|
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
|
|
|
HC THER IVNTJ COG FUNCJ CNTCT EA ADD'L 15 MIN - OT
|
Facility
|
OP
|
$143.02
|
|
|
Service Code
|
CPT 97130 GO
|
| Hospital Charge Code |
01737130
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.92
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Centivo All Commercial |
$72.94
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$72.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
|
|
HC THER IVNTJ COG FUNCJ CNTCT EA ADD'L 15 MIN - OT
|
Facility
|
IP
|
$143.02
|
|
|
Service Code
|
CPT 97130 GO
|
| Hospital Charge Code |
01737130
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC THER PROCED GRP-15 MIN-OT
|
Facility
|
OP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738082
|
|
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 THER PROCED GRP-15 MIN-OT
|
Facility
|
IP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738082
|
|
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 THER PROCED GRP-15 MIN-PT
|
Facility
|
IP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728074
|
|
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 PROCED GRP-15 MIN-PT
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728074
|
|
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 THER PROCED GRP-30 MIN-OT
|
Facility
|
IP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738083
|
|
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 THER PROCED GRP-30 MIN-OT
|
Facility
|
OP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738083
|
|
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 THER PROCED GRP-30 MIN-PT
|
Facility
|
IP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728075
|
|
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 PROCED GRP-30 MIN-PT
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728075
|
|
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 THER PROCED GRP-45 MIN-OT
|
Facility
|
OP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738084
|
|
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 THER PROCED GRP-45 MIN-OT
|
Facility
|
IP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738084
|
|
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 THER PROCED GRP-45 MIN-PT
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728096
|
|
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 THER PROCED GRP-45 MIN-PT
|
Facility
|
IP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728096
|
|
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 PROCED GRP-60 MIN-OT
|
Facility
|
OP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738085
|
|
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 THER PROCED GRP-60 MIN-OT
|
Facility
|
IP
|
$98.11
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
01738085
|
|
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 THER PROCED GRP-60 MIN-PT
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728076
|
|
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 THER PROCED GRP-60 MIN-PT
|
Facility
|
IP
|
$94.34
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
01728076
|
|
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 PROC GROUP-RESP FUNCTION
|
Facility
|
OP
|
$258.28
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
01600239
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$240.20 |
| Rate for Payer: Aetna Commercial |
$217.99
|
| Rate for Payer: Aetna Medicare |
$85.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.76
|
| Rate for Payer: Cash Price |
$160.14
|
| Rate for Payer: Cash Price |
$160.14
|
| Rate for Payer: Centivo All Commercial |
$131.73
|
| Rate for Payer: Cigna All Commercial |
$222.90
|
| Rate for Payer: CORVEL All Commercial |
$240.20
|
| Rate for Payer: Coventry All Commercial |
$227.29
|
| Rate for Payer: Encore All Commercial |
$237.75
|
| Rate for Payer: Frontpath All Commercial |
$237.62
|
| Rate for Payer: Humana ChoiceCare |
$223.08
|
| Rate for Payer: Humana Medicare |
$131.73
|
| Rate for Payer: Lucent All Commercial |
$131.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.46
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$193.71
|
| Rate for Payer: PHP All Commercial |
$195.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.73
|
| Rate for Payer: Sagamore Health Network All Products |
$199.40
|
| Rate for Payer: Signature Care EPO |
$214.38
|
| Rate for Payer: Signature Care PPO |
$227.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$219.54
|
| Rate for Payer: United Healthcare Commercial |
$203.53
|
| Rate for Payer: United Healthcare Medicare |
$85.23
|
|
|
HC THER PROC GROUP-RESP FUNCTION
|
Facility
|
IP
|
$258.28
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
01600239
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$240.20 |
| Rate for Payer: Aetna Commercial |
$223.16
|
| Rate for Payer: Cash Price |
$160.14
|
| Rate for Payer: Cigna All Commercial |
$222.90
|
| Rate for Payer: CORVEL All Commercial |
$240.20
|
| Rate for Payer: Coventry All Commercial |
$227.29
|
| Rate for Payer: Encore All Commercial |
$237.75
|
| Rate for Payer: Frontpath All Commercial |
$237.62
|
| Rate for Payer: Humana ChoiceCare |
$223.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.46
|
| Rate for Payer: PHCS All Commercial |
$193.71
|
| Rate for Payer: PHP All Commercial |
$195.88
|
| Rate for Payer: Sagamore Health Network All Products |
$199.40
|
| Rate for Payer: Signature Care EPO |
$214.38
|
| Rate for Payer: Signature Care PPO |
$227.29
|
| Rate for Payer: United Healthcare Commercial |
$203.53
|
|
|
HC THER PROC-STRNGTH/ENDUR/15 MIN
|
Facility
|
OP
|
$238.68
|
|
|
Service Code
|
CPT G0237
|
| Hospital Charge Code |
01600237
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$221.97 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$137.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.64
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Centivo All Commercial |
$121.73
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Humana Medicare |
$121.73
|
| Rate for Payer: Lucent All Commercial |
$121.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.09
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202.88
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
| Rate for Payer: United Healthcare Medicare |
$78.76
|
|
|
HC THER PROC-STRNGTH/ENDUR/15 MIN
|
Facility
|
IP
|
$238.68
|
|
|
Service Code
|
CPT G0237
|
| Hospital Charge Code |
01600237
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$221.97 |
| Rate for Payer: Aetna Commercial |
$206.22
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
|
|
HC THINPREP HPV 36391
|
Facility
|
IP
|
$76.70
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
63044017
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.53 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$66.27
|
| Rate for Payer: Cash Price |
$47.56
|
| Rate for Payer: Cigna All Commercial |
$66.20
|
| Rate for Payer: CORVEL All Commercial |
$71.33
|
| Rate for Payer: Coventry All Commercial |
$67.50
|
| Rate for Payer: Encore All Commercial |
$70.61
|
| Rate for Payer: Frontpath All Commercial |
$70.57
|
| Rate for Payer: Humana ChoiceCare |
$66.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.03
|
| Rate for Payer: PHCS All Commercial |
$57.53
|
| Rate for Payer: PHP All Commercial |
$58.17
|
| Rate for Payer: Sagamore Health Network All Products |
$59.22
|
| Rate for Payer: Signature Care EPO |
$63.66
|
| Rate for Payer: Signature Care PPO |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$60.44
|
|
|
HC THINPREP HPV 36391
|
Facility
|
OP
|
$76.70
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
63044017
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.31 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$64.74
|
| Rate for Payer: Aetna Medicare |
$25.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.84
|
| Rate for Payer: Cash Price |
$47.56
|
| Rate for Payer: Cash Price |
$47.56
|
| Rate for Payer: Centivo All Commercial |
$39.12
|
| Rate for Payer: Cigna All Commercial |
$66.20
|
| Rate for Payer: CORVEL All Commercial |
$71.33
|
| Rate for Payer: Coventry All Commercial |
$67.50
|
| Rate for Payer: Encore All Commercial |
$70.61
|
| Rate for Payer: Frontpath All Commercial |
$70.57
|
| Rate for Payer: Humana ChoiceCare |
$66.25
|
| Rate for Payer: Humana Medicare |
$39.12
|
| Rate for Payer: Lucent All Commercial |
$39.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.03
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$57.53
|
| Rate for Payer: PHP All Commercial |
$58.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.91
|
| Rate for Payer: Sagamore Health Network All Products |
$59.22
|
| Rate for Payer: Signature Care EPO |
$63.66
|
| Rate for Payer: Signature Care PPO |
$67.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.20
|
| Rate for Payer: United Healthcare Commercial |
$60.44
|
| Rate for Payer: United Healthcare Medicare |
$25.31
|
|
