|
HC U/S MATERNITY > 14 WKS EA ADD GESTATION
|
Facility
|
IP
|
$1,401.37
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
01646811
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,051.03 |
| Max. Negotiated Rate |
$1,303.27 |
| Rate for Payer: Aetna Commercial |
$1,210.78
|
| Rate for Payer: Cash Price |
$868.85
|
| 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: Lutheran Preferred All Commercial |
$1,261.23
|
| Rate for Payer: PHCS All Commercial |
$1,051.03
|
| Rate for Payer: PHP All Commercial |
$1,062.80
|
| 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: United Healthcare Commercial |
$1,104.28
|
|
|
HC U/S MATERNITY LIMITED 1 OR MORE FETUS(S)
|
Facility
|
IP
|
$877.61
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
01646815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$658.21 |
| Max. Negotiated Rate |
$816.18 |
| Rate for Payer: Aetna Commercial |
$758.25
|
| Rate for Payer: Cash Price |
$544.12
|
| Rate for Payer: Cigna All Commercial |
$757.38
|
| Rate for Payer: CORVEL All Commercial |
$816.18
|
| Rate for Payer: Coventry All Commercial |
$772.30
|
| Rate for Payer: Encore All Commercial |
$807.84
|
| Rate for Payer: Frontpath All Commercial |
$807.40
|
| Rate for Payer: Humana ChoiceCare |
$757.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$789.85
|
| Rate for Payer: PHCS All Commercial |
$658.21
|
| Rate for Payer: PHP All Commercial |
$665.58
|
| Rate for Payer: Sagamore Health Network All Products |
$677.51
|
| Rate for Payer: Signature Care EPO |
$728.41
|
| Rate for Payer: Signature Care PPO |
$772.30
|
| Rate for Payer: United Healthcare Commercial |
$691.56
|
|
|
HC U/S MATERNITY LIMITED 1 OR MORE FETUS(S)
|
Facility
|
OP
|
$877.61
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
01646815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.11 |
| Max. Negotiated Rate |
$816.18 |
| Rate for Payer: Aetna Commercial |
$740.70
|
| Rate for Payer: Aetna Medicare |
$289.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$289.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$504.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$548.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$158.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$318.57
|
| Rate for Payer: Cash Price |
$544.12
|
| Rate for Payer: Cash Price |
$544.12
|
| Rate for Payer: Centivo All Commercial |
$447.58
|
| Rate for Payer: Cigna All Commercial |
$757.38
|
| Rate for Payer: CORVEL All Commercial |
$816.18
|
| Rate for Payer: Coventry All Commercial |
$772.30
|
| Rate for Payer: Encore All Commercial |
$807.84
|
| Rate for Payer: Frontpath All Commercial |
$807.40
|
| Rate for Payer: Humana ChoiceCare |
$757.99
|
| Rate for Payer: Humana Medicare |
$447.58
|
| Rate for Payer: Lucent All Commercial |
$447.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$789.85
|
| Rate for Payer: Managed Health Services Medicaid |
$158.11
|
| Rate for Payer: MDWise Medicaid |
$158.11
|
| Rate for Payer: PHCS All Commercial |
$658.21
|
| Rate for Payer: PHP All Commercial |
$665.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$342.27
|
| Rate for Payer: Sagamore Health Network All Products |
$677.51
|
| Rate for Payer: Signature Care EPO |
$728.41
|
| Rate for Payer: Signature Care PPO |
$772.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$745.97
|
| Rate for Payer: United Healthcare Commercial |
$691.56
|
| Rate for Payer: United Healthcare Medicare |
$289.61
|
|
|
HC U/S MATERNITY RE-EVAL PER FETUS
|
Facility
|
OP
|
$1,032.75
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
01646816
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.62 |
| Max. Negotiated Rate |
$960.46 |
| Rate for Payer: Aetna Commercial |
$871.64
|
| Rate for Payer: Aetna Medicare |
$340.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$593.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$645.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$200.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$391.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$374.89
|
| Rate for Payer: Cash Price |
$640.31
|
| Rate for Payer: Cash Price |
$640.31
|
| Rate for Payer: Centivo All Commercial |
$526.70
|
| Rate for Payer: Cigna All Commercial |
$891.26
|
| Rate for Payer: CORVEL All Commercial |
$960.46
|
| Rate for Payer: Coventry All Commercial |
$908.82
|
| Rate for Payer: Encore All Commercial |
$950.65
|
| Rate for Payer: Frontpath All Commercial |
$950.13
|
| Rate for Payer: Humana ChoiceCare |
$891.99
|
| Rate for Payer: Humana Medicare |
$526.70
|
| Rate for Payer: Lucent All Commercial |
$526.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.48
|
| Rate for Payer: Managed Health Services Medicaid |
$200.62
|
| Rate for Payer: MDWise Medicaid |
$200.62
|
| Rate for Payer: PHCS All Commercial |
$774.56
|
| Rate for Payer: PHP All Commercial |
$783.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.77
|
| Rate for Payer: Sagamore Health Network All Products |
$797.28
|
| Rate for Payer: Signature Care EPO |
$857.18
|
| Rate for Payer: Signature Care PPO |
$908.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$877.84
|
| Rate for Payer: United Healthcare Commercial |
$813.81
|
| Rate for Payer: United Healthcare Medicare |
$340.81
|
|
|
HC U/S MATERNITY RE-EVAL PER FETUS
|
Facility
|
IP
|
$1,032.75
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
01646816
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$774.56 |
| Max. Negotiated Rate |
$960.46 |
| Rate for Payer: Aetna Commercial |
$892.30
|
| Rate for Payer: Cash Price |
$640.31
|
| Rate for Payer: Cigna All Commercial |
$891.26
|
| Rate for Payer: CORVEL All Commercial |
$960.46
|
| Rate for Payer: Coventry All Commercial |
$908.82
|
| Rate for Payer: Encore All Commercial |
$950.65
|
| Rate for Payer: Frontpath All Commercial |
$950.13
|
| Rate for Payer: Humana ChoiceCare |
$891.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.48
|
| Rate for Payer: PHCS All Commercial |
$774.56
|
| Rate for Payer: PHP All Commercial |
$783.24
|
| Rate for Payer: Sagamore Health Network All Products |
$797.28
|
| Rate for Payer: Signature Care EPO |
$857.18
|
| Rate for Payer: Signature Care PPO |
$908.82
|
| Rate for Payer: United Healthcare Commercial |
$813.81
|
|
|
HC U/S MATERNITY RE-EVAL PER FETUS CMCH - 59
|
Facility
|
OP
|
$1,032.75
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
01645916
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$340.81 |
| Max. Negotiated Rate |
$960.46 |
| Rate for Payer: Aetna Commercial |
$871.64
|
| Rate for Payer: Aetna Medicare |
$340.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$593.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$645.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$391.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$374.89
|
| Rate for Payer: Cash Price |
$640.31
|
| Rate for Payer: Centivo All Commercial |
$526.70
|
| Rate for Payer: Cigna All Commercial |
$891.26
|
| Rate for Payer: CORVEL All Commercial |
$960.46
|
| Rate for Payer: Coventry All Commercial |
$908.82
|
| Rate for Payer: Encore All Commercial |
$950.65
|
| Rate for Payer: Frontpath All Commercial |
$950.13
|
| Rate for Payer: Humana ChoiceCare |
$891.99
|
| Rate for Payer: Humana Medicare |
$526.70
|
| Rate for Payer: Lucent All Commercial |
$526.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.48
|
| Rate for Payer: PHCS All Commercial |
$774.56
|
| Rate for Payer: PHP All Commercial |
$783.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.77
|
| Rate for Payer: Sagamore Health Network All Products |
$797.28
|
| Rate for Payer: Signature Care EPO |
$857.18
|
| Rate for Payer: Signature Care PPO |
$908.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$877.84
|
| Rate for Payer: United Healthcare Commercial |
$813.81
|
| Rate for Payer: United Healthcare Medicare |
$340.81
|
|
|
HC U/S MATERNITY RE-EVAL PER FETUS CMCH - 59
|
Facility
|
IP
|
$1,032.75
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
01645916
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$774.56 |
| Max. Negotiated Rate |
$960.46 |
| Rate for Payer: Aetna Commercial |
$892.30
|
| Rate for Payer: Cash Price |
$640.31
|
| Rate for Payer: Cigna All Commercial |
$891.26
|
| Rate for Payer: CORVEL All Commercial |
$960.46
|
| Rate for Payer: Coventry All Commercial |
$908.82
|
| Rate for Payer: Encore All Commercial |
$950.65
|
| Rate for Payer: Frontpath All Commercial |
$950.13
|
| Rate for Payer: Humana ChoiceCare |
$891.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.48
|
| Rate for Payer: PHCS All Commercial |
$774.56
|
| Rate for Payer: PHP All Commercial |
$783.24
|
| Rate for Payer: Sagamore Health Network All Products |
$797.28
|
| Rate for Payer: Signature Care EPO |
$857.18
|
| Rate for Payer: Signature Care PPO |
$908.82
|
| Rate for Payer: United Healthcare Commercial |
$813.81
|
|
|
HC U/S MISC UNLISTED
|
Facility
|
OP
|
$771.11
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
01646999
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$254.47 |
| Max. Negotiated Rate |
$717.13 |
| Rate for Payer: Aetna Commercial |
$650.82
|
| Rate for Payer: Aetna Medicare |
$254.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$482.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.91
|
| Rate for Payer: Cash Price |
$478.09
|
| Rate for Payer: Centivo All Commercial |
$393.27
|
| Rate for Payer: Cigna All Commercial |
$665.47
|
| Rate for Payer: CORVEL All Commercial |
$717.13
|
| Rate for Payer: Coventry All Commercial |
$678.58
|
| Rate for Payer: Encore All Commercial |
$709.81
|
| Rate for Payer: Frontpath All Commercial |
$709.42
|
| Rate for Payer: Humana ChoiceCare |
$666.01
|
| Rate for Payer: Humana Medicare |
$393.27
|
| Rate for Payer: Lucent All Commercial |
$393.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$694.00
|
| Rate for Payer: PHCS All Commercial |
$578.33
|
| Rate for Payer: PHP All Commercial |
$584.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.73
|
| Rate for Payer: Sagamore Health Network All Products |
$595.30
|
| Rate for Payer: Signature Care EPO |
$640.02
|
| Rate for Payer: Signature Care PPO |
$678.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$655.44
|
| Rate for Payer: United Healthcare Commercial |
$607.63
|
| Rate for Payer: United Healthcare Medicare |
$254.47
|
|
|
HC U/S MISC UNLISTED
|
Facility
|
IP
|
$771.11
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
01646999
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$578.33 |
| Max. Negotiated Rate |
$717.13 |
| Rate for Payer: Aetna Commercial |
$666.24
|
| Rate for Payer: Cash Price |
$478.09
|
| Rate for Payer: Cigna All Commercial |
$665.47
|
| Rate for Payer: CORVEL All Commercial |
$717.13
|
| Rate for Payer: Coventry All Commercial |
$678.58
|
| Rate for Payer: Encore All Commercial |
$709.81
|
| Rate for Payer: Frontpath All Commercial |
$709.42
|
| Rate for Payer: Humana ChoiceCare |
$666.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$694.00
|
| Rate for Payer: PHCS All Commercial |
$578.33
|
| Rate for Payer: PHP All Commercial |
$584.81
|
| Rate for Payer: Sagamore Health Network All Products |
$595.30
|
| Rate for Payer: Signature Care EPO |
$640.02
|
| Rate for Payer: Signature Care PPO |
$678.58
|
| Rate for Payer: United Healthcare Commercial |
$607.63
|
|
|
HC U/S NECK OR HEAD - SOFT TISSUE
|
Facility
|
IP
|
$1,273.13
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
01646536
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$954.85 |
| Max. Negotiated Rate |
$1,184.01 |
| Rate for Payer: Aetna Commercial |
$1,099.99
|
| Rate for Payer: Cash Price |
$789.34
|
| Rate for Payer: Cigna All Commercial |
$1,098.71
|
| Rate for Payer: CORVEL All Commercial |
$1,184.01
|
| Rate for Payer: Coventry All Commercial |
$1,120.36
|
| Rate for Payer: Encore All Commercial |
$1,171.92
|
| Rate for Payer: Frontpath All Commercial |
$1,171.28
|
| Rate for Payer: Humana ChoiceCare |
$1,099.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,145.82
|
| Rate for Payer: PHCS All Commercial |
$954.85
|
| Rate for Payer: PHP All Commercial |
$965.54
|
| Rate for Payer: Sagamore Health Network All Products |
$982.86
|
| Rate for Payer: Signature Care EPO |
$1,056.70
|
| Rate for Payer: Signature Care PPO |
$1,120.36
|
| Rate for Payer: United Healthcare Commercial |
$1,003.23
|
|
|
HC U/S NECK OR HEAD - SOFT TISSUE
|
Facility
|
OP
|
$1,273.13
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
01646536
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.68 |
| Max. Negotiated Rate |
$1,184.01 |
| Rate for Payer: Aetna Commercial |
$1,074.52
|
| Rate for Payer: Aetna Medicare |
$420.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$420.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$731.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$795.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$255.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$483.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$462.15
|
| Rate for Payer: Cash Price |
$789.34
|
| Rate for Payer: Cash Price |
$789.34
|
| Rate for Payer: Centivo All Commercial |
$649.30
|
| Rate for Payer: Cigna All Commercial |
$1,098.71
|
| Rate for Payer: CORVEL All Commercial |
$1,184.01
|
| Rate for Payer: Coventry All Commercial |
$1,120.36
|
| Rate for Payer: Encore All Commercial |
$1,171.92
|
| Rate for Payer: Frontpath All Commercial |
$1,171.28
|
| Rate for Payer: Humana ChoiceCare |
$1,099.61
|
| Rate for Payer: Humana Medicare |
$649.30
|
| Rate for Payer: Lucent All Commercial |
$649.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,145.82
|
| Rate for Payer: Managed Health Services Medicaid |
$255.68
|
| Rate for Payer: MDWise Medicaid |
$255.68
|
| Rate for Payer: PHCS All Commercial |
$954.85
|
| Rate for Payer: PHP All Commercial |
$965.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$496.52
|
| Rate for Payer: Sagamore Health Network All Products |
$982.86
|
| Rate for Payer: Signature Care EPO |
$1,056.70
|
| Rate for Payer: Signature Care PPO |
$1,120.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,082.16
|
| Rate for Payer: United Healthcare Commercial |
$1,003.23
|
| Rate for Payer: United Healthcare Medicare |
$420.13
|
|
|
HC U/S PELVIC
|
Facility
|
OP
|
$1,011.25
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
01646715
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.08 |
| Max. Negotiated Rate |
$940.46 |
| Rate for Payer: Aetna Commercial |
$853.49
|
| Rate for Payer: Aetna Medicare |
$333.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$333.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$580.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$632.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$245.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$383.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$367.08
|
| Rate for Payer: Cash Price |
$626.97
|
| Rate for Payer: Cash Price |
$626.97
|
| Rate for Payer: Centivo All Commercial |
$515.74
|
| Rate for Payer: Cigna All Commercial |
$872.71
|
| Rate for Payer: CORVEL All Commercial |
$940.46
|
| Rate for Payer: Coventry All Commercial |
$889.90
|
| Rate for Payer: Encore All Commercial |
$930.85
|
| Rate for Payer: Frontpath All Commercial |
$930.35
|
| Rate for Payer: Humana ChoiceCare |
$873.42
|
| Rate for Payer: Humana Medicare |
$515.74
|
| Rate for Payer: Lucent All Commercial |
$515.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$910.12
|
| Rate for Payer: Managed Health Services Medicaid |
$245.08
|
| Rate for Payer: MDWise Medicaid |
$245.08
|
| Rate for Payer: PHCS All Commercial |
$758.44
|
| Rate for Payer: PHP All Commercial |
$766.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$394.39
|
| Rate for Payer: Sagamore Health Network All Products |
$780.68
|
| Rate for Payer: Signature Care EPO |
$839.34
|
| Rate for Payer: Signature Care PPO |
$889.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$859.56
|
| Rate for Payer: United Healthcare Commercial |
$796.86
|
| Rate for Payer: United Healthcare Medicare |
$333.71
|
|
|
HC U/S PELVIC
|
Facility
|
IP
|
$1,011.25
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
01646715
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$758.44 |
| Max. Negotiated Rate |
$940.46 |
| Rate for Payer: Aetna Commercial |
$873.72
|
| Rate for Payer: Cash Price |
$626.97
|
| Rate for Payer: Cigna All Commercial |
$872.71
|
| Rate for Payer: CORVEL All Commercial |
$940.46
|
| Rate for Payer: Coventry All Commercial |
$889.90
|
| Rate for Payer: Encore All Commercial |
$930.85
|
| Rate for Payer: Frontpath All Commercial |
$930.35
|
| Rate for Payer: Humana ChoiceCare |
$873.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$910.12
|
| Rate for Payer: PHCS All Commercial |
$758.44
|
| Rate for Payer: PHP All Commercial |
$766.93
|
| Rate for Payer: Sagamore Health Network All Products |
$780.68
|
| Rate for Payer: Signature Care EPO |
$839.34
|
| Rate for Payer: Signature Care PPO |
$889.90
|
| Rate for Payer: United Healthcare Commercial |
$796.86
|
|
|
HC U/S PELVIC LIMITED
|
Facility
|
IP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
01644705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$664.82 |
| Max. Negotiated Rate |
$824.38 |
| Rate for Payer: Aetna Commercial |
$765.88
|
| Rate for Payer: Cash Price |
$549.59
|
| Rate for Payer: Cigna All Commercial |
$764.99
|
| Rate for Payer: CORVEL All Commercial |
$824.38
|
| Rate for Payer: Coventry All Commercial |
$780.06
|
| Rate for Payer: Encore All Commercial |
$815.96
|
| Rate for Payer: Frontpath All Commercial |
$815.52
|
| Rate for Payer: Humana ChoiceCare |
$765.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$797.79
|
| Rate for Payer: PHCS All Commercial |
$664.82
|
| Rate for Payer: PHP All Commercial |
$672.27
|
| Rate for Payer: Sagamore Health Network All Products |
$684.32
|
| Rate for Payer: Signature Care EPO |
$735.74
|
| Rate for Payer: Signature Care PPO |
$780.06
|
| Rate for Payer: United Healthcare Commercial |
$698.51
|
|
|
HC U/S PELVIC LIMITED
|
Facility
|
OP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
01644705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.34 |
| Max. Negotiated Rate |
$824.38 |
| Rate for Payer: Aetna Commercial |
$748.15
|
| Rate for Payer: Aetna Medicare |
$292.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$509.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$554.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$94.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.77
|
| Rate for Payer: Cash Price |
$549.59
|
| Rate for Payer: Cash Price |
$549.59
|
| Rate for Payer: Centivo All Commercial |
$452.08
|
| Rate for Payer: Cigna All Commercial |
$764.99
|
| Rate for Payer: CORVEL All Commercial |
$824.38
|
| Rate for Payer: Coventry All Commercial |
$780.06
|
| Rate for Payer: Encore All Commercial |
$815.96
|
| Rate for Payer: Frontpath All Commercial |
$815.52
|
| Rate for Payer: Humana ChoiceCare |
$765.61
|
| Rate for Payer: Humana Medicare |
$452.08
|
| Rate for Payer: Lucent All Commercial |
$452.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$797.79
|
| Rate for Payer: Managed Health Services Medicaid |
$94.34
|
| Rate for Payer: MDWise Medicaid |
$94.34
|
| Rate for Payer: PHCS All Commercial |
$664.82
|
| Rate for Payer: PHP All Commercial |
$672.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.71
|
| Rate for Payer: Sagamore Health Network All Products |
$684.32
|
| Rate for Payer: Signature Care EPO |
$735.74
|
| Rate for Payer: Signature Care PPO |
$780.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$753.47
|
| Rate for Payer: United Healthcare Commercial |
$698.51
|
| Rate for Payer: United Healthcare Medicare |
$292.52
|
|
|
HC U/S PERC BREAST ASP CYST
|
Facility
|
OP
|
$512.07
|
|
| Hospital Charge Code |
01649000
|
|
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 PERC BREAST ASP CYST
|
Facility
|
IP
|
$512.07
|
|
| Hospital Charge Code |
01649000
|
|
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 PULSE VOL RECORD W/O EXER
|
Facility
|
OP
|
$681.62
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
01643923
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$224.93 |
| Max. Negotiated Rate |
$633.90 |
| Rate for Payer: Aetna Commercial |
$575.28
|
| Rate for Payer: Aetna Medicare |
$224.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$224.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$391.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$426.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$248.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$258.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$247.43
|
| Rate for Payer: Cash Price |
$422.60
|
| Rate for Payer: Cash Price |
$422.60
|
| Rate for Payer: Centivo All Commercial |
$347.62
|
| Rate for Payer: Cigna All Commercial |
$588.23
|
| Rate for Payer: CORVEL All Commercial |
$633.90
|
| Rate for Payer: Coventry All Commercial |
$599.82
|
| Rate for Payer: Encore All Commercial |
$627.43
|
| Rate for Payer: Frontpath All Commercial |
$627.09
|
| Rate for Payer: Humana ChoiceCare |
$588.71
|
| Rate for Payer: Humana Medicare |
$347.62
|
| Rate for Payer: Lucent All Commercial |
$347.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$613.45
|
| Rate for Payer: Managed Health Services Medicaid |
$248.04
|
| Rate for Payer: MDWise Medicaid |
$248.04
|
| Rate for Payer: PHCS All Commercial |
$511.21
|
| Rate for Payer: PHP All Commercial |
$516.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$265.83
|
| Rate for Payer: Sagamore Health Network All Products |
$526.21
|
| Rate for Payer: Signature Care EPO |
$565.74
|
| Rate for Payer: Signature Care PPO |
$599.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$579.37
|
| Rate for Payer: United Healthcare Commercial |
$537.11
|
| Rate for Payer: United Healthcare Medicare |
$224.93
|
|
|
HC U/S PULSE VOL RECORD W/O EXER
|
Facility
|
IP
|
$681.62
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
01643923
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$511.21 |
| Max. Negotiated Rate |
$633.90 |
| Rate for Payer: Aetna Commercial |
$588.92
|
| Rate for Payer: Cash Price |
$422.60
|
| Rate for Payer: Cigna All Commercial |
$588.23
|
| Rate for Payer: CORVEL All Commercial |
$633.90
|
| Rate for Payer: Coventry All Commercial |
$599.82
|
| Rate for Payer: Encore All Commercial |
$627.43
|
| Rate for Payer: Frontpath All Commercial |
$627.09
|
| Rate for Payer: Humana ChoiceCare |
$588.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$613.45
|
| Rate for Payer: PHCS All Commercial |
$511.21
|
| Rate for Payer: PHP All Commercial |
$516.94
|
| Rate for Payer: Sagamore Health Network All Products |
$526.21
|
| Rate for Payer: Signature Care EPO |
$565.74
|
| Rate for Payer: Signature Care PPO |
$599.82
|
| Rate for Payer: United Healthcare Commercial |
$537.11
|
|
|
HC U/S RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$1,215.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
01646770
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$911.77 |
| Max. Negotiated Rate |
$1,130.60 |
| Rate for Payer: Aetna Commercial |
$1,050.36
|
| Rate for Payer: Cash Price |
$753.73
|
| Rate for Payer: Cigna All Commercial |
$1,049.15
|
| Rate for Payer: CORVEL All Commercial |
$1,130.60
|
| Rate for Payer: Coventry All Commercial |
$1,069.81
|
| Rate for Payer: Encore All Commercial |
$1,119.05
|
| Rate for Payer: Frontpath All Commercial |
$1,118.44
|
| Rate for Payer: Humana ChoiceCare |
$1,050.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,094.13
|
| Rate for Payer: PHCS All Commercial |
$911.77
|
| Rate for Payer: PHP All Commercial |
$921.98
|
| Rate for Payer: Sagamore Health Network All Products |
$938.52
|
| Rate for Payer: Signature Care EPO |
$1,009.03
|
| Rate for Payer: Signature Care PPO |
$1,069.81
|
| Rate for Payer: United Healthcare Commercial |
$957.97
|
|
|
HC U/S RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$1,215.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
01646770
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.50 |
| Max. Negotiated Rate |
$1,130.60 |
| Rate for Payer: Aetna Commercial |
$1,026.05
|
| Rate for Payer: Aetna Medicare |
$401.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$401.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$698.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$759.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$261.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.30
|
| Rate for Payer: Cash Price |
$753.73
|
| Rate for Payer: Cash Price |
$753.73
|
| Rate for Payer: Centivo All Commercial |
$620.01
|
| Rate for Payer: Cigna All Commercial |
$1,049.15
|
| Rate for Payer: CORVEL All Commercial |
$1,130.60
|
| Rate for Payer: Coventry All Commercial |
$1,069.81
|
| Rate for Payer: Encore All Commercial |
$1,119.05
|
| Rate for Payer: Frontpath All Commercial |
$1,118.44
|
| Rate for Payer: Humana ChoiceCare |
$1,050.00
|
| Rate for Payer: Humana Medicare |
$620.01
|
| Rate for Payer: Lucent All Commercial |
$620.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,094.13
|
| Rate for Payer: Managed Health Services Medicaid |
$261.50
|
| Rate for Payer: MDWise Medicaid |
$261.50
|
| Rate for Payer: PHCS All Commercial |
$911.77
|
| Rate for Payer: PHP All Commercial |
$921.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$474.12
|
| Rate for Payer: Sagamore Health Network All Products |
$938.52
|
| Rate for Payer: Signature Care EPO |
$1,009.03
|
| Rate for Payer: Signature Care PPO |
$1,069.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,033.34
|
| Rate for Payer: United Healthcare Commercial |
$957.97
|
| Rate for Payer: United Healthcare Medicare |
$401.18
|
|
|
HC U/S RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$1,038.99
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
01646775
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$966.26 |
| Rate for Payer: Aetna Commercial |
$876.91
|
| Rate for Payer: Aetna Medicare |
$342.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$342.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$596.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$649.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$99.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$394.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$377.15
|
| Rate for Payer: Cash Price |
$644.18
|
| Rate for Payer: Cash Price |
$644.18
|
| Rate for Payer: Centivo All Commercial |
$529.89
|
| Rate for Payer: Cigna All Commercial |
$896.65
|
| Rate for Payer: CORVEL All Commercial |
$966.26
|
| Rate for Payer: Coventry All Commercial |
$914.31
|
| Rate for Payer: Encore All Commercial |
$956.39
|
| Rate for Payer: Frontpath All Commercial |
$955.87
|
| Rate for Payer: Humana ChoiceCare |
$897.38
|
| Rate for Payer: Humana Medicare |
$529.89
|
| Rate for Payer: Lucent All Commercial |
$529.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$935.09
|
| Rate for Payer: Managed Health Services Medicaid |
$99.18
|
| Rate for Payer: MDWise Medicaid |
$99.18
|
| Rate for Payer: PHCS All Commercial |
$779.24
|
| Rate for Payer: PHP All Commercial |
$787.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$405.21
|
| Rate for Payer: Sagamore Health Network All Products |
$802.10
|
| Rate for Payer: Signature Care EPO |
$862.36
|
| Rate for Payer: Signature Care PPO |
$914.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$883.14
|
| Rate for Payer: United Healthcare Commercial |
$818.73
|
| Rate for Payer: United Healthcare Medicare |
$342.87
|
|
|
HC U/S RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$1,038.99
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
01646775
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$779.24 |
| Max. Negotiated Rate |
$966.26 |
| Rate for Payer: Aetna Commercial |
$897.69
|
| Rate for Payer: Cash Price |
$644.18
|
| Rate for Payer: Cigna All Commercial |
$896.65
|
| Rate for Payer: CORVEL All Commercial |
$966.26
|
| Rate for Payer: Coventry All Commercial |
$914.31
|
| Rate for Payer: Encore All Commercial |
$956.39
|
| Rate for Payer: Frontpath All Commercial |
$955.87
|
| Rate for Payer: Humana ChoiceCare |
$897.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$935.09
|
| Rate for Payer: PHCS All Commercial |
$779.24
|
| Rate for Payer: PHP All Commercial |
$787.97
|
| Rate for Payer: Sagamore Health Network All Products |
$802.10
|
| Rate for Payer: Signature Care EPO |
$862.36
|
| Rate for Payer: Signature Care PPO |
$914.31
|
| Rate for Payer: United Healthcare Commercial |
$818.73
|
|
|
HC U/S SOFT TISSUE ABDOMEN
|
Facility
|
IP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
01647705
|
|
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 SOFT TISSUE ABDOMEN
|
Facility
|
OP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
01647705
|
|
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
|
|
