|
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
|
|
|
HC U/S COLOR FLOW ART LOW EXT UNI
|
Facility
|
OP
|
$1,070.28
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
01643926
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$353.19 |
| Max. Negotiated Rate |
$995.36 |
| Rate for Payer: Aetna Commercial |
$903.31
|
| Rate for Payer: Aetna Medicare |
$353.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$379.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.51
|
| Rate for Payer: Cash Price |
$663.57
|
| Rate for Payer: Cash Price |
$663.57
|
| Rate for Payer: Centivo All Commercial |
$545.84
|
| Rate for Payer: Cigna All Commercial |
$923.65
|
| Rate for Payer: CORVEL All Commercial |
$995.36
|
| Rate for Payer: Coventry All Commercial |
$941.84
|
| Rate for Payer: Encore All Commercial |
$985.19
|
| Rate for Payer: Frontpath All Commercial |
$984.65
|
| Rate for Payer: Humana ChoiceCare |
$924.40
|
| Rate for Payer: Humana Medicare |
$545.84
|
| Rate for Payer: Lucent All Commercial |
$545.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.25
|
| Rate for Payer: Managed Health Services Medicaid |
$379.98
|
| Rate for Payer: MDWise Medicaid |
$379.98
|
| Rate for Payer: PHCS All Commercial |
$802.71
|
| Rate for Payer: PHP All Commercial |
$811.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.41
|
| Rate for Payer: Sagamore Health Network All Products |
$826.25
|
| Rate for Payer: Signature Care EPO |
$888.33
|
| Rate for Payer: Signature Care PPO |
$941.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.73
|
| Rate for Payer: United Healthcare Commercial |
$843.38
|
| Rate for Payer: United Healthcare Medicare |
$353.19
|
|
|
HC U/S COLOR FLOW ART LOW EXT UNI
|
Facility
|
IP
|
$1,070.28
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
01643926
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$802.71 |
| Max. Negotiated Rate |
$995.36 |
| Rate for Payer: Aetna Commercial |
$924.72
|
| Rate for Payer: Cash Price |
$663.57
|
| Rate for Payer: Cigna All Commercial |
$923.65
|
| Rate for Payer: CORVEL All Commercial |
$995.36
|
| Rate for Payer: Coventry All Commercial |
$941.84
|
| Rate for Payer: Encore All Commercial |
$985.19
|
| Rate for Payer: Frontpath All Commercial |
$984.65
|
| Rate for Payer: Humana ChoiceCare |
$924.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.25
|
| Rate for Payer: PHCS All Commercial |
$802.71
|
| Rate for Payer: PHP All Commercial |
$811.70
|
| Rate for Payer: Sagamore Health Network All Products |
$826.25
|
| Rate for Payer: Signature Care EPO |
$888.33
|
| Rate for Payer: Signature Care PPO |
$941.84
|
| Rate for Payer: United Healthcare Commercial |
$843.38
|
|
|
HC U/S COLOR FLOW ART UP EXT BIL
|
Facility
|
OP
|
$1,731.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
01643928
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$571.23 |
| Max. Negotiated Rate |
$1,609.83 |
| Rate for Payer: Aetna Commercial |
$1,460.97
|
| Rate for Payer: Aetna Medicare |
$571.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$571.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$994.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,082.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$739.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$656.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$628.35
|
| Rate for Payer: Cash Price |
$1,073.22
|
| Rate for Payer: Cash Price |
$1,073.22
|
| Rate for Payer: Centivo All Commercial |
$882.81
|
| Rate for Payer: Cigna All Commercial |
$1,493.85
|
| Rate for Payer: CORVEL All Commercial |
$1,609.83
|
| Rate for Payer: Coventry All Commercial |
$1,523.28
|
| Rate for Payer: Encore All Commercial |
$1,593.39
|
| Rate for Payer: Frontpath All Commercial |
$1,592.52
|
| Rate for Payer: Humana ChoiceCare |
$1,495.07
|
| Rate for Payer: Humana Medicare |
$882.81
|
| Rate for Payer: Lucent All Commercial |
$882.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,557.90
|
| Rate for Payer: Managed Health Services Medicaid |
$739.52
|
| Rate for Payer: MDWise Medicaid |
$739.52
|
| Rate for Payer: PHCS All Commercial |
$1,298.25
|
| Rate for Payer: PHP All Commercial |
$1,312.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$675.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,336.33
|
| Rate for Payer: Signature Care EPO |
$1,436.73
|
| Rate for Payer: Signature Care PPO |
$1,523.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,471.35
|
| Rate for Payer: United Healthcare Commercial |
$1,364.03
|
| Rate for Payer: United Healthcare Medicare |
$571.23
|
|
|
HC U/S COLOR FLOW ART UP EXT BIL
|
Facility
|
IP
|
$1,731.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
01643928
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,298.25 |
| Max. Negotiated Rate |
$1,609.83 |
| Rate for Payer: Aetna Commercial |
$1,495.59
|
| Rate for Payer: Cash Price |
$1,073.22
|
| Rate for Payer: Cigna All Commercial |
$1,493.85
|
| Rate for Payer: CORVEL All Commercial |
$1,609.83
|
| Rate for Payer: Coventry All Commercial |
$1,523.28
|
| Rate for Payer: Encore All Commercial |
$1,593.39
|
| Rate for Payer: Frontpath All Commercial |
$1,592.52
|
| Rate for Payer: Humana ChoiceCare |
$1,495.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,557.90
|
| Rate for Payer: PHCS All Commercial |
$1,298.25
|
| Rate for Payer: PHP All Commercial |
$1,312.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,336.33
|
| Rate for Payer: Signature Care EPO |
$1,436.73
|
| Rate for Payer: Signature Care PPO |
$1,523.28
|
| Rate for Payer: United Healthcare Commercial |
$1,364.03
|
|
|
HC U/S COLOR FLOW ART UP EXT UNI
|
Facility
|
OP
|
$930.91
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
01643931
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$865.75 |
| Rate for Payer: Aetna Commercial |
$785.69
|
| Rate for Payer: Aetna Medicare |
$307.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$379.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.92
|
| Rate for Payer: Cash Price |
$577.17
|
| Rate for Payer: Cash Price |
$577.17
|
| Rate for Payer: Centivo All Commercial |
$474.77
|
| Rate for Payer: Cigna All Commercial |
$803.38
|
| Rate for Payer: CORVEL All Commercial |
$865.75
|
| Rate for Payer: Coventry All Commercial |
$819.20
|
| Rate for Payer: Encore All Commercial |
$856.91
|
| Rate for Payer: Frontpath All Commercial |
$856.44
|
| Rate for Payer: Humana ChoiceCare |
$804.03
|
| Rate for Payer: Humana Medicare |
$474.77
|
| Rate for Payer: Lucent All Commercial |
$474.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.82
|
| Rate for Payer: Managed Health Services Medicaid |
$379.98
|
| Rate for Payer: MDWise Medicaid |
$379.98
|
| Rate for Payer: PHCS All Commercial |
$698.18
|
| Rate for Payer: PHP All Commercial |
$706.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.06
|
| Rate for Payer: Sagamore Health Network All Products |
$718.66
|
| Rate for Payer: Signature Care EPO |
$772.66
|
| Rate for Payer: Signature Care PPO |
$819.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.28
|
| Rate for Payer: United Healthcare Commercial |
$733.56
|
| Rate for Payer: United Healthcare Medicare |
$307.20
|
|
|
HC U/S COLOR FLOW ART UP EXT UNI
|
Facility
|
IP
|
$930.91
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
01643931
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$698.18 |
| Max. Negotiated Rate |
$865.75 |
| Rate for Payer: Aetna Commercial |
$804.31
|
| Rate for Payer: Cash Price |
$577.17
|
| Rate for Payer: Cigna All Commercial |
$803.38
|
| Rate for Payer: CORVEL All Commercial |
$865.75
|
| Rate for Payer: Coventry All Commercial |
$819.20
|
| Rate for Payer: Encore All Commercial |
$856.91
|
| Rate for Payer: Frontpath All Commercial |
$856.44
|
| Rate for Payer: Humana ChoiceCare |
$804.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.82
|
| Rate for Payer: PHCS All Commercial |
$698.18
|
| Rate for Payer: PHP All Commercial |
$706.00
|
| Rate for Payer: Sagamore Health Network All Products |
$718.66
|
| Rate for Payer: Signature Care EPO |
$772.66
|
| Rate for Payer: Signature Care PPO |
$819.20
|
| Rate for Payer: United Healthcare Commercial |
$733.56
|
|
|
HC US CYST ASP/BIOP GUIDE BIL
|
Facility
|
IP
|
$1,419.13
|
|
|
Service Code
|
CPT 76942 50
|
| Hospital Charge Code |
21643003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,064.34 |
| Max. Negotiated Rate |
$1,319.79 |
| Rate for Payer: Aetna Commercial |
$1,226.12
|
| Rate for Payer: Cash Price |
$879.86
|
| Rate for Payer: Cigna All Commercial |
$1,224.71
|
| Rate for Payer: CORVEL All Commercial |
$1,319.79
|
| Rate for Payer: Coventry All Commercial |
$1,248.83
|
| Rate for Payer: Encore All Commercial |
$1,306.31
|
| Rate for Payer: Frontpath All Commercial |
$1,305.60
|
| Rate for Payer: Humana ChoiceCare |
$1,225.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,277.21
|
| Rate for Payer: PHCS All Commercial |
$1,064.34
|
| Rate for Payer: PHP All Commercial |
$1,076.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,095.57
|
| Rate for Payer: Signature Care EPO |
$1,177.87
|
| Rate for Payer: Signature Care PPO |
$1,248.83
|
| Rate for Payer: United Healthcare Commercial |
$1,118.27
|
|
|
HC US CYST ASP/BIOP GUIDE BIL
|
Facility
|
OP
|
$1,419.13
|
|
|
Service Code
|
CPT 76942 50
|
| Hospital Charge Code |
21643003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$468.31 |
| Max. Negotiated Rate |
$1,319.79 |
| Rate for Payer: Aetna Commercial |
$1,197.74
|
| Rate for Payer: Aetna Medicare |
$468.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$468.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$815.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$887.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$538.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$515.14
|
| Rate for Payer: Cash Price |
$879.86
|
| Rate for Payer: Centivo All Commercial |
$723.75
|
| Rate for Payer: Cigna All Commercial |
$1,224.71
|
| Rate for Payer: CORVEL All Commercial |
$1,319.79
|
| Rate for Payer: Coventry All Commercial |
$1,248.83
|
| Rate for Payer: Encore All Commercial |
$1,306.31
|
| Rate for Payer: Frontpath All Commercial |
$1,305.60
|
| Rate for Payer: Humana ChoiceCare |
$1,225.70
|
| Rate for Payer: Humana Medicare |
$723.75
|
| Rate for Payer: Lucent All Commercial |
$723.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,277.21
|
| Rate for Payer: PHCS All Commercial |
$1,064.34
|
| Rate for Payer: PHP All Commercial |
$1,076.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$553.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,095.57
|
| Rate for Payer: Signature Care EPO |
$1,177.87
|
| Rate for Payer: Signature Care PPO |
$1,248.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,206.26
|
| Rate for Payer: United Healthcare Commercial |
$1,118.27
|
| Rate for Payer: United Healthcare Medicare |
$468.31
|
|
|
HC U/S CYST/RENAL ASPIRATION
|
Facility
|
OP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01646938
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.87 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,145.09
|
| Rate for Payer: Aetna Medicare |
$447.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$447.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$779.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$848.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$107.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$514.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$492.50
|
| Rate for Payer: Cash Price |
$841.18
|
| Rate for Payer: Cash Price |
$841.18
|
| Rate for Payer: Centivo All Commercial |
$691.94
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Humana Medicare |
$691.94
|
| Rate for Payer: Lucent All Commercial |
$691.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: Managed Health Services Medicaid |
$107.87
|
| Rate for Payer: MDWise Medicaid |
$107.87
|
| Rate for Payer: PHCS All Commercial |
$1,017.56
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$529.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.41
|
| Rate for Payer: Signature Care EPO |
$1,126.10
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,153.23
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
| Rate for Payer: United Healthcare Medicare |
$447.73
|
|
|
HC U/S CYST/RENAL ASPIRATION
|
Facility
|
IP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01646938
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,017.56 |
| Max. Negotiated Rate |
$1,261.77 |
| Rate for Payer: Aetna Commercial |
$1,172.23
|
| Rate for Payer: Cash Price |
$841.18
|
| Rate for Payer: Cigna All Commercial |
$1,170.87
|
| Rate for Payer: CORVEL All Commercial |
$1,261.77
|
| Rate for Payer: Coventry All Commercial |
$1,193.93
|
| Rate for Payer: Encore All Commercial |
$1,248.88
|
| Rate for Payer: Frontpath All Commercial |
$1,248.20
|
| Rate for Payer: Humana ChoiceCare |
$1,171.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.07
|
| Rate for Payer: PHCS All Commercial |
$1,017.56
|
| Rate for Payer: PHP All Commercial |
$1,028.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,047.41
|
| Rate for Payer: Signature Care EPO |
$1,126.10
|
| Rate for Payer: Signature Care PPO |
$1,193.93
|
| Rate for Payer: United Healthcare Commercial |
$1,069.11
|
|
|
HC U/S DOPPLER UMB ARTERY FETAL
|
Facility
|
IP
|
$616.70
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
01646820
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$462.53 |
| Max. Negotiated Rate |
$573.53 |
| Rate for Payer: Aetna Commercial |
$532.83
|
| Rate for Payer: Cash Price |
$382.36
|
| Rate for Payer: Cigna All Commercial |
$532.21
|
| Rate for Payer: CORVEL All Commercial |
$573.53
|
| Rate for Payer: Coventry All Commercial |
$542.70
|
| Rate for Payer: Encore All Commercial |
$567.67
|
| Rate for Payer: Frontpath All Commercial |
$567.37
|
| Rate for Payer: Humana ChoiceCare |
$532.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.03
|
| Rate for Payer: PHCS All Commercial |
$462.53
|
| Rate for Payer: PHP All Commercial |
$467.71
|
| Rate for Payer: Sagamore Health Network All Products |
$476.09
|
| Rate for Payer: Signature Care EPO |
$511.86
|
| Rate for Payer: Signature Care PPO |
$542.70
|
| Rate for Payer: United Healthcare Commercial |
$485.96
|
|
|
HC U/S DOPPLER UMB ARTERY FETAL
|
Facility
|
OP
|
$616.70
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
01646820
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.39 |
| Max. Negotiated Rate |
$573.53 |
| Rate for Payer: Aetna Commercial |
$520.50
|
| Rate for Payer: Aetna Medicare |
$203.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$64.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.86
|
| Rate for Payer: Cash Price |
$382.36
|
| Rate for Payer: Cash Price |
$382.36
|
| Rate for Payer: Centivo All Commercial |
$314.52
|
| Rate for Payer: Cigna All Commercial |
$532.21
|
| Rate for Payer: CORVEL All Commercial |
$573.53
|
| Rate for Payer: Coventry All Commercial |
$542.70
|
| Rate for Payer: Encore All Commercial |
$567.67
|
| Rate for Payer: Frontpath All Commercial |
$567.37
|
| Rate for Payer: Humana ChoiceCare |
$532.65
|
| Rate for Payer: Humana Medicare |
$314.52
|
| Rate for Payer: Lucent All Commercial |
$314.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.03
|
| Rate for Payer: Managed Health Services Medicaid |
$64.39
|
| Rate for Payer: MDWise Medicaid |
$64.39
|
| Rate for Payer: PHCS All Commercial |
$462.53
|
| Rate for Payer: PHP All Commercial |
$467.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.51
|
| Rate for Payer: Sagamore Health Network All Products |
$476.09
|
| Rate for Payer: Signature Care EPO |
$511.86
|
| Rate for Payer: Signature Care PPO |
$542.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.20
|
| Rate for Payer: United Healthcare Commercial |
$485.96
|
| Rate for Payer: United Healthcare Medicare |
$203.51
|
|
|
HC U/S DRAINAGE - UNLISTED
|
Facility
|
OP
|
$512.07
|
|
| Hospital Charge Code |
01649001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.98 |
| Max. Negotiated Rate |
$476.23 |
| Rate for Payer: Aetna Commercial |
$432.19
|
| Rate for Payer: Aetna Medicare |
$168.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.88
|
| Rate for Payer: Cash Price |
$317.48
|
| Rate for Payer: Centivo All Commercial |
$261.16
|
| Rate for Payer: Cigna All Commercial |
$441.92
|
| Rate for Payer: CORVEL All Commercial |
$476.23
|
| Rate for Payer: Coventry All Commercial |
$450.62
|
| Rate for Payer: Encore All Commercial |
$471.36
|
| Rate for Payer: Frontpath All Commercial |
$471.10
|
| Rate for Payer: Humana ChoiceCare |
$442.28
|
| Rate for Payer: Humana Medicare |
$261.16
|
| Rate for Payer: Lucent All Commercial |
$261.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.86
|
| Rate for Payer: PHCS All Commercial |
$384.05
|
| Rate for Payer: PHP All Commercial |
$388.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.71
|
| Rate for Payer: Sagamore Health Network All Products |
$395.32
|
| Rate for Payer: Signature Care EPO |
$425.02
|
| Rate for Payer: Signature Care PPO |
$450.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.26
|
| Rate for Payer: United Healthcare Commercial |
$403.51
|
| Rate for Payer: United Healthcare Medicare |
$168.98
|
|
|
HC U/S DRAINAGE - UNLISTED
|
Facility
|
IP
|
$512.07
|
|
| Hospital Charge Code |
01649001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.05 |
| Max. Negotiated Rate |
$476.23 |
| Rate for Payer: Aetna Commercial |
$442.43
|
| Rate for Payer: Cash Price |
$317.48
|
| Rate for Payer: Cigna All Commercial |
$441.92
|
| Rate for Payer: CORVEL All Commercial |
$476.23
|
| Rate for Payer: Coventry All Commercial |
$450.62
|
| Rate for Payer: Encore All Commercial |
$471.36
|
| Rate for Payer: Frontpath All Commercial |
$471.10
|
| Rate for Payer: Humana ChoiceCare |
$442.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.86
|
| Rate for Payer: PHCS All Commercial |
$384.05
|
| Rate for Payer: PHP All Commercial |
$388.35
|
| Rate for Payer: Sagamore Health Network All Products |
$395.32
|
| Rate for Payer: Signature Care EPO |
$425.02
|
| Rate for Payer: Signature Care PPO |
$450.62
|
| Rate for Payer: United Healthcare Commercial |
$403.51
|
|
|
HC U/S DRAINAGE - UNLISTED BILATERAL
|
Facility
|
IP
|
$768.08
|
|
| Hospital Charge Code |
01643004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.06 |
| Max. Negotiated Rate |
$714.31 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Cash Price |
$476.21
|
| Rate for Payer: Cigna All Commercial |
$662.85
|
| Rate for Payer: CORVEL All Commercial |
$714.31
|
| Rate for Payer: Coventry All Commercial |
$675.91
|
| Rate for Payer: Encore All Commercial |
$707.02
|
| Rate for Payer: Frontpath All Commercial |
$706.63
|
| Rate for Payer: Humana ChoiceCare |
$663.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$691.27
|
| Rate for Payer: PHCS All Commercial |
$576.06
|
| Rate for Payer: PHP All Commercial |
$582.51
|
| Rate for Payer: Sagamore Health Network All Products |
$592.96
|
| Rate for Payer: Signature Care EPO |
$637.51
|
| Rate for Payer: Signature Care PPO |
$675.91
|
| Rate for Payer: United Healthcare Commercial |
$605.25
|
|
|
HC U/S DRAINAGE - UNLISTED BILATERAL
|
Facility
|
OP
|
$768.08
|
|
| Hospital Charge Code |
01643004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.47 |
| Max. Negotiated Rate |
$714.31 |
| Rate for Payer: Aetna Commercial |
$648.26
|
| Rate for Payer: Aetna Medicare |
$253.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$253.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$441.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$480.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$291.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$278.81
|
| Rate for Payer: Cash Price |
$476.21
|
| Rate for Payer: Centivo All Commercial |
$391.72
|
| Rate for Payer: Cigna All Commercial |
$662.85
|
| Rate for Payer: CORVEL All Commercial |
$714.31
|
| Rate for Payer: Coventry All Commercial |
$675.91
|
| Rate for Payer: Encore All Commercial |
$707.02
|
| Rate for Payer: Frontpath All Commercial |
$706.63
|
| Rate for Payer: Humana ChoiceCare |
$663.39
|
| Rate for Payer: Humana Medicare |
$391.72
|
| Rate for Payer: Lucent All Commercial |
$391.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$691.27
|
| Rate for Payer: PHCS All Commercial |
$576.06
|
| Rate for Payer: PHP All Commercial |
$582.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$299.55
|
| Rate for Payer: Sagamore Health Network All Products |
$592.96
|
| Rate for Payer: Signature Care EPO |
$637.51
|
| Rate for Payer: Signature Care PPO |
$675.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$652.87
|
| Rate for Payer: United Healthcare Commercial |
$605.25
|
| Rate for Payer: United Healthcare Medicare |
$253.47
|
|
|
HC U/S DUPLEX ARTERIAL FLOW; COMPL
|
Facility
|
IP
|
$1,724.51
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
01643975
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,293.39 |
| Max. Negotiated Rate |
$1,603.80 |
| Rate for Payer: Aetna Commercial |
$1,489.98
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna All Commercial |
$1,488.26
|
| Rate for Payer: CORVEL All Commercial |
$1,603.80
|
| Rate for Payer: Coventry All Commercial |
$1,517.57
|
| Rate for Payer: Encore All Commercial |
$1,587.42
|
| Rate for Payer: Frontpath All Commercial |
$1,586.55
|
| Rate for Payer: Humana ChoiceCare |
$1,489.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,552.06
|
| Rate for Payer: PHCS All Commercial |
$1,293.39
|
| Rate for Payer: PHP All Commercial |
$1,307.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,331.32
|
| Rate for Payer: Signature Care EPO |
$1,431.35
|
| Rate for Payer: Signature Care PPO |
$1,517.57
|
| Rate for Payer: United Healthcare Commercial |
$1,358.92
|
|
|
HC U/S DUPLEX ARTERIAL FLOW; COMPL
|
Facility
|
OP
|
$1,724.51
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
01643975
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$569.09 |
| Max. Negotiated Rate |
$1,603.80 |
| Rate for Payer: Aetna Commercial |
$1,455.49
|
| Rate for Payer: Aetna Medicare |
$569.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$569.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$990.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,077.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$739.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$654.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$626.00
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Centivo All Commercial |
$879.50
|
| Rate for Payer: Cigna All Commercial |
$1,488.26
|
| Rate for Payer: CORVEL All Commercial |
$1,603.80
|
| Rate for Payer: Coventry All Commercial |
$1,517.57
|
| Rate for Payer: Encore All Commercial |
$1,587.42
|
| Rate for Payer: Frontpath All Commercial |
$1,586.55
|
| Rate for Payer: Humana ChoiceCare |
$1,489.46
|
| Rate for Payer: Humana Medicare |
$879.50
|
| Rate for Payer: Lucent All Commercial |
$879.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,552.06
|
| Rate for Payer: Managed Health Services Medicaid |
$739.52
|
| Rate for Payer: MDWise Medicaid |
$739.52
|
| Rate for Payer: PHCS All Commercial |
$1,293.39
|
| Rate for Payer: PHP All Commercial |
$1,307.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$672.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,331.32
|
| Rate for Payer: Signature Care EPO |
$1,431.35
|
| Rate for Payer: Signature Care PPO |
$1,517.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,465.84
|
| Rate for Payer: United Healthcare Commercial |
$1,358.92
|
| Rate for Payer: United Healthcare Medicare |
$569.09
|
|
|
HC U/S ELASTOGRAPHY; PARENCHYMA
|
Facility
|
IP
|
$420.24
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
01646981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.18 |
| Max. Negotiated Rate |
$390.82 |
| Rate for Payer: Aetna Commercial |
$363.09
|
| Rate for Payer: Cash Price |
$260.55
|
| Rate for Payer: Cigna All Commercial |
$362.67
|
| Rate for Payer: CORVEL All Commercial |
$390.82
|
| Rate for Payer: Coventry All Commercial |
$369.81
|
| Rate for Payer: Encore All Commercial |
$386.83
|
| Rate for Payer: Frontpath All Commercial |
$386.62
|
| Rate for Payer: Humana ChoiceCare |
$362.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.22
|
| Rate for Payer: PHCS All Commercial |
$315.18
|
| Rate for Payer: PHP All Commercial |
$318.71
|
| Rate for Payer: Sagamore Health Network All Products |
$324.43
|
| Rate for Payer: Signature Care EPO |
$348.80
|
| Rate for Payer: Signature Care PPO |
$369.81
|
| Rate for Payer: United Healthcare Commercial |
$331.15
|
|
|
HC U/S ELASTOGRAPHY; PARENCHYMA
|
Facility
|
OP
|
$420.24
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
01646981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$438.79 |
| Rate for Payer: Aetna Commercial |
$354.68
|
| Rate for Payer: Aetna Medicare |
$138.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$438.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.55
|
| Rate for Payer: Cash Price |
$260.55
|
| Rate for Payer: Cash Price |
$260.55
|
| Rate for Payer: Centivo All Commercial |
$214.32
|
| Rate for Payer: Cigna All Commercial |
$362.67
|
| Rate for Payer: CORVEL All Commercial |
$390.82
|
| Rate for Payer: Coventry All Commercial |
$369.81
|
| Rate for Payer: Encore All Commercial |
$386.83
|
| Rate for Payer: Frontpath All Commercial |
$386.62
|
| Rate for Payer: Humana ChoiceCare |
$362.96
|
| Rate for Payer: Humana Medicare |
$214.32
|
| Rate for Payer: Lucent All Commercial |
$214.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.22
|
| Rate for Payer: Managed Health Services Medicaid |
$438.79
|
| Rate for Payer: MDWise Medicaid |
$438.79
|
| Rate for Payer: PHCS All Commercial |
$315.18
|
| Rate for Payer: PHP All Commercial |
$318.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.89
|
| Rate for Payer: Sagamore Health Network All Products |
$324.43
|
| Rate for Payer: Signature Care EPO |
$348.80
|
| Rate for Payer: Signature Care PPO |
$369.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.20
|
| Rate for Payer: United Healthcare Commercial |
$331.15
|
| Rate for Payer: United Healthcare Medicare |
$138.68
|
|
|
HC US EXTREMITY NON VASCULAR BIL
|
Facility
|
IP
|
$1,261.54
|
|
|
Service Code
|
CPT 76881 50
|
| Hospital Charge Code |
21643002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$946.15 |
| Max. Negotiated Rate |
$1,173.23 |
| Rate for Payer: Aetna Commercial |
$1,089.97
|
| Rate for Payer: Cash Price |
$782.15
|
| Rate for Payer: Cigna All Commercial |
$1,088.71
|
| Rate for Payer: CORVEL All Commercial |
$1,173.23
|
| Rate for Payer: Coventry All Commercial |
$1,110.15
|
| Rate for Payer: Encore All Commercial |
$1,161.24
|
| Rate for Payer: Frontpath All Commercial |
$1,160.61
|
| Rate for Payer: Humana ChoiceCare |
$1,089.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,135.38
|
| Rate for Payer: PHCS All Commercial |
$946.15
|
| Rate for Payer: PHP All Commercial |
$956.75
|
| Rate for Payer: Sagamore Health Network All Products |
$973.91
|
| Rate for Payer: Signature Care EPO |
$1,047.07
|
| Rate for Payer: Signature Care PPO |
$1,110.15
|
| Rate for Payer: United Healthcare Commercial |
$994.09
|
|
|
HC US EXTREMITY NON VASCULAR BIL
|
Facility
|
OP
|
$1,261.54
|
|
|
Service Code
|
CPT 76881 50
|
| Hospital Charge Code |
21643002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$416.31 |
| Max. Negotiated Rate |
$1,173.23 |
| Rate for Payer: Aetna Commercial |
$1,064.74
|
| Rate for Payer: Aetna Medicare |
$416.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$416.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$724.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$788.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$478.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$457.94
|
| Rate for Payer: Cash Price |
$782.15
|
| Rate for Payer: Centivo All Commercial |
$643.38
|
| Rate for Payer: Cigna All Commercial |
$1,088.71
|
| Rate for Payer: CORVEL All Commercial |
$1,173.23
|
| Rate for Payer: Coventry All Commercial |
$1,110.15
|
| Rate for Payer: Encore All Commercial |
$1,161.24
|
| Rate for Payer: Frontpath All Commercial |
$1,160.61
|
| Rate for Payer: Humana ChoiceCare |
$1,089.59
|
| Rate for Payer: Humana Medicare |
$643.38
|
| Rate for Payer: Lucent All Commercial |
$643.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,135.38
|
| Rate for Payer: PHCS All Commercial |
$946.15
|
| Rate for Payer: PHP All Commercial |
$956.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$492.00
|
| Rate for Payer: Sagamore Health Network All Products |
$973.91
|
| Rate for Payer: Signature Care EPO |
$1,047.07
|
| Rate for Payer: Signature Care PPO |
$1,110.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,072.31
|
| Rate for Payer: United Healthcare Commercial |
$994.09
|
| Rate for Payer: United Healthcare Medicare |
$416.31
|
|
|
HC US EXTREMITY NON VASCULAR LT
|
Facility
|
OP
|
$840.70
|
|
|
Service Code
|
CPT 76881 LT
|
| Hospital Charge Code |
01643002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$277.43 |
| Max. Negotiated Rate |
$781.86 |
| Rate for Payer: Aetna Commercial |
$709.55
|
| Rate for Payer: Aetna Medicare |
$277.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$277.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$482.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$525.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$319.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$305.18
|
| Rate for Payer: Cash Price |
$521.24
|
| Rate for Payer: Centivo All Commercial |
$428.76
|
| Rate for Payer: Cigna All Commercial |
$725.53
|
| Rate for Payer: CORVEL All Commercial |
$781.86
|
| Rate for Payer: Coventry All Commercial |
$739.82
|
| Rate for Payer: Encore All Commercial |
$773.87
|
| Rate for Payer: Frontpath All Commercial |
$773.45
|
| Rate for Payer: Humana ChoiceCare |
$726.12
|
| Rate for Payer: Humana Medicare |
$428.76
|
| Rate for Payer: Lucent All Commercial |
$428.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.63
|
| Rate for Payer: PHCS All Commercial |
$630.53
|
| Rate for Payer: PHP All Commercial |
$637.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.87
|
| Rate for Payer: Sagamore Health Network All Products |
$649.02
|
| Rate for Payer: Signature Care EPO |
$697.78
|
| Rate for Payer: Signature Care PPO |
$739.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$714.60
|
| Rate for Payer: United Healthcare Commercial |
$662.48
|
| Rate for Payer: United Healthcare Medicare |
$277.43
|
|
|
HC US EXTREMITY NON VASCULAR LT
|
Facility
|
IP
|
$840.70
|
|
|
Service Code
|
CPT 76881 LT
|
| Hospital Charge Code |
01643002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$630.53 |
| Max. Negotiated Rate |
$781.86 |
| Rate for Payer: Aetna Commercial |
$726.37
|
| Rate for Payer: Cash Price |
$521.24
|
| Rate for Payer: Cigna All Commercial |
$725.53
|
| Rate for Payer: CORVEL All Commercial |
$781.86
|
| Rate for Payer: Coventry All Commercial |
$739.82
|
| Rate for Payer: Encore All Commercial |
$773.87
|
| Rate for Payer: Frontpath All Commercial |
$773.45
|
| Rate for Payer: Humana ChoiceCare |
$726.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.63
|
| Rate for Payer: PHCS All Commercial |
$630.53
|
| Rate for Payer: PHP All Commercial |
$637.59
|
| Rate for Payer: Sagamore Health Network All Products |
$649.02
|
| Rate for Payer: Signature Care EPO |
$697.78
|
| Rate for Payer: Signature Care PPO |
$739.82
|
| Rate for Payer: United Healthcare Commercial |
$662.48
|
|
