
|
| Rate for Payer: Sagamore Health Network All Products |
$188.99
|
| Rate for Payer: Signature Care EPO |
$203.18
|
| Rate for Payer: Signature Care PPO |
$215.42
|
| Rate for Payer: United Healthcare Commercial |
$192.90
|
|
|
HC PULMONARY STRESS TEST/SIMPLE
|
Facility
OP
|
$244.80
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
01604620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$80.78 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$206.61
|
| Rate for Payer: Aetna Medicare |
$80.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.86
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Centivo All Commercial |
$124.85
|
| Rate for Payer: Cigna All Commercial |
$211.26
|
| Rate for Payer: CORVEL All Commercial |
$227.66
|
| Rate for Payer: Coventry All Commercial |
$215.42
|
| Rate for Payer: Encore All Commercial |
$225.34
|
| Rate for Payer: Frontpath All Commercial |
$225.22
|
| Rate for Payer: Humana ChoiceCare |
$211.43
|
| Rate for Payer: Humana Medicare |
$124.85
|
| Rate for Payer: Lucent All Commercial |
$124.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.32
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$183.60
|
| Rate for Payer: PHP All Commercial |
$185.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.47
|
| Rate for Payer: Sagamore Health Network All Products |
$188.99
|
| Rate for Payer: Signature Care EPO |
$203.18
|
| Rate for Payer: Signature Care PPO |
$215.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.08
|
| Rate for Payer: United Healthcare Commercial |
$192.90
|
| Rate for Payer: United Healthcare Medicare |
$80.78
|
|
|
HC PULM REHAB WITH CONT OXIMTRY MNTR
|
Facility
IP
|
$350.28
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
01604626
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$262.71 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$302.64
|
| Rate for Payer: Cash Price |
$217.17
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.24
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Sagamore Health Network All Products |
$270.41
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.24
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
|
|
HC PULM REHAB WITH CONT OXIMTRY MNTR
|
Facility
OP
|
$350.28
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
01604626
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$295.63
|
| Rate for Payer: Aetna Medicare |
$115.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.15
|
| Rate for Payer: Cash Price |
$217.17
|
| Rate for Payer: Centivo All Commercial |
$178.64
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.24
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Humana Medicare |
$178.64
|
| Rate for Payer: Lucent All Commercial |
$178.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.61
|
| Rate for Payer: Sagamore Health Network All Products |
$270.41
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.74
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
| Rate for Payer: United Healthcare Medicare |
$115.59
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
OP
|
$350.28
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
01604625
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$295.63
|
| Rate for Payer: Aetna Medicare |
$115.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.15
|
| Rate for Payer: Cash Price |
$217.17
|
| Rate for Payer: Centivo All Commercial |
$178.64
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.24
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Humana Medicare |
$178.64
|
| Rate for Payer: Lucent All Commercial |
$178.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.61
|
| Rate for Payer: Sagamore Health Network All Products |
$270.41
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.74
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
| Rate for Payer: United Healthcare Medicare |
$115.59
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
IP
|
$350.28
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
01604625
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$262.71 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$302.64
|
| Rate for Payer: Cash Price |
$217.17
|
| Rate for Payer: Cigna All Commercial |
$302.29
|
| Rate for Payer: CORVEL All Commercial |
$325.76
|
| Rate for Payer: Coventry All Commercial |
$308.24
|
| Rate for Payer: Encore All Commercial |
$322.43
|
| Rate for Payer: Frontpath All Commercial |
$322.26
|
| Rate for Payer: Humana ChoiceCare |
$302.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.25
|
| Rate for Payer: PHCS All Commercial |
$262.71
|
| Rate for Payer: PHP All Commercial |
$265.65
|
| Rate for Payer: Sagamore Health Network All Products |
$270.41
|
| Rate for Payer: Signature Care EPO |
$290.73
|
| Rate for Payer: Signature Care PPO |
$308.24
|
| Rate for Payer: United Healthcare Commercial |
$276.02
|
|
|
HC PULSE OXIMETRY NB SCREEN
|
Facility
OP
|
$106.08
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
01014760
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$186.46 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.51
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Centivo All Commercial |
$54.10
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$54.10
|
| Rate for Payer: Lucent All Commercial |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$35.01
|
|
|
HC PULSE OXIMETRY NB SCREEN
|
Facility
IP
|
$106.08
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
01014760
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC PYRUVIC ACID-BLOOD
|
Facility
OP
|
$99.07
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
63001671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$83.62
|
| Rate for Payer: Aetna Medicare |
$32.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.96
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Centivo All Commercial |
$50.53
|
| Rate for Payer: Cigna All Commercial |
$85.50
|
| Rate for Payer: CORVEL All Commercial |
$92.14
|
| Rate for Payer: Coventry All Commercial |
$87.18
|
| Rate for Payer: Encore All Commercial |
$91.20
|
| Rate for Payer: Frontpath All Commercial |
$91.15
|
| Rate for Payer: Humana ChoiceCare |
$85.57
|
| Rate for Payer: Humana Medicare |
$50.53
|
| Rate for Payer: Lucent All Commercial |
$50.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.17
|
| Rate for Payer: Managed Health Services Medicaid |
$12.15
|
| Rate for Payer: MDWise Medicaid |
$12.15
|
| Rate for Payer: PHCS All Commercial |
$74.30
|
| Rate for Payer: PHP All Commercial |
$75.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.64
|
| Rate for Payer: Sagamore Health Network All Products |
$76.48
|
| Rate for Payer: Signature Care EPO |
$82.23
|
| Rate for Payer: Signature Care PPO |
$87.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.21
|
| Rate for Payer: United Healthcare Commercial |
$78.07
|
| Rate for Payer: United Healthcare Medicare |
$32.69
|
|
