|
HC SPECIAL TREATMENT PROC
|
Facility
IP
|
$3,606.72
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
01547470
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,705.04 |
| Max. Negotiated Rate |
$3,354.25 |
| Rate for Payer: Aetna Commercial |
$3,116.21
|
| Rate for Payer: Cash Price |
$2,236.17
|
| Rate for Payer: Cigna All Commercial |
$3,112.60
|
| Rate for Payer: CORVEL All Commercial |
$3,354.25
|
| Rate for Payer: Coventry All Commercial |
$3,173.91
|
| Rate for Payer: Encore All Commercial |
$3,319.99
|
| Rate for Payer: Frontpath All Commercial |
$3,318.18
|
| Rate for Payer: Humana ChoiceCare |
$3,115.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,246.05
|
| Rate for Payer: PHCS All Commercial |
$2,705.04
|
| Rate for Payer: PHP All Commercial |
$2,735.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,784.39
|
| Rate for Payer: Signature Care EPO |
$2,993.58
|
| Rate for Payer: Signature Care PPO |
$3,173.91
|
| Rate for Payer: United Healthcare Commercial |
$2,842.10
|
|
|
HC SPECIAL TREATMENT PROC
|
Facility
OP
|
$3,606.72
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
01547470
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$125.27 |
| Max. Negotiated Rate |
$3,354.25 |
| Rate for Payer: Aetna Commercial |
$3,044.07
|
| Rate for Payer: Aetna Medicare |
$1,190.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,190.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,071.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,254.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$125.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,368.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,309.24
|
| Rate for Payer: Cash Price |
$2,236.17
|
| Rate for Payer: Cash Price |
$2,236.17
|
| Rate for Payer: Centivo All Commercial |
$1,839.43
|
| Rate for Payer: Cigna All Commercial |
$3,112.60
|
| Rate for Payer: CORVEL All Commercial |
$3,354.25
|
| Rate for Payer: Coventry All Commercial |
$3,173.91
|
| Rate for Payer: Encore All Commercial |
$3,319.99
|
| Rate for Payer: Frontpath All Commercial |
$3,318.18
|
| Rate for Payer: Humana ChoiceCare |
$3,115.12
|
| Rate for Payer: Humana Medicare |
$1,839.43
|
| Rate for Payer: Lucent All Commercial |
$1,839.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,246.05
|
| Rate for Payer: Managed Health Services Medicaid |
$125.27
|
| Rate for Payer: MDWise Medicaid |
$125.27
|
| Rate for Payer: PHCS All Commercial |
$2,705.04
|
| Rate for Payer: PHP All Commercial |
$2,735.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,406.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,784.39
|
| Rate for Payer: Signature Care EPO |
$2,993.58
|
| Rate for Payer: Signature Care PPO |
$3,173.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,065.71
|
| Rate for Payer: United Healthcare Commercial |
$2,842.10
|
| Rate for Payer: United Healthcare Medicare |
$1,190.22
|
|
|
HC SPERM COUNT-POST VAS
|
Facility
IP
|
$172.79
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
63001247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.59 |
| Max. Negotiated Rate |
$160.69 |
| Rate for Payer: Aetna Commercial |
$149.29
|
| Rate for Payer: Cash Price |
$107.13
|
| Rate for Payer: Cigna All Commercial |
$149.12
|
| Rate for Payer: CORVEL All Commercial |
$160.69
|
| Rate for Payer: Coventry All Commercial |
$152.05
|
| Rate for Payer: Encore All Commercial |
$159.05
|
| Rate for Payer: Frontpath All Commercial |
$158.96
|
| Rate for Payer: Humana ChoiceCare |
$149.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.51
|
| Rate for Payer: PHCS All Commercial |
$129.59
|
| Rate for Payer: PHP All Commercial |
$131.04
|
| Rate for Payer: Sagamore Health Network All Products |
$133.39
|
| Rate for Payer: Signature Care EPO |
$143.41
|
| Rate for Payer: Signature Care PPO |
$152.05
|
| Rate for Payer: United Healthcare Commercial |
$136.16
|
|
|
HC SPERM COUNT-POST VAS
|
Facility
OP
|
$172.79
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
63001247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$160.69 |
| Rate for Payer: Aetna Commercial |
$145.83
|
| Rate for Payer: Aetna Medicare |
$57.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.72
|
| Rate for Payer: Cash Price |
$107.13
|
| Rate for Payer: Cash Price |
$107.13
|
| Rate for Payer: Centivo All Commercial |
$88.12
|
| Rate for Payer: Cigna All Commercial |
$149.12
|
| Rate for Payer: CORVEL All Commercial |
$160.69
|
| Rate for Payer: Coventry All Commercial |
$152.05
|
| Rate for Payer: Encore All Commercial |
$159.05
|
| Rate for Payer: Frontpath All Commercial |
$158.96
|
| Rate for Payer: Humana ChoiceCare |
$149.24
|
| Rate for Payer: Humana Medicare |
$88.12
|
| Rate for Payer: Lucent All Commercial |
$88.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.51
|
| Rate for Payer: Managed Health Services Medicaid |
$11.90
|
| Rate for Payer: MDWise Medicaid |
$11.90
|
| Rate for Payer: PHCS All Commercial |
$129.59
|
| Rate for Payer: PHP All Commercial |
$131.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.39
|
| Rate for Payer: Sagamore Health Network All Products |
$133.39
|
| Rate for Payer: Signature Care EPO |
$143.41
|
| Rate for Payer: Signature Care PPO |
$152.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$146.87
|
| Rate for Payer: United Healthcare Commercial |
$136.16
|
| Rate for Payer: United Healthcare Medicare |
$57.02
|
|
|
HC SP GEN DEVICE AAC TX
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01742609
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC SP GEN DEVICE AAC TX
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01742609
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC SP GEN DEVICE THER SVCS-30 MIN
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01748074
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC SP GEN DEVICE THER SVCS-30 MIN
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01748074
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC SP GEN DEVICE THER SVCS-45 MIN
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01748075
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC SP GEN DEVICE THER SVCS-45 MIN
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01748075
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC SP GEN DEVICE THER SVCS-60 MIN
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01748076
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC SP GEN DEVICE THER SVCS-60 MIN
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
01748076
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC S PIN 1.8X3.5 HDLS
|
Facility
IP
|
$2,472.50
|
|
| Hospital Charge Code |
41607023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,854.38 |
| Max. Negotiated Rate |
$2,299.42 |
| Rate for Payer: Aetna Commercial |
$2,136.24
|
| Rate for Payer: Cash Price |
$1,532.95
|
| Rate for Payer: Cigna All Commercial |
$2,133.77
|
| Rate for Payer: CORVEL All Commercial |
$2,299.42
|
| Rate for Payer: Coventry All Commercial |
$2,175.80
|
| Rate for Payer: Encore All Commercial |
$2,275.94
|
| Rate for Payer: Frontpath All Commercial |
$2,274.70
|
| Rate for Payer: Humana ChoiceCare |
$2,135.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,225.25
|
| Rate for Payer: PHCS All Commercial |
$1,854.38
|
| Rate for Payer: PHP All Commercial |
$1,875.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,908.77
|
| Rate for Payer: Signature Care EPO |
$2,052.18
|
| Rate for Payer: Signature Care PPO |
$2,175.80
|
| Rate for Payer: United Healthcare Commercial |
$1,948.33
|
|
|
HC S PIN 1.8X3.5 HDLS
|
Facility
OP
|
$2,472.50
|
|
| Hospital Charge Code |
41607023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,299.42 |
| Rate for Payer: Aetna Commercial |
$2,086.79
|
| Rate for Payer: Aetna Medicare |
$815.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$815.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,419.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,545.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$938.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$897.52
|
| Rate for Payer: Cash Price |
$1,532.95
|
| Rate for Payer: Cash Price |
$1,532.95
|
| Rate for Payer: Centivo All Commercial |
$1,260.98
|
| Rate for Payer: Cigna All Commercial |
$2,133.77
|
| Rate for Payer: CORVEL All Commercial |
$2,299.42
|
| Rate for Payer: Coventry All Commercial |
$2,175.80
|
| Rate for Payer: Encore All Commercial |
$2,275.94
|
| Rate for Payer: Frontpath All Commercial |
$2,274.70
|
| Rate for Payer: Humana ChoiceCare |
$2,135.50
|
| Rate for Payer: Humana Medicare |
$1,260.98
|
| Rate for Payer: Lucent All Commercial |
$1,260.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,225.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,854.38
|
| Rate for Payer: PHP All Commercial |
$1,875.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$964.28
|
| Rate for Payer: Sagamore Health Network All Products |
$1,908.77
|
| Rate for Payer: Signature Care EPO |
$2,052.18
|
| Rate for Payer: Signature Care PPO |
$2,175.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,101.62
|
| Rate for Payer: United Healthcare Commercial |
$1,948.33
|
| Rate for Payer: United Healthcare Medicare |
$815.92
|
|
|
HC SPINAL FLUID CELL CT
|
Facility
IP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.39 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$124.86
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cigna All Commercial |
$124.72
|
| Rate for Payer: CORVEL All Commercial |
$134.40
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: PHCS All Commercial |
$108.39
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.95
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: United Healthcare Commercial |
$113.88
|
|
|
HC SPINAL FLUID CELL CT
|
Facility
OP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Aetna Medicare |
$47.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.46
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Centivo All Commercial |
$73.70
|
| Rate for Payer: Cigna All Commercial |
$124.72
|
| Rate for Payer: CORVEL All Commercial |
$134.40
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.82
|
| Rate for Payer: Humana Medicare |
$73.70
|
| Rate for Payer: Lucent All Commercial |
$73.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: Managed Health Services Medicaid |
$4.72
|
| Rate for Payer: MDWise Medicaid |
$4.72
|
| Rate for Payer: PHCS All Commercial |
$108.39
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.36
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.95
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.84
|
| Rate for Payer: United Healthcare Commercial |
$113.88
|
| Rate for Payer: United Healthcare Medicare |
$47.69
|
|
|
HC SPINAL FLUID GLUCOSE
|
Facility
IP
|
$113.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$98.39
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.22
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.22
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
|
|
HC SPINAL FLUID GLUCOSE
|
Facility
OP
|
$113.88
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
63001116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$96.12
|
| Rate for Payer: Aetna Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.34
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Centivo All Commercial |
$58.08
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.22
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Humana Medicare |
$58.08
|
| Rate for Payer: Lucent All Commercial |
$58.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: Managed Health Services Medicaid |
$3.93
|
| Rate for Payer: MDWise Medicaid |
$3.93
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.41
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.80
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
| Rate for Payer: United Healthcare Medicare |
$37.58
|
|
|
HC SPINAL FLUID PROTEIN
|
Facility
IP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.96 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: PHCS All Commercial |
$92.96
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
|
|
HC SPINAL FLUID PROTEIN
|
Facility
OP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$104.61
|
| Rate for Payer: Aetna Medicare |
$40.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.99
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Centivo All Commercial |
$63.21
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Humana Medicare |
$63.21
|
| Rate for Payer: Lucent All Commercial |
$63.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: Managed Health Services Medicaid |
$4.00
|
| Rate for Payer: MDWise Medicaid |
$4.00
|
| Rate for Payer: PHCS All Commercial |
$92.96
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.34
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.35
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
| Rate for Payer: United Healthcare Medicare |
$40.90
|
|
|
HC S PLATE VARIAX COMP 90 7-H
|
Facility
OP
|
$2,811.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,614.79 |
| Rate for Payer: Aetna Commercial |
$2,372.99
|
| Rate for Payer: Aetna Medicare |
$927.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$927.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,614.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,757.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,067.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,020.61
|
| Rate for Payer: Cash Price |
$1,743.19
|
| Rate for Payer: Cash Price |
$1,743.19
|
| Rate for Payer: Centivo All Commercial |
$1,433.92
|
| Rate for Payer: Cigna All Commercial |
$2,426.41
|
| Rate for Payer: CORVEL All Commercial |
$2,614.79
|
| Rate for Payer: Coventry All Commercial |
$2,474.21
|
| Rate for Payer: Encore All Commercial |
$2,588.08
|
| Rate for Payer: Frontpath All Commercial |
$2,586.67
|
| Rate for Payer: Humana ChoiceCare |
$2,428.38
|
| Rate for Payer: Humana Medicare |
$1,433.92
|
| Rate for Payer: Lucent All Commercial |
$1,433.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,530.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,108.70
|
| Rate for Payer: PHP All Commercial |
$2,132.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,096.52
|
| Rate for Payer: Sagamore Health Network All Products |
$2,170.56
|
| Rate for Payer: Signature Care EPO |
$2,333.63
|
| Rate for Payer: Signature Care PPO |
$2,474.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,389.86
|
| Rate for Payer: United Healthcare Commercial |
$2,215.54
|
| Rate for Payer: United Healthcare Medicare |
$927.83
|
|
|
HC S PLATE VARIAX COMP 90 7-H
|
Facility
IP
|
$2,811.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.70 |
| Max. Negotiated Rate |
$2,614.79 |
| Rate for Payer: Aetna Commercial |
$2,429.22
|
| Rate for Payer: Cash Price |
$1,743.19
|
| Rate for Payer: Cigna All Commercial |
$2,426.41
|
| Rate for Payer: CORVEL All Commercial |
$2,614.79
|
| Rate for Payer: Coventry All Commercial |
$2,474.21
|
| Rate for Payer: Encore All Commercial |
$2,588.08
|
| Rate for Payer: Frontpath All Commercial |
$2,586.67
|
| Rate for Payer: Humana ChoiceCare |
$2,428.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,530.44
|
| Rate for Payer: PHCS All Commercial |
$2,108.70
|
| Rate for Payer: PHP All Commercial |
$2,132.32
|
| Rate for Payer: Sagamore Health Network All Products |
$2,170.56
|
| Rate for Payer: Signature Care EPO |
$2,333.63
|
| Rate for Payer: Signature Care PPO |
$2,474.21
|
| Rate for Payer: United Healthcare Commercial |
$2,215.54
|
|
|
HC S PLATE VOLAR NRW XXL 2.7 8-H
|
Facility
OP
|
$9,903.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,210.35 |
| Rate for Payer: Aetna Commercial |
$8,358.64
|
| Rate for Payer: Aetna Medicare |
$3,268.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,268.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,687.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,190.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,758.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,595.01
|
| Rate for Payer: Cash Price |
$6,140.23
|
| Rate for Payer: Cash Price |
$6,140.23
|
| Rate for Payer: Centivo All Commercial |
$5,050.84
|
| Rate for Payer: Cigna All Commercial |
$8,546.81
|
| Rate for Payer: CORVEL All Commercial |
$9,210.35
|
| Rate for Payer: Coventry All Commercial |
$8,715.17
|
| Rate for Payer: Encore All Commercial |
$9,116.26
|
| Rate for Payer: Frontpath All Commercial |
$9,111.31
|
| Rate for Payer: Humana ChoiceCare |
$8,553.74
|
| Rate for Payer: Humana Medicare |
$5,050.84
|
| Rate for Payer: Lucent All Commercial |
$5,050.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,913.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,427.70
|
| Rate for Payer: PHP All Commercial |
$7,510.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,862.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,645.58
|
| Rate for Payer: Signature Care EPO |
$8,219.99
|
| Rate for Payer: Signature Care PPO |
$8,715.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,418.06
|
| Rate for Payer: United Healthcare Commercial |
$7,804.04
|
| Rate for Payer: United Healthcare Medicare |
$3,268.19
|
|
|
HC S PLATE VOLAR NRW XXL 2.7 8-H
|
Facility
IP
|
$9,903.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,427.70 |
| Max. Negotiated Rate |
$9,210.35 |
| Rate for Payer: Aetna Commercial |
$8,556.71
|
| Rate for Payer: Cash Price |
$6,140.23
|
| Rate for Payer: Cigna All Commercial |
$8,546.81
|
| Rate for Payer: CORVEL All Commercial |
$9,210.35
|
| Rate for Payer: Coventry All Commercial |
$8,715.17
|
| Rate for Payer: Encore All Commercial |
$9,116.26
|
| Rate for Payer: Frontpath All Commercial |
$9,111.31
|
| Rate for Payer: Humana ChoiceCare |
$8,553.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,913.24
|
| Rate for Payer: PHCS All Commercial |
$7,427.70
|
| Rate for Payer: PHP All Commercial |
$7,510.89
|
| Rate for Payer: Sagamore Health Network All Products |
$7,645.58
|
| Rate for Payer: Signature Care EPO |
$8,219.99
|
| Rate for Payer: Signature Care PPO |
$8,715.17
|
| Rate for Payer: United Healthcare Commercial |
$7,804.04
|
|
|
HC SPLINT 3PT HINGED LEFT LG
|
Facility
OP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| Rate for Payer: Aetna Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.53
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Centivo All Commercial |
$274.71
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Humana Medicare |
$274.71
|
| Rate for Payer: Lucent All Commercial |
$274.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.07
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$457.85
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
| Rate for Payer: United Healthcare Medicare |
$177.75
|
|
