|
HC SPLINT; L THUMB DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,FA
|
| Hospital Charge Code |
01738071
|
|
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; L THUMB STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,FA
|
| Hospital Charge Code |
01738072
|
|
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; L THUMB STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,FA
|
| Hospital Charge Code |
01738072
|
|
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 OT DORSAL RESTING LEFT
|
Facility
IP
|
$616.84
|
|
| Hospital Charge Code |
41601808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$462.63 |
| Max. Negotiated Rate |
$573.66 |
| Rate for Payer: Aetna Commercial |
$532.95
|
| Rate for Payer: Cash Price |
$382.44
|
| Rate for Payer: Cigna All Commercial |
$532.33
|
| Rate for Payer: CORVEL All Commercial |
$573.66
|
| Rate for Payer: Coventry All Commercial |
$542.82
|
| Rate for Payer: Encore All Commercial |
$567.80
|
| Rate for Payer: Frontpath All Commercial |
$567.49
|
| Rate for Payer: Humana ChoiceCare |
$532.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.16
|
| Rate for Payer: PHCS All Commercial |
$462.63
|
| Rate for Payer: PHP All Commercial |
$467.81
|
| Rate for Payer: Sagamore Health Network All Products |
$476.20
|
| Rate for Payer: Signature Care EPO |
$511.98
|
| Rate for Payer: Signature Care PPO |
$542.82
|
| Rate for Payer: United Healthcare Commercial |
$486.07
|
|
|
HC SPLINT OT DORSAL RESTING LEFT
|
Facility
OP
|
$616.84
|
|
| Hospital Charge Code |
41601808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$573.66 |
| Rate for Payer: Aetna Commercial |
$520.61
|
| Rate for Payer: Aetna Medicare |
$203.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.91
|
| Rate for Payer: Cash Price |
$382.44
|
| Rate for Payer: Cash Price |
$382.44
|
| Rate for Payer: Centivo All Commercial |
$314.59
|
| Rate for Payer: Cigna All Commercial |
$532.33
|
| Rate for Payer: CORVEL All Commercial |
$573.66
|
| Rate for Payer: Coventry All Commercial |
$542.82
|
| Rate for Payer: Encore All Commercial |
$567.80
|
| Rate for Payer: Frontpath All Commercial |
$567.49
|
| Rate for Payer: Humana ChoiceCare |
$532.76
|
| Rate for Payer: Humana Medicare |
$314.59
|
| Rate for Payer: Lucent All Commercial |
$314.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.16
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$462.63
|
| Rate for Payer: PHP All Commercial |
$467.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.57
|
| Rate for Payer: Sagamore Health Network All Products |
$476.20
|
| Rate for Payer: Signature Care EPO |
$511.98
|
| Rate for Payer: Signature Care PPO |
$542.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.31
|
| Rate for Payer: United Healthcare Commercial |
$486.07
|
| Rate for Payer: United Healthcare Medicare |
$203.56
|
|
|
HC SPLINT OT DORSAL RESTING RIGHT
|
Facility
OP
|
$616.84
|
|
| Hospital Charge Code |
41601810
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$573.66 |
| Rate for Payer: Aetna Commercial |
$520.61
|
| Rate for Payer: Aetna Medicare |
$203.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.91
|
| Rate for Payer: Cash Price |
$382.44
|
| Rate for Payer: Cash Price |
$382.44
|
| Rate for Payer: Centivo All Commercial |
$314.59
|
| Rate for Payer: Cigna All Commercial |
$532.33
|
| Rate for Payer: CORVEL All Commercial |
$573.66
|
| Rate for Payer: Coventry All Commercial |
$542.82
|
| Rate for Payer: Encore All Commercial |
$567.80
|
| Rate for Payer: Frontpath All Commercial |
$567.49
|
| Rate for Payer: Humana ChoiceCare |
$532.76
|
| Rate for Payer: Humana Medicare |
$314.59
|
| Rate for Payer: Lucent All Commercial |
$314.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.16
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$462.63
|
| Rate for Payer: PHP All Commercial |
$467.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.57
|
| Rate for Payer: Sagamore Health Network All Products |
$476.20
|
| Rate for Payer: Signature Care EPO |
$511.98
|
| Rate for Payer: Signature Care PPO |
$542.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.31
|
| Rate for Payer: United Healthcare Commercial |
$486.07
|
| Rate for Payer: United Healthcare Medicare |
$203.56
|
|
|
HC SPLINT OT DORSAL RESTING RIGHT
|
Facility
IP
|
$616.84
|
|
| Hospital Charge Code |
41601810
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$462.63 |
| Max. Negotiated Rate |
$573.66 |
| Rate for Payer: Aetna Commercial |
$532.95
|
| Rate for Payer: Cash Price |
$382.44
|
| Rate for Payer: Cigna All Commercial |
$532.33
|
| Rate for Payer: CORVEL All Commercial |
$573.66
|
| Rate for Payer: Coventry All Commercial |
$542.82
|
| Rate for Payer: Encore All Commercial |
$567.80
|
| Rate for Payer: Frontpath All Commercial |
$567.49
|
| Rate for Payer: Humana ChoiceCare |
$532.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.16
|
| Rate for Payer: PHCS All Commercial |
$462.63
|
| Rate for Payer: PHP All Commercial |
$467.81
|
| Rate for Payer: Sagamore Health Network All Products |
$476.20
|
| Rate for Payer: Signature Care EPO |
$511.98
|
| Rate for Payer: Signature Care PPO |
$542.82
|
| Rate for Payer: United Healthcare Commercial |
$486.07
|
|
|
HC SPLINT POLYCENTRIC 3 POINT HINGED UD
|
Facility
OP
|
$538.65
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
41601827
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$177.75 |
| 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 |
$310.09
|
| 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 |
$310.09
|
| Rate for Payer: MDWise Medicaid |
$310.09
|
| 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
|
|
|
HC SPLINT POLYCENTRIC 3 POINT HINGED UD
|
Facility
IP
|
$538.65
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
41601827
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$465.39
|
| Rate for Payer: Cash Price |
$333.96
|
| 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: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| 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: United Healthcare Commercial |
$424.46
|
|
|
HC SPLINT POSTERIOR LEG LG
|
Facility
OP
|
$438.90
|
|
| Hospital Charge Code |
41601846
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$408.18 |
| Rate for Payer: Aetna Commercial |
$370.43
|
| Rate for Payer: Aetna Medicare |
$144.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$252.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$274.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.32
|
| Rate for Payer: Cash Price |
$272.12
|
| Rate for Payer: Centivo All Commercial |
$223.84
|
| Rate for Payer: Cigna All Commercial |
$378.77
|
| Rate for Payer: CORVEL All Commercial |
$408.18
|
| Rate for Payer: Coventry All Commercial |
$386.23
|
| Rate for Payer: Encore All Commercial |
$404.01
|
| Rate for Payer: Frontpath All Commercial |
$403.79
|
| Rate for Payer: Humana ChoiceCare |
$379.08
|
| Rate for Payer: Humana Medicare |
$223.84
|
| Rate for Payer: Lucent All Commercial |
$223.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$395.01
|
| Rate for Payer: PHCS All Commercial |
$329.18
|
| Rate for Payer: PHP All Commercial |
$332.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.17
|
| Rate for Payer: Sagamore Health Network All Products |
$338.83
|
| Rate for Payer: Signature Care EPO |
$364.29
|
| Rate for Payer: Signature Care PPO |
$386.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$373.06
|
| Rate for Payer: United Healthcare Commercial |
$345.85
|
| Rate for Payer: United Healthcare Medicare |
$144.84
|
|
|
HC SPLINT POSTERIOR LEG LG
|
Facility
IP
|
$438.90
|
|
| Hospital Charge Code |
41601846
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.18 |
| Max. Negotiated Rate |
$408.18 |
| Rate for Payer: Aetna Commercial |
$379.21
|
| Rate for Payer: Cash Price |
$272.12
|
| Rate for Payer: Cigna All Commercial |
$378.77
|
| Rate for Payer: CORVEL All Commercial |
$408.18
|
| Rate for Payer: Coventry All Commercial |
$386.23
|
| Rate for Payer: Encore All Commercial |
$404.01
|
| Rate for Payer: Frontpath All Commercial |
$403.79
|
| Rate for Payer: Humana ChoiceCare |
$379.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$395.01
|
| Rate for Payer: PHCS All Commercial |
$329.18
|
| Rate for Payer: PHP All Commercial |
$332.86
|
| Rate for Payer: Sagamore Health Network All Products |
$338.83
|
| Rate for Payer: Signature Care EPO |
$364.29
|
| Rate for Payer: Signature Care PPO |
$386.23
|
| Rate for Payer: United Healthcare Commercial |
$345.85
|
|
|
HC SPLINT; R THUMB DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F5
|
| Hospital Charge Code |
51738071
|
|
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; R THUMB DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F5
|
| Hospital Charge Code |
51738071
|
|
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; R THUMB STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F5
|
| Hospital Charge Code |
51738072
|
|
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; R THUMB STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F5
|
| Hospital Charge Code |
51738072
|
|
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; SHORT ARM STATIC-OT
|
Facility
IP
|
$438.60
|
|
|
Service Code
|
CPT 29125 GO
|
| Hospital Charge Code |
01738076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$407.90 |
| Rate for Payer: Aetna Commercial |
$378.95
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Cigna All Commercial |
$378.51
|
| Rate for Payer: CORVEL All Commercial |
$407.90
|
| Rate for Payer: Coventry All Commercial |
$385.97
|
| Rate for Payer: Encore All Commercial |
$403.73
|
| Rate for Payer: Frontpath All Commercial |
$403.51
|
| Rate for Payer: Humana ChoiceCare |
$378.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.74
|
| Rate for Payer: PHCS All Commercial |
$328.95
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Sagamore Health Network All Products |
$338.60
|
| Rate for Payer: Signature Care EPO |
$364.04
|
| Rate for Payer: Signature Care PPO |
$385.97
|
| Rate for Payer: United Healthcare Commercial |
$345.62
|
|
|
HC SPLINT; SHORT ARM STATIC-OT
|
Facility
OP
|
$438.60
|
|
|
Service Code
|
CPT 29125 GO
|
| Hospital Charge Code |
01738076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$407.90 |
| Rate for Payer: Aetna Commercial |
$370.18
|
| Rate for Payer: Aetna Medicare |
$144.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$251.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$274.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.21
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Centivo All Commercial |
$223.69
|
| Rate for Payer: Cigna All Commercial |
$378.51
|
| Rate for Payer: CORVEL All Commercial |
$407.90
|
| Rate for Payer: Coventry All Commercial |
$385.97
|
| Rate for Payer: Encore All Commercial |
$403.73
|
| Rate for Payer: Frontpath All Commercial |
$403.51
|
| Rate for Payer: Humana ChoiceCare |
$378.82
|
| Rate for Payer: Humana Medicare |
$223.69
|
| Rate for Payer: Lucent All Commercial |
$223.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.74
|
| Rate for Payer: PHCS All Commercial |
$328.95
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.05
|
| Rate for Payer: Sagamore Health Network All Products |
$338.60
|
| Rate for Payer: Signature Care EPO |
$364.04
|
| Rate for Payer: Signature Care PPO |
$385.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.81
|
| Rate for Payer: United Healthcare Commercial |
$345.62
|
| Rate for Payer: United Healthcare Medicare |
$144.74
|
|
|
HC SPLINT THUMB ARTH S/M
|
Facility
IP
|
$74.34
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
41601867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$69.14 |
| Rate for Payer: Aetna Commercial |
$64.23
|
| Rate for Payer: Cash Price |
$46.09
|
| Rate for Payer: Cigna All Commercial |
$64.16
|
| Rate for Payer: CORVEL All Commercial |
$69.14
|
| Rate for Payer: Coventry All Commercial |
$65.42
|
| Rate for Payer: Encore All Commercial |
$68.43
|
| Rate for Payer: Frontpath All Commercial |
$68.39
|
| Rate for Payer: Humana ChoiceCare |
$64.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.91
|
| Rate for Payer: PHCS All Commercial |
$55.76
|
| Rate for Payer: PHP All Commercial |
$56.38
|
| Rate for Payer: Sagamore Health Network All Products |
$57.39
|
| Rate for Payer: Signature Care EPO |
$61.70
|
| Rate for Payer: Signature Care PPO |
$65.42
|
| Rate for Payer: United Healthcare Commercial |
$58.58
|
|
|
HC SPLINT THUMB ARTH S/M
|
Facility
OP
|
$74.34
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
41601867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$69.14 |
| Rate for Payer: Aetna Commercial |
$62.74
|
| Rate for Payer: Aetna Medicare |
$24.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.99
|
| Rate for Payer: Cash Price |
$46.09
|
| Rate for Payer: Cash Price |
$46.09
|
| Rate for Payer: Centivo All Commercial |
$37.91
|
| Rate for Payer: Cigna All Commercial |
$64.16
|
| Rate for Payer: CORVEL All Commercial |
$69.14
|
| Rate for Payer: Coventry All Commercial |
$65.42
|
| Rate for Payer: Encore All Commercial |
$68.43
|
| Rate for Payer: Frontpath All Commercial |
$68.39
|
| Rate for Payer: Humana ChoiceCare |
$64.21
|
| Rate for Payer: Humana Medicare |
$37.91
|
| Rate for Payer: Lucent All Commercial |
$37.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.91
|
| Rate for Payer: Managed Health Services Medicaid |
$27.19
|
| Rate for Payer: MDWise Medicaid |
$27.19
|
| Rate for Payer: PHCS All Commercial |
$55.76
|
| Rate for Payer: PHP All Commercial |
$56.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.99
|
| Rate for Payer: Sagamore Health Network All Products |
$57.39
|
| Rate for Payer: Signature Care EPO |
$61.70
|
| Rate for Payer: Signature Care PPO |
$65.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.19
|
| Rate for Payer: United Healthcare Commercial |
$58.58
|
| Rate for Payer: United Healthcare Medicare |
$24.53
|
|
|
HC SPLINT ULNAR DEV MED LEFT
|
Facility
OP
|
$318.50
|
|
|
Service Code
|
CPT L3809
|
| Hospital Charge Code |
41607071
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.10 |
| Max. Negotiated Rate |
$296.20 |
| Rate for Payer: Aetna Commercial |
$268.81
|
| Rate for Payer: Aetna Medicare |
$105.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$199.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.62
|
| Rate for Payer: Cash Price |
$197.47
|
| Rate for Payer: Cash Price |
$197.47
|
| Rate for Payer: Centivo All Commercial |
$162.44
|
| Rate for Payer: Cigna All Commercial |
$274.87
|
| Rate for Payer: CORVEL All Commercial |
$296.20
|
| Rate for Payer: Coventry All Commercial |
$280.28
|
| Rate for Payer: Encore All Commercial |
$293.18
|
| Rate for Payer: Frontpath All Commercial |
$293.02
|
| Rate for Payer: Humana ChoiceCare |
$275.09
|
| Rate for Payer: Humana Medicare |
$162.44
|
| Rate for Payer: Lucent All Commercial |
$162.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.65
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$238.88
|
| Rate for Payer: PHP All Commercial |
$241.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.22
|
| Rate for Payer: Sagamore Health Network All Products |
$245.88
|
| Rate for Payer: Signature Care EPO |
$264.36
|
| Rate for Payer: Signature Care PPO |
$280.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$270.72
|
| Rate for Payer: United Healthcare Commercial |
$250.98
|
| Rate for Payer: United Healthcare Medicare |
$105.10
|
|
|
HC SPLINT ULNAR DEV MED LEFT
|
Facility
IP
|
$318.50
|
|
|
Service Code
|
CPT L3809
|
| Hospital Charge Code |
41607071
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$296.20 |
| Rate for Payer: Aetna Commercial |
$275.18
|
| Rate for Payer: Cash Price |
$197.47
|
| Rate for Payer: Cigna All Commercial |
$274.87
|
| Rate for Payer: CORVEL All Commercial |
$296.20
|
| Rate for Payer: Coventry All Commercial |
$280.28
|
| Rate for Payer: Encore All Commercial |
$293.18
|
| Rate for Payer: Frontpath All Commercial |
$293.02
|
| Rate for Payer: Humana ChoiceCare |
$275.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.65
|
| Rate for Payer: PHCS All Commercial |
$238.88
|
| Rate for Payer: PHP All Commercial |
$241.55
|
| Rate for Payer: Sagamore Health Network All Products |
$245.88
|
| Rate for Payer: Signature Care EPO |
$264.36
|
| Rate for Payer: Signature Care PPO |
$280.28
|
| Rate for Payer: United Healthcare Commercial |
$250.98
|
|
|
HC SPLINT ULNAR DEV MED RIGHT
|
Facility
IP
|
$318.50
|
|
|
Service Code
|
CPT L3809
|
| Hospital Charge Code |
41607070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$296.20 |
| Rate for Payer: Aetna Commercial |
$275.18
|
| Rate for Payer: Cash Price |
$197.47
|
| Rate for Payer: Cigna All Commercial |
$274.87
|
| Rate for Payer: CORVEL All Commercial |
$296.20
|
| Rate for Payer: Coventry All Commercial |
$280.28
|
| Rate for Payer: Encore All Commercial |
$293.18
|
| Rate for Payer: Frontpath All Commercial |
$293.02
|
| Rate for Payer: Humana ChoiceCare |
$275.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.65
|
| Rate for Payer: PHCS All Commercial |
$238.88
|
| Rate for Payer: PHP All Commercial |
$241.55
|
| Rate for Payer: Sagamore Health Network All Products |
$245.88
|
| Rate for Payer: Signature Care EPO |
$264.36
|
| Rate for Payer: Signature Care PPO |
$280.28
|
| Rate for Payer: United Healthcare Commercial |
$250.98
|
|
|
HC SPLINT ULNAR DEV MED RIGHT
|
Facility
OP
|
$318.50
|
|
|
Service Code
|
CPT L3809
|
| Hospital Charge Code |
41607070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.10 |
| Max. Negotiated Rate |
$296.20 |
| Rate for Payer: Aetna Commercial |
$268.81
|
| Rate for Payer: Aetna Medicare |
$105.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$199.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.62
|
| Rate for Payer: Cash Price |
$197.47
|
| Rate for Payer: Cash Price |
$197.47
|
| Rate for Payer: Centivo All Commercial |
$162.44
|
| Rate for Payer: Cigna All Commercial |
$274.87
|
| Rate for Payer: CORVEL All Commercial |
$296.20
|
| Rate for Payer: Coventry All Commercial |
$280.28
|
| Rate for Payer: Encore All Commercial |
$293.18
|
| Rate for Payer: Frontpath All Commercial |
$293.02
|
| Rate for Payer: Humana ChoiceCare |
$275.09
|
| Rate for Payer: Humana Medicare |
$162.44
|
| Rate for Payer: Lucent All Commercial |
$162.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.65
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$238.88
|
| Rate for Payer: PHP All Commercial |
$241.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.22
|
| Rate for Payer: Sagamore Health Network All Products |
$245.88
|
| Rate for Payer: Signature Care EPO |
$264.36
|
| Rate for Payer: Signature Care PPO |
$280.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$270.72
|
| Rate for Payer: United Healthcare Commercial |
$250.98
|
| Rate for Payer: United Healthcare Medicare |
$105.10
|
|
|
HC S. PNEUMONIAE AG, UR
|
Facility
OP
|
$66.41
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
63001357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$61.76 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Medicare |
$21.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.11
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: Centivo All Commercial |
$33.87
|
| Rate for Payer: Cigna All Commercial |
$57.31
|
| Rate for Payer: CORVEL All Commercial |
$61.76
|
| Rate for Payer: Coventry All Commercial |
$58.44
|
| Rate for Payer: Encore All Commercial |
$61.13
|
| Rate for Payer: Frontpath All Commercial |
$61.10
|
| Rate for Payer: Humana ChoiceCare |
$57.36
|
| Rate for Payer: Humana Medicare |
$33.87
|
| Rate for Payer: Lucent All Commercial |
$33.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.77
|
| Rate for Payer: Managed Health Services Medicaid |
$16.07
|
| Rate for Payer: MDWise Medicaid |
$16.07
|
| Rate for Payer: PHCS All Commercial |
$49.81
|
| Rate for Payer: PHP All Commercial |
$50.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.90
|
| Rate for Payer: Sagamore Health Network All Products |
$51.27
|
| Rate for Payer: Signature Care EPO |
$55.12
|
| Rate for Payer: Signature Care PPO |
$58.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.45
|
| Rate for Payer: United Healthcare Commercial |
$52.33
|
| Rate for Payer: United Healthcare Medicare |
$21.92
|
|
|
HC S. PNEUMONIAE AG, UR
|
Facility
IP
|
$66.41
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
63001357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.81 |
| Max. Negotiated Rate |
$61.76 |
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: Cigna All Commercial |
$57.31
|
| Rate for Payer: CORVEL All Commercial |
$61.76
|
| Rate for Payer: Coventry All Commercial |
$58.44
|
| Rate for Payer: Encore All Commercial |
$61.13
|
| Rate for Payer: Frontpath All Commercial |
$61.10
|
| Rate for Payer: Humana ChoiceCare |
$57.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.77
|
| Rate for Payer: PHCS All Commercial |
$49.81
|
| Rate for Payer: PHP All Commercial |
$50.37
|
| Rate for Payer: Sagamore Health Network All Products |
$51.27
|
| Rate for Payer: Signature Care EPO |
$55.12
|
| Rate for Payer: Signature Care PPO |
$58.44
|
| Rate for Payer: United Healthcare Commercial |
$52.33
|
|
