|
HC TWISTER POLYP RETRIEVAL 13
|
Facility
|
IP
|
$110.88
|
|
| Hospital Charge Code |
41602821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$103.12 |
| Rate for Payer: Aetna Commercial |
$95.80
|
| Rate for Payer: Cash Price |
$68.75
|
| Rate for Payer: Cigna All Commercial |
$95.69
|
| Rate for Payer: CORVEL All Commercial |
$103.12
|
| Rate for Payer: Coventry All Commercial |
$97.57
|
| Rate for Payer: Encore All Commercial |
$102.07
|
| Rate for Payer: Frontpath All Commercial |
$102.01
|
| Rate for Payer: Humana ChoiceCare |
$95.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.79
|
| Rate for Payer: PHCS All Commercial |
$83.16
|
| Rate for Payer: PHP All Commercial |
$84.09
|
| Rate for Payer: Sagamore Health Network All Products |
$85.60
|
| Rate for Payer: Signature Care EPO |
$92.03
|
| Rate for Payer: Signature Care PPO |
$97.57
|
| Rate for Payer: United Healthcare Commercial |
$87.37
|
|
|
HC ULTRASOUND/15 MIN-OT
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
01738089
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.43
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Centivo All Commercial |
$62.42
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Humana Medicare |
$62.42
|
| Rate for Payer: Lucent All Commercial |
$62.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.04
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
| Rate for Payer: United Healthcare Medicare |
$40.39
|
|
|
HC ULTRASOUND/15 MIN-OT
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
01738089
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
|
|
HC ULTRASOUND/15 MIN-PT
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
01728087
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Cash Price |
$64.51
|
| Rate for Payer: Cigna All Commercial |
$89.79
|
| Rate for Payer: CORVEL All Commercial |
$96.76
|
| Rate for Payer: Coventry All Commercial |
$91.56
|
| Rate for Payer: Encore All Commercial |
$95.77
|
| Rate for Payer: Frontpath All Commercial |
$95.72
|
| Rate for Payer: Humana ChoiceCare |
$89.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.64
|
| Rate for Payer: PHCS All Commercial |
$78.03
|
| Rate for Payer: PHP All Commercial |
$78.90
|
| Rate for Payer: Sagamore Health Network All Products |
$80.32
|
| Rate for Payer: Signature Care EPO |
$86.35
|
| Rate for Payer: Signature Care PPO |
$91.56
|
| Rate for Payer: United Healthcare Commercial |
$81.98
|
|
|
HC ULTRASOUND/15 MIN-PT
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
01728087
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$87.81
|
| Rate for Payer: Aetna Medicare |
$34.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.77
|
| Rate for Payer: Cash Price |
$64.51
|
| Rate for Payer: Centivo All Commercial |
$53.06
|
| Rate for Payer: Cigna All Commercial |
$89.79
|
| Rate for Payer: CORVEL All Commercial |
$96.76
|
| Rate for Payer: Coventry All Commercial |
$91.56
|
| Rate for Payer: Encore All Commercial |
$95.77
|
| Rate for Payer: Frontpath All Commercial |
$95.72
|
| Rate for Payer: Humana ChoiceCare |
$89.86
|
| Rate for Payer: Humana Medicare |
$53.06
|
| Rate for Payer: Lucent All Commercial |
$53.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.64
|
| Rate for Payer: PHCS All Commercial |
$78.03
|
| Rate for Payer: PHP All Commercial |
$78.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.58
|
| Rate for Payer: Sagamore Health Network All Products |
$80.32
|
| Rate for Payer: Signature Care EPO |
$86.35
|
| Rate for Payer: Signature Care PPO |
$91.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.43
|
| Rate for Payer: United Healthcare Commercial |
$81.98
|
| Rate for Payer: United Healthcare Medicare |
$34.33
|
|
|
HC ULTRASOUND BREAST COMPLETE BILATERAL
|
Facility
|
OP
|
$1,299.52
|
|
|
Service Code
|
CPT 76641 50
|
| Hospital Charge Code |
21649641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$428.84 |
| Max. Negotiated Rate |
$1,208.55 |
| Rate for Payer: Aetna Commercial |
$1,096.80
|
| Rate for Payer: Aetna Medicare |
$428.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$428.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$746.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$812.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$493.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$471.73
|
| Rate for Payer: Cash Price |
$805.70
|
| Rate for Payer: Centivo All Commercial |
$662.76
|
| Rate for Payer: Cigna All Commercial |
$1,121.49
|
| Rate for Payer: CORVEL All Commercial |
$1,208.55
|
| Rate for Payer: Coventry All Commercial |
$1,143.58
|
| Rate for Payer: Encore All Commercial |
$1,196.21
|
| Rate for Payer: Frontpath All Commercial |
$1,195.56
|
| Rate for Payer: Humana ChoiceCare |
$1,122.40
|
| Rate for Payer: Humana Medicare |
$662.76
|
| Rate for Payer: Lucent All Commercial |
$662.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,169.57
|
| Rate for Payer: PHCS All Commercial |
$974.64
|
| Rate for Payer: PHP All Commercial |
$985.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$506.81
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.23
|
| Rate for Payer: Signature Care EPO |
$1,078.60
|
| Rate for Payer: Signature Care PPO |
$1,143.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,104.59
|
| Rate for Payer: United Healthcare Commercial |
$1,024.02
|
| Rate for Payer: United Healthcare Medicare |
$428.84
|
|
|
HC ULTRASOUND BREAST COMPLETE BILATERAL
|
Facility
|
IP
|
$1,299.52
|
|
|
Service Code
|
CPT 76641 50
|
| Hospital Charge Code |
21649641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$974.64 |
| Max. Negotiated Rate |
$1,208.55 |
| Rate for Payer: Aetna Commercial |
$1,122.79
|
| Rate for Payer: Cash Price |
$805.70
|
| Rate for Payer: Cigna All Commercial |
$1,121.49
|
| Rate for Payer: CORVEL All Commercial |
$1,208.55
|
| Rate for Payer: Coventry All Commercial |
$1,143.58
|
| Rate for Payer: Encore All Commercial |
$1,196.21
|
| Rate for Payer: Frontpath All Commercial |
$1,195.56
|
| Rate for Payer: Humana ChoiceCare |
$1,122.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,169.57
|
| Rate for Payer: PHCS All Commercial |
$974.64
|
| Rate for Payer: PHP All Commercial |
$985.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.23
|
| Rate for Payer: Signature Care EPO |
$1,078.60
|
| Rate for Payer: Signature Care PPO |
$1,143.58
|
| Rate for Payer: United Healthcare Commercial |
$1,024.02
|
|
|
HC ULTRASOUND BREAST COMPLETE LT
|
Facility
|
OP
|
$866.35
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
01646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$285.89 |
| Max. Negotiated Rate |
$805.70 |
| Rate for Payer: Aetna Commercial |
$731.20
|
| Rate for Payer: Aetna Medicare |
$285.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$497.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$541.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.48
|
| Rate for Payer: Cash Price |
$537.14
|
| Rate for Payer: Centivo All Commercial |
$441.84
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.70
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.47
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.26
|
| Rate for Payer: Humana Medicare |
$441.84
|
| Rate for Payer: Lucent All Commercial |
$441.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.71
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.88
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$736.40
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
| Rate for Payer: United Healthcare Medicare |
$285.89
|
|
|
HC ULTRASOUND BREAST COMPLETE LT
|
Facility
|
IP
|
$866.35
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
01646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$649.76 |
| Max. Negotiated Rate |
$805.70 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Cash Price |
$537.14
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.70
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.47
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.71
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
|
|
HC ULTRASOUND BREAST COMPLETE RT
|
Facility
|
OP
|
$866.35
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
21646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$285.89 |
| Max. Negotiated Rate |
$805.70 |
| Rate for Payer: Aetna Commercial |
$731.20
|
| Rate for Payer: Aetna Medicare |
$285.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$497.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$541.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.48
|
| Rate for Payer: Cash Price |
$537.14
|
| Rate for Payer: Centivo All Commercial |
$441.84
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.70
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.47
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.26
|
| Rate for Payer: Humana Medicare |
$441.84
|
| Rate for Payer: Lucent All Commercial |
$441.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.71
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.88
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$736.40
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
| Rate for Payer: United Healthcare Medicare |
$285.89
|
|
|
HC ULTRASOUND BREAST COMPLETE RT
|
Facility
|
IP
|
$866.35
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
21646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$649.76 |
| Max. Negotiated Rate |
$805.70 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Cash Price |
$537.14
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.70
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.47
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.71
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
|
|
HC ULTRASOUND BREAST LIMITED BILATERAL
|
Facility
|
IP
|
$665.04
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
21649642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$498.78 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$574.59
|
| Rate for Payer: Cash Price |
$412.33
|
| Rate for Payer: Cigna All Commercial |
$573.93
|
| Rate for Payer: CORVEL All Commercial |
$618.49
|
| Rate for Payer: Coventry All Commercial |
$585.24
|
| Rate for Payer: Encore All Commercial |
$612.17
|
| Rate for Payer: Frontpath All Commercial |
$611.84
|
| Rate for Payer: Humana ChoiceCare |
$574.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$598.54
|
| Rate for Payer: PHCS All Commercial |
$498.78
|
| Rate for Payer: PHP All Commercial |
$504.37
|
| Rate for Payer: Sagamore Health Network All Products |
$513.41
|
| Rate for Payer: Signature Care EPO |
$551.98
|
| Rate for Payer: Signature Care PPO |
$585.24
|
| Rate for Payer: United Healthcare Commercial |
$524.05
|
|
|
HC ULTRASOUND BREAST LIMITED BILATERAL
|
Facility
|
OP
|
$665.04
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
21649642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$219.46 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$561.29
|
| Rate for Payer: Aetna Medicare |
$219.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$219.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$381.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$415.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$252.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$241.41
|
| Rate for Payer: Cash Price |
$412.33
|
| Rate for Payer: Centivo All Commercial |
$339.17
|
| Rate for Payer: Cigna All Commercial |
$573.93
|
| Rate for Payer: CORVEL All Commercial |
$618.49
|
| Rate for Payer: Coventry All Commercial |
$585.24
|
| Rate for Payer: Encore All Commercial |
$612.17
|
| Rate for Payer: Frontpath All Commercial |
$611.84
|
| Rate for Payer: Humana ChoiceCare |
$574.40
|
| Rate for Payer: Humana Medicare |
$339.17
|
| Rate for Payer: Lucent All Commercial |
$339.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$598.54
|
| Rate for Payer: PHCS All Commercial |
$498.78
|
| Rate for Payer: PHP All Commercial |
$504.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$259.37
|
| Rate for Payer: Sagamore Health Network All Products |
$513.41
|
| Rate for Payer: Signature Care EPO |
$551.98
|
| Rate for Payer: Signature Care PPO |
$585.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$565.28
|
| Rate for Payer: United Healthcare Commercial |
$524.05
|
| Rate for Payer: United Healthcare Medicare |
$219.46
|
|
|
HC ULTRASOUND BREAST LIMITED LT
|
Facility
|
IP
|
$649.77
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
01646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$487.33 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$561.40
|
| Rate for Payer: Cash Price |
$402.86
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
|
|
HC ULTRASOUND BREAST LIMITED LT
|
Facility
|
OP
|
$649.77
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
01646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.42 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$548.41
|
| Rate for Payer: Aetna Medicare |
$214.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.87
|
| Rate for Payer: Cash Price |
$402.86
|
| Rate for Payer: Centivo All Commercial |
$331.38
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Humana Medicare |
$331.38
|
| Rate for Payer: Lucent All Commercial |
$331.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.41
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.31
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
| Rate for Payer: United Healthcare Medicare |
$214.42
|
|
|
HC ULTRASOUND BREAST LIMITED RT
|
Facility
|
IP
|
$649.77
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
21646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$487.33 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$561.40
|
| Rate for Payer: Cash Price |
$402.86
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
|
|
HC ULTRASOUND BREAST LIMITED RT
|
Facility
|
OP
|
$649.77
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
21646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.42 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$548.41
|
| Rate for Payer: Aetna Medicare |
$214.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.87
|
| Rate for Payer: Cash Price |
$402.86
|
| Rate for Payer: Centivo All Commercial |
$331.38
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Humana Medicare |
$331.38
|
| Rate for Payer: Lucent All Commercial |
$331.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.41
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.31
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
| Rate for Payer: United Healthcare Medicare |
$214.42
|
|
|
HC ULTRASOUND-NEONATAL HEADS
|
Facility
|
OP
|
$599.78
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
01646506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$197.93 |
| Max. Negotiated Rate |
$557.80 |
| Rate for Payer: Aetna Commercial |
$506.21
|
| Rate for Payer: Aetna Medicare |
$197.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$197.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$344.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$374.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$249.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$227.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$217.72
|
| Rate for Payer: Cash Price |
$371.86
|
| Rate for Payer: Cash Price |
$371.86
|
| Rate for Payer: Centivo All Commercial |
$305.89
|
| Rate for Payer: Cigna All Commercial |
$517.61
|
| Rate for Payer: CORVEL All Commercial |
$557.80
|
| Rate for Payer: Coventry All Commercial |
$527.81
|
| Rate for Payer: Encore All Commercial |
$552.10
|
| Rate for Payer: Frontpath All Commercial |
$551.80
|
| Rate for Payer: Humana ChoiceCare |
$518.03
|
| Rate for Payer: Humana Medicare |
$305.89
|
| Rate for Payer: Lucent All Commercial |
$305.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$539.80
|
| Rate for Payer: Managed Health Services Medicaid |
$249.91
|
| Rate for Payer: MDWise Medicaid |
$249.91
|
| Rate for Payer: PHCS All Commercial |
$449.84
|
| Rate for Payer: PHP All Commercial |
$454.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$233.91
|
| Rate for Payer: Sagamore Health Network All Products |
$463.03
|
| Rate for Payer: Signature Care EPO |
$497.82
|
| Rate for Payer: Signature Care PPO |
$527.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$509.81
|
| Rate for Payer: United Healthcare Commercial |
$472.63
|
| Rate for Payer: United Healthcare Medicare |
$197.93
|
|
|
HC ULTRASOUND-NEONATAL HEADS
|
Facility
|
IP
|
$599.78
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
01646506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.84 |
| Max. Negotiated Rate |
$557.80 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Cash Price |
$371.86
|
| Rate for Payer: Cigna All Commercial |
$517.61
|
| Rate for Payer: CORVEL All Commercial |
$557.80
|
| Rate for Payer: Coventry All Commercial |
$527.81
|
| Rate for Payer: Encore All Commercial |
$552.10
|
| Rate for Payer: Frontpath All Commercial |
$551.80
|
| Rate for Payer: Humana ChoiceCare |
$518.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$539.80
|
| Rate for Payer: PHCS All Commercial |
$449.84
|
| Rate for Payer: PHP All Commercial |
$454.87
|
| Rate for Payer: Sagamore Health Network All Products |
$463.03
|
| Rate for Payer: Signature Care EPO |
$497.82
|
| Rate for Payer: Signature Care PPO |
$527.81
|
| Rate for Payer: United Healthcare Commercial |
$472.63
|
|
|
HC UMBILICAL CORD TESTING
|
Facility
|
OP
|
$380.97
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63080307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$354.30 |
| Rate for Payer: Aetna Commercial |
$321.54
|
| Rate for Payer: Aetna Medicare |
$125.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.29
|
| Rate for Payer: Cash Price |
$236.20
|
| Rate for Payer: Cash Price |
$236.20
|
| Rate for Payer: Centivo All Commercial |
$194.29
|
| Rate for Payer: Cigna All Commercial |
$328.78
|
| Rate for Payer: CORVEL All Commercial |
$354.30
|
| Rate for Payer: Coventry All Commercial |
$335.25
|
| Rate for Payer: Encore All Commercial |
$350.68
|
| Rate for Payer: Frontpath All Commercial |
$350.49
|
| Rate for Payer: Humana ChoiceCare |
$329.04
|
| Rate for Payer: Humana Medicare |
$194.29
|
| Rate for Payer: Lucent All Commercial |
$194.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.87
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$285.73
|
| Rate for Payer: PHP All Commercial |
$288.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.58
|
| Rate for Payer: Sagamore Health Network All Products |
$294.11
|
| Rate for Payer: Signature Care EPO |
$316.21
|
| Rate for Payer: Signature Care PPO |
$335.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$323.82
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
| Rate for Payer: United Healthcare Medicare |
$125.72
|
|
|
HC UMBILICAL CORD TESTING
|
Facility
|
IP
|
$380.97
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63080307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.73 |
| Max. Negotiated Rate |
$354.30 |
| Rate for Payer: Aetna Commercial |
$329.16
|
| Rate for Payer: Cash Price |
$236.20
|
| Rate for Payer: Cigna All Commercial |
$328.78
|
| Rate for Payer: CORVEL All Commercial |
$354.30
|
| Rate for Payer: Coventry All Commercial |
$335.25
|
| Rate for Payer: Encore All Commercial |
$350.68
|
| Rate for Payer: Frontpath All Commercial |
$350.49
|
| Rate for Payer: Humana ChoiceCare |
$329.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.87
|
| Rate for Payer: PHCS All Commercial |
$285.73
|
| Rate for Payer: PHP All Commercial |
$288.93
|
| Rate for Payer: Sagamore Health Network All Products |
$294.11
|
| Rate for Payer: Signature Care EPO |
$316.21
|
| Rate for Payer: Signature Care PPO |
$335.25
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
|
|
HC UNIL APP MULTI COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
|
OP
|
$393.76
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
01722006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$129.94 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$332.33
|
| Rate for Payer: Aetna Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.94
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Centivo All Commercial |
$200.82
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Humana Medicare |
$200.82
|
| Rate for Payer: Lucent All Commercial |
$200.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.57
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$334.70
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
| Rate for Payer: United Healthcare Medicare |
$129.94
|
|
|
HC UNIL APP MULTI COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
|
IP
|
$393.76
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
01722006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$295.32 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$340.21
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
|
|
HC UNIL APP MULTI COMPRESS UPPER ARM/FA/H/F PT
|
Facility
|
IP
|
$393.76
|
|
|
Service Code
|
CPT 29584 GP
|
| Hospital Charge Code |
01722009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$295.32 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$340.21
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
|
|
HC UNIL APP MULTI COMPRESS UPPER ARM/FA/H/F PT
|
Facility
|
OP
|
$393.76
|
|
|
Service Code
|
CPT 29584 GP
|
| Hospital Charge Code |
01722009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$129.94 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$332.33
|
| Rate for Payer: Aetna Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.94
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Centivo All Commercial |
$200.82
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Humana Medicare |
$200.82
|
| Rate for Payer: Lucent All Commercial |
$200.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.57
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$334.70
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
| Rate for Payer: United Healthcare Medicare |
$129.94
|
|
