|
HC U/S ABDOMEN LIMITED
|
Facility
|
OP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
01646705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$216.10 |
| Max. Negotiated Rate |
$1,190.44 |
| Rate for Payer: Aetna Commercial |
$1,080.35
|
| Rate for Payer: Aetna Medicare |
$422.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$422.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$735.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$800.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$216.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$485.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$464.65
|
| Rate for Payer: Cash Price |
$793.62
|
| Rate for Payer: Cash Price |
$793.62
|
| Rate for Payer: Centivo All Commercial |
$652.82
|
| Rate for Payer: Cigna All Commercial |
$1,104.67
|
| Rate for Payer: CORVEL All Commercial |
$1,190.44
|
| Rate for Payer: Coventry All Commercial |
$1,126.43
|
| Rate for Payer: Encore All Commercial |
$1,178.28
|
| Rate for Payer: Frontpath All Commercial |
$1,177.64
|
| Rate for Payer: Humana ChoiceCare |
$1,105.57
|
| Rate for Payer: Humana Medicare |
$652.82
|
| Rate for Payer: Lucent All Commercial |
$652.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.03
|
| Rate for Payer: Managed Health Services Medicaid |
$216.10
|
| Rate for Payer: MDWise Medicaid |
$216.10
|
| Rate for Payer: PHCS All Commercial |
$960.03
|
| Rate for Payer: PHP All Commercial |
$970.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.22
|
| Rate for Payer: Sagamore Health Network All Products |
$988.19
|
| Rate for Payer: Signature Care EPO |
$1,062.43
|
| Rate for Payer: Signature Care PPO |
$1,126.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,088.03
|
| Rate for Payer: United Healthcare Commercial |
$1,008.67
|
| Rate for Payer: United Healthcare Medicare |
$422.41
|
|
|
HC U/S ABDOMEN LIMITED
|
Facility
|
IP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
01646705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$960.03 |
| Max. Negotiated Rate |
$1,190.44 |
| Rate for Payer: Aetna Commercial |
$1,105.95
|
| Rate for Payer: Cash Price |
$793.62
|
| Rate for Payer: Cigna All Commercial |
$1,104.67
|
| Rate for Payer: CORVEL All Commercial |
$1,190.44
|
| Rate for Payer: Coventry All Commercial |
$1,126.43
|
| Rate for Payer: Encore All Commercial |
$1,178.28
|
| Rate for Payer: Frontpath All Commercial |
$1,177.64
|
| Rate for Payer: Humana ChoiceCare |
$1,105.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.03
|
| Rate for Payer: PHCS All Commercial |
$960.03
|
| Rate for Payer: PHP All Commercial |
$970.78
|
| Rate for Payer: Sagamore Health Network All Products |
$988.19
|
| Rate for Payer: Signature Care EPO |
$1,062.43
|
| Rate for Payer: Signature Care PPO |
$1,126.43
|
| Rate for Payer: United Healthcare Commercial |
$1,008.67
|
|
|
HC U/S ABDOMINAL DOPPLER LIMITED
|
Facility
|
IP
|
$1,337.02
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
01643976
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,002.76 |
| Max. Negotiated Rate |
$1,243.42 |
| Rate for Payer: Aetna Commercial |
$1,155.18
|
| Rate for Payer: Cash Price |
$828.95
|
| Rate for Payer: Cigna All Commercial |
$1,153.84
|
| Rate for Payer: CORVEL All Commercial |
$1,243.42
|
| Rate for Payer: Coventry All Commercial |
$1,176.57
|
| Rate for Payer: Encore All Commercial |
$1,230.72
|
| Rate for Payer: Frontpath All Commercial |
$1,230.05
|
| Rate for Payer: Humana ChoiceCare |
$1,154.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,203.31
|
| Rate for Payer: PHCS All Commercial |
$1,002.76
|
| Rate for Payer: PHP All Commercial |
$1,013.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,032.18
|
| Rate for Payer: Signature Care EPO |
$1,109.72
|
| Rate for Payer: Signature Care PPO |
$1,176.57
|
| Rate for Payer: United Healthcare Commercial |
$1,053.57
|
|
|
HC U/S ABDOMINAL DOPPLER LIMITED
|
Facility
|
OP
|
$1,337.02
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
01643976
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$379.98 |
| Max. Negotiated Rate |
$1,243.42 |
| Rate for Payer: Aetna Commercial |
$1,128.44
|
| Rate for Payer: Aetna Medicare |
$441.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$441.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$767.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$835.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$379.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$507.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$485.34
|
| Rate for Payer: Cash Price |
$828.95
|
| Rate for Payer: Cash Price |
$828.95
|
| Rate for Payer: Centivo All Commercial |
$681.88
|
| Rate for Payer: Cigna All Commercial |
$1,153.84
|
| Rate for Payer: CORVEL All Commercial |
$1,243.42
|
| Rate for Payer: Coventry All Commercial |
$1,176.57
|
| Rate for Payer: Encore All Commercial |
$1,230.72
|
| Rate for Payer: Frontpath All Commercial |
$1,230.05
|
| Rate for Payer: Humana ChoiceCare |
$1,154.78
|
| Rate for Payer: Humana Medicare |
$681.88
|
| Rate for Payer: Lucent All Commercial |
$681.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,203.31
|
| Rate for Payer: Managed Health Services Medicaid |
$379.98
|
| Rate for Payer: MDWise Medicaid |
$379.98
|
| Rate for Payer: PHCS All Commercial |
$1,002.76
|
| Rate for Payer: PHP All Commercial |
$1,013.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$521.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,032.18
|
| Rate for Payer: Signature Care EPO |
$1,109.72
|
| Rate for Payer: Signature Care PPO |
$1,176.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,136.46
|
| Rate for Payer: United Healthcare Commercial |
$1,053.57
|
| Rate for Payer: United Healthcare Medicare |
$441.22
|
|
|
HC U/S AMNIOCENTESIS GUIDANCE
|
Facility
|
OP
|
$598.29
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
01646810
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$556.41 |
| Rate for Payer: Aetna Commercial |
$504.96
|
| Rate for Payer: Aetna Medicare |
$197.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$197.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$343.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$227.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$217.18
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Centivo All Commercial |
$305.13
|
| Rate for Payer: Cigna All Commercial |
$516.33
|
| Rate for Payer: CORVEL All Commercial |
$556.41
|
| Rate for Payer: Coventry All Commercial |
$526.50
|
| Rate for Payer: Encore All Commercial |
$550.73
|
| Rate for Payer: Frontpath All Commercial |
$550.43
|
| Rate for Payer: Humana ChoiceCare |
$516.74
|
| Rate for Payer: Humana Medicare |
$305.13
|
| Rate for Payer: Lucent All Commercial |
$305.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.46
|
| Rate for Payer: Managed Health Services Medicaid |
$35.41
|
| Rate for Payer: MDWise Medicaid |
$35.41
|
| Rate for Payer: PHCS All Commercial |
$448.72
|
| Rate for Payer: PHP All Commercial |
$453.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$233.33
|
| Rate for Payer: Sagamore Health Network All Products |
$461.88
|
| Rate for Payer: Signature Care EPO |
$496.58
|
| Rate for Payer: Signature Care PPO |
$526.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$508.55
|
| Rate for Payer: United Healthcare Commercial |
$471.45
|
| Rate for Payer: United Healthcare Medicare |
$197.44
|
|
|
HC U/S AMNIOCENTESIS GUIDANCE
|
Facility
|
IP
|
$598.29
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
01646810
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$448.72 |
| Max. Negotiated Rate |
$556.41 |
| Rate for Payer: Aetna Commercial |
$516.92
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cigna All Commercial |
$516.33
|
| Rate for Payer: CORVEL All Commercial |
$556.41
|
| Rate for Payer: Coventry All Commercial |
$526.50
|
| Rate for Payer: Encore All Commercial |
$550.73
|
| Rate for Payer: Frontpath All Commercial |
$550.43
|
| Rate for Payer: Humana ChoiceCare |
$516.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.46
|
| Rate for Payer: PHCS All Commercial |
$448.72
|
| Rate for Payer: PHP All Commercial |
$453.74
|
| Rate for Payer: Sagamore Health Network All Products |
$461.88
|
| Rate for Payer: Signature Care EPO |
$496.58
|
| Rate for Payer: Signature Care PPO |
$526.50
|
| Rate for Payer: United Healthcare Commercial |
$471.45
|
|
|
HC U/S ANKLE/BRACHIAL INDEX
|
Facility
|
OP
|
$679.54
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
01643922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$131.27 |
| Max. Negotiated Rate |
$631.98 |
| Rate for Payer: Aetna Commercial |
$573.54
|
| Rate for Payer: Aetna Medicare |
$224.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$224.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$390.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$424.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$131.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$246.67
|
| Rate for Payer: Cash Price |
$421.32
|
| Rate for Payer: Cash Price |
$421.32
|
| Rate for Payer: Centivo All Commercial |
$346.57
|
| Rate for Payer: Cigna All Commercial |
$586.45
|
| Rate for Payer: CORVEL All Commercial |
$631.98
|
| Rate for Payer: Coventry All Commercial |
$598.00
|
| Rate for Payer: Encore All Commercial |
$625.52
|
| Rate for Payer: Frontpath All Commercial |
$625.18
|
| Rate for Payer: Humana ChoiceCare |
$586.92
|
| Rate for Payer: Humana Medicare |
$346.57
|
| Rate for Payer: Lucent All Commercial |
$346.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$611.59
|
| Rate for Payer: Managed Health Services Medicaid |
$131.27
|
| Rate for Payer: MDWise Medicaid |
$131.27
|
| Rate for Payer: PHCS All Commercial |
$509.66
|
| Rate for Payer: PHP All Commercial |
$515.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$265.02
|
| Rate for Payer: Sagamore Health Network All Products |
$524.61
|
| Rate for Payer: Signature Care EPO |
$564.02
|
| Rate for Payer: Signature Care PPO |
$598.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$577.61
|
| Rate for Payer: United Healthcare Commercial |
$535.48
|
| Rate for Payer: United Healthcare Medicare |
$224.25
|
|
|
HC U/S ANKLE/BRACHIAL INDEX
|
Facility
|
IP
|
$679.54
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
01643922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$509.66 |
| Max. Negotiated Rate |
$631.98 |
| Rate for Payer: Aetna Commercial |
$587.13
|
| Rate for Payer: Cash Price |
$421.32
|
| Rate for Payer: Cigna All Commercial |
$586.45
|
| Rate for Payer: CORVEL All Commercial |
$631.98
|
| Rate for Payer: Coventry All Commercial |
$598.00
|
| Rate for Payer: Encore All Commercial |
$625.52
|
| Rate for Payer: Frontpath All Commercial |
$625.18
|
| Rate for Payer: Humana ChoiceCare |
$586.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$611.59
|
| Rate for Payer: PHCS All Commercial |
$509.66
|
| Rate for Payer: PHP All Commercial |
$515.37
|
| Rate for Payer: Sagamore Health Network All Products |
$524.61
|
| Rate for Payer: Signature Care EPO |
$564.02
|
| Rate for Payer: Signature Care PPO |
$598.00
|
| Rate for Payer: United Healthcare Commercial |
$535.48
|
|
|
HC U/S A-V FISTULA
|
Facility
|
IP
|
$777.02
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
01643990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$582.76 |
| Max. Negotiated Rate |
$722.62 |
| Rate for Payer: Aetna Commercial |
$671.34
|
| Rate for Payer: Cash Price |
$481.75
|
| Rate for Payer: Cigna All Commercial |
$670.56
|
| Rate for Payer: CORVEL All Commercial |
$722.62
|
| Rate for Payer: Coventry All Commercial |
$683.77
|
| Rate for Payer: Encore All Commercial |
$715.24
|
| Rate for Payer: Frontpath All Commercial |
$714.85
|
| Rate for Payer: Humana ChoiceCare |
$671.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.31
|
| Rate for Payer: PHCS All Commercial |
$582.76
|
| Rate for Payer: PHP All Commercial |
$589.29
|
| Rate for Payer: Sagamore Health Network All Products |
$599.86
|
| Rate for Payer: Signature Care EPO |
$644.92
|
| Rate for Payer: Signature Care PPO |
$683.77
|
| Rate for Payer: United Healthcare Commercial |
$612.29
|
|
|
HC U/S A-V FISTULA
|
Facility
|
OP
|
$777.02
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
01643990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$722.62 |
| Rate for Payer: Aetna Commercial |
$655.80
|
| Rate for Payer: Aetna Medicare |
$256.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$485.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$255.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$294.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.06
|
| Rate for Payer: Cash Price |
$481.75
|
| Rate for Payer: Cash Price |
$481.75
|
| Rate for Payer: Centivo All Commercial |
$396.28
|
| Rate for Payer: Cigna All Commercial |
$670.56
|
| Rate for Payer: CORVEL All Commercial |
$722.62
|
| Rate for Payer: Coventry All Commercial |
$683.77
|
| Rate for Payer: Encore All Commercial |
$715.24
|
| Rate for Payer: Frontpath All Commercial |
$714.85
|
| Rate for Payer: Humana ChoiceCare |
$671.11
|
| Rate for Payer: Humana Medicare |
$396.28
|
| Rate for Payer: Lucent All Commercial |
$396.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.31
|
| Rate for Payer: Managed Health Services Medicaid |
$255.53
|
| Rate for Payer: MDWise Medicaid |
$255.53
|
| Rate for Payer: PHCS All Commercial |
$582.76
|
| Rate for Payer: PHP All Commercial |
$589.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.04
|
| Rate for Payer: Sagamore Health Network All Products |
$599.86
|
| Rate for Payer: Signature Care EPO |
$644.92
|
| Rate for Payer: Signature Care PPO |
$683.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$660.46
|
| Rate for Payer: United Healthcare Commercial |
$612.29
|
| Rate for Payer: United Healthcare Medicare |
$256.42
|
|
|
HC U/S BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$849.82
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
01646809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.83 |
| Max. Negotiated Rate |
$790.34 |
| Rate for Payer: Aetna Commercial |
$717.25
|
| Rate for Payer: Aetna Medicare |
$280.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$488.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$531.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$137.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.49
|
| Rate for Payer: Cash Price |
$526.89
|
| Rate for Payer: Cash Price |
$526.89
|
| Rate for Payer: Centivo All Commercial |
$433.41
|
| Rate for Payer: Cigna All Commercial |
$733.40
|
| Rate for Payer: CORVEL All Commercial |
$790.34
|
| Rate for Payer: Coventry All Commercial |
$747.84
|
| Rate for Payer: Encore All Commercial |
$782.26
|
| Rate for Payer: Frontpath All Commercial |
$781.84
|
| Rate for Payer: Humana ChoiceCare |
$733.99
|
| Rate for Payer: Humana Medicare |
$433.41
|
| Rate for Payer: Lucent All Commercial |
$433.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.84
|
| Rate for Payer: Managed Health Services Medicaid |
$137.83
|
| Rate for Payer: MDWise Medicaid |
$137.83
|
| Rate for Payer: PHCS All Commercial |
$637.37
|
| Rate for Payer: PHP All Commercial |
$644.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.43
|
| Rate for Payer: Sagamore Health Network All Products |
$656.06
|
| Rate for Payer: Signature Care EPO |
$705.35
|
| Rate for Payer: Signature Care PPO |
$747.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$722.35
|
| Rate for Payer: United Healthcare Commercial |
$669.66
|
| Rate for Payer: United Healthcare Medicare |
$280.44
|
|
|
HC U/S BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$849.82
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
01646809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$637.37 |
| Max. Negotiated Rate |
$790.34 |
| Rate for Payer: Aetna Commercial |
$734.25
|
| Rate for Payer: Cash Price |
$526.89
|
| Rate for Payer: Cigna All Commercial |
$733.40
|
| Rate for Payer: CORVEL All Commercial |
$790.34
|
| Rate for Payer: Coventry All Commercial |
$747.84
|
| Rate for Payer: Encore All Commercial |
$782.26
|
| Rate for Payer: Frontpath All Commercial |
$781.84
|
| Rate for Payer: Humana ChoiceCare |
$733.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.84
|
| Rate for Payer: PHCS All Commercial |
$637.37
|
| Rate for Payer: PHP All Commercial |
$644.51
|
| Rate for Payer: Sagamore Health Network All Products |
$656.06
|
| Rate for Payer: Signature Care EPO |
$705.35
|
| Rate for Payer: Signature Care PPO |
$747.84
|
| Rate for Payer: United Healthcare Commercial |
$669.66
|
|
|
HC U/S BIOPSY - UNLISTED
|
Facility
|
OP
|
$893.38
|
|
| Hospital Charge Code |
01649002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.81 |
| Max. Negotiated Rate |
$830.84 |
| Rate for Payer: Aetna Commercial |
$754.01
|
| Rate for Payer: Aetna Medicare |
$294.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$513.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$558.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$339.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$324.30
|
| Rate for Payer: Cash Price |
$553.89
|
| Rate for Payer: Centivo All Commercial |
$455.62
|
| Rate for Payer: Cigna All Commercial |
$770.98
|
| Rate for Payer: CORVEL All Commercial |
$830.84
|
| Rate for Payer: Coventry All Commercial |
$786.17
|
| Rate for Payer: Encore All Commercial |
$822.35
|
| Rate for Payer: Frontpath All Commercial |
$821.91
|
| Rate for Payer: Humana ChoiceCare |
$771.61
|
| Rate for Payer: Humana Medicare |
$455.62
|
| Rate for Payer: Lucent All Commercial |
$455.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$804.04
|
| Rate for Payer: PHCS All Commercial |
$670.03
|
| Rate for Payer: PHP All Commercial |
$677.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.42
|
| Rate for Payer: Sagamore Health Network All Products |
$689.69
|
| Rate for Payer: Signature Care EPO |
$741.50
|
| Rate for Payer: Signature Care PPO |
$786.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$759.37
|
| Rate for Payer: United Healthcare Commercial |
$703.98
|
| Rate for Payer: United Healthcare Medicare |
$294.81
|
|
|
HC U/S BIOPSY - UNLISTED
|
Facility
|
IP
|
$893.38
|
|
| Hospital Charge Code |
01649002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$670.03 |
| Max. Negotiated Rate |
$830.84 |
| Rate for Payer: Aetna Commercial |
$771.88
|
| Rate for Payer: Cash Price |
$553.89
|
| Rate for Payer: Cigna All Commercial |
$770.98
|
| Rate for Payer: CORVEL All Commercial |
$830.84
|
| Rate for Payer: Coventry All Commercial |
$786.17
|
| Rate for Payer: Encore All Commercial |
$822.35
|
| Rate for Payer: Frontpath All Commercial |
$821.91
|
| Rate for Payer: Humana ChoiceCare |
$771.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$804.04
|
| Rate for Payer: PHCS All Commercial |
$670.03
|
| Rate for Payer: PHP All Commercial |
$677.54
|
| Rate for Payer: Sagamore Health Network All Products |
$689.69
|
| Rate for Payer: Signature Care EPO |
$741.50
|
| Rate for Payer: Signature Care PPO |
$786.17
|
| Rate for Payer: United Healthcare Commercial |
$703.98
|
|
|
HC U/S BIOPSY - UNLISTED BILATERAL
|
Facility
|
OP
|
$1,340.05
|
|
| Hospital Charge Code |
01643005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.21 |
| Max. Negotiated Rate |
$1,246.24 |
| Rate for Payer: Aetna Commercial |
$1,131.00
|
| Rate for Payer: Aetna Medicare |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$769.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$837.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$508.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$486.44
|
| Rate for Payer: Cash Price |
$830.83
|
| Rate for Payer: Centivo All Commercial |
$683.42
|
| Rate for Payer: Cigna All Commercial |
$1,156.46
|
| Rate for Payer: CORVEL All Commercial |
$1,246.24
|
| Rate for Payer: Coventry All Commercial |
$1,179.24
|
| Rate for Payer: Encore All Commercial |
$1,233.51
|
| Rate for Payer: Frontpath All Commercial |
$1,232.84
|
| Rate for Payer: Humana ChoiceCare |
$1,157.40
|
| Rate for Payer: Humana Medicare |
$683.42
|
| Rate for Payer: Lucent All Commercial |
$683.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,206.04
|
| Rate for Payer: PHCS All Commercial |
$1,005.03
|
| Rate for Payer: PHP All Commercial |
$1,016.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$522.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.52
|
| Rate for Payer: Signature Care EPO |
$1,112.24
|
| Rate for Payer: Signature Care PPO |
$1,179.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,139.04
|
| Rate for Payer: United Healthcare Commercial |
$1,055.96
|
| Rate for Payer: United Healthcare Medicare |
$442.21
|
|
|
HC U/S BIOPSY - UNLISTED BILATERAL
|
Facility
|
IP
|
$1,340.05
|
|
| Hospital Charge Code |
01643005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,005.03 |
| Max. Negotiated Rate |
$1,246.24 |
| Rate for Payer: Aetna Commercial |
$1,157.80
|
| Rate for Payer: Cash Price |
$830.83
|
| Rate for Payer: Cigna All Commercial |
$1,156.46
|
| Rate for Payer: CORVEL All Commercial |
$1,246.24
|
| Rate for Payer: Coventry All Commercial |
$1,179.24
|
| Rate for Payer: Encore All Commercial |
$1,233.51
|
| Rate for Payer: Frontpath All Commercial |
$1,232.84
|
| Rate for Payer: Humana ChoiceCare |
$1,157.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,206.04
|
| Rate for Payer: PHCS All Commercial |
$1,005.03
|
| Rate for Payer: PHP All Commercial |
$1,016.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.52
|
| Rate for Payer: Signature Care EPO |
$1,112.24
|
| Rate for Payer: Signature Care PPO |
$1,179.24
|
| Rate for Payer: United Healthcare Commercial |
$1,055.96
|
|
|
HC U/S BX OR EXC PERC LN; SUPERF
|
Facility
|
OP
|
$2,871.81
|
|
| Hospital Charge Code |
01648505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$947.70 |
| Max. Negotiated Rate |
$2,670.78 |
| Rate for Payer: Aetna Commercial |
$2,423.81
|
| Rate for Payer: Aetna Medicare |
$947.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$947.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,649.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,795.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,089.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,042.47
|
| Rate for Payer: Cash Price |
$1,780.52
|
| Rate for Payer: Centivo All Commercial |
$1,464.62
|
| Rate for Payer: Cigna All Commercial |
$2,478.37
|
| Rate for Payer: CORVEL All Commercial |
$2,670.78
|
| Rate for Payer: Coventry All Commercial |
$2,527.19
|
| Rate for Payer: Encore All Commercial |
$2,643.50
|
| Rate for Payer: Frontpath All Commercial |
$2,642.07
|
| Rate for Payer: Humana ChoiceCare |
$2,480.38
|
| Rate for Payer: Humana Medicare |
$1,464.62
|
| Rate for Payer: Lucent All Commercial |
$1,464.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,584.63
|
| Rate for Payer: PHCS All Commercial |
$2,153.86
|
| Rate for Payer: PHP All Commercial |
$2,177.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,120.01
|
| Rate for Payer: Sagamore Health Network All Products |
$2,217.04
|
| Rate for Payer: Signature Care EPO |
$2,383.60
|
| Rate for Payer: Signature Care PPO |
$2,527.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,441.04
|
| Rate for Payer: United Healthcare Commercial |
$2,262.99
|
| Rate for Payer: United Healthcare Medicare |
$947.70
|
|
|
HC U/S BX OR EXC PERC LN; SUPERF
|
Facility
|
IP
|
$2,871.81
|
|
| Hospital Charge Code |
01648505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,153.86 |
| Max. Negotiated Rate |
$2,670.78 |
| Rate for Payer: Aetna Commercial |
$2,481.24
|
| Rate for Payer: Cash Price |
$1,780.52
|
| Rate for Payer: Cigna All Commercial |
$2,478.37
|
| Rate for Payer: CORVEL All Commercial |
$2,670.78
|
| Rate for Payer: Coventry All Commercial |
$2,527.19
|
| Rate for Payer: Encore All Commercial |
$2,643.50
|
| Rate for Payer: Frontpath All Commercial |
$2,642.07
|
| Rate for Payer: Humana ChoiceCare |
$2,480.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,584.63
|
| Rate for Payer: PHCS All Commercial |
$2,153.86
|
| Rate for Payer: PHP All Commercial |
$2,177.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,217.04
|
| Rate for Payer: Signature Care EPO |
$2,383.60
|
| Rate for Payer: Signature Care PPO |
$2,527.19
|
| Rate for Payer: United Healthcare Commercial |
$2,262.99
|
|
|
HC U/S CAROTID DOPPLER BILATERAL
|
Facility
|
IP
|
$1,552.60
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
01646900
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,164.45 |
| Max. Negotiated Rate |
$1,443.92 |
| Rate for Payer: Aetna Commercial |
$1,341.45
|
| Rate for Payer: Cash Price |
$962.61
|
| Rate for Payer: Cigna All Commercial |
$1,339.90
|
| Rate for Payer: CORVEL All Commercial |
$1,443.92
|
| Rate for Payer: Coventry All Commercial |
$1,366.29
|
| Rate for Payer: Encore All Commercial |
$1,429.17
|
| Rate for Payer: Frontpath All Commercial |
$1,428.39
|
| Rate for Payer: Humana ChoiceCare |
$1,340.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,397.34
|
| Rate for Payer: PHCS All Commercial |
$1,164.45
|
| Rate for Payer: PHP All Commercial |
$1,177.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,198.61
|
| Rate for Payer: Signature Care EPO |
$1,288.66
|
| Rate for Payer: Signature Care PPO |
$1,366.29
|
| Rate for Payer: United Healthcare Commercial |
$1,223.45
|
|
|
HC U/S CAROTID DOPPLER BILATERAL
|
Facility
|
OP
|
$1,552.60
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
01646900
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$379.98 |
| Max. Negotiated Rate |
$1,443.92 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Medicare |
$512.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$512.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$891.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$970.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$379.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$589.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$563.59
|
| Rate for Payer: Cash Price |
$962.61
|
| Rate for Payer: Cash Price |
$962.61
|
| Rate for Payer: Centivo All Commercial |
$791.83
|
| Rate for Payer: Cigna All Commercial |
$1,339.90
|
| Rate for Payer: CORVEL All Commercial |
$1,443.92
|
| Rate for Payer: Coventry All Commercial |
$1,366.29
|
| Rate for Payer: Encore All Commercial |
$1,429.17
|
| Rate for Payer: Frontpath All Commercial |
$1,428.39
|
| Rate for Payer: Humana ChoiceCare |
$1,340.98
|
| Rate for Payer: Humana Medicare |
$791.83
|
| Rate for Payer: Lucent All Commercial |
$791.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,397.34
|
| Rate for Payer: Managed Health Services Medicaid |
$379.98
|
| Rate for Payer: MDWise Medicaid |
$379.98
|
| Rate for Payer: PHCS All Commercial |
$1,164.45
|
| Rate for Payer: PHP All Commercial |
$1,177.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$605.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,198.61
|
| Rate for Payer: Signature Care EPO |
$1,288.66
|
| Rate for Payer: Signature Care PPO |
$1,366.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,319.71
|
| Rate for Payer: United Healthcare Commercial |
$1,223.45
|
| Rate for Payer: United Healthcare Medicare |
$512.36
|
|
|
HC U/S CHEST WALL
|
Facility
|
IP
|
$701.45
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
01646706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$526.09 |
| Max. Negotiated Rate |
$652.35 |
| Rate for Payer: Aetna Commercial |
$606.06
|
| Rate for Payer: Cash Price |
$434.90
|
| Rate for Payer: Cigna All Commercial |
$605.35
|
| Rate for Payer: CORVEL All Commercial |
$652.35
|
| Rate for Payer: Coventry All Commercial |
$617.28
|
| Rate for Payer: Encore All Commercial |
$645.69
|
| Rate for Payer: Frontpath All Commercial |
$645.34
|
| Rate for Payer: Humana ChoiceCare |
$605.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.31
|
| Rate for Payer: PHCS All Commercial |
$526.09
|
| Rate for Payer: PHP All Commercial |
$531.98
|
| Rate for Payer: Sagamore Health Network All Products |
$541.52
|
| Rate for Payer: Signature Care EPO |
$582.21
|
| Rate for Payer: Signature Care PPO |
$617.28
|
| Rate for Payer: United Healthcare Commercial |
$552.75
|
|
|
HC U/S CHEST WALL
|
Facility
|
OP
|
$701.45
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
01646706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$652.35 |
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: Aetna Medicare |
$231.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$402.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$166.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.63
|
| Rate for Payer: Cash Price |
$434.90
|
| Rate for Payer: Cash Price |
$434.90
|
| Rate for Payer: Centivo All Commercial |
$357.74
|
| Rate for Payer: Cigna All Commercial |
$605.35
|
| Rate for Payer: CORVEL All Commercial |
$652.35
|
| Rate for Payer: Coventry All Commercial |
$617.28
|
| Rate for Payer: Encore All Commercial |
$645.69
|
| Rate for Payer: Frontpath All Commercial |
$645.34
|
| Rate for Payer: Humana ChoiceCare |
$605.85
|
| Rate for Payer: Humana Medicare |
$357.74
|
| Rate for Payer: Lucent All Commercial |
$357.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.31
|
| Rate for Payer: Managed Health Services Medicaid |
$166.80
|
| Rate for Payer: MDWise Medicaid |
$166.80
|
| Rate for Payer: PHCS All Commercial |
$526.09
|
| Rate for Payer: PHP All Commercial |
$531.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.57
|
| Rate for Payer: Sagamore Health Network All Products |
$541.52
|
| Rate for Payer: Signature Care EPO |
$582.21
|
| Rate for Payer: Signature Care PPO |
$617.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.24
|
| Rate for Payer: United Healthcare Commercial |
$552.75
|
| Rate for Payer: United Healthcare Medicare |
$231.48
|
|
|
HC U/S CLR FL ART LWR EXT UNI LTD
|
Facility
|
OP
|
$1,104.16
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
01643932
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$364.37 |
| Max. Negotiated Rate |
$1,026.87 |
| Rate for Payer: Aetna Commercial |
$931.91
|
| Rate for Payer: Aetna Medicare |
$364.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$364.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$634.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$690.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$379.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$419.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$400.81
|
| Rate for Payer: Cash Price |
$684.58
|
| Rate for Payer: Cash Price |
$684.58
|
| Rate for Payer: Centivo All Commercial |
$563.12
|
| Rate for Payer: Cigna All Commercial |
$952.89
|
| Rate for Payer: CORVEL All Commercial |
$1,026.87
|
| Rate for Payer: Coventry All Commercial |
$971.66
|
| Rate for Payer: Encore All Commercial |
$1,016.38
|
| Rate for Payer: Frontpath All Commercial |
$1,015.83
|
| Rate for Payer: Humana ChoiceCare |
$953.66
|
| Rate for Payer: Humana Medicare |
$563.12
|
| Rate for Payer: Lucent All Commercial |
$563.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.74
|
| Rate for Payer: Managed Health Services Medicaid |
$379.98
|
| Rate for Payer: MDWise Medicaid |
$379.98
|
| Rate for Payer: PHCS All Commercial |
$828.12
|
| Rate for Payer: PHP All Commercial |
$837.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.62
|
| Rate for Payer: Sagamore Health Network All Products |
$852.41
|
| Rate for Payer: Signature Care EPO |
$916.45
|
| Rate for Payer: Signature Care PPO |
$971.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.54
|
| Rate for Payer: United Healthcare Commercial |
$870.08
|
| Rate for Payer: United Healthcare Medicare |
$364.37
|
|
|
HC U/S CLR FL ART LWR EXT UNI LTD
|
Facility
|
IP
|
$1,104.16
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
01643932
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$828.12 |
| Max. Negotiated Rate |
$1,026.87 |
| Rate for Payer: Aetna Commercial |
$953.99
|
| Rate for Payer: Cash Price |
$684.58
|
| Rate for Payer: Cigna All Commercial |
$952.89
|
| Rate for Payer: CORVEL All Commercial |
$1,026.87
|
| Rate for Payer: Coventry All Commercial |
$971.66
|
| Rate for Payer: Encore All Commercial |
$1,016.38
|
| Rate for Payer: Frontpath All Commercial |
$1,015.83
|
| Rate for Payer: Humana ChoiceCare |
$953.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.74
|
| Rate for Payer: PHCS All Commercial |
$828.12
|
| Rate for Payer: PHP All Commercial |
$837.40
|
| Rate for Payer: Sagamore Health Network All Products |
$852.41
|
| Rate for Payer: Signature Care EPO |
$916.45
|
| Rate for Payer: Signature Care PPO |
$971.66
|
| Rate for Payer: United Healthcare Commercial |
$870.08
|
|
|
HC U/S COLOR FLOW ART LOW EXT BIL
|
Facility
|
IP
|
$1,656.25
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
01643925
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,242.18 |
| Max. Negotiated Rate |
$1,540.31 |
| Rate for Payer: Aetna Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$1,026.87
|
| Rate for Payer: Cigna All Commercial |
$1,429.34
|
| Rate for Payer: CORVEL All Commercial |
$1,540.31
|
| Rate for Payer: Coventry All Commercial |
$1,457.50
|
| Rate for Payer: Encore All Commercial |
$1,524.57
|
| Rate for Payer: Frontpath All Commercial |
$1,523.75
|
| Rate for Payer: Humana ChoiceCare |
$1,430.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,490.62
|
| Rate for Payer: PHCS All Commercial |
$1,242.18
|
| Rate for Payer: PHP All Commercial |
$1,256.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,278.62
|
| Rate for Payer: Signature Care EPO |
$1,374.68
|
| Rate for Payer: Signature Care PPO |
$1,457.50
|
| Rate for Payer: United Healthcare Commercial |
$1,305.12
|
|
