|
HC U/S COLOR FLOW ART UP EXT UNI
|
Facility
|
IP
|
$930.91
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
1643931
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$698.18 |
| Max. Negotiated Rate |
$865.75 |
| Rate for Payer: Aetna Commercial |
$804.31
|
| Rate for Payer: Cash Price |
$558.55
|
| Rate for Payer: Cigna All Commercial |
$803.38
|
| Rate for Payer: CORVEL All Commercial |
$865.75
|
| Rate for Payer: Coventry All Commercial |
$819.20
|
| Rate for Payer: Encore All Commercial |
$856.90
|
| Rate for Payer: Frontpath All Commercial |
$856.44
|
| Rate for Payer: Humana ChoiceCare |
$804.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.82
|
| Rate for Payer: PHCS All Commercial |
$698.18
|
| Rate for Payer: PHP All Commercial |
$706.00
|
| Rate for Payer: Sagamore Health Network All Products |
$718.66
|
| Rate for Payer: Signature Care EPO |
$772.66
|
| Rate for Payer: Signature Care PPO |
$819.20
|
| Rate for Payer: United Healthcare Commercial |
$733.56
|
|
|
HC U/S COLOR FLOW ART UP EXT UNI
|
Facility
|
OP
|
$930.91
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
1643931
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$865.75 |
| Rate for Payer: Aetna Commercial |
$785.69
|
| Rate for Payer: Aetna Medicare |
$297.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$534.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$342.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$327.68
|
| Rate for Payer: Cash Price |
$558.55
|
| Rate for Payer: Cash Price |
$558.55
|
| Rate for Payer: Centivo All Commercial |
$506.42
|
| Rate for Payer: Cigna All Commercial |
$803.38
|
| Rate for Payer: CORVEL All Commercial |
$865.75
|
| Rate for Payer: Coventry All Commercial |
$819.20
|
| Rate for Payer: Encore All Commercial |
$856.90
|
| Rate for Payer: Frontpath All Commercial |
$856.44
|
| Rate for Payer: Humana ChoiceCare |
$804.03
|
| Rate for Payer: Humana Medicare |
$297.89
|
| Rate for Payer: Lucent All Commercial |
$506.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.82
|
| Rate for Payer: Managed Health Services Medicaid |
$97.43
|
| Rate for Payer: MDWise Medicaid |
$97.43
|
| Rate for Payer: PHCS All Commercial |
$698.18
|
| Rate for Payer: PHP All Commercial |
$706.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.05
|
| Rate for Payer: Sagamore Health Network All Products |
$718.66
|
| Rate for Payer: Signature Care EPO |
$772.66
|
| Rate for Payer: Signature Care PPO |
$819.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.27
|
| Rate for Payer: United Healthcare Commercial |
$733.56
|
| Rate for Payer: United Healthcare Medicare |
$297.89
|
|
|
HC U/S CYST/RENAL ASPIRATION
|
Facility
|
IP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1646938
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,017.55 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,172.22
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: PHCS All Commercial |
$1,017.55
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.40
|
| Rate for Payer: Signature Care EPO |
$1,126.09
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
|
|
HC U/S CYST/RENAL ASPIRATION
|
Facility
|
OP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1646938
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,145.09
|
| Rate for Payer: Aetna Medicare |
$434.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$420.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$779.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$848.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$499.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$477.57
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Centivo All Commercial |
$738.07
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Humana Medicare |
$434.16
|
| Rate for Payer: Lucent All Commercial |
$738.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: Managed Health Services Medicaid |
$27.66
|
| Rate for Payer: MDWise Medicaid |
$27.66
|
| Rate for Payer: PHCS All Commercial |
$1,017.55
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$529.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.40
|
| Rate for Payer: Signature Care EPO |
$1,126.09
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,153.23
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
| Rate for Payer: United Healthcare Medicare |
$434.16
|
|
|
HC U/S DOPPLER UMB ARTERY FETAL
|
Facility
|
IP
|
$616.70
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
1646820
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$462.52 |
| Max. Negotiated Rate |
$573.53 |
| Rate for Payer: Aetna Commercial |
$532.83
|
| Rate for Payer: Cash Price |
$370.02
|
| Rate for Payer: Cigna All Commercial |
$532.21
|
| Rate for Payer: CORVEL All Commercial |
$573.53
|
| Rate for Payer: Coventry All Commercial |
$542.70
|
| Rate for Payer: Encore All Commercial |
$567.67
|
| Rate for Payer: Frontpath All Commercial |
$567.36
|
| Rate for Payer: Humana ChoiceCare |
$532.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.03
|
| Rate for Payer: PHCS All Commercial |
$462.52
|
| Rate for Payer: PHP All Commercial |
$467.71
|
| Rate for Payer: Sagamore Health Network All Products |
$476.09
|
| Rate for Payer: Signature Care EPO |
$511.86
|
| Rate for Payer: Signature Care PPO |
$542.70
|
| Rate for Payer: United Healthcare Commercial |
$485.96
|
|
|
HC U/S DOPPLER UMB ARTERY FETAL
|
Facility
|
OP
|
$616.70
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
1646820
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$573.53 |
| Rate for Payer: Aetna Commercial |
$520.49
|
| Rate for Payer: Aetna Medicare |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$354.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$226.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$217.08
|
| Rate for Payer: Cash Price |
$370.02
|
| Rate for Payer: Cash Price |
$370.02
|
| Rate for Payer: Centivo All Commercial |
$335.48
|
| Rate for Payer: Cigna All Commercial |
$532.21
|
| Rate for Payer: CORVEL All Commercial |
$573.53
|
| Rate for Payer: Coventry All Commercial |
$542.70
|
| Rate for Payer: Encore All Commercial |
$567.67
|
| Rate for Payer: Frontpath All Commercial |
$567.36
|
| Rate for Payer: Humana ChoiceCare |
$532.64
|
| Rate for Payer: Humana Medicare |
$197.34
|
| Rate for Payer: Lucent All Commercial |
$335.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.03
|
| Rate for Payer: Managed Health Services Medicaid |
$16.51
|
| Rate for Payer: MDWise Medicaid |
$16.51
|
| Rate for Payer: PHCS All Commercial |
$462.52
|
| Rate for Payer: PHP All Commercial |
$467.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.51
|
| Rate for Payer: Sagamore Health Network All Products |
$476.09
|
| Rate for Payer: Signature Care EPO |
$511.86
|
| Rate for Payer: Signature Care PPO |
$542.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.20
|
| Rate for Payer: United Healthcare Commercial |
$485.96
|
| Rate for Payer: United Healthcare Medicare |
$197.34
|
|
|
HC U/S DRAINAGE - UNLISTED
|
Facility
|
OP
|
$512.07
|
|
| Hospital Charge Code |
1649001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.74 |
| Max. Negotiated Rate |
$476.23 |
| Rate for Payer: Aetna Commercial |
$432.19
|
| Rate for Payer: Aetna Medicare |
$163.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$294.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.25
|
| Rate for Payer: Cash Price |
$307.24
|
| Rate for Payer: Centivo All Commercial |
$278.57
|
| Rate for Payer: Cigna All Commercial |
$441.92
|
| Rate for Payer: CORVEL All Commercial |
$476.23
|
| Rate for Payer: Coventry All Commercial |
$450.62
|
| Rate for Payer: Encore All Commercial |
$471.36
|
| Rate for Payer: Frontpath All Commercial |
$471.10
|
| Rate for Payer: Humana ChoiceCare |
$442.27
|
| Rate for Payer: Humana Medicare |
$163.86
|
| Rate for Payer: Lucent All Commercial |
$278.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.86
|
| Rate for Payer: PHCS All Commercial |
$384.05
|
| Rate for Payer: PHP All Commercial |
$388.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.71
|
| Rate for Payer: Sagamore Health Network All Products |
$395.32
|
| Rate for Payer: Signature Care EPO |
$425.02
|
| Rate for Payer: Signature Care PPO |
$450.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.26
|
| Rate for Payer: United Healthcare Commercial |
$403.51
|
| Rate for Payer: United Healthcare Medicare |
$163.86
|
|
|
HC U/S DRAINAGE - UNLISTED
|
Facility
|
IP
|
$512.07
|
|
| Hospital Charge Code |
1649001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.05 |
| Max. Negotiated Rate |
$476.23 |
| Rate for Payer: Aetna Commercial |
$442.43
|
| Rate for Payer: Cash Price |
$307.24
|
| Rate for Payer: Cigna All Commercial |
$441.92
|
| Rate for Payer: CORVEL All Commercial |
$476.23
|
| Rate for Payer: Coventry All Commercial |
$450.62
|
| Rate for Payer: Encore All Commercial |
$471.36
|
| Rate for Payer: Frontpath All Commercial |
$471.10
|
| Rate for Payer: Humana ChoiceCare |
$442.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.86
|
| Rate for Payer: PHCS All Commercial |
$384.05
|
| Rate for Payer: PHP All Commercial |
$388.35
|
| Rate for Payer: Sagamore Health Network All Products |
$395.32
|
| Rate for Payer: Signature Care EPO |
$425.02
|
| Rate for Payer: Signature Care PPO |
$450.62
|
| Rate for Payer: United Healthcare Commercial |
$403.51
|
|
|
HC U/S DUPLEX ARTERIAL FLOW; COMPL
|
Facility
|
OP
|
$1,724.51
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
1643975
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$189.62 |
| Max. Negotiated Rate |
$1,603.79 |
| Rate for Payer: Aetna Commercial |
$1,455.49
|
| Rate for Payer: Aetna Medicare |
$551.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$189.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$534.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$990.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,077.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$189.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$634.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$607.03
|
| Rate for Payer: Cash Price |
$1,034.71
|
| Rate for Payer: Cash Price |
$1,034.71
|
| Rate for Payer: Centivo All Commercial |
$938.13
|
| Rate for Payer: Cigna All Commercial |
$1,488.25
|
| Rate for Payer: CORVEL All Commercial |
$1,603.79
|
| Rate for Payer: Coventry All Commercial |
$1,517.57
|
| Rate for Payer: Encore All Commercial |
$1,587.41
|
| Rate for Payer: Frontpath All Commercial |
$1,586.55
|
| Rate for Payer: Humana ChoiceCare |
$1,489.46
|
| Rate for Payer: Humana Medicare |
$551.84
|
| Rate for Payer: Lucent All Commercial |
$938.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,552.06
|
| Rate for Payer: Managed Health Services Medicaid |
$189.62
|
| Rate for Payer: MDWise Medicaid |
$189.62
|
| Rate for Payer: PHCS All Commercial |
$1,293.38
|
| Rate for Payer: PHP All Commercial |
$1,307.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$672.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,331.32
|
| Rate for Payer: Signature Care EPO |
$1,431.34
|
| Rate for Payer: Signature Care PPO |
$1,517.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,465.83
|
| Rate for Payer: United Healthcare Commercial |
$1,358.91
|
| Rate for Payer: United Healthcare Medicare |
$551.84
|
|
|
HC U/S DUPLEX ARTERIAL FLOW; COMPL
|
Facility
|
IP
|
$1,724.51
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
1643975
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,293.38 |
| Max. Negotiated Rate |
$1,603.79 |
| Rate for Payer: Aetna Commercial |
$1,489.98
|
| Rate for Payer: Cash Price |
$1,034.71
|
| Rate for Payer: Cigna All Commercial |
$1,488.25
|
| Rate for Payer: CORVEL All Commercial |
$1,603.79
|
| Rate for Payer: Coventry All Commercial |
$1,517.57
|
| Rate for Payer: Encore All Commercial |
$1,587.41
|
| Rate for Payer: Frontpath All Commercial |
$1,586.55
|
| Rate for Payer: Humana ChoiceCare |
$1,489.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,552.06
|
| Rate for Payer: PHCS All Commercial |
$1,293.38
|
| Rate for Payer: PHP All Commercial |
$1,307.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,331.32
|
| Rate for Payer: Signature Care EPO |
$1,431.34
|
| Rate for Payer: Signature Care PPO |
$1,517.57
|
| Rate for Payer: United Healthcare Commercial |
$1,358.91
|
|
|
HC U/S ELASTOGRAPHY; PARENCHYMA
|
Facility
|
IP
|
$420.24
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
1646981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.18 |
| Max. Negotiated Rate |
$390.82 |
| Rate for Payer: Aetna Commercial |
$363.09
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cigna All Commercial |
$362.67
|
| Rate for Payer: CORVEL All Commercial |
$390.82
|
| Rate for Payer: Coventry All Commercial |
$369.81
|
| Rate for Payer: Encore All Commercial |
$386.83
|
| Rate for Payer: Frontpath All Commercial |
$386.62
|
| Rate for Payer: Humana ChoiceCare |
$362.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.22
|
| Rate for Payer: PHCS All Commercial |
$315.18
|
| Rate for Payer: PHP All Commercial |
$318.71
|
| Rate for Payer: Sagamore Health Network All Products |
$324.43
|
| Rate for Payer: Signature Care EPO |
$348.80
|
| Rate for Payer: Signature Care PPO |
$369.81
|
| Rate for Payer: United Healthcare Commercial |
$331.15
|
|
|
HC U/S ELASTOGRAPHY; PARENCHYMA
|
Facility
|
OP
|
$420.24
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
1646981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.51 |
| Max. Negotiated Rate |
$390.82 |
| Rate for Payer: Aetna Commercial |
$354.68
|
| Rate for Payer: Aetna Medicare |
$134.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$241.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$112.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$147.92
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Centivo All Commercial |
$228.61
|
| Rate for Payer: Cigna All Commercial |
$362.67
|
| Rate for Payer: CORVEL All Commercial |
$390.82
|
| Rate for Payer: Coventry All Commercial |
$369.81
|
| Rate for Payer: Encore All Commercial |
$386.83
|
| Rate for Payer: Frontpath All Commercial |
$386.62
|
| Rate for Payer: Humana ChoiceCare |
$362.96
|
| Rate for Payer: Humana Medicare |
$134.48
|
| Rate for Payer: Lucent All Commercial |
$228.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.22
|
| Rate for Payer: Managed Health Services Medicaid |
$112.51
|
| Rate for Payer: MDWise Medicaid |
$112.51
|
| Rate for Payer: PHCS All Commercial |
$315.18
|
| Rate for Payer: PHP All Commercial |
$318.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.89
|
| Rate for Payer: Sagamore Health Network All Products |
$324.43
|
| Rate for Payer: Signature Care EPO |
$348.80
|
| Rate for Payer: Signature Care PPO |
$369.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.20
|
| Rate for Payer: United Healthcare Commercial |
$331.15
|
| Rate for Payer: United Healthcare Medicare |
$134.48
|
|
|
HC U/S EXTR NON-VASC LMTD BILATERAL
|
Facility
|
OP
|
$704.31
|
|
|
Service Code
|
CPT 76882 50
|
| Hospital Charge Code |
21646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$655.01 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Aetna Medicare |
$225.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$218.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$404.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$247.92
|
| Rate for Payer: Cash Price |
$422.59
|
| Rate for Payer: Cash Price |
$422.59
|
| Rate for Payer: Centivo All Commercial |
$383.14
|
| Rate for Payer: Cigna All Commercial |
$607.82
|
| Rate for Payer: CORVEL All Commercial |
$655.01
|
| Rate for Payer: Coventry All Commercial |
$619.79
|
| Rate for Payer: Encore All Commercial |
$648.32
|
| Rate for Payer: Frontpath All Commercial |
$647.97
|
| Rate for Payer: Humana ChoiceCare |
$608.31
|
| Rate for Payer: Humana Medicare |
$225.38
|
| Rate for Payer: Lucent All Commercial |
$383.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.88
|
| Rate for Payer: Managed Health Services Medicaid |
$7.60
|
| Rate for Payer: MDWise Medicaid |
$7.60
|
| Rate for Payer: PHCS All Commercial |
$528.23
|
| Rate for Payer: PHP All Commercial |
$534.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.68
|
| Rate for Payer: Sagamore Health Network All Products |
$543.73
|
| Rate for Payer: Signature Care EPO |
$584.58
|
| Rate for Payer: Signature Care PPO |
$619.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$598.66
|
| Rate for Payer: United Healthcare Commercial |
$555.00
|
| Rate for Payer: United Healthcare Medicare |
$225.38
|
|
|
HC U/S EXTR NON-VASC LMTD BILATERAL
|
Facility
|
IP
|
$704.31
|
|
|
Service Code
|
CPT 76882 50
|
| Hospital Charge Code |
21646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$528.23 |
| Max. Negotiated Rate |
$655.01 |
| Rate for Payer: Aetna Commercial |
$608.52
|
| Rate for Payer: Cash Price |
$422.59
|
| Rate for Payer: Cigna All Commercial |
$607.82
|
| Rate for Payer: CORVEL All Commercial |
$655.01
|
| Rate for Payer: Coventry All Commercial |
$619.79
|
| Rate for Payer: Encore All Commercial |
$648.32
|
| Rate for Payer: Frontpath All Commercial |
$647.97
|
| Rate for Payer: Humana ChoiceCare |
$608.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.88
|
| Rate for Payer: PHCS All Commercial |
$528.23
|
| Rate for Payer: PHP All Commercial |
$534.15
|
| Rate for Payer: Sagamore Health Network All Products |
$543.73
|
| Rate for Payer: Signature Care EPO |
$584.58
|
| Rate for Payer: Signature Care PPO |
$619.79
|
| Rate for Payer: United Healthcare Commercial |
$555.00
|
|
|
HC U/S EXTR NON-VASC LMTD LT
|
Facility
|
OP
|
$891.27
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
1646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$828.88 |
| Rate for Payer: Aetna Commercial |
$752.23
|
| Rate for Payer: Aetna Medicare |
$285.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$511.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$557.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$327.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$313.73
|
| Rate for Payer: Cash Price |
$534.76
|
| Rate for Payer: Cash Price |
$534.76
|
| Rate for Payer: Centivo All Commercial |
$484.85
|
| Rate for Payer: Cigna All Commercial |
$769.17
|
| Rate for Payer: CORVEL All Commercial |
$828.88
|
| Rate for Payer: Coventry All Commercial |
$784.32
|
| Rate for Payer: Encore All Commercial |
$820.41
|
| Rate for Payer: Frontpath All Commercial |
$819.97
|
| Rate for Payer: Humana ChoiceCare |
$769.79
|
| Rate for Payer: Humana Medicare |
$285.21
|
| Rate for Payer: Lucent All Commercial |
$484.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$802.14
|
| Rate for Payer: Managed Health Services Medicaid |
$7.60
|
| Rate for Payer: MDWise Medicaid |
$7.60
|
| Rate for Payer: PHCS All Commercial |
$668.45
|
| Rate for Payer: PHP All Commercial |
$675.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$347.60
|
| Rate for Payer: Sagamore Health Network All Products |
$688.06
|
| Rate for Payer: Signature Care EPO |
$739.75
|
| Rate for Payer: Signature Care PPO |
$784.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$757.58
|
| Rate for Payer: United Healthcare Commercial |
$702.32
|
| Rate for Payer: United Healthcare Medicare |
$285.21
|
|
|
HC U/S EXTR NON-VASC LMTD LT
|
Facility
|
IP
|
$891.27
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
1646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$668.45 |
| Max. Negotiated Rate |
$828.88 |
| Rate for Payer: Aetna Commercial |
$770.06
|
| Rate for Payer: Cash Price |
$534.76
|
| Rate for Payer: Cigna All Commercial |
$769.17
|
| Rate for Payer: CORVEL All Commercial |
$828.88
|
| Rate for Payer: Coventry All Commercial |
$784.32
|
| Rate for Payer: Encore All Commercial |
$820.41
|
| Rate for Payer: Frontpath All Commercial |
$819.97
|
| Rate for Payer: Humana ChoiceCare |
$769.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$802.14
|
| Rate for Payer: PHCS All Commercial |
$668.45
|
| Rate for Payer: PHP All Commercial |
$675.94
|
| Rate for Payer: Sagamore Health Network All Products |
$688.06
|
| Rate for Payer: Signature Care EPO |
$739.75
|
| Rate for Payer: Signature Care PPO |
$784.32
|
| Rate for Payer: United Healthcare Commercial |
$702.32
|
|
|
HC U/S EXTR NON-VASC LMTD RT
|
Facility
|
OP
|
$840.70
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
11646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Aetna Commercial |
$709.55
|
| Rate for Payer: Aetna Medicare |
$269.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$260.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$482.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$525.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$295.93
|
| Rate for Payer: Cash Price |
$504.42
|
| Rate for Payer: Cash Price |
$504.42
|
| Rate for Payer: Centivo All Commercial |
$457.34
|
| Rate for Payer: Cigna All Commercial |
$725.52
|
| Rate for Payer: CORVEL All Commercial |
$781.85
|
| Rate for Payer: Coventry All Commercial |
$739.82
|
| Rate for Payer: Encore All Commercial |
$773.86
|
| Rate for Payer: Frontpath All Commercial |
$773.44
|
| Rate for Payer: Humana ChoiceCare |
$726.11
|
| Rate for Payer: Humana Medicare |
$269.02
|
| Rate for Payer: Lucent All Commercial |
$457.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.63
|
| Rate for Payer: Managed Health Services Medicaid |
$7.60
|
| Rate for Payer: MDWise Medicaid |
$7.60
|
| Rate for Payer: PHCS All Commercial |
$630.52
|
| Rate for Payer: PHP All Commercial |
$637.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.87
|
| Rate for Payer: Sagamore Health Network All Products |
$649.02
|
| Rate for Payer: Signature Care EPO |
$697.78
|
| Rate for Payer: Signature Care PPO |
$739.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$714.60
|
| Rate for Payer: United Healthcare Commercial |
$662.47
|
| Rate for Payer: United Healthcare Medicare |
$269.02
|
|
|
HC U/S EXTR NON-VASC LMTD RT
|
Facility
|
IP
|
$840.70
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
11646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$630.52 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Aetna Commercial |
$726.36
|
| Rate for Payer: Cash Price |
$504.42
|
| Rate for Payer: Cigna All Commercial |
$725.52
|
| Rate for Payer: CORVEL All Commercial |
$781.85
|
| Rate for Payer: Coventry All Commercial |
$739.82
|
| Rate for Payer: Encore All Commercial |
$773.86
|
| Rate for Payer: Frontpath All Commercial |
$773.44
|
| Rate for Payer: Humana ChoiceCare |
$726.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.63
|
| Rate for Payer: PHCS All Commercial |
$630.52
|
| Rate for Payer: PHP All Commercial |
$637.59
|
| Rate for Payer: Sagamore Health Network All Products |
$649.02
|
| Rate for Payer: Signature Care EPO |
$697.78
|
| Rate for Payer: Signature Care PPO |
$739.82
|
| Rate for Payer: United Healthcare Commercial |
$662.47
|
|
|
HC U/S GUIDANCE FOR NEEDLE PLCMNT
|
Facility
|
OP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1646943
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,145.09
|
| Rate for Payer: Aetna Medicare |
$434.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$420.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$779.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$848.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$499.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$477.57
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Centivo All Commercial |
$738.07
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Humana Medicare |
$434.16
|
| Rate for Payer: Lucent All Commercial |
$738.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: Managed Health Services Medicaid |
$27.66
|
| Rate for Payer: MDWise Medicaid |
$27.66
|
| Rate for Payer: PHCS All Commercial |
$1,017.55
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$529.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.40
|
| Rate for Payer: Signature Care EPO |
$1,126.09
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,153.23
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
| Rate for Payer: United Healthcare Medicare |
$434.16
|
|
|
HC U/S GUIDANCE FOR NEEDLE PLCMNT
|
Facility
|
IP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1646943
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,017.55 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,172.22
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: PHCS All Commercial |
$1,017.55
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.40
|
| Rate for Payer: Signature Care EPO |
$1,126.09
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
|
|
HC U/S GUIDANCE VASCULAR ACCESS
|
Facility
|
IP
|
$562.77
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1616937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$422.08 |
| Max. Negotiated Rate |
$523.38 |
| Rate for Payer: Aetna Commercial |
$486.23
|
| Rate for Payer: Cash Price |
$337.66
|
| Rate for Payer: Cigna All Commercial |
$485.67
|
| Rate for Payer: CORVEL All Commercial |
$523.38
|
| Rate for Payer: Coventry All Commercial |
$495.24
|
| Rate for Payer: Encore All Commercial |
$518.03
|
| Rate for Payer: Frontpath All Commercial |
$517.75
|
| Rate for Payer: Humana ChoiceCare |
$486.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.49
|
| Rate for Payer: PHCS All Commercial |
$422.08
|
| Rate for Payer: PHP All Commercial |
$426.80
|
| Rate for Payer: Sagamore Health Network All Products |
$434.46
|
| Rate for Payer: Signature Care EPO |
$467.10
|
| Rate for Payer: Signature Care PPO |
$495.24
|
| Rate for Payer: United Healthcare Commercial |
$443.46
|
|
|
HC U/S GUIDANCE VASCULAR ACCESS
|
Facility
|
OP
|
$562.77
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1616937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$523.38 |
| Rate for Payer: Aetna Commercial |
$474.98
|
| Rate for Payer: Aetna Medicare |
$180.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$174.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$323.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$351.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.10
|
| Rate for Payer: Cash Price |
$337.66
|
| Rate for Payer: Cash Price |
$337.66
|
| Rate for Payer: Centivo All Commercial |
$306.15
|
| Rate for Payer: Cigna All Commercial |
$485.67
|
| Rate for Payer: CORVEL All Commercial |
$523.38
|
| Rate for Payer: Coventry All Commercial |
$495.24
|
| Rate for Payer: Encore All Commercial |
$518.03
|
| Rate for Payer: Frontpath All Commercial |
$517.75
|
| Rate for Payer: Humana ChoiceCare |
$486.06
|
| Rate for Payer: Humana Medicare |
$180.09
|
| Rate for Payer: Lucent All Commercial |
$306.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.49
|
| Rate for Payer: Managed Health Services Medicaid |
$14.53
|
| Rate for Payer: MDWise Medicaid |
$14.53
|
| Rate for Payer: PHCS All Commercial |
$422.08
|
| Rate for Payer: PHP All Commercial |
$426.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$219.48
|
| Rate for Payer: Sagamore Health Network All Products |
$434.46
|
| Rate for Payer: Signature Care EPO |
$467.10
|
| Rate for Payer: Signature Care PPO |
$495.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$478.35
|
| Rate for Payer: United Healthcare Commercial |
$443.46
|
| Rate for Payer: United Healthcare Medicare |
$180.09
|
|
|
HC U/S GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1696937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,145.09
|
| Rate for Payer: Aetna Medicare |
$434.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$420.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$779.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$848.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$499.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$477.57
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Centivo All Commercial |
$738.07
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Humana Medicare |
$434.16
|
| Rate for Payer: Lucent All Commercial |
$738.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: Managed Health Services Medicaid |
$27.66
|
| Rate for Payer: MDWise Medicaid |
$27.66
|
| Rate for Payer: PHCS All Commercial |
$1,017.55
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$529.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.40
|
| Rate for Payer: Signature Care EPO |
$1,126.09
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,153.23
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
| Rate for Payer: United Healthcare Medicare |
$434.16
|
|
|
HC U/S GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1696937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,017.55 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,172.22
|
| Rate for Payer: Cash Price |
$814.04
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: PHCS All Commercial |
$1,017.55
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.40
|
| Rate for Payer: Signature Care EPO |
$1,126.09
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
|
|
HC U/S GUIDED NEEDLE PLACMNT SUBS
|
Facility
|
IP
|
$1,051.36
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1697937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$788.52 |
| Max. Negotiated Rate |
$977.76 |
| Rate for Payer: Aetna Commercial |
$908.38
|
| Rate for Payer: Cash Price |
$630.82
|
| Rate for Payer: Cigna All Commercial |
$907.32
|
| Rate for Payer: CORVEL All Commercial |
$977.76
|
| Rate for Payer: Coventry All Commercial |
$925.20
|
| Rate for Payer: Encore All Commercial |
$967.78
|
| Rate for Payer: Frontpath All Commercial |
$967.25
|
| Rate for Payer: Humana ChoiceCare |
$908.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$946.22
|
| Rate for Payer: PHCS All Commercial |
$788.52
|
| Rate for Payer: PHP All Commercial |
$797.35
|
| Rate for Payer: Sagamore Health Network All Products |
$811.65
|
| Rate for Payer: Signature Care EPO |
$872.63
|
| Rate for Payer: Signature Care PPO |
$925.20
|
| Rate for Payer: United Healthcare Commercial |
$828.47
|
|
