|
HC TESTOSTERONE TOTAL
|
Facility
|
OP
|
$277.40
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
63001161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$257.98 |
| Rate for Payer: Aetna Commercial |
$234.12
|
| Rate for Payer: Aetna Medicare |
$91.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$127.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.70
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Centivo All Commercial |
$141.47
|
| Rate for Payer: Cigna All Commercial |
$239.40
|
| Rate for Payer: CORVEL All Commercial |
$257.98
|
| Rate for Payer: Coventry All Commercial |
$244.11
|
| Rate for Payer: Encore All Commercial |
$255.35
|
| Rate for Payer: Frontpath All Commercial |
$255.21
|
| Rate for Payer: Humana ChoiceCare |
$239.59
|
| Rate for Payer: Humana Medicare |
$141.47
|
| Rate for Payer: Lucent All Commercial |
$141.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.66
|
| Rate for Payer: Managed Health Services Medicaid |
$25.81
|
| Rate for Payer: MDWise Medicaid |
$25.81
|
| Rate for Payer: PHCS All Commercial |
$208.05
|
| Rate for Payer: PHP All Commercial |
$210.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.19
|
| Rate for Payer: Sagamore Health Network All Products |
$214.15
|
| Rate for Payer: Signature Care EPO |
$230.24
|
| Rate for Payer: Signature Care PPO |
$244.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$235.79
|
| Rate for Payer: United Healthcare Commercial |
$218.59
|
| Rate for Payer: United Healthcare Medicare |
$91.54
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
IP
|
$277.40
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
63001161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.05 |
| Max. Negotiated Rate |
$257.98 |
| Rate for Payer: Aetna Commercial |
$239.67
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Cigna All Commercial |
$239.40
|
| Rate for Payer: CORVEL All Commercial |
$257.98
|
| Rate for Payer: Coventry All Commercial |
$244.11
|
| Rate for Payer: Encore All Commercial |
$255.35
|
| Rate for Payer: Frontpath All Commercial |
$255.21
|
| Rate for Payer: Humana ChoiceCare |
$239.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.66
|
| Rate for Payer: PHCS All Commercial |
$208.05
|
| Rate for Payer: PHP All Commercial |
$210.38
|
| Rate for Payer: Sagamore Health Network All Products |
$214.15
|
| Rate for Payer: Signature Care EPO |
$230.24
|
| Rate for Payer: Signature Care PPO |
$244.11
|
| Rate for Payer: United Healthcare Commercial |
$218.59
|
|
|
HC TETANUS/DIPHTHERIA ANTIBODY PROFILE
|
Facility
|
IP
|
$57.38
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63044041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: Cash Price |
$35.57
|
| Rate for Payer: Cigna All Commercial |
$49.51
|
| Rate for Payer: CORVEL All Commercial |
$53.36
|
| Rate for Payer: Coventry All Commercial |
$50.49
|
| Rate for Payer: Encore All Commercial |
$52.81
|
| Rate for Payer: Frontpath All Commercial |
$52.78
|
| Rate for Payer: Humana ChoiceCare |
$49.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.64
|
| Rate for Payer: PHCS All Commercial |
$43.03
|
| Rate for Payer: PHP All Commercial |
$43.51
|
| Rate for Payer: Sagamore Health Network All Products |
$44.29
|
| Rate for Payer: Signature Care EPO |
$47.62
|
| Rate for Payer: Signature Care PPO |
$50.49
|
| Rate for Payer: United Healthcare Commercial |
$45.21
|
|
|
HC TETANUS/DIPHTHERIA ANTIBODY PROFILE
|
Facility
|
OP
|
$57.38
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63044041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna Medicare |
$18.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.83
|
| Rate for Payer: Cash Price |
$35.57
|
| Rate for Payer: Cash Price |
$35.57
|
| Rate for Payer: Centivo All Commercial |
$29.26
|
| Rate for Payer: Cigna All Commercial |
$49.51
|
| Rate for Payer: CORVEL All Commercial |
$53.36
|
| Rate for Payer: Coventry All Commercial |
$50.49
|
| Rate for Payer: Encore All Commercial |
$52.81
|
| Rate for Payer: Frontpath All Commercial |
$52.78
|
| Rate for Payer: Humana ChoiceCare |
$49.55
|
| Rate for Payer: Humana Medicare |
$29.26
|
| Rate for Payer: Lucent All Commercial |
$29.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.64
|
| Rate for Payer: Managed Health Services Medicaid |
$14.99
|
| Rate for Payer: MDWise Medicaid |
$14.99
|
| Rate for Payer: PHCS All Commercial |
$43.03
|
| Rate for Payer: PHP All Commercial |
$43.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.38
|
| Rate for Payer: Sagamore Health Network All Products |
$44.29
|
| Rate for Payer: Signature Care EPO |
$47.62
|
| Rate for Payer: Signature Care PPO |
$50.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.77
|
| Rate for Payer: United Healthcare Commercial |
$45.21
|
| Rate for Payer: United Healthcare Medicare |
$18.93
|
|
|
HC TETANUS/DIPHTHERIA ANTIBODY PROFILE-B
|
Facility
|
IP
|
$57.38
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63044042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: Cash Price |
$35.57
|
| Rate for Payer: Cigna All Commercial |
$49.51
|
| Rate for Payer: CORVEL All Commercial |
$53.36
|
| Rate for Payer: Coventry All Commercial |
$50.49
|
| Rate for Payer: Encore All Commercial |
$52.81
|
| Rate for Payer: Frontpath All Commercial |
$52.78
|
| Rate for Payer: Humana ChoiceCare |
$49.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.64
|
| Rate for Payer: PHCS All Commercial |
$43.03
|
| Rate for Payer: PHP All Commercial |
$43.51
|
| Rate for Payer: Sagamore Health Network All Products |
$44.29
|
| Rate for Payer: Signature Care EPO |
$47.62
|
| Rate for Payer: Signature Care PPO |
$50.49
|
| Rate for Payer: United Healthcare Commercial |
$45.21
|
|
|
HC TETANUS/DIPHTHERIA ANTIBODY PROFILE-B
|
Facility
|
OP
|
$57.38
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63044042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna Medicare |
$18.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.83
|
| Rate for Payer: Cash Price |
$35.57
|
| Rate for Payer: Cash Price |
$35.57
|
| Rate for Payer: Centivo All Commercial |
$29.26
|
| Rate for Payer: Cigna All Commercial |
$49.51
|
| Rate for Payer: CORVEL All Commercial |
$53.36
|
| Rate for Payer: Coventry All Commercial |
$50.49
|
| Rate for Payer: Encore All Commercial |
$52.81
|
| Rate for Payer: Frontpath All Commercial |
$52.78
|
| Rate for Payer: Humana ChoiceCare |
$49.55
|
| Rate for Payer: Humana Medicare |
$29.26
|
| Rate for Payer: Lucent All Commercial |
$29.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.64
|
| Rate for Payer: Managed Health Services Medicaid |
$14.99
|
| Rate for Payer: MDWise Medicaid |
$14.99
|
| Rate for Payer: PHCS All Commercial |
$43.03
|
| Rate for Payer: PHP All Commercial |
$43.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.38
|
| Rate for Payer: Sagamore Health Network All Products |
$44.29
|
| Rate for Payer: Signature Care EPO |
$47.62
|
| Rate for Payer: Signature Care PPO |
$50.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.77
|
| Rate for Payer: United Healthcare Commercial |
$45.21
|
| Rate for Payer: United Healthcare Medicare |
$18.93
|
|
|
HC TETANUS IGG ANTIBODY
|
Facility
|
IP
|
$420.55
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63001047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.41 |
| Max. Negotiated Rate |
$391.11 |
| Rate for Payer: Aetna Commercial |
$363.35
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cigna All Commercial |
$362.93
|
| Rate for Payer: CORVEL All Commercial |
$391.11
|
| Rate for Payer: Coventry All Commercial |
$370.08
|
| Rate for Payer: Encore All Commercial |
$387.11
|
| Rate for Payer: Frontpath All Commercial |
$386.90
|
| Rate for Payer: Humana ChoiceCare |
$363.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.49
|
| Rate for Payer: PHCS All Commercial |
$315.41
|
| Rate for Payer: PHP All Commercial |
$318.94
|
| Rate for Payer: Sagamore Health Network All Products |
$324.66
|
| Rate for Payer: Signature Care EPO |
$349.05
|
| Rate for Payer: Signature Care PPO |
$370.08
|
| Rate for Payer: United Healthcare Commercial |
$331.39
|
|
|
HC TETANUS IGG ANTIBODY
|
Facility
|
OP
|
$420.55
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63001047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$391.11 |
| Rate for Payer: Aetna Commercial |
$354.94
|
| Rate for Payer: Aetna Medicare |
$138.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.66
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Centivo All Commercial |
$214.48
|
| Rate for Payer: Cigna All Commercial |
$362.93
|
| Rate for Payer: CORVEL All Commercial |
$391.11
|
| Rate for Payer: Coventry All Commercial |
$370.08
|
| Rate for Payer: Encore All Commercial |
$387.11
|
| Rate for Payer: Frontpath All Commercial |
$386.90
|
| Rate for Payer: Humana ChoiceCare |
$363.23
|
| Rate for Payer: Humana Medicare |
$214.48
|
| Rate for Payer: Lucent All Commercial |
$214.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.49
|
| Rate for Payer: Managed Health Services Medicaid |
$14.99
|
| Rate for Payer: MDWise Medicaid |
$14.99
|
| Rate for Payer: PHCS All Commercial |
$315.41
|
| Rate for Payer: PHP All Commercial |
$318.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.01
|
| Rate for Payer: Sagamore Health Network All Products |
$324.66
|
| Rate for Payer: Signature Care EPO |
$349.05
|
| Rate for Payer: Signature Care PPO |
$370.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.46
|
| Rate for Payer: United Healthcare Commercial |
$331.39
|
| Rate for Payer: United Healthcare Medicare |
$138.78
|
|
|
HC THEOPHYLLINE
|
Facility
|
IP
|
$208.74
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
63001313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$194.13 |
| Rate for Payer: Aetna Commercial |
$180.35
|
| Rate for Payer: Cash Price |
$129.42
|
| Rate for Payer: Cigna All Commercial |
$180.15
|
| Rate for Payer: CORVEL All Commercial |
$194.13
|
| Rate for Payer: Coventry All Commercial |
$183.69
|
| Rate for Payer: Encore All Commercial |
$192.15
|
| Rate for Payer: Frontpath All Commercial |
$192.04
|
| Rate for Payer: Humana ChoiceCare |
$180.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.87
|
| Rate for Payer: PHCS All Commercial |
$156.56
|
| Rate for Payer: PHP All Commercial |
$158.31
|
| Rate for Payer: Sagamore Health Network All Products |
$161.15
|
| Rate for Payer: Signature Care EPO |
$173.26
|
| Rate for Payer: Signature Care PPO |
$183.69
|
| Rate for Payer: United Healthcare Commercial |
$164.49
|
|
|
HC THEOPHYLLINE
|
Facility
|
OP
|
$208.74
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
63001313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$194.13 |
| Rate for Payer: Aetna Commercial |
$176.18
|
| Rate for Payer: Aetna Medicare |
$68.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$119.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.77
|
| Rate for Payer: Cash Price |
$129.42
|
| Rate for Payer: Cash Price |
$129.42
|
| Rate for Payer: Centivo All Commercial |
$106.46
|
| Rate for Payer: Cigna All Commercial |
$180.15
|
| Rate for Payer: CORVEL All Commercial |
$194.13
|
| Rate for Payer: Coventry All Commercial |
$183.69
|
| Rate for Payer: Encore All Commercial |
$192.15
|
| Rate for Payer: Frontpath All Commercial |
$192.04
|
| Rate for Payer: Humana ChoiceCare |
$180.29
|
| Rate for Payer: Humana Medicare |
$106.46
|
| Rate for Payer: Lucent All Commercial |
$106.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.87
|
| Rate for Payer: Managed Health Services Medicaid |
$14.14
|
| Rate for Payer: MDWise Medicaid |
$14.14
|
| Rate for Payer: PHCS All Commercial |
$156.56
|
| Rate for Payer: PHP All Commercial |
$158.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.41
|
| Rate for Payer: Sagamore Health Network All Products |
$161.15
|
| Rate for Payer: Signature Care EPO |
$173.26
|
| Rate for Payer: Signature Care PPO |
$183.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.43
|
| Rate for Payer: United Healthcare Commercial |
$164.49
|
| Rate for Payer: United Healthcare Medicare |
$68.89
|
|
|
HC THER ACTIVITIES/15 MIN-OT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
01738087
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$120.96
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.17
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
|
|
HC THER ACTIVITIES/15 MIN-OT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
01738087
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$118.16
|
| Rate for Payer: Aetna Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.82
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Centivo All Commercial |
$71.40
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.91
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: Lucent All Commercial |
$71.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
|
|
HC THERAPEUTIC ACTIV/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
01728077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC THERAPEUTIC ACTIV/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
01728077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$264.07
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
00529195
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$409.66 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$87.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$151.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$409.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.86
|
| Rate for Payer: Cash Price |
$163.72
|
| Rate for Payer: Cash Price |
$163.72
|
| Rate for Payer: Centivo All Commercial |
$134.67
|
| Rate for Payer: Cigna All Commercial |
$227.89
|
| Rate for Payer: CORVEL All Commercial |
$245.58
|
| Rate for Payer: Coventry All Commercial |
$232.38
|
| Rate for Payer: Encore All Commercial |
$243.07
|
| Rate for Payer: Frontpath All Commercial |
$242.94
|
| Rate for Payer: Humana ChoiceCare |
$228.08
|
| Rate for Payer: Humana Medicare |
$134.67
|
| Rate for Payer: Lucent All Commercial |
$134.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.66
|
| Rate for Payer: Managed Health Services Medicaid |
$409.66
|
| Rate for Payer: MDWise Medicaid |
$409.66
|
| Rate for Payer: PHCS All Commercial |
$198.05
|
| Rate for Payer: PHP All Commercial |
$200.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.99
|
| Rate for Payer: Sagamore Health Network All Products |
$203.86
|
| Rate for Payer: Signature Care EPO |
$219.18
|
| Rate for Payer: Signature Care PPO |
$232.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$224.46
|
| Rate for Payer: United Healthcare Commercial |
$208.09
|
| Rate for Payer: United Healthcare Medicare |
$87.14
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$264.07
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
00529195
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$198.05 |
| Max. Negotiated Rate |
$245.58 |
| Rate for Payer: Aetna Commercial |
$228.15
|
| Rate for Payer: Cash Price |
$163.72
|
| Rate for Payer: Cigna All Commercial |
$227.89
|
| Rate for Payer: CORVEL All Commercial |
$245.58
|
| Rate for Payer: Coventry All Commercial |
$232.38
|
| Rate for Payer: Encore All Commercial |
$243.07
|
| Rate for Payer: Frontpath All Commercial |
$242.94
|
| Rate for Payer: Humana ChoiceCare |
$228.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.66
|
| Rate for Payer: PHCS All Commercial |
$198.05
|
| Rate for Payer: PHP All Commercial |
$200.27
|
| Rate for Payer: Sagamore Health Network All Products |
$203.86
|
| Rate for Payer: Signature Care EPO |
$219.18
|
| Rate for Payer: Signature Care PPO |
$232.38
|
| Rate for Payer: United Healthcare Commercial |
$208.09
|
|
|
HC THERAPEUTIC REHAB GROUP - OT
|
Facility
|
OP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01737150
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$91.25 |
| Rate for Payer: Aetna Commercial |
$82.81
|
| Rate for Payer: Aetna Medicare |
$32.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.62
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Centivo All Commercial |
$50.04
|
| Rate for Payer: Cigna All Commercial |
$84.67
|
| Rate for Payer: CORVEL All Commercial |
$91.25
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.31
|
| Rate for Payer: Frontpath All Commercial |
$90.26
|
| Rate for Payer: Humana ChoiceCare |
$84.74
|
| Rate for Payer: Humana Medicare |
$50.04
|
| Rate for Payer: Lucent All Commercial |
$50.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.30
|
| Rate for Payer: PHCS All Commercial |
$73.59
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.26
|
| Rate for Payer: Sagamore Health Network All Products |
$75.74
|
| Rate for Payer: Signature Care EPO |
$81.43
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.40
|
| Rate for Payer: United Healthcare Commercial |
$77.31
|
| Rate for Payer: United Healthcare Medicare |
$32.38
|
|
|
HC THERAPEUTIC REHAB GROUP - OT
|
Facility
|
IP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01737150
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.59 |
| Max. Negotiated Rate |
$91.25 |
| Rate for Payer: Aetna Commercial |
$84.77
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cigna All Commercial |
$84.67
|
| Rate for Payer: CORVEL All Commercial |
$91.25
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.31
|
| Rate for Payer: Frontpath All Commercial |
$90.26
|
| Rate for Payer: Humana ChoiceCare |
$84.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.30
|
| Rate for Payer: PHCS All Commercial |
$73.59
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Sagamore Health Network All Products |
$75.74
|
| Rate for Payer: Signature Care EPO |
$81.43
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: United Healthcare Commercial |
$77.31
|
|
|
HC THERAPEUTIC REHAB GROUP - PT
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$87.74 |
| Rate for Payer: Aetna Commercial |
$79.62
|
| Rate for Payer: Aetna Medicare |
$31.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.25
|
| Rate for Payer: Cash Price |
$58.49
|
| Rate for Payer: Centivo All Commercial |
$48.11
|
| Rate for Payer: Cigna All Commercial |
$81.42
|
| Rate for Payer: CORVEL All Commercial |
$87.74
|
| Rate for Payer: Coventry All Commercial |
$83.02
|
| Rate for Payer: Encore All Commercial |
$86.84
|
| Rate for Payer: Frontpath All Commercial |
$86.79
|
| Rate for Payer: Humana ChoiceCare |
$81.48
|
| Rate for Payer: Humana Medicare |
$48.11
|
| Rate for Payer: Lucent All Commercial |
$48.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.91
|
| Rate for Payer: PHCS All Commercial |
$70.75
|
| Rate for Payer: PHP All Commercial |
$71.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.79
|
| Rate for Payer: Sagamore Health Network All Products |
$72.83
|
| Rate for Payer: Signature Care EPO |
$78.30
|
| Rate for Payer: Signature Care PPO |
$83.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.19
|
| Rate for Payer: United Healthcare Commercial |
$74.34
|
| Rate for Payer: United Healthcare Medicare |
$31.13
|
|
|
HC THERAPEUTIC REHAB GROUP - PT
|
Facility
|
IP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$87.74 |
| Rate for Payer: Aetna Commercial |
$81.51
|
| Rate for Payer: Cash Price |
$58.49
|
| Rate for Payer: Cigna All Commercial |
$81.42
|
| Rate for Payer: CORVEL All Commercial |
$87.74
|
| Rate for Payer: Coventry All Commercial |
$83.02
|
| Rate for Payer: Encore All Commercial |
$86.84
|
| Rate for Payer: Frontpath All Commercial |
$86.79
|
| Rate for Payer: Humana ChoiceCare |
$81.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.91
|
| Rate for Payer: PHCS All Commercial |
$70.75
|
| Rate for Payer: PHP All Commercial |
$71.55
|
| Rate for Payer: Sagamore Health Network All Products |
$72.83
|
| Rate for Payer: Signature Care EPO |
$78.30
|
| Rate for Payer: Signature Care PPO |
$83.02
|
| Rate for Payer: United Healthcare Commercial |
$74.34
|
|
|
HC THER EXERCISE/15 MIN-OT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
01738080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$120.96
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.17
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
|
|
HC THER EXERCISE/15 MIN-OT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
01738080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$118.16
|
| Rate for Payer: Aetna Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.82
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Centivo All Commercial |
$71.40
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.91
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: Lucent All Commercial |
$71.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
|
|
HC THER EXERCISE/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
01728078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC THER EXERCISE/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
01728078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MIN - OT
|
Facility
|
OP
|
$164.24
|
|
|
Service Code
|
CPT 97129 GO
|
| Hospital Charge Code |
01737129
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$152.74 |
| Rate for Payer: Aetna Commercial |
$138.62
|
| Rate for Payer: Aetna Medicare |
$54.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.62
|
| Rate for Payer: Cash Price |
$101.83
|
| Rate for Payer: Centivo All Commercial |
$83.76
|
| Rate for Payer: Cigna All Commercial |
$141.74
|
| Rate for Payer: CORVEL All Commercial |
$152.74
|
| Rate for Payer: Coventry All Commercial |
$144.53
|
| Rate for Payer: Encore All Commercial |
$151.18
|
| Rate for Payer: Frontpath All Commercial |
$151.10
|
| Rate for Payer: Humana ChoiceCare |
$141.85
|
| Rate for Payer: Humana Medicare |
$83.76
|
| Rate for Payer: Lucent All Commercial |
$83.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.82
|
| Rate for Payer: PHCS All Commercial |
$123.18
|
| Rate for Payer: PHP All Commercial |
$124.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.05
|
| Rate for Payer: Sagamore Health Network All Products |
$126.79
|
| Rate for Payer: Signature Care EPO |
$136.32
|
| Rate for Payer: Signature Care PPO |
$144.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.60
|
| Rate for Payer: United Healthcare Commercial |
$129.42
|
| Rate for Payer: United Healthcare Medicare |
$54.20
|
|
