|
HC ACU VDU PLATE LEFT STD
|
Facility
IP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.60 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,969.92
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
|
|
HC ACU VDU PLATE RIGHT LONG
|
Facility
IP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.60 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,969.92
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
|
|
HC ACU VDU PLATE RIGHT LONG
|
Facility
OP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,924.32
|
| Rate for Payer: Aetna Medicare |
$752.40
|
| Rate for Payer: Anthem Exchange |
$1,309.40
|
| Rate for Payer: Anthem Medicare |
$752.40
|
| Rate for Payer: Anthem PPO |
$1,309.40
|
| Rate for Payer: Anthem Traditional |
$1,425.23
|
| Rate for Payer: Caresource Just 4 Me |
$865.26
|
| Rate for Payer: Caresource Medicare |
$827.64
|
| Rate for Payer: Centivo/Paragon All Products |
$1,162.80
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Humana Medicare |
$1,162.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,162.80
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$889.20
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,938.00
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare Medicare |
$752.40
|
|
|
HC ACU VDU PLATE RIGHT STD
|
Facility
IP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.60 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,969.92
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
|
|
HC ACU VDU PLATE RIGHT STD
|
Facility
OP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,924.32
|
| Rate for Payer: Aetna Medicare |
$752.40
|
| Rate for Payer: Anthem Exchange |
$1,309.40
|
| Rate for Payer: Anthem Medicare |
$752.40
|
| Rate for Payer: Anthem PPO |
$1,309.40
|
| Rate for Payer: Anthem Traditional |
$1,425.23
|
| Rate for Payer: Caresource Just 4 Me |
$865.26
|
| Rate for Payer: Caresource Medicare |
$827.64
|
| Rate for Payer: Centivo/Paragon All Products |
$1,162.80
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Humana Medicare |
$1,162.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,162.80
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$889.20
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,938.00
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare Medicare |
$752.40
|
|
|
HC ACU VOLAR LUNATE SUT PLATE
|
Facility
IP
|
$2,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.30 |
| Max. Negotiated Rate |
$1,946.86 |
| Rate for Payer: Aetna Commercial |
$1,827.36
|
| Rate for Payer: Cigna All Products |
$1,825.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,861.20
|
| Rate for Payer: Encore All Products |
$1,946.86
|
| Rate for Payer: Frontpath All Products |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$1,826.73
|
| Rate for Payer: Lutheran Preferred All Products |
$1,903.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,586.25
|
| Rate for Payer: PHP All Products |
$1,604.02
|
| Rate for Payer: Sagamore All Products |
$1,632.78
|
| Rate for Payer: Self Pay/Cash Rate |
$1,311.30
|
| Rate for Payer: Signature Care EPO |
$1,755.45
|
| Rate for Payer: Signature Care PPO |
$1,861.20
|
| Rate for Payer: United Healthcare Commercial |
$1,666.62
|
|
|
HC ACU VOLAR LUNATE SUT PLATE
|
Facility
OP
|
$2,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.95 |
| Max. Negotiated Rate |
$1,946.86 |
| Rate for Payer: Aetna Commercial |
$1,785.06
|
| Rate for Payer: Aetna Medicare |
$697.95
|
| Rate for Payer: Anthem Exchange |
$1,214.64
|
| Rate for Payer: Anthem Medicare |
$697.95
|
| Rate for Payer: Anthem PPO |
$1,214.64
|
| Rate for Payer: Anthem Traditional |
$1,322.09
|
| Rate for Payer: Caresource Just 4 Me |
$802.64
|
| Rate for Payer: Caresource Medicare |
$767.75
|
| Rate for Payer: Centivo/Paragon All Products |
$1,078.65
|
| Rate for Payer: Cigna All Products |
$1,825.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,861.20
|
| Rate for Payer: Encore All Products |
$1,946.86
|
| Rate for Payer: Frontpath All Products |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$1,826.73
|
| Rate for Payer: Humana Medicare |
$1,078.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,078.65
|
| Rate for Payer: Lutheran Preferred All Products |
$1,903.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,586.25
|
| Rate for Payer: PHP All Products |
$1,604.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$824.85
|
| Rate for Payer: Sagamore All Products |
$1,632.78
|
| Rate for Payer: Self Pay/Cash Rate |
$1,311.30
|
| Rate for Payer: Signature Care EPO |
$1,755.45
|
| Rate for Payer: Signature Care PPO |
$1,861.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,797.75
|
| Rate for Payer: United Healthcare Commercial |
$1,666.62
|
| Rate for Payer: United Healthcare Medicare |
$697.95
|
|
|
HC ACYLCARNITINE QT
|
Facility
OP
|
$170.07
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
63001447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$156.55 |
| Rate for Payer: Aetna Commercial |
$143.54
|
| Rate for Payer: Aetna Medicare |
$56.12
|
| Rate for Payer: Anthem Exchange |
$97.67
|
| Rate for Payer: Anthem Medicaid |
$16.87
|
| Rate for Payer: Anthem Medicare |
$56.12
|
| Rate for Payer: Anthem PPO |
$97.67
|
| Rate for Payer: Anthem Traditional |
$106.31
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$16.87
|
| Rate for Payer: Caresource Just 4 Me |
$64.54
|
| Rate for Payer: Caresource Medicare |
$61.74
|
| Rate for Payer: Centivo/Paragon All Products |
$86.74
|
| Rate for Payer: Cigna All Products |
$146.77
|
| Rate for Payer: Coventry/First Health All Products |
$149.66
|
| Rate for Payer: Encore All Products |
$156.55
|
| Rate for Payer: Frontpath All Products |
$156.46
|
| Rate for Payer: Humana ChoiceCare |
$146.89
|
| Rate for Payer: Humana Medicare |
$86.74
|
| Rate for Payer: Lucent/Coldwater Veneers |
$86.74
|
| Rate for Payer: Lutheran Preferred All Products |
$153.06
|
| Rate for Payer: Managed Health Services All Products |
$16.87
|
| Rate for Payer: MDWise All Products |
$16.87
|
| Rate for Payer: PHCS/Multiplan All Products |
$127.55
|
| Rate for Payer: PHP All Products |
$128.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$66.33
|
| Rate for Payer: Sagamore All Products |
$131.29
|
| Rate for Payer: Self Pay/Cash Rate |
$105.44
|
| Rate for Payer: Signature Care EPO |
$141.16
|
| Rate for Payer: Signature Care PPO |
$149.66
|
| Rate for Payer: Three Rivers Preferred All Products |
$144.56
|
| Rate for Payer: United Healthcare Commercial |
$134.02
|
| Rate for Payer: United Healthcare Medicare |
$56.12
|
|
|
HC ACYLCARNITINE QT
|
Facility
IP
|
$170.07
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
63001447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$156.55 |
| Rate for Payer: Aetna Commercial |
$146.94
|
| Rate for Payer: Cigna All Products |
$146.77
|
| Rate for Payer: Coventry/First Health All Products |
$149.66
|
| Rate for Payer: Encore All Products |
$156.55
|
| Rate for Payer: Frontpath All Products |
$156.46
|
| Rate for Payer: Humana ChoiceCare |
$146.89
|
| Rate for Payer: Lutheran Preferred All Products |
$153.06
|
| Rate for Payer: PHCS/Multiplan All Products |
$127.55
|
| Rate for Payer: PHP All Products |
$128.98
|
| Rate for Payer: Sagamore All Products |
$131.29
|
| Rate for Payer: Self Pay/Cash Rate |
$105.44
|
| Rate for Payer: Signature Care EPO |
$141.16
|
| Rate for Payer: Signature Care PPO |
$149.66
|
| Rate for Payer: United Healthcare Commercial |
$134.02
|
|
|
HC ADAPTER 3.2MM MEDTRONIC STYLE
|
Facility
OP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.61 |
| Max. Negotiated Rate |
$328.07 |
| Rate for Payer: Aetna Commercial |
$300.80
|
| Rate for Payer: Aetna Medicare |
$117.61
|
| Rate for Payer: Anthem Exchange |
$204.68
|
| Rate for Payer: Anthem Medicare |
$117.61
|
| Rate for Payer: Anthem PPO |
$204.68
|
| Rate for Payer: Anthem Traditional |
$222.79
|
| Rate for Payer: Caresource Just 4 Me |
$135.25
|
| Rate for Payer: Caresource Medicare |
$129.37
|
| Rate for Payer: Centivo/Paragon All Products |
$181.76
|
| Rate for Payer: Cigna All Products |
$307.57
|
| Rate for Payer: Coventry/First Health All Products |
$313.63
|
| Rate for Payer: Encore All Products |
$328.07
|
| Rate for Payer: Frontpath All Products |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Humana Medicare |
$181.76
|
| Rate for Payer: Lucent/Coldwater Veneers |
$181.76
|
| Rate for Payer: Lutheran Preferred All Products |
$320.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$267.30
|
| Rate for Payer: PHP All Products |
$270.29
|
| Rate for Payer: Plain Church Group Ministry All Products |
$139.00
|
| Rate for Payer: Sagamore All Products |
$275.14
|
| Rate for Payer: Self Pay/Cash Rate |
$220.97
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: Three Rivers Preferred All Products |
$302.94
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
| Rate for Payer: United Healthcare Medicare |
$117.61
|
|
|
HC ADAPTER 3.2MM MEDTRONIC STYLE
|
Facility
IP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.97 |
| Max. Negotiated Rate |
$328.07 |
| Rate for Payer: Aetna Commercial |
$307.93
|
| Rate for Payer: Cigna All Products |
$307.57
|
| Rate for Payer: Coventry/First Health All Products |
$313.63
|
| Rate for Payer: Encore All Products |
$328.07
|
| Rate for Payer: Frontpath All Products |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Lutheran Preferred All Products |
$320.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$267.30
|
| Rate for Payer: PHP All Products |
$270.29
|
| Rate for Payer: Sagamore All Products |
$275.14
|
| Rate for Payer: Self Pay/Cash Rate |
$220.97
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
|
|
HC ADAPTER MULTIPORT C-MPA-200
|
Facility
OP
|
$100.80
|
|
| Hospital Charge Code |
41602316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$92.79 |
| Rate for Payer: Signature Care PPO |
$88.70
|
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna Medicare |
$33.26
|
| Rate for Payer: Anthem Exchange |
$57.89
|
| Rate for Payer: Anthem Medicare |
$33.26
|
| Rate for Payer: Anthem PPO |
$57.89
|
| Rate for Payer: Anthem Traditional |
$63.01
|
| Rate for Payer: Caresource Just 4 Me |
$38.25
|
| Rate for Payer: Caresource Medicare |
$36.59
|
| Rate for Payer: Centivo/Paragon All Products |
$51.41
|
| Rate for Payer: Cigna All Products |
$86.99
|
| Rate for Payer: Coventry/First Health All Products |
$88.70
|
| Rate for Payer: Encore All Products |
$92.79
|
| Rate for Payer: Frontpath All Products |
$92.74
|
| Rate for Payer: Humana ChoiceCare |
$87.06
|
| Rate for Payer: Humana Medicare |
$51.41
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.41
|
| Rate for Payer: Lutheran Preferred All Products |
$90.72
|
| Rate for Payer: PHCS/Multiplan All Products |
$75.60
|
| Rate for Payer: PHP All Products |
$76.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$39.31
|
| Rate for Payer: Sagamore All Products |
$77.82
|
| Rate for Payer: Self Pay/Cash Rate |
$62.50
|
| Rate for Payer: Signature Care EPO |
$83.66
|
| Rate for Payer: Three Rivers Preferred All Products |
$85.68
|
| Rate for Payer: United Healthcare Commercial |
$79.43
|
| Rate for Payer: United Healthcare Medicare |
$33.26
|
|
|
HC ADAPTER MULTIPORT C-MPA-200
|
Facility
IP
|
$100.80
|
|
| Hospital Charge Code |
41602316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$92.79 |
| Rate for Payer: Aetna Commercial |
$87.09
|
| Rate for Payer: Cigna All Products |
$86.99
|
| Rate for Payer: Coventry/First Health All Products |
$88.70
|
| Rate for Payer: Encore All Products |
$92.79
|
| Rate for Payer: Frontpath All Products |
$92.74
|
| Rate for Payer: Humana ChoiceCare |
$87.06
|
| Rate for Payer: Lutheran Preferred All Products |
$90.72
|
| Rate for Payer: PHCS/Multiplan All Products |
$75.60
|
| Rate for Payer: PHP All Products |
$76.45
|
| Rate for Payer: Sagamore All Products |
$77.82
|
| Rate for Payer: Self Pay/Cash Rate |
$62.50
|
| Rate for Payer: Signature Care EPO |
$83.66
|
| Rate for Payer: Signature Care PPO |
$88.70
|
| Rate for Payer: United Healthcare Commercial |
$79.43
|
|
|
HC ADD APP COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
OP
|
$386.04
|
|
|
Service Code
|
CPT 29581 50,GP
|
| Hospital Charge Code |
1722010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$127.39 |
| Max. Negotiated Rate |
$355.35 |
| Rate for Payer: Aetna Commercial |
$325.82
|
| Rate for Payer: Aetna Medicare |
$127.39
|
| Rate for Payer: Anthem Exchange |
$221.70
|
| Rate for Payer: Anthem Medicaid |
$190.59
|
| Rate for Payer: Anthem Medicare |
$127.39
|
| Rate for Payer: Anthem PPO |
$221.70
|
| Rate for Payer: Anthem Traditional |
$241.31
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$190.59
|
| Rate for Payer: Caresource Just 4 Me |
$146.50
|
| Rate for Payer: Caresource Medicare |
$140.13
|
| Rate for Payer: Centivo/Paragon All Products |
$196.88
|
| Rate for Payer: Cigna All Products |
$333.15
|
| Rate for Payer: Coventry/First Health All Products |
$339.72
|
| Rate for Payer: Encore All Products |
$355.35
|
| Rate for Payer: Frontpath All Products |
$355.16
|
| Rate for Payer: Humana ChoiceCare |
$333.42
|
| Rate for Payer: Humana Medicare |
$196.88
|
| Rate for Payer: Lucent/Coldwater Veneers |
$196.88
|
| Rate for Payer: Lutheran Preferred All Products |
$347.44
|
| Rate for Payer: Managed Health Services All Products |
$190.59
|
| Rate for Payer: MDWise All Products |
$190.59
|
| Rate for Payer: PHCS/Multiplan All Products |
$289.53
|
| Rate for Payer: PHP All Products |
$292.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$150.56
|
| Rate for Payer: Sagamore All Products |
$298.02
|
| Rate for Payer: Self Pay/Cash Rate |
$239.34
|
| Rate for Payer: Signature Care EPO |
$320.41
|
| Rate for Payer: Signature Care PPO |
$339.72
|
| Rate for Payer: Three Rivers Preferred All Products |
$328.13
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Medicare |
$127.39
|
|
|
HC ADD APP COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
IP
|
$386.04
|
|
|
Service Code
|
CPT 29581 50,GP
|
| Hospital Charge Code |
1722010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$239.34 |
| Max. Negotiated Rate |
$355.35 |
| Rate for Payer: Aetna Commercial |
$333.54
|
| Rate for Payer: Cigna All Products |
$333.15
|
| Rate for Payer: Coventry/First Health All Products |
$339.72
|
| Rate for Payer: Encore All Products |
$355.35
|
| Rate for Payer: Frontpath All Products |
$355.16
|
| Rate for Payer: Humana ChoiceCare |
$333.42
|
| Rate for Payer: Lutheran Preferred All Products |
$347.44
|
| Rate for Payer: PHCS/Multiplan All Products |
$289.53
|
| Rate for Payer: PHP All Products |
$292.77
|
| Rate for Payer: Sagamore All Products |
$298.02
|
| Rate for Payer: Self Pay/Cash Rate |
$239.34
|
| Rate for Payer: Signature Care EPO |
$320.41
|
| Rate for Payer: Signature Care PPO |
$339.72
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
HC ADD APP COMPRESS UPPER ARM/FA/H/F PT
|
Facility
OP
|
$386.04
|
|
|
Service Code
|
CPT 29584 50,GP
|
| Hospital Charge Code |
1722013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$127.39 |
| Max. Negotiated Rate |
$355.35 |
| Rate for Payer: Aetna Commercial |
$325.82
|
| Rate for Payer: Aetna Medicare |
$127.39
|
| Rate for Payer: Anthem Exchange |
$221.70
|
| Rate for Payer: Anthem Medicaid |
$285.87
|
| Rate for Payer: Anthem Medicare |
$127.39
|
| Rate for Payer: Anthem PPO |
$221.70
|
| Rate for Payer: Anthem Traditional |
$241.31
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$285.87
|
| Rate for Payer: Caresource Just 4 Me |
$146.50
|
| Rate for Payer: Caresource Medicare |
$140.13
|
| Rate for Payer: Centivo/Paragon All Products |
$196.88
|
| Rate for Payer: Cigna All Products |
$333.15
|
| Rate for Payer: Coventry/First Health All Products |
$339.72
|
| Rate for Payer: Encore All Products |
$355.35
|
| Rate for Payer: Frontpath All Products |
$355.16
|
| Rate for Payer: Humana ChoiceCare |
$333.42
|
| Rate for Payer: Humana Medicare |
$196.88
|
| Rate for Payer: Lucent/Coldwater Veneers |
$196.88
|
| Rate for Payer: Lutheran Preferred All Products |
$347.44
|
| Rate for Payer: Managed Health Services All Products |
$285.87
|
| Rate for Payer: MDWise All Products |
$285.87
|
| Rate for Payer: PHCS/Multiplan All Products |
$289.53
|
| Rate for Payer: PHP All Products |
$292.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$150.56
|
| Rate for Payer: Sagamore All Products |
$298.02
|
| Rate for Payer: Self Pay/Cash Rate |
$239.34
|
| Rate for Payer: Signature Care EPO |
$320.41
|
| Rate for Payer: Signature Care PPO |
$339.72
|
| Rate for Payer: Three Rivers Preferred All Products |
$328.13
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Medicare |
$127.39
|
|
|
HC ADD APP COMPRESS UPPER ARM/FA/H/F PT
|
Facility
IP
|
$386.04
|
|
|
Service Code
|
CPT 29584 50,GP
|
| Hospital Charge Code |
1722013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$239.34 |
| Max. Negotiated Rate |
$355.35 |
| Rate for Payer: Aetna Commercial |
$333.54
|
| Rate for Payer: Cigna All Products |
$333.15
|
| Rate for Payer: Coventry/First Health All Products |
$339.72
|
| Rate for Payer: Encore All Products |
$355.35
|
| Rate for Payer: Frontpath All Products |
$355.16
|
| Rate for Payer: Humana ChoiceCare |
$333.42
|
| Rate for Payer: Lutheran Preferred All Products |
$347.44
|
| Rate for Payer: PHCS/Multiplan All Products |
$289.53
|
| Rate for Payer: PHP All Products |
$292.77
|
| Rate for Payer: Sagamore All Products |
$298.02
|
| Rate for Payer: Self Pay/Cash Rate |
$239.34
|
| Rate for Payer: Signature Care EPO |
$320.41
|
| Rate for Payer: Signature Care PPO |
$339.72
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
HC ADDL HIGH RESOLUTION
|
Facility
IP
|
$170.77
|
|
|
Service Code
|
CPT 88289
|
| Hospital Charge Code |
63002094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.88 |
| Max. Negotiated Rate |
$157.19 |
| Rate for Payer: Aetna Commercial |
$147.55
|
| Rate for Payer: Cigna All Products |
$147.37
|
| Rate for Payer: Coventry/First Health All Products |
$150.28
|
| Rate for Payer: Encore All Products |
$157.19
|
| Rate for Payer: Frontpath All Products |
$157.11
|
| Rate for Payer: Humana ChoiceCare |
$147.49
|
| Rate for Payer: Lutheran Preferred All Products |
$153.69
|
| Rate for Payer: PHCS/Multiplan All Products |
$128.08
|
| Rate for Payer: PHP All Products |
$129.51
|
| Rate for Payer: Sagamore All Products |
$131.83
|
| Rate for Payer: Self Pay/Cash Rate |
$105.88
|
| Rate for Payer: Signature Care EPO |
$141.74
|
| Rate for Payer: Signature Care PPO |
$150.28
|
| Rate for Payer: United Healthcare Commercial |
$134.57
|
|
|
HC ADDL HIGH RESOLUTION
|
Facility
OP
|
$170.77
|
|
|
Service Code
|
CPT 88289
|
| Hospital Charge Code |
63002094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$157.19 |
| Rate for Payer: Aetna Commercial |
$144.13
|
| Rate for Payer: Aetna Medicare |
$56.35
|
| Rate for Payer: Anthem Exchange |
$98.07
|
| Rate for Payer: Anthem Medicaid |
$34.43
|
| Rate for Payer: Anthem Medicare |
$56.35
|
| Rate for Payer: Anthem PPO |
$98.07
|
| Rate for Payer: Anthem Traditional |
$106.75
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$34.43
|
| Rate for Payer: Caresource Just 4 Me |
$64.81
|
| Rate for Payer: Caresource Medicare |
$61.99
|
| Rate for Payer: Centivo/Paragon All Products |
$87.09
|
| Rate for Payer: Cigna All Products |
$147.37
|
| Rate for Payer: Coventry/First Health All Products |
$150.28
|
| Rate for Payer: Encore All Products |
$157.19
|
| Rate for Payer: Frontpath All Products |
$157.11
|
| Rate for Payer: Humana ChoiceCare |
$147.49
|
| Rate for Payer: Humana Medicare |
$87.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$87.09
|
| Rate for Payer: Lutheran Preferred All Products |
$153.69
|
| Rate for Payer: Managed Health Services All Products |
$34.43
|
| Rate for Payer: MDWise All Products |
$34.43
|
| Rate for Payer: PHCS/Multiplan All Products |
$128.08
|
| Rate for Payer: PHP All Products |
$129.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$66.60
|
| Rate for Payer: Sagamore All Products |
$131.83
|
| Rate for Payer: Self Pay/Cash Rate |
$105.88
|
| Rate for Payer: Signature Care EPO |
$141.74
|
| Rate for Payer: Signature Care PPO |
$150.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$145.15
|
| Rate for Payer: United Healthcare Commercial |
$134.57
|
| Rate for Payer: United Healthcare Medicare |
$56.35
|
|
|
HC ADHESIVE SKIN TOPICAL SWIFTSET
|
Facility
OP
|
$103.69
|
|
| Hospital Charge Code |
41602239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$95.45 |
| Rate for Payer: Aetna Commercial |
$87.51
|
| Rate for Payer: Aetna Medicare |
$34.22
|
| Rate for Payer: Anthem Exchange |
$59.55
|
| Rate for Payer: Anthem Medicare |
$34.22
|
| Rate for Payer: Anthem PPO |
$59.55
|
| Rate for Payer: Anthem Traditional |
$64.82
|
| Rate for Payer: Caresource Just 4 Me |
$39.35
|
| Rate for Payer: Caresource Medicare |
$37.64
|
| Rate for Payer: Centivo/Paragon All Products |
$52.88
|
| Rate for Payer: Cigna All Products |
$89.48
|
| Rate for Payer: Coventry/First Health All Products |
$91.25
|
| Rate for Payer: Encore All Products |
$95.45
|
| Rate for Payer: Frontpath All Products |
$95.39
|
| Rate for Payer: Humana ChoiceCare |
$89.56
|
| Rate for Payer: Humana Medicare |
$52.88
|
| Rate for Payer: Lucent/Coldwater Veneers |
$52.88
|
| Rate for Payer: Lutheran Preferred All Products |
$93.32
|
| Rate for Payer: PHCS/Multiplan All Products |
$77.77
|
| Rate for Payer: PHP All Products |
$78.64
|
| Rate for Payer: Plain Church Group Ministry All Products |
$40.44
|
| Rate for Payer: Sagamore All Products |
$80.05
|
| Rate for Payer: Self Pay/Cash Rate |
$64.29
|
| Rate for Payer: Signature Care EPO |
$86.06
|
| Rate for Payer: Signature Care PPO |
$91.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$88.14
|
| Rate for Payer: United Healthcare Commercial |
$81.71
|
| Rate for Payer: United Healthcare Medicare |
$34.22
|
|
|
HC ADHESIVE SKIN TOPICAL SWIFTSET
|
Facility
IP
|
$103.69
|
|
| Hospital Charge Code |
41602239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$95.45 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Cigna All Products |
$89.48
|
| Rate for Payer: Coventry/First Health All Products |
$91.25
|
| Rate for Payer: Encore All Products |
$95.45
|
| Rate for Payer: Frontpath All Products |
$95.39
|
| Rate for Payer: Humana ChoiceCare |
$89.56
|
| Rate for Payer: Lutheran Preferred All Products |
$93.32
|
| Rate for Payer: PHCS/Multiplan All Products |
$77.77
|
| Rate for Payer: PHP All Products |
$78.64
|
| Rate for Payer: Sagamore All Products |
$80.05
|
| Rate for Payer: Self Pay/Cash Rate |
$64.29
|
| Rate for Payer: Signature Care EPO |
$86.06
|
| Rate for Payer: Signature Care PPO |
$91.25
|
| Rate for Payer: United Healthcare Commercial |
$81.71
|
|
|
HC ADL/SELF CARE/15 MIN-OT
|
Facility
IP
|
$137.25
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1738000
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.09 |
| Max. Negotiated Rate |
$126.34 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Cigna All Products |
$118.45
|
| Rate for Payer: Coventry/First Health All Products |
$120.78
|
| Rate for Payer: Encore All Products |
$126.34
|
| Rate for Payer: Frontpath All Products |
$126.27
|
| Rate for Payer: Humana ChoiceCare |
$118.54
|
| Rate for Payer: Lutheran Preferred All Products |
$123.53
|
| Rate for Payer: PHCS/Multiplan All Products |
$102.94
|
| Rate for Payer: PHP All Products |
$104.09
|
| Rate for Payer: Sagamore All Products |
$105.96
|
| Rate for Payer: Self Pay/Cash Rate |
$85.09
|
| Rate for Payer: Signature Care EPO |
$113.92
|
| Rate for Payer: Signature Care PPO |
$120.78
|
| Rate for Payer: United Healthcare Commercial |
$108.15
|
|
|
HC ADL/SELF CARE/15 MIN-OT
|
Facility
OP
|
$137.25
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1738000
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$126.34 |
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna Medicare |
$45.29
|
| Rate for Payer: Anthem Exchange |
$78.82
|
| Rate for Payer: Anthem Medicare |
$45.29
|
| Rate for Payer: Anthem PPO |
$78.82
|
| Rate for Payer: Anthem Traditional |
$85.79
|
| Rate for Payer: Caresource Just 4 Me |
$52.09
|
| Rate for Payer: Caresource Medicare |
$49.82
|
| Rate for Payer: Centivo/Paragon All Products |
$70.00
|
| Rate for Payer: Cigna All Products |
$118.45
|
| Rate for Payer: Coventry/First Health All Products |
$120.78
|
| Rate for Payer: Encore All Products |
$126.34
|
| Rate for Payer: Frontpath All Products |
$126.27
|
| Rate for Payer: Humana ChoiceCare |
$118.54
|
| Rate for Payer: Humana Medicare |
$70.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$70.00
|
| Rate for Payer: Lutheran Preferred All Products |
$123.53
|
| Rate for Payer: PHCS/Multiplan All Products |
$102.94
|
| Rate for Payer: PHP All Products |
$104.09
|
| Rate for Payer: Plain Church Group Ministry All Products |
$53.53
|
| Rate for Payer: Sagamore All Products |
$105.96
|
| Rate for Payer: Self Pay/Cash Rate |
$85.09
|
| Rate for Payer: Signature Care EPO |
$113.92
|
| Rate for Payer: Signature Care PPO |
$120.78
|
| Rate for Payer: Three Rivers Preferred All Products |
$116.66
|
| Rate for Payer: United Healthcare Commercial |
$108.15
|
| Rate for Payer: United Healthcare Medicare |
$45.29
|
|
|
HC ADL/SELF CARE/15 MIN-PT
|
Facility
IP
|
$134.83
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
1728000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.59 |
| Max. Negotiated Rate |
$124.11 |
| Rate for Payer: Aetna Commercial |
$116.49
|
| Rate for Payer: Cigna All Products |
$116.36
|
| Rate for Payer: Coventry/First Health All Products |
$118.65
|
| Rate for Payer: Encore All Products |
$124.11
|
| Rate for Payer: Frontpath All Products |
$124.04
|
| Rate for Payer: Humana ChoiceCare |
$116.45
|
| Rate for Payer: Lutheran Preferred All Products |
$121.35
|
| Rate for Payer: PHCS/Multiplan All Products |
$101.12
|
| Rate for Payer: PHP All Products |
$102.26
|
| Rate for Payer: Sagamore All Products |
$104.09
|
| Rate for Payer: Self Pay/Cash Rate |
$83.59
|
| Rate for Payer: Signature Care EPO |
$111.91
|
| Rate for Payer: Signature Care PPO |
$118.65
|
| Rate for Payer: United Healthcare Commercial |
$106.25
|
|
|
HC ADL/SELF CARE/15 MIN-PT
|
Facility
OP
|
$134.83
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
1728000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$124.11 |
| Rate for Payer: Aetna Commercial |
$113.80
|
| Rate for Payer: Aetna Medicare |
$44.49
|
| Rate for Payer: Anthem Exchange |
$77.43
|
| Rate for Payer: Anthem Medicare |
$44.49
|
| Rate for Payer: Anthem PPO |
$77.43
|
| Rate for Payer: Anthem Traditional |
$84.28
|
| Rate for Payer: Caresource Just 4 Me |
$51.17
|
| Rate for Payer: Caresource Medicare |
$48.94
|
| Rate for Payer: Centivo/Paragon All Products |
$68.76
|
| Rate for Payer: Cigna All Products |
$116.36
|
| Rate for Payer: Coventry/First Health All Products |
$118.65
|
| Rate for Payer: Encore All Products |
$124.11
|
| Rate for Payer: Frontpath All Products |
$124.04
|
| Rate for Payer: Humana ChoiceCare |
$116.45
|
| Rate for Payer: Humana Medicare |
$68.76
|
| Rate for Payer: Lucent/Coldwater Veneers |
$68.76
|
| Rate for Payer: Lutheran Preferred All Products |
$121.35
|
| Rate for Payer: PHCS/Multiplan All Products |
$101.12
|
| Rate for Payer: PHP All Products |
$102.26
|
| Rate for Payer: Plain Church Group Ministry All Products |
$52.58
|
| Rate for Payer: Sagamore All Products |
$104.09
|
| Rate for Payer: Self Pay/Cash Rate |
$83.59
|
| Rate for Payer: Signature Care EPO |
$111.91
|
| Rate for Payer: Signature Care PPO |
$118.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$114.61
|
| Rate for Payer: United Healthcare Commercial |
$106.25
|
| Rate for Payer: United Healthcare Medicare |
$44.49
|
|
