|
HC US EXTREMITY NON VASCULAR RT
|
Facility
|
IP
|
$840.70
|
|
|
Service Code
|
CPT 76881 RT
|
| Hospital Charge Code |
11643002
|
|
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
|
|
|
HC US EXTREMITY NON VASCULAR RT
|
Facility
|
OP
|
$840.70
|
|
|
Service Code
|
CPT 76881 RT
|
| Hospital Charge Code |
11643002
|
|
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 U/S EXTR NON-VASC LMTD BILATERAL
|
Facility
|
IP
|
$704.31
|
|
|
Service Code
|
CPT 76882 50
|
| Hospital Charge Code |
21646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$528.23 |
| Max. Negotiated Rate |
$655.01 |
| Rate for Payer: Aetna Commercial |
$608.52
|
| Rate for Payer: Cash Price |
$436.67
|
| Rate for Payer: Cigna All Commercial |
$607.82
|
| Rate for Payer: CORVEL All Commercial |
$655.01
|
| Rate for Payer: Coventry All Commercial |
$619.79
|
| Rate for Payer: Encore All Commercial |
$648.32
|
| Rate for Payer: Frontpath All Commercial |
$647.97
|
| Rate for Payer: Humana ChoiceCare |
$608.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.88
|
| Rate for Payer: PHCS All Commercial |
$528.23
|
| Rate for Payer: PHP All Commercial |
$534.15
|
| Rate for Payer: Sagamore Health Network All Products |
$543.73
|
| Rate for Payer: Signature Care EPO |
$584.58
|
| Rate for Payer: Signature Care PPO |
$619.79
|
| Rate for Payer: United Healthcare Commercial |
$555.00
|
|
|
HC U/S EXTR NON-VASC LMTD BILATERAL
|
Facility
|
OP
|
$704.31
|
|
|
Service Code
|
CPT 76882 50
|
| Hospital Charge Code |
21646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$232.42 |
| Max. Negotiated Rate |
$655.01 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Aetna Medicare |
$232.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$404.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.66
|
| Rate for Payer: Cash Price |
$436.67
|
| Rate for Payer: Centivo All Commercial |
$359.20
|
| Rate for Payer: Cigna All Commercial |
$607.82
|
| Rate for Payer: CORVEL All Commercial |
$655.01
|
| Rate for Payer: Coventry All Commercial |
$619.79
|
| Rate for Payer: Encore All Commercial |
$648.32
|
| Rate for Payer: Frontpath All Commercial |
$647.97
|
| Rate for Payer: Humana ChoiceCare |
$608.31
|
| Rate for Payer: Humana Medicare |
$359.20
|
| Rate for Payer: Lucent All Commercial |
$359.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.88
|
| Rate for Payer: PHCS All Commercial |
$528.23
|
| Rate for Payer: PHP All Commercial |
$534.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.68
|
| Rate for Payer: Sagamore Health Network All Products |
$543.73
|
| Rate for Payer: Signature Care EPO |
$584.58
|
| Rate for Payer: Signature Care PPO |
$619.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$598.66
|
| Rate for Payer: United Healthcare Commercial |
$555.00
|
| Rate for Payer: United Healthcare Medicare |
$232.42
|
|
|
HC U/S EXTR NON-VASC LMTD LT
|
Facility
|
IP
|
$891.27
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
01646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$668.45 |
| Max. Negotiated Rate |
$828.88 |
| Rate for Payer: Aetna Commercial |
$770.05
|
| Rate for Payer: Cash Price |
$552.59
|
| Rate for Payer: Cigna All Commercial |
$769.16
|
| Rate for Payer: CORVEL All Commercial |
$828.88
|
| Rate for Payer: Coventry All Commercial |
$784.31
|
| Rate for Payer: Encore All Commercial |
$820.41
|
| Rate for Payer: Frontpath All Commercial |
$819.96
|
| Rate for Payer: Humana ChoiceCare |
$769.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$802.14
|
| Rate for Payer: PHCS All Commercial |
$668.45
|
| Rate for Payer: PHP All Commercial |
$675.94
|
| Rate for Payer: Sagamore Health Network All Products |
$688.06
|
| Rate for Payer: Signature Care EPO |
$739.75
|
| Rate for Payer: Signature Care PPO |
$784.31
|
| Rate for Payer: United Healthcare Commercial |
$702.32
|
|
|
HC U/S EXTR NON-VASC LMTD LT
|
Facility
|
OP
|
$891.27
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
01646880
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$294.12 |
| Max. Negotiated Rate |
$828.88 |
| Rate for Payer: Aetna Commercial |
$752.23
|
| Rate for Payer: Aetna Medicare |
$294.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$511.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$557.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$338.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$323.53
|
| Rate for Payer: Cash Price |
$552.59
|
| Rate for Payer: Centivo All Commercial |
$454.55
|
| Rate for Payer: Cigna All Commercial |
$769.16
|
| Rate for Payer: CORVEL All Commercial |
$828.88
|
| Rate for Payer: Coventry All Commercial |
$784.31
|
| Rate for Payer: Encore All Commercial |
$820.41
|
| Rate for Payer: Frontpath All Commercial |
$819.96
|
| Rate for Payer: Humana ChoiceCare |
$769.79
|
| Rate for Payer: Humana Medicare |
$454.55
|
| Rate for Payer: Lucent All Commercial |
$454.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$802.14
|
| Rate for Payer: PHCS All Commercial |
$668.45
|
| Rate for Payer: PHP All Commercial |
$675.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$347.59
|
| Rate for Payer: Sagamore Health Network All Products |
$688.06
|
| Rate for Payer: Signature Care EPO |
$739.75
|
| Rate for Payer: Signature Care PPO |
$784.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$757.58
|
| Rate for Payer: United Healthcare Commercial |
$702.32
|
| Rate for Payer: United Healthcare Medicare |
$294.12
|
|
|
HC U/S EXTR NON-VASC LMTD RT
|
Facility
|
IP
|
$840.70
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
11646880
|
|
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
|
|
|
HC U/S EXTR NON-VASC LMTD RT
|
Facility
|
OP
|
$840.70
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
11646880
|
|
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 U/S GUIDANCE FOR NEEDLE PLCMNT
|
Facility
|
IP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01646943
|
|
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 GUIDANCE FOR NEEDLE PLCMNT
|
Facility
|
OP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01646943
|
|
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 GUIDANCE VASCULAR ACCESS
|
Facility
|
IP
|
$562.77
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
01616937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$422.08 |
| Max. Negotiated Rate |
$523.38 |
| Rate for Payer: Aetna Commercial |
$486.24
|
| Rate for Payer: Cash Price |
$348.92
|
| Rate for Payer: Cigna All Commercial |
$485.67
|
| Rate for Payer: CORVEL All Commercial |
$523.38
|
| Rate for Payer: Coventry All Commercial |
$495.24
|
| Rate for Payer: Encore All Commercial |
$518.03
|
| Rate for Payer: Frontpath All Commercial |
$517.75
|
| Rate for Payer: Humana ChoiceCare |
$486.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.50
|
| Rate for Payer: PHCS All Commercial |
$422.08
|
| Rate for Payer: PHP All Commercial |
$426.81
|
| Rate for Payer: Sagamore Health Network All Products |
$434.46
|
| Rate for Payer: Signature Care EPO |
$467.10
|
| Rate for Payer: Signature Care PPO |
$495.24
|
| Rate for Payer: United Healthcare Commercial |
$443.47
|
|
|
HC U/S GUIDANCE VASCULAR ACCESS
|
Facility
|
OP
|
$562.77
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
01616937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$56.67 |
| Max. Negotiated Rate |
$523.38 |
| Rate for Payer: Aetna Commercial |
$474.98
|
| Rate for Payer: Aetna Medicare |
$185.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$323.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$351.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$56.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.29
|
| Rate for Payer: Cash Price |
$348.92
|
| Rate for Payer: Cash Price |
$348.92
|
| Rate for Payer: Centivo All Commercial |
$287.02
|
| Rate for Payer: Cigna All Commercial |
$485.67
|
| Rate for Payer: CORVEL All Commercial |
$523.38
|
| Rate for Payer: Coventry All Commercial |
$495.24
|
| Rate for Payer: Encore All Commercial |
$518.03
|
| Rate for Payer: Frontpath All Commercial |
$517.75
|
| Rate for Payer: Humana ChoiceCare |
$486.07
|
| Rate for Payer: Humana Medicare |
$287.02
|
| Rate for Payer: Lucent All Commercial |
$287.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.50
|
| Rate for Payer: Managed Health Services Medicaid |
$56.67
|
| Rate for Payer: MDWise Medicaid |
$56.67
|
| Rate for Payer: PHCS All Commercial |
$422.08
|
| Rate for Payer: PHP All Commercial |
$426.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$219.48
|
| Rate for Payer: Sagamore Health Network All Products |
$434.46
|
| Rate for Payer: Signature Care EPO |
$467.10
|
| Rate for Payer: Signature Care PPO |
$495.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$478.36
|
| Rate for Payer: United Healthcare Commercial |
$443.47
|
| Rate for Payer: United Healthcare Medicare |
$185.72
|
|
|
HC U/S GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01696937
|
|
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 GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,356.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01696937
|
|
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 GUIDED NEEDLE PLACMNT SUBS
|
Facility
|
IP
|
$1,051.36
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01697937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$788.52 |
| Max. Negotiated Rate |
$977.76 |
| Rate for Payer: Aetna Commercial |
$908.37
|
| Rate for Payer: Cash Price |
$651.84
|
| Rate for Payer: Cigna All Commercial |
$907.32
|
| Rate for Payer: CORVEL All Commercial |
$977.76
|
| Rate for Payer: Coventry All Commercial |
$925.20
|
| Rate for Payer: Encore All Commercial |
$967.78
|
| Rate for Payer: Frontpath All Commercial |
$967.25
|
| Rate for Payer: Humana ChoiceCare |
$908.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$946.22
|
| Rate for Payer: PHCS All Commercial |
$788.52
|
| Rate for Payer: PHP All Commercial |
$797.35
|
| Rate for Payer: Sagamore Health Network All Products |
$811.65
|
| Rate for Payer: Signature Care EPO |
$872.63
|
| Rate for Payer: Signature Care PPO |
$925.20
|
| Rate for Payer: United Healthcare Commercial |
$828.47
|
|
|
HC U/S GUIDED NEEDLE PLACMNT SUBS
|
Facility
|
OP
|
$1,051.36
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
01697937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.87 |
| Max. Negotiated Rate |
$977.76 |
| Rate for Payer: Aetna Commercial |
$887.35
|
| Rate for Payer: Aetna Medicare |
$346.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$657.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$107.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.64
|
| Rate for Payer: Cash Price |
$651.84
|
| Rate for Payer: Cash Price |
$651.84
|
| Rate for Payer: Centivo All Commercial |
$536.19
|
| Rate for Payer: Cigna All Commercial |
$907.32
|
| Rate for Payer: CORVEL All Commercial |
$977.76
|
| Rate for Payer: Coventry All Commercial |
$925.20
|
| Rate for Payer: Encore All Commercial |
$967.78
|
| Rate for Payer: Frontpath All Commercial |
$967.25
|
| Rate for Payer: Humana ChoiceCare |
$908.06
|
| Rate for Payer: Humana Medicare |
$536.19
|
| Rate for Payer: Lucent All Commercial |
$536.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$946.22
|
| Rate for Payer: Managed Health Services Medicaid |
$107.87
|
| Rate for Payer: MDWise Medicaid |
$107.87
|
| Rate for Payer: PHCS All Commercial |
$788.52
|
| Rate for Payer: PHP All Commercial |
$797.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$410.03
|
| Rate for Payer: Sagamore Health Network All Products |
$811.65
|
| Rate for Payer: Signature Care EPO |
$872.63
|
| Rate for Payer: Signature Care PPO |
$925.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$893.66
|
| Rate for Payer: United Healthcare Commercial |
$828.47
|
| Rate for Payer: United Healthcare Medicare |
$346.95
|
|
|
HC U/S INFANT HIPS
|
Facility
|
IP
|
$364.84
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
01646885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.63 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna Commercial |
$315.23
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna All Commercial |
$314.86
|
| Rate for Payer: CORVEL All Commercial |
$339.30
|
| Rate for Payer: Coventry All Commercial |
$321.06
|
| Rate for Payer: Encore All Commercial |
$335.84
|
| Rate for Payer: Frontpath All Commercial |
$335.66
|
| Rate for Payer: Humana ChoiceCare |
$315.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.36
|
| Rate for Payer: PHCS All Commercial |
$273.63
|
| Rate for Payer: PHP All Commercial |
$276.70
|
| Rate for Payer: Sagamore Health Network All Products |
$281.66
|
| Rate for Payer: Signature Care EPO |
$302.82
|
| Rate for Payer: Signature Care PPO |
$321.06
|
| Rate for Payer: United Healthcare Commercial |
$287.50
|
|
|
HC U/S INFANT HIPS
|
Facility
|
OP
|
$364.84
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
01646885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna Commercial |
$307.93
|
| Rate for Payer: Aetna Medicare |
$120.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$209.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$304.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$138.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$132.44
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Centivo All Commercial |
$186.07
|
| Rate for Payer: Cigna All Commercial |
$314.86
|
| Rate for Payer: CORVEL All Commercial |
$339.30
|
| Rate for Payer: Coventry All Commercial |
$321.06
|
| Rate for Payer: Encore All Commercial |
$335.84
|
| Rate for Payer: Frontpath All Commercial |
$335.66
|
| Rate for Payer: Humana ChoiceCare |
$315.12
|
| Rate for Payer: Humana Medicare |
$186.07
|
| Rate for Payer: Lucent All Commercial |
$186.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.36
|
| Rate for Payer: Managed Health Services Medicaid |
$304.01
|
| Rate for Payer: MDWise Medicaid |
$304.01
|
| Rate for Payer: PHCS All Commercial |
$273.63
|
| Rate for Payer: PHP All Commercial |
$276.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.29
|
| Rate for Payer: Sagamore Health Network All Products |
$281.66
|
| Rate for Payer: Signature Care EPO |
$302.82
|
| Rate for Payer: Signature Care PPO |
$321.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$310.12
|
| Rate for Payer: United Healthcare Commercial |
$287.50
|
| Rate for Payer: United Healthcare Medicare |
$120.40
|
|
|
HC U/S MATERNITY < 14 WEEKS INITIAL GESTATION
|
Facility
|
IP
|
$1,025.50
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
01647801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$769.12 |
| Max. Negotiated Rate |
$953.71 |
| Rate for Payer: Aetna Commercial |
$886.03
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cigna All Commercial |
$885.00
|
| Rate for Payer: CORVEL All Commercial |
$953.71
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Sagamore Health Network All Products |
$791.68
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
|
|
HC U/S MATERNITY < 14 WEEKS INITIAL GESTATION
|
Facility
|
OP
|
$1,025.50
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
01647801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$210.29 |
| Max. Negotiated Rate |
$953.71 |
| Rate for Payer: Aetna Commercial |
$865.52
|
| Rate for Payer: Aetna Medicare |
$338.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$588.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$210.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.26
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Centivo All Commercial |
$523.00
|
| Rate for Payer: Cigna All Commercial |
$885.00
|
| Rate for Payer: CORVEL All Commercial |
$953.71
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Humana Medicare |
$523.00
|
| Rate for Payer: Lucent All Commercial |
$523.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: Managed Health Services Medicaid |
$210.29
|
| Rate for Payer: MDWise Medicaid |
$210.29
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.94
|
| Rate for Payer: Sagamore Health Network All Products |
$791.68
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.67
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
| Rate for Payer: United Healthcare Medicare |
$338.41
|
|
|
HC U/S MATERNITY > 14 WEEKS INITIAL GESTATION
|
Facility
|
IP
|
$1,025.50
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
01646800
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$769.12 |
| Max. Negotiated Rate |
$953.71 |
| Rate for Payer: Aetna Commercial |
$886.03
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cigna All Commercial |
$885.00
|
| Rate for Payer: CORVEL All Commercial |
$953.71
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Sagamore Health Network All Products |
$791.68
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
|
|
HC U/S MATERNITY > 14 WEEKS INITIAL GESTATION
|
Facility
|
OP
|
$1,025.50
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
01646800
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.41 |
| Max. Negotiated Rate |
$953.71 |
| Rate for Payer: Aetna Commercial |
$865.52
|
| Rate for Payer: Aetna Medicare |
$338.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$588.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$263.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.26
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Centivo All Commercial |
$523.00
|
| Rate for Payer: Cigna All Commercial |
$885.00
|
| Rate for Payer: CORVEL All Commercial |
$953.71
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Humana Medicare |
$523.00
|
| Rate for Payer: Lucent All Commercial |
$523.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: Managed Health Services Medicaid |
$263.41
|
| Rate for Payer: MDWise Medicaid |
$263.41
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.94
|
| Rate for Payer: Sagamore Health Network All Products |
$791.68
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.67
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
| Rate for Payer: United Healthcare Medicare |
$338.41
|
|
|
HC U/S MATERNITY < 14 WKS EA ADD GESTATION
|
Facility
|
IP
|
$1,025.50
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
01646802
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$769.12 |
| Max. Negotiated Rate |
$953.71 |
| Rate for Payer: Aetna Commercial |
$886.03
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cigna All Commercial |
$885.00
|
| Rate for Payer: CORVEL All Commercial |
$953.71
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Sagamore Health Network All Products |
$791.68
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
|
|
HC U/S MATERNITY < 14 WKS EA ADD GESTATION
|
Facility
|
OP
|
$1,025.50
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
01646802
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$953.71 |
| Rate for Payer: Aetna Commercial |
$865.52
|
| Rate for Payer: Aetna Medicare |
$338.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$588.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$69.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.26
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Centivo All Commercial |
$523.00
|
| Rate for Payer: Cigna All Commercial |
$885.00
|
| Rate for Payer: CORVEL All Commercial |
$953.71
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Humana Medicare |
$523.00
|
| Rate for Payer: Lucent All Commercial |
$523.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: Managed Health Services Medicaid |
$69.23
|
| Rate for Payer: MDWise Medicaid |
$69.23
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.94
|
| Rate for Payer: Sagamore Health Network All Products |
$791.68
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.67
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
| Rate for Payer: United Healthcare Medicare |
$338.41
|
|
|
HC U/S MATERNITY > 14 WKS EA ADD GESTATION
|
Facility
|
OP
|
$1,401.37
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
01646811
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$130.10 |
| Max. Negotiated Rate |
$1,303.27 |
| Rate for Payer: Aetna Commercial |
$1,182.75
|
| Rate for Payer: Aetna Medicare |
$462.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$462.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$804.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$876.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$130.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$531.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$508.70
|
| Rate for Payer: Cash Price |
$868.85
|
| Rate for Payer: Cash Price |
$868.85
|
| Rate for Payer: Centivo All Commercial |
$714.70
|
| Rate for Payer: Cigna All Commercial |
$1,209.38
|
| Rate for Payer: CORVEL All Commercial |
$1,303.27
|
| Rate for Payer: Coventry All Commercial |
$1,233.20
|
| Rate for Payer: Encore All Commercial |
$1,289.96
|
| Rate for Payer: Frontpath All Commercial |
$1,289.26
|
| Rate for Payer: Humana ChoiceCare |
$1,210.36
|
| Rate for Payer: Humana Medicare |
$714.70
|
| Rate for Payer: Lucent All Commercial |
$714.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,261.23
|
| Rate for Payer: Managed Health Services Medicaid |
$130.10
|
| Rate for Payer: MDWise Medicaid |
$130.10
|
| Rate for Payer: PHCS All Commercial |
$1,051.03
|
| Rate for Payer: PHP All Commercial |
$1,062.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,081.86
|
| Rate for Payer: Signature Care EPO |
$1,163.14
|
| Rate for Payer: Signature Care PPO |
$1,233.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,191.16
|
| Rate for Payer: United Healthcare Commercial |
$1,104.28
|
| Rate for Payer: United Healthcare Medicare |
$462.45
|
|
