|
HC SPLINT; FINGER L 4 STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F3
|
| Hospital Charge Code |
31738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$264.85
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Centivo All Commercial |
$160.04
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Humana Medicare |
$160.04
|
| Rate for Payer: Lucent All Commercial |
$160.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.38
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.73
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
| Rate for Payer: United Healthcare Medicare |
$103.55
|
|
|
HC SPLINT; FINGER L 5 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F4
|
| Hospital Charge Code |
41738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER L 5 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F4
|
| Hospital Charge Code |
41738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER L 5 STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F4
|
| Hospital Charge Code |
41738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$264.85
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Centivo All Commercial |
$160.04
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Humana Medicare |
$160.04
|
| Rate for Payer: Lucent All Commercial |
$160.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.38
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.73
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
| Rate for Payer: United Healthcare Medicare |
$103.55
|
|
|
HC SPLINT; FINGER L 5 STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F4
|
| Hospital Charge Code |
41738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
|
|
HC SPLINT; FINGER R 10 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F9
|
| Hospital Charge Code |
91738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER R 10 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F9
|
| Hospital Charge Code |
91738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER R 10 STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F9
|
| Hospital Charge Code |
91738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
|
|
HC SPLINT; FINGER R 10 STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F9
|
| Hospital Charge Code |
91738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$264.85
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Centivo All Commercial |
$160.04
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Humana Medicare |
$160.04
|
| Rate for Payer: Lucent All Commercial |
$160.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.38
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.73
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
| Rate for Payer: United Healthcare Medicare |
$103.55
|
|
|
HC SPLINT; FINGER R 7 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F6
|
| Hospital Charge Code |
61738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER R 7 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F6
|
| Hospital Charge Code |
61738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER R 7 STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F6
|
| Hospital Charge Code |
61738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
|
|
HC SPLINT; FINGER R 7 STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F6
|
| Hospital Charge Code |
61738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$264.85
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Centivo All Commercial |
$160.04
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Humana Medicare |
$160.04
|
| Rate for Payer: Lucent All Commercial |
$160.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.38
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.73
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
| Rate for Payer: United Healthcare Medicare |
$103.55
|
|
|
HC SPLINT; FINGER R 8 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F7
|
| Hospital Charge Code |
71738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER R 8 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F7
|
| Hospital Charge Code |
71738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER R 8 STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F7
|
| Hospital Charge Code |
71738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$264.85
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Centivo All Commercial |
$160.04
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Humana Medicare |
$160.04
|
| Rate for Payer: Lucent All Commercial |
$160.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.38
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.73
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
| Rate for Payer: United Healthcare Medicare |
$103.55
|
|
|
HC SPLINT; FINGER R 8 STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F7
|
| Hospital Charge Code |
71738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
|
|
HC SPLINT; FINGER R 9 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F8
|
| Hospital Charge Code |
81738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER R 9 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F8
|
| Hospital Charge Code |
81738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER R 9 STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F8
|
| Hospital Charge Code |
81738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$264.85
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Centivo All Commercial |
$160.04
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Humana Medicare |
$160.04
|
| Rate for Payer: Lucent All Commercial |
$160.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.38
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.73
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
| Rate for Payer: United Healthcare Medicare |
$103.55
|
|
|
HC SPLINT; FINGER R 9 STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F8
|
| Hospital Charge Code |
81738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
|
|
HC SPLINT FINGER STAX #2
|
Facility
IP
|
$9.45
|
|
| Hospital Charge Code |
41601844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
|
|
HC SPLINT FINGER STAX #2
|
Facility
OP
|
$9.45
|
|
| Hospital Charge Code |
41601844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.98
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Centivo All Commercial |
$4.82
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Lucent All Commercial |
$4.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.69
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.03
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
|
|
HC SPLINT FINGER STAX #3
|
Facility
IP
|
$16.17
|
|
| Hospital Charge Code |
41601836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$15.04 |
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cigna All Commercial |
$13.95
|
| Rate for Payer: CORVEL All Commercial |
$15.04
|
| Rate for Payer: Coventry All Commercial |
$14.23
|
| Rate for Payer: Encore All Commercial |
$14.88
|
| Rate for Payer: Frontpath All Commercial |
$14.88
|
| Rate for Payer: Humana ChoiceCare |
$13.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$12.13
|
| Rate for Payer: PHP All Commercial |
$12.26
|
| Rate for Payer: Sagamore Health Network All Products |
$12.48
|
| Rate for Payer: Signature Care EPO |
$13.42
|
| Rate for Payer: Signature Care PPO |
$14.23
|
| Rate for Payer: United Healthcare Commercial |
$12.74
|
|
|
HC SPLINT FINGER STAX #3
|
Facility
OP
|
$16.17
|
|
| Hospital Charge Code |
41601836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$15.04 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.87
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Centivo All Commercial |
$8.25
|
| Rate for Payer: Cigna All Commercial |
$13.95
|
| Rate for Payer: CORVEL All Commercial |
$15.04
|
| Rate for Payer: Coventry All Commercial |
$14.23
|
| Rate for Payer: Encore All Commercial |
$14.88
|
| Rate for Payer: Frontpath All Commercial |
$14.88
|
| Rate for Payer: Humana ChoiceCare |
$13.97
|
| Rate for Payer: Humana Medicare |
$8.25
|
| Rate for Payer: Lucent All Commercial |
$8.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$12.13
|
| Rate for Payer: PHP All Commercial |
$12.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.31
|
| Rate for Payer: Sagamore Health Network All Products |
$12.48
|
| Rate for Payer: Signature Care EPO |
$13.42
|
| Rate for Payer: Signature Care PPO |
$14.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$12.74
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
|
