|
HC U/S ABDOMINAL DOPPLER LIMITED
|
Facility
|
IP
|
$1,337.02
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
1643976
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,002.76 |
| Max. Negotiated Rate |
$1,243.43 |
| Rate for Payer: Aetna Commercial |
$1,155.19
|
| Rate for Payer: Cash Price |
$802.21
|
| Rate for Payer: Cigna All Commercial |
$1,153.85
|
| Rate for Payer: CORVEL All Commercial |
$1,243.43
|
| Rate for Payer: Coventry All Commercial |
$1,176.58
|
| Rate for Payer: Encore All Commercial |
$1,230.73
|
| Rate for Payer: Frontpath All Commercial |
$1,230.06
|
| Rate for Payer: Humana ChoiceCare |
$1,154.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,203.32
|
| Rate for Payer: PHCS All Commercial |
$1,002.76
|
| Rate for Payer: PHP All Commercial |
$1,014.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,032.18
|
| Rate for Payer: Signature Care EPO |
$1,109.73
|
| Rate for Payer: Signature Care PPO |
$1,176.58
|
| Rate for Payer: United Healthcare Commercial |
$1,053.57
|
|
|
HC U/S AMNIOCENTESIS GUIDANCE
|
Facility
|
IP
|
$598.29
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
1646810
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$448.72 |
| Max. Negotiated Rate |
$556.41 |
| Rate for Payer: Aetna Commercial |
$516.92
|
| Rate for Payer: Cash Price |
$358.97
|
| Rate for Payer: Cigna All Commercial |
$516.32
|
| Rate for Payer: CORVEL All Commercial |
$556.41
|
| Rate for Payer: Coventry All Commercial |
$526.50
|
| Rate for Payer: Encore All Commercial |
$550.73
|
| Rate for Payer: Frontpath All Commercial |
$550.43
|
| Rate for Payer: Humana ChoiceCare |
$516.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.46
|
| Rate for Payer: PHCS All Commercial |
$448.72
|
| Rate for Payer: PHP All Commercial |
$453.74
|
| Rate for Payer: Sagamore Health Network All Products |
$461.88
|
| Rate for Payer: Signature Care EPO |
$496.58
|
| Rate for Payer: Signature Care PPO |
$526.50
|
| Rate for Payer: United Healthcare Commercial |
$471.45
|
|
|
HC U/S AMNIOCENTESIS GUIDANCE
|
Facility
|
OP
|
$598.29
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
1646810
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$556.41 |
| Rate for Payer: Aetna Commercial |
$504.96
|
| Rate for Payer: Aetna Medicare |
$191.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$343.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.60
|
| Rate for Payer: Cash Price |
$358.97
|
| Rate for Payer: Cash Price |
$358.97
|
| Rate for Payer: Centivo All Commercial |
$325.47
|
| Rate for Payer: Cigna All Commercial |
$516.32
|
| Rate for Payer: CORVEL All Commercial |
$556.41
|
| Rate for Payer: Coventry All Commercial |
$526.50
|
| Rate for Payer: Encore All Commercial |
$550.73
|
| Rate for Payer: Frontpath All Commercial |
$550.43
|
| Rate for Payer: Humana ChoiceCare |
$516.74
|
| Rate for Payer: Humana Medicare |
$191.45
|
| Rate for Payer: Lucent All Commercial |
$325.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.46
|
| Rate for Payer: Managed Health Services Medicaid |
$9.08
|
| Rate for Payer: MDWise Medicaid |
$9.08
|
| Rate for Payer: PHCS All Commercial |
$448.72
|
| Rate for Payer: PHP All Commercial |
$453.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$233.33
|
| Rate for Payer: Sagamore Health Network All Products |
$461.88
|
| Rate for Payer: Signature Care EPO |
$496.58
|
| Rate for Payer: Signature Care PPO |
$526.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$508.55
|
| Rate for Payer: United Healthcare Commercial |
$471.45
|
| Rate for Payer: United Healthcare Medicare |
$191.45
|
|
|
HC U/S ANKLE/BRACHIAL INDEX
|
Facility
|
IP
|
$679.54
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
1643922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$509.65 |
| Max. Negotiated Rate |
$631.97 |
| Rate for Payer: Aetna Commercial |
$587.12
|
| Rate for Payer: Cash Price |
$407.72
|
| Rate for Payer: Cigna All Commercial |
$586.44
|
| Rate for Payer: CORVEL All Commercial |
$631.97
|
| Rate for Payer: Coventry All Commercial |
$598.00
|
| Rate for Payer: Encore All Commercial |
$625.52
|
| Rate for Payer: Frontpath All Commercial |
$625.18
|
| Rate for Payer: Humana ChoiceCare |
$586.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$611.59
|
| Rate for Payer: PHCS All Commercial |
$509.65
|
| Rate for Payer: PHP All Commercial |
$515.36
|
| Rate for Payer: Sagamore Health Network All Products |
$524.60
|
| Rate for Payer: Signature Care EPO |
$564.02
|
| Rate for Payer: Signature Care PPO |
$598.00
|
| Rate for Payer: United Healthcare Commercial |
$535.48
|
|
|
HC U/S ANKLE/BRACHIAL INDEX
|
Facility
|
OP
|
$679.54
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
1643922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$631.97 |
| Rate for Payer: Aetna Commercial |
$573.53
|
| Rate for Payer: Aetna Medicare |
$217.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$210.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$390.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$424.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$33.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$250.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$239.20
|
| Rate for Payer: Cash Price |
$407.72
|
| Rate for Payer: Cash Price |
$407.72
|
| Rate for Payer: Centivo All Commercial |
$369.67
|
| Rate for Payer: Cigna All Commercial |
$586.44
|
| Rate for Payer: CORVEL All Commercial |
$631.97
|
| Rate for Payer: Coventry All Commercial |
$598.00
|
| Rate for Payer: Encore All Commercial |
$625.52
|
| Rate for Payer: Frontpath All Commercial |
$625.18
|
| Rate for Payer: Humana ChoiceCare |
$586.92
|
| Rate for Payer: Humana Medicare |
$217.45
|
| Rate for Payer: Lucent All Commercial |
$369.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$611.59
|
| Rate for Payer: Managed Health Services Medicaid |
$33.66
|
| Rate for Payer: MDWise Medicaid |
$33.66
|
| Rate for Payer: PHCS All Commercial |
$509.65
|
| Rate for Payer: PHP All Commercial |
$515.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$265.02
|
| Rate for Payer: Sagamore Health Network All Products |
$524.60
|
| Rate for Payer: Signature Care EPO |
$564.02
|
| Rate for Payer: Signature Care PPO |
$598.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$577.61
|
| Rate for Payer: United Healthcare Commercial |
$535.48
|
| Rate for Payer: United Healthcare Medicare |
$217.45
|
|
|
HC U/S A-V FISTULA
|
Facility
|
OP
|
$777.02
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
1643990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$722.63 |
| Rate for Payer: Aetna Commercial |
$655.80
|
| Rate for Payer: Aetna Medicare |
$248.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$240.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$446.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$485.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$285.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$273.51
|
| Rate for Payer: Cash Price |
$466.21
|
| Rate for Payer: Cash Price |
$466.21
|
| Rate for Payer: Centivo All Commercial |
$422.70
|
| Rate for Payer: Cigna All Commercial |
$670.57
|
| Rate for Payer: CORVEL All Commercial |
$722.63
|
| Rate for Payer: Coventry All Commercial |
$683.78
|
| Rate for Payer: Encore All Commercial |
$715.25
|
| Rate for Payer: Frontpath All Commercial |
$714.86
|
| Rate for Payer: Humana ChoiceCare |
$671.11
|
| Rate for Payer: Humana Medicare |
$248.65
|
| Rate for Payer: Lucent All Commercial |
$422.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.32
|
| Rate for Payer: Managed Health Services Medicaid |
$65.52
|
| Rate for Payer: MDWise Medicaid |
$65.52
|
| Rate for Payer: PHCS All Commercial |
$582.76
|
| Rate for Payer: PHP All Commercial |
$589.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.04
|
| Rate for Payer: Sagamore Health Network All Products |
$599.86
|
| Rate for Payer: Signature Care EPO |
$644.93
|
| Rate for Payer: Signature Care PPO |
$683.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$660.47
|
| Rate for Payer: United Healthcare Commercial |
$612.29
|
| Rate for Payer: United Healthcare Medicare |
$248.65
|
|
|
HC U/S A-V FISTULA
|
Facility
|
IP
|
$777.02
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
1643990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$582.76 |
| Max. Negotiated Rate |
$722.63 |
| Rate for Payer: Aetna Commercial |
$671.35
|
| Rate for Payer: Cash Price |
$466.21
|
| Rate for Payer: Cigna All Commercial |
$670.57
|
| Rate for Payer: CORVEL All Commercial |
$722.63
|
| Rate for Payer: Coventry All Commercial |
$683.78
|
| Rate for Payer: Encore All Commercial |
$715.25
|
| Rate for Payer: Frontpath All Commercial |
$714.86
|
| Rate for Payer: Humana ChoiceCare |
$671.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.32
|
| Rate for Payer: PHCS All Commercial |
$582.76
|
| Rate for Payer: PHP All Commercial |
$589.29
|
| Rate for Payer: Sagamore Health Network All Products |
$599.86
|
| Rate for Payer: Signature Care EPO |
$644.93
|
| Rate for Payer: Signature Care PPO |
$683.78
|
| Rate for Payer: United Healthcare Commercial |
$612.29
|
|
|
HC U/S BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$849.82
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
1646809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$637.37 |
| Max. Negotiated Rate |
$790.33 |
| Rate for Payer: Aetna Commercial |
$734.24
|
| Rate for Payer: Cash Price |
$509.89
|
| Rate for Payer: Cigna All Commercial |
$733.39
|
| Rate for Payer: CORVEL All Commercial |
$790.33
|
| Rate for Payer: Coventry All Commercial |
$747.84
|
| Rate for Payer: Encore All Commercial |
$782.26
|
| Rate for Payer: Frontpath All Commercial |
$781.83
|
| Rate for Payer: Humana ChoiceCare |
$733.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.84
|
| Rate for Payer: PHCS All Commercial |
$637.37
|
| Rate for Payer: PHP All Commercial |
$644.50
|
| Rate for Payer: Sagamore Health Network All Products |
$656.06
|
| Rate for Payer: Signature Care EPO |
$705.35
|
| Rate for Payer: Signature Care PPO |
$747.84
|
| Rate for Payer: United Healthcare Commercial |
$669.66
|
|
|
HC U/S BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$849.82
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
1646809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$790.33 |
| Rate for Payer: Aetna Commercial |
$717.25
|
| Rate for Payer: Aetna Medicare |
$271.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$488.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$531.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.14
|
| Rate for Payer: Cash Price |
$509.89
|
| Rate for Payer: Cash Price |
$509.89
|
| Rate for Payer: Centivo All Commercial |
$462.30
|
| Rate for Payer: Cigna All Commercial |
$733.39
|
| Rate for Payer: CORVEL All Commercial |
$790.33
|
| Rate for Payer: Coventry All Commercial |
$747.84
|
| Rate for Payer: Encore All Commercial |
$782.26
|
| Rate for Payer: Frontpath All Commercial |
$781.83
|
| Rate for Payer: Humana ChoiceCare |
$733.99
|
| Rate for Payer: Humana Medicare |
$271.94
|
| Rate for Payer: Lucent All Commercial |
$462.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.84
|
| Rate for Payer: Managed Health Services Medicaid |
$35.34
|
| Rate for Payer: MDWise Medicaid |
$35.34
|
| Rate for Payer: PHCS All Commercial |
$637.37
|
| Rate for Payer: PHP All Commercial |
$644.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.43
|
| Rate for Payer: Sagamore Health Network All Products |
$656.06
|
| Rate for Payer: Signature Care EPO |
$705.35
|
| Rate for Payer: Signature Care PPO |
$747.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$722.35
|
| Rate for Payer: United Healthcare Commercial |
$669.66
|
| Rate for Payer: United Healthcare Medicare |
$271.94
|
|
|
HC U/S BIOPSY - UNLISTED
|
Facility
|
IP
|
$893.38
|
|
| Hospital Charge Code |
1649002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$670.03 |
| Max. Negotiated Rate |
$830.84 |
| Rate for Payer: Aetna Commercial |
$771.88
|
| Rate for Payer: Cash Price |
$536.03
|
| Rate for Payer: Cigna All Commercial |
$770.99
|
| Rate for Payer: CORVEL All Commercial |
$830.84
|
| Rate for Payer: Coventry All Commercial |
$786.17
|
| Rate for Payer: Encore All Commercial |
$822.36
|
| Rate for Payer: Frontpath All Commercial |
$821.91
|
| Rate for Payer: Humana ChoiceCare |
$771.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$804.04
|
| Rate for Payer: PHCS All Commercial |
$670.03
|
| Rate for Payer: PHP All Commercial |
$677.54
|
| Rate for Payer: Sagamore Health Network All Products |
$689.69
|
| Rate for Payer: Signature Care EPO |
$741.51
|
| Rate for Payer: Signature Care PPO |
$786.17
|
| Rate for Payer: United Healthcare Commercial |
$703.98
|
|
|
HC U/S BIOPSY - UNLISTED
|
Facility
|
OP
|
$893.38
|
|
| Hospital Charge Code |
1649002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.95 |
| Max. Negotiated Rate |
$830.84 |
| Rate for Payer: Aetna Commercial |
$754.01
|
| Rate for Payer: Aetna Medicare |
$285.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$513.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$558.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.47
|
| Rate for Payer: Cash Price |
$536.03
|
| Rate for Payer: Centivo All Commercial |
$486.00
|
| Rate for Payer: Cigna All Commercial |
$770.99
|
| Rate for Payer: CORVEL All Commercial |
$830.84
|
| Rate for Payer: Coventry All Commercial |
$786.17
|
| Rate for Payer: Encore All Commercial |
$822.36
|
| Rate for Payer: Frontpath All Commercial |
$821.91
|
| Rate for Payer: Humana ChoiceCare |
$771.61
|
| Rate for Payer: Humana Medicare |
$285.88
|
| Rate for Payer: Lucent All Commercial |
$486.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$804.04
|
| Rate for Payer: PHCS All Commercial |
$670.03
|
| Rate for Payer: PHP All Commercial |
$677.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.42
|
| Rate for Payer: Sagamore Health Network All Products |
$689.69
|
| Rate for Payer: Signature Care EPO |
$741.51
|
| Rate for Payer: Signature Care PPO |
$786.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$759.37
|
| Rate for Payer: United Healthcare Commercial |
$703.98
|
| Rate for Payer: United Healthcare Medicare |
$285.88
|
|
|
HC U/S BX OR EXC PERC LN; SUPERF
|
Facility
|
IP
|
$2,871.81
|
|
| Hospital Charge Code |
1648505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,153.86 |
| Max. Negotiated Rate |
$2,670.78 |
| Rate for Payer: Aetna Commercial |
$2,481.24
|
| Rate for Payer: Cash Price |
$1,723.09
|
| Rate for Payer: Cigna All Commercial |
$2,478.37
|
| Rate for Payer: CORVEL All Commercial |
$2,670.78
|
| Rate for Payer: Coventry All Commercial |
$2,527.19
|
| Rate for Payer: Encore All Commercial |
$2,643.50
|
| Rate for Payer: Frontpath All Commercial |
$2,642.07
|
| Rate for Payer: Humana ChoiceCare |
$2,480.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,584.63
|
| Rate for Payer: PHCS All Commercial |
$2,153.86
|
| Rate for Payer: PHP All Commercial |
$2,177.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,217.04
|
| Rate for Payer: Signature Care EPO |
$2,383.60
|
| Rate for Payer: Signature Care PPO |
$2,527.19
|
| Rate for Payer: United Healthcare Commercial |
$2,262.99
|
|
|
HC U/S BX OR EXC PERC LN; SUPERF
|
Facility
|
OP
|
$2,871.81
|
|
| Hospital Charge Code |
1648505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$890.26 |
| Max. Negotiated Rate |
$2,670.78 |
| Rate for Payer: Aetna Commercial |
$2,423.81
|
| Rate for Payer: Aetna Medicare |
$918.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$890.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,649.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,795.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,056.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,010.88
|
| Rate for Payer: Cash Price |
$1,723.09
|
| Rate for Payer: Centivo All Commercial |
$1,562.26
|
| Rate for Payer: Cigna All Commercial |
$2,478.37
|
| Rate for Payer: CORVEL All Commercial |
$2,670.78
|
| Rate for Payer: Coventry All Commercial |
$2,527.19
|
| Rate for Payer: Encore All Commercial |
$2,643.50
|
| Rate for Payer: Frontpath All Commercial |
$2,642.07
|
| Rate for Payer: Humana ChoiceCare |
$2,480.38
|
| Rate for Payer: Humana Medicare |
$918.98
|
| Rate for Payer: Lucent All Commercial |
$1,562.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,584.63
|
| Rate for Payer: PHCS All Commercial |
$2,153.86
|
| Rate for Payer: PHP All Commercial |
$2,177.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,120.01
|
| Rate for Payer: Sagamore Health Network All Products |
$2,217.04
|
| Rate for Payer: Signature Care EPO |
$2,383.60
|
| Rate for Payer: Signature Care PPO |
$2,527.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,441.04
|
| Rate for Payer: United Healthcare Commercial |
$2,262.99
|
| Rate for Payer: United Healthcare Medicare |
$918.98
|
|
|
HC U/S CAROTID DOPPLER BILATERAL
|
Facility
|
IP
|
$1,552.60
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
1646900
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,164.45 |
| Max. Negotiated Rate |
$1,443.92 |
| Rate for Payer: Aetna Commercial |
$1,341.45
|
| Rate for Payer: Cash Price |
$931.56
|
| Rate for Payer: Cigna All Commercial |
$1,339.89
|
| Rate for Payer: CORVEL All Commercial |
$1,443.92
|
| Rate for Payer: Coventry All Commercial |
$1,366.29
|
| Rate for Payer: Encore All Commercial |
$1,429.17
|
| Rate for Payer: Frontpath All Commercial |
$1,428.39
|
| Rate for Payer: Humana ChoiceCare |
$1,340.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,397.34
|
| Rate for Payer: PHCS All Commercial |
$1,164.45
|
| Rate for Payer: PHP All Commercial |
$1,177.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,198.61
|
| Rate for Payer: Signature Care EPO |
$1,288.66
|
| Rate for Payer: Signature Care PPO |
$1,366.29
|
| Rate for Payer: United Healthcare Commercial |
$1,223.45
|
|
|
HC U/S CAROTID DOPPLER BILATERAL
|
Facility
|
OP
|
$1,552.60
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
1646900
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$1,443.92 |
| Rate for Payer: Aetna Commercial |
$1,310.39
|
| Rate for Payer: Aetna Medicare |
$496.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$481.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$891.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$970.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$571.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$546.52
|
| Rate for Payer: Cash Price |
$931.56
|
| Rate for Payer: Cash Price |
$931.56
|
| Rate for Payer: Centivo All Commercial |
$844.61
|
| Rate for Payer: Cigna All Commercial |
$1,339.89
|
| Rate for Payer: CORVEL All Commercial |
$1,443.92
|
| Rate for Payer: Coventry All Commercial |
$1,366.29
|
| Rate for Payer: Encore All Commercial |
$1,429.17
|
| Rate for Payer: Frontpath All Commercial |
$1,428.39
|
| Rate for Payer: Humana ChoiceCare |
$1,340.98
|
| Rate for Payer: Humana Medicare |
$496.83
|
| Rate for Payer: Lucent All Commercial |
$844.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,397.34
|
| Rate for Payer: Managed Health Services Medicaid |
$97.43
|
| Rate for Payer: MDWise Medicaid |
$97.43
|
| Rate for Payer: PHCS All Commercial |
$1,164.45
|
| Rate for Payer: PHP All Commercial |
$1,177.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$605.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,198.61
|
| Rate for Payer: Signature Care EPO |
$1,288.66
|
| Rate for Payer: Signature Care PPO |
$1,366.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,319.71
|
| Rate for Payer: United Healthcare Commercial |
$1,223.45
|
| Rate for Payer: United Healthcare Medicare |
$496.83
|
|
|
HC U/S CHEST WALL
|
Facility
|
IP
|
$701.45
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
1646706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$526.09 |
| Max. Negotiated Rate |
$652.35 |
| Rate for Payer: Aetna Commercial |
$606.05
|
| Rate for Payer: Cash Price |
$420.87
|
| Rate for Payer: Cigna All Commercial |
$605.35
|
| Rate for Payer: CORVEL All Commercial |
$652.35
|
| Rate for Payer: Coventry All Commercial |
$617.28
|
| Rate for Payer: Encore All Commercial |
$645.68
|
| Rate for Payer: Frontpath All Commercial |
$645.33
|
| Rate for Payer: Humana ChoiceCare |
$605.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.30
|
| Rate for Payer: PHCS All Commercial |
$526.09
|
| Rate for Payer: PHP All Commercial |
$531.98
|
| Rate for Payer: Sagamore Health Network All Products |
$541.52
|
| Rate for Payer: Signature Care EPO |
$582.20
|
| Rate for Payer: Signature Care PPO |
$617.28
|
| Rate for Payer: United Healthcare Commercial |
$552.74
|
|
|
HC U/S CHEST WALL
|
Facility
|
OP
|
$701.45
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
1646706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$652.35 |
| Rate for Payer: Aetna Commercial |
$592.02
|
| Rate for Payer: Aetna Medicare |
$224.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$217.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$402.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$258.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$246.91
|
| Rate for Payer: Cash Price |
$420.87
|
| Rate for Payer: Cash Price |
$420.87
|
| Rate for Payer: Centivo All Commercial |
$381.59
|
| Rate for Payer: Cigna All Commercial |
$605.35
|
| Rate for Payer: CORVEL All Commercial |
$652.35
|
| Rate for Payer: Coventry All Commercial |
$617.28
|
| Rate for Payer: Encore All Commercial |
$645.68
|
| Rate for Payer: Frontpath All Commercial |
$645.33
|
| Rate for Payer: Humana ChoiceCare |
$605.84
|
| Rate for Payer: Humana Medicare |
$224.46
|
| Rate for Payer: Lucent All Commercial |
$381.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.30
|
| Rate for Payer: Managed Health Services Medicaid |
$42.77
|
| Rate for Payer: MDWise Medicaid |
$42.77
|
| Rate for Payer: PHCS All Commercial |
$526.09
|
| Rate for Payer: PHP All Commercial |
$531.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.57
|
| Rate for Payer: Sagamore Health Network All Products |
$541.52
|
| Rate for Payer: Signature Care EPO |
$582.20
|
| Rate for Payer: Signature Care PPO |
$617.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.23
|
| Rate for Payer: United Healthcare Commercial |
$552.74
|
| Rate for Payer: United Healthcare Medicare |
$224.46
|
|
|
HC U/S CLR FL ART LWR EXT UNI LTD
|
Facility
|
OP
|
$1,104.16
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1643932
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$1,026.87 |
| Rate for Payer: Aetna Commercial |
$931.91
|
| Rate for Payer: Aetna Medicare |
$353.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$342.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$634.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$690.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.66
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Centivo All Commercial |
$600.66
|
| Rate for Payer: Cigna All Commercial |
$952.89
|
| Rate for Payer: CORVEL All Commercial |
$1,026.87
|
| Rate for Payer: Coventry All Commercial |
$971.66
|
| Rate for Payer: Encore All Commercial |
$1,016.38
|
| Rate for Payer: Frontpath All Commercial |
$1,015.83
|
| Rate for Payer: Humana ChoiceCare |
$953.66
|
| Rate for Payer: Humana Medicare |
$353.33
|
| Rate for Payer: Lucent All Commercial |
$600.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.74
|
| Rate for Payer: Managed Health Services Medicaid |
$97.43
|
| Rate for Payer: MDWise Medicaid |
$97.43
|
| Rate for Payer: PHCS All Commercial |
$828.12
|
| Rate for Payer: PHP All Commercial |
$837.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.62
|
| Rate for Payer: Sagamore Health Network All Products |
$852.41
|
| Rate for Payer: Signature Care EPO |
$916.45
|
| Rate for Payer: Signature Care PPO |
$971.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.54
|
| Rate for Payer: United Healthcare Commercial |
$870.08
|
| Rate for Payer: United Healthcare Medicare |
$353.33
|
|
|
HC U/S CLR FL ART LWR EXT UNI LTD
|
Facility
|
IP
|
$1,104.16
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1643932
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$828.12 |
| Max. Negotiated Rate |
$1,026.87 |
| Rate for Payer: Aetna Commercial |
$953.99
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna All Commercial |
$952.89
|
| Rate for Payer: CORVEL All Commercial |
$1,026.87
|
| Rate for Payer: Coventry All Commercial |
$971.66
|
| Rate for Payer: Encore All Commercial |
$1,016.38
|
| Rate for Payer: Frontpath All Commercial |
$1,015.83
|
| Rate for Payer: Humana ChoiceCare |
$953.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.74
|
| Rate for Payer: PHCS All Commercial |
$828.12
|
| Rate for Payer: PHP All Commercial |
$837.39
|
| Rate for Payer: Sagamore Health Network All Products |
$852.41
|
| Rate for Payer: Signature Care EPO |
$916.45
|
| Rate for Payer: Signature Care PPO |
$971.66
|
| Rate for Payer: United Healthcare Commercial |
$870.08
|
|
|
HC U/S COLOR FLOW ART LOW EXT BIL
|
Facility
|
IP
|
$1,656.25
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
1643925
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,242.19 |
| Max. Negotiated Rate |
$1,540.31 |
| Rate for Payer: Aetna Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$993.75
|
| Rate for Payer: Cigna All Commercial |
$1,429.34
|
| Rate for Payer: CORVEL All Commercial |
$1,540.31
|
| Rate for Payer: Coventry All Commercial |
$1,457.50
|
| Rate for Payer: Encore All Commercial |
$1,524.58
|
| Rate for Payer: Frontpath All Commercial |
$1,523.75
|
| Rate for Payer: Humana ChoiceCare |
$1,430.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,490.62
|
| Rate for Payer: PHCS All Commercial |
$1,242.19
|
| Rate for Payer: PHP All Commercial |
$1,256.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,278.62
|
| Rate for Payer: Signature Care EPO |
$1,374.69
|
| Rate for Payer: Signature Care PPO |
$1,457.50
|
| Rate for Payer: United Healthcare Commercial |
$1,305.12
|
|
|
HC U/S COLOR FLOW ART LOW EXT BIL
|
Facility
|
OP
|
$1,656.25
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
1643925
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$1,540.31 |
| Rate for Payer: Aetna Commercial |
$1,397.88
|
| Rate for Payer: Aetna Medicare |
$530.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$513.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$951.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,035.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$609.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$583.00
|
| Rate for Payer: Cash Price |
$993.75
|
| Rate for Payer: Cash Price |
$993.75
|
| Rate for Payer: Centivo All Commercial |
$901.00
|
| Rate for Payer: Cigna All Commercial |
$1,429.34
|
| Rate for Payer: CORVEL All Commercial |
$1,540.31
|
| Rate for Payer: Coventry All Commercial |
$1,457.50
|
| Rate for Payer: Encore All Commercial |
$1,524.58
|
| Rate for Payer: Frontpath All Commercial |
$1,523.75
|
| Rate for Payer: Humana ChoiceCare |
$1,430.50
|
| Rate for Payer: Humana Medicare |
$530.00
|
| Rate for Payer: Lucent All Commercial |
$901.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,490.62
|
| Rate for Payer: Managed Health Services Medicaid |
$97.43
|
| Rate for Payer: MDWise Medicaid |
$97.43
|
| Rate for Payer: PHCS All Commercial |
$1,242.19
|
| Rate for Payer: PHP All Commercial |
$1,256.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$645.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,278.62
|
| Rate for Payer: Signature Care EPO |
$1,374.69
|
| Rate for Payer: Signature Care PPO |
$1,457.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,407.81
|
| Rate for Payer: United Healthcare Commercial |
$1,305.12
|
| Rate for Payer: United Healthcare Medicare |
$530.00
|
|
|
HC U/S COLOR FLOW ART LOW EXT UNI
|
Facility
|
IP
|
$1,070.28
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1643926
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$802.71 |
| Max. Negotiated Rate |
$995.36 |
| Rate for Payer: Aetna Commercial |
$924.72
|
| Rate for Payer: Cash Price |
$642.17
|
| Rate for Payer: Cigna All Commercial |
$923.65
|
| Rate for Payer: CORVEL All Commercial |
$995.36
|
| Rate for Payer: Coventry All Commercial |
$941.85
|
| Rate for Payer: Encore All Commercial |
$985.19
|
| Rate for Payer: Frontpath All Commercial |
$984.66
|
| Rate for Payer: Humana ChoiceCare |
$924.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.25
|
| Rate for Payer: PHCS All Commercial |
$802.71
|
| Rate for Payer: PHP All Commercial |
$811.70
|
| Rate for Payer: Sagamore Health Network All Products |
$826.26
|
| Rate for Payer: Signature Care EPO |
$888.33
|
| Rate for Payer: Signature Care PPO |
$941.85
|
| Rate for Payer: United Healthcare Commercial |
$843.38
|
|
|
HC U/S COLOR FLOW ART LOW EXT UNI
|
Facility
|
OP
|
$1,070.28
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1643926
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$995.36 |
| Rate for Payer: Aetna Commercial |
$903.32
|
| Rate for Payer: Aetna Medicare |
$342.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$614.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$393.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$376.74
|
| Rate for Payer: Cash Price |
$642.17
|
| Rate for Payer: Cash Price |
$642.17
|
| Rate for Payer: Centivo All Commercial |
$582.23
|
| Rate for Payer: Cigna All Commercial |
$923.65
|
| Rate for Payer: CORVEL All Commercial |
$995.36
|
| Rate for Payer: Coventry All Commercial |
$941.85
|
| Rate for Payer: Encore All Commercial |
$985.19
|
| Rate for Payer: Frontpath All Commercial |
$984.66
|
| Rate for Payer: Humana ChoiceCare |
$924.40
|
| Rate for Payer: Humana Medicare |
$342.49
|
| Rate for Payer: Lucent All Commercial |
$582.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.25
|
| Rate for Payer: Managed Health Services Medicaid |
$97.43
|
| Rate for Payer: MDWise Medicaid |
$97.43
|
| Rate for Payer: PHCS All Commercial |
$802.71
|
| Rate for Payer: PHP All Commercial |
$811.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.41
|
| Rate for Payer: Sagamore Health Network All Products |
$826.26
|
| Rate for Payer: Signature Care EPO |
$888.33
|
| Rate for Payer: Signature Care PPO |
$941.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.74
|
| Rate for Payer: United Healthcare Commercial |
$843.38
|
| Rate for Payer: United Healthcare Medicare |
$342.49
|
|
|
HC U/S COLOR FLOW ART UP EXT BIL
|
Facility
|
IP
|
$1,731.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
1643928
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,298.25 |
| Max. Negotiated Rate |
$1,609.83 |
| Rate for Payer: Aetna Commercial |
$1,495.58
|
| Rate for Payer: Cash Price |
$1,038.60
|
| Rate for Payer: Cigna All Commercial |
$1,493.85
|
| Rate for Payer: CORVEL All Commercial |
$1,609.83
|
| Rate for Payer: Coventry All Commercial |
$1,523.28
|
| Rate for Payer: Encore All Commercial |
$1,593.39
|
| Rate for Payer: Frontpath All Commercial |
$1,592.52
|
| Rate for Payer: Humana ChoiceCare |
$1,495.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,557.90
|
| Rate for Payer: PHCS All Commercial |
$1,298.25
|
| Rate for Payer: PHP All Commercial |
$1,312.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,336.33
|
| Rate for Payer: Signature Care EPO |
$1,436.73
|
| Rate for Payer: Signature Care PPO |
$1,523.28
|
| Rate for Payer: United Healthcare Commercial |
$1,364.03
|
|
|
HC U/S COLOR FLOW ART UP EXT BIL
|
Facility
|
OP
|
$1,731.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
1643928
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$189.62 |
| Max. Negotiated Rate |
$1,609.83 |
| Rate for Payer: Aetna Commercial |
$1,460.96
|
| Rate for Payer: Aetna Medicare |
$553.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$189.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$536.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$994.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,082.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$189.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$637.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$609.31
|
| Rate for Payer: Cash Price |
$1,038.60
|
| Rate for Payer: Cash Price |
$1,038.60
|
| Rate for Payer: Centivo All Commercial |
$941.66
|
| Rate for Payer: Cigna All Commercial |
$1,493.85
|
| Rate for Payer: CORVEL All Commercial |
$1,609.83
|
| Rate for Payer: Coventry All Commercial |
$1,523.28
|
| Rate for Payer: Encore All Commercial |
$1,593.39
|
| Rate for Payer: Frontpath All Commercial |
$1,592.52
|
| Rate for Payer: Humana ChoiceCare |
$1,495.06
|
| Rate for Payer: Humana Medicare |
$553.92
|
| Rate for Payer: Lucent All Commercial |
$941.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,557.90
|
| Rate for Payer: Managed Health Services Medicaid |
$189.62
|
| Rate for Payer: MDWise Medicaid |
$189.62
|
| Rate for Payer: PHCS All Commercial |
$1,298.25
|
| Rate for Payer: PHP All Commercial |
$1,312.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$675.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,336.33
|
| Rate for Payer: Signature Care EPO |
$1,436.73
|
| Rate for Payer: Signature Care PPO |
$1,523.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,471.35
|
| Rate for Payer: United Healthcare Commercial |
$1,364.03
|
| Rate for Payer: United Healthcare Medicare |
$553.92
|
|
