|
HC U/S SOFT TISSUE PELVIS
|
Facility
|
OP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
01646857
|
|
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 SOFT TISSUE PELVIS
|
Facility
|
IP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
01646857
|
|
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 SPINAL CANAL/CONTENTS
|
Facility
|
IP
|
$448.80
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
01646801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$417.38 |
| Rate for Payer: Aetna Commercial |
$387.76
|
| Rate for Payer: Cash Price |
$278.26
|
| Rate for Payer: Cigna All Commercial |
$387.31
|
| Rate for Payer: CORVEL All Commercial |
$417.38
|
| Rate for Payer: Coventry All Commercial |
$394.94
|
| Rate for Payer: Encore All Commercial |
$413.12
|
| Rate for Payer: Frontpath All Commercial |
$412.90
|
| Rate for Payer: Humana ChoiceCare |
$387.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$403.92
|
| Rate for Payer: PHCS All Commercial |
$336.60
|
| Rate for Payer: PHP All Commercial |
$340.37
|
| Rate for Payer: Sagamore Health Network All Products |
$346.47
|
| Rate for Payer: Signature Care EPO |
$372.50
|
| Rate for Payer: Signature Care PPO |
$394.94
|
| Rate for Payer: United Healthcare Commercial |
$353.65
|
|
|
HC U/S SPINAL CANAL/CONTENTS
|
Facility
|
OP
|
$448.80
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
01646801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$148.10 |
| Max. Negotiated Rate |
$417.38 |
| Rate for Payer: Aetna Commercial |
$378.79
|
| Rate for Payer: Aetna Medicare |
$148.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$257.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$280.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$223.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.91
|
| Rate for Payer: Cash Price |
$278.26
|
| Rate for Payer: Cash Price |
$278.26
|
| Rate for Payer: Centivo All Commercial |
$228.89
|
| Rate for Payer: Cigna All Commercial |
$387.31
|
| Rate for Payer: CORVEL All Commercial |
$417.38
|
| Rate for Payer: Coventry All Commercial |
$394.94
|
| Rate for Payer: Encore All Commercial |
$413.12
|
| Rate for Payer: Frontpath All Commercial |
$412.90
|
| Rate for Payer: Humana ChoiceCare |
$387.63
|
| Rate for Payer: Humana Medicare |
$228.89
|
| Rate for Payer: Lucent All Commercial |
$228.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$403.92
|
| Rate for Payer: Managed Health Services Medicaid |
$223.82
|
| Rate for Payer: MDWise Medicaid |
$223.82
|
| Rate for Payer: PHCS All Commercial |
$336.60
|
| Rate for Payer: PHP All Commercial |
$340.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.03
|
| Rate for Payer: Sagamore Health Network All Products |
$346.47
|
| Rate for Payer: Signature Care EPO |
$372.50
|
| Rate for Payer: Signature Care PPO |
$394.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$381.48
|
| Rate for Payer: United Healthcare Commercial |
$353.65
|
| Rate for Payer: United Healthcare Medicare |
$148.10
|
|
|
HC U/S TESTICULAR
|
Facility
|
OP
|
$1,282.30
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
01640001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$1,192.54 |
| Rate for Payer: Aetna Commercial |
$1,082.26
|
| Rate for Payer: Aetna Medicare |
$423.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$423.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$736.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$801.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$113.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$486.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$465.48
|
| Rate for Payer: Cash Price |
$795.03
|
| Rate for Payer: Cash Price |
$795.03
|
| Rate for Payer: Centivo All Commercial |
$653.97
|
| Rate for Payer: Cigna All Commercial |
$1,106.63
|
| Rate for Payer: CORVEL All Commercial |
$1,192.54
|
| Rate for Payer: Coventry All Commercial |
$1,128.43
|
| Rate for Payer: Encore All Commercial |
$1,180.36
|
| Rate for Payer: Frontpath All Commercial |
$1,179.72
|
| Rate for Payer: Humana ChoiceCare |
$1,107.53
|
| Rate for Payer: Humana Medicare |
$653.97
|
| Rate for Payer: Lucent All Commercial |
$653.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,154.07
|
| Rate for Payer: Managed Health Services Medicaid |
$113.69
|
| Rate for Payer: MDWise Medicaid |
$113.69
|
| Rate for Payer: PHCS All Commercial |
$961.73
|
| Rate for Payer: PHP All Commercial |
$972.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$500.10
|
| Rate for Payer: Sagamore Health Network All Products |
$989.94
|
| Rate for Payer: Signature Care EPO |
$1,064.31
|
| Rate for Payer: Signature Care PPO |
$1,128.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,089.96
|
| Rate for Payer: United Healthcare Commercial |
$1,010.45
|
| Rate for Payer: United Healthcare Medicare |
$423.16
|
|
|
HC U/S TESTICULAR
|
Facility
|
IP
|
$1,282.30
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
01640001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$961.73 |
| Max. Negotiated Rate |
$1,192.54 |
| Rate for Payer: Aetna Commercial |
$1,107.91
|
| Rate for Payer: Cash Price |
$795.03
|
| Rate for Payer: Cigna All Commercial |
$1,106.63
|
| Rate for Payer: CORVEL All Commercial |
$1,192.54
|
| Rate for Payer: Coventry All Commercial |
$1,128.43
|
| Rate for Payer: Encore All Commercial |
$1,180.36
|
| Rate for Payer: Frontpath All Commercial |
$1,179.72
|
| Rate for Payer: Humana ChoiceCare |
$1,107.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,154.07
|
| Rate for Payer: PHCS All Commercial |
$961.73
|
| Rate for Payer: PHP All Commercial |
$972.50
|
| Rate for Payer: Sagamore Health Network All Products |
$989.94
|
| Rate for Payer: Signature Care EPO |
$1,064.31
|
| Rate for Payer: Signature Care PPO |
$1,128.43
|
| Rate for Payer: United Healthcare Commercial |
$1,010.45
|
|
|
HC U/S THYROID
|
Facility
|
IP
|
$1,193.19
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
01646530
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$894.89 |
| Max. Negotiated Rate |
$1,109.66 |
| Rate for Payer: Aetna Commercial |
$1,030.91
|
| Rate for Payer: Cash Price |
$739.78
|
| Rate for Payer: Cigna All Commercial |
$1,029.72
|
| Rate for Payer: CORVEL All Commercial |
$1,109.66
|
| Rate for Payer: Coventry All Commercial |
$1,050.00
|
| Rate for Payer: Encore All Commercial |
$1,098.33
|
| Rate for Payer: Frontpath All Commercial |
$1,097.73
|
| Rate for Payer: Humana ChoiceCare |
$1,030.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,073.87
|
| Rate for Payer: PHCS All Commercial |
$894.89
|
| Rate for Payer: PHP All Commercial |
$904.91
|
| Rate for Payer: Sagamore Health Network All Products |
$921.14
|
| Rate for Payer: Signature Care EPO |
$990.34
|
| Rate for Payer: Signature Care PPO |
$1,050.00
|
| Rate for Payer: United Healthcare Commercial |
$940.23
|
|
|
HC U/S THYROID
|
Facility
|
OP
|
$1,193.19
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
01646530
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.68 |
| Max. Negotiated Rate |
$1,109.66 |
| Rate for Payer: Aetna Commercial |
$1,007.05
|
| Rate for Payer: Aetna Medicare |
$393.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$393.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$685.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$745.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$255.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.13
|
| Rate for Payer: Cash Price |
$739.78
|
| Rate for Payer: Cash Price |
$739.78
|
| Rate for Payer: Centivo All Commercial |
$608.52
|
| Rate for Payer: Cigna All Commercial |
$1,029.72
|
| Rate for Payer: CORVEL All Commercial |
$1,109.66
|
| Rate for Payer: Coventry All Commercial |
$1,050.00
|
| Rate for Payer: Encore All Commercial |
$1,098.33
|
| Rate for Payer: Frontpath All Commercial |
$1,097.73
|
| Rate for Payer: Humana ChoiceCare |
$1,030.55
|
| Rate for Payer: Humana Medicare |
$608.52
|
| Rate for Payer: Lucent All Commercial |
$608.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,073.87
|
| Rate for Payer: Managed Health Services Medicaid |
$255.68
|
| Rate for Payer: MDWise Medicaid |
$255.68
|
| Rate for Payer: PHCS All Commercial |
$894.89
|
| Rate for Payer: PHP All Commercial |
$904.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.34
|
| Rate for Payer: Sagamore Health Network All Products |
$921.14
|
| Rate for Payer: Signature Care EPO |
$990.34
|
| Rate for Payer: Signature Care PPO |
$1,050.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,014.21
|
| Rate for Payer: United Healthcare Commercial |
$940.23
|
| Rate for Payer: United Healthcare Medicare |
$393.75
|
|
|
HC U/S TRANSVAGINAL MATERNITY
|
Facility
|
OP
|
$898.49
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
01646817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$835.59 |
| Rate for Payer: Aetna Commercial |
$758.32
|
| Rate for Payer: Aetna Medicare |
$296.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$296.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$516.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$561.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$173.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$326.15
|
| Rate for Payer: Cash Price |
$557.06
|
| Rate for Payer: Cash Price |
$557.06
|
| Rate for Payer: Centivo All Commercial |
$458.23
|
| Rate for Payer: Cigna All Commercial |
$775.39
|
| Rate for Payer: CORVEL All Commercial |
$835.59
|
| Rate for Payer: Coventry All Commercial |
$790.67
|
| Rate for Payer: Encore All Commercial |
$827.06
|
| Rate for Payer: Frontpath All Commercial |
$826.61
|
| Rate for Payer: Humana ChoiceCare |
$776.02
|
| Rate for Payer: Humana Medicare |
$458.23
|
| Rate for Payer: Lucent All Commercial |
$458.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.64
|
| Rate for Payer: Managed Health Services Medicaid |
$173.59
|
| Rate for Payer: MDWise Medicaid |
$173.59
|
| Rate for Payer: PHCS All Commercial |
$673.87
|
| Rate for Payer: PHP All Commercial |
$681.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.41
|
| Rate for Payer: Sagamore Health Network All Products |
$693.63
|
| Rate for Payer: Signature Care EPO |
$745.74
|
| Rate for Payer: Signature Care PPO |
$790.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$763.71
|
| Rate for Payer: United Healthcare Commercial |
$708.01
|
| Rate for Payer: United Healthcare Medicare |
$296.50
|
|
|
HC U/S TRANSVAGINAL MATERNITY
|
Facility
|
IP
|
$898.49
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
01646817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$673.87 |
| Max. Negotiated Rate |
$835.59 |
| Rate for Payer: Aetna Commercial |
$776.29
|
| Rate for Payer: Cash Price |
$557.06
|
| Rate for Payer: Cigna All Commercial |
$775.39
|
| Rate for Payer: CORVEL All Commercial |
$835.59
|
| Rate for Payer: Coventry All Commercial |
$790.67
|
| Rate for Payer: Encore All Commercial |
$827.06
|
| Rate for Payer: Frontpath All Commercial |
$826.61
|
| Rate for Payer: Humana ChoiceCare |
$776.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.64
|
| Rate for Payer: PHCS All Commercial |
$673.87
|
| Rate for Payer: PHP All Commercial |
$681.41
|
| Rate for Payer: Sagamore Health Network All Products |
$693.63
|
| Rate for Payer: Signature Care EPO |
$745.74
|
| Rate for Payer: Signature Care PPO |
$790.67
|
| Rate for Payer: United Healthcare Commercial |
$708.01
|
|
|
HC U/S TRANSVAGINAL NON-MATERNITY
|
Facility
|
IP
|
$902.12
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
01646830
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$676.59 |
| Max. Negotiated Rate |
$838.97 |
| Rate for Payer: Aetna Commercial |
$779.43
|
| Rate for Payer: Cash Price |
$559.31
|
| Rate for Payer: Cigna All Commercial |
$778.53
|
| Rate for Payer: CORVEL All Commercial |
$838.97
|
| Rate for Payer: Coventry All Commercial |
$793.86
|
| Rate for Payer: Encore All Commercial |
$830.40
|
| Rate for Payer: Frontpath All Commercial |
$829.95
|
| Rate for Payer: Humana ChoiceCare |
$779.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$811.91
|
| Rate for Payer: PHCS All Commercial |
$676.59
|
| Rate for Payer: PHP All Commercial |
$684.17
|
| Rate for Payer: Sagamore Health Network All Products |
$696.44
|
| Rate for Payer: Signature Care EPO |
$748.76
|
| Rate for Payer: Signature Care PPO |
$793.86
|
| Rate for Payer: United Healthcare Commercial |
$710.87
|
|
|
HC U/S TRANSVAGINAL NON-MATERNITY
|
Facility
|
OP
|
$902.12
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
01646830
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.91 |
| Max. Negotiated Rate |
$838.97 |
| Rate for Payer: Aetna Commercial |
$761.39
|
| Rate for Payer: Aetna Medicare |
$297.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$297.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$518.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$563.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$249.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$342.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$327.47
|
| Rate for Payer: Cash Price |
$559.31
|
| Rate for Payer: Cash Price |
$559.31
|
| Rate for Payer: Centivo All Commercial |
$460.08
|
| Rate for Payer: Cigna All Commercial |
$778.53
|
| Rate for Payer: CORVEL All Commercial |
$838.97
|
| Rate for Payer: Coventry All Commercial |
$793.86
|
| Rate for Payer: Encore All Commercial |
$830.40
|
| Rate for Payer: Frontpath All Commercial |
$829.95
|
| Rate for Payer: Humana ChoiceCare |
$779.16
|
| Rate for Payer: Humana Medicare |
$460.08
|
| Rate for Payer: Lucent All Commercial |
$460.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$811.91
|
| Rate for Payer: Managed Health Services Medicaid |
$249.91
|
| Rate for Payer: MDWise Medicaid |
$249.91
|
| Rate for Payer: PHCS All Commercial |
$676.59
|
| Rate for Payer: PHP All Commercial |
$684.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$351.83
|
| Rate for Payer: Sagamore Health Network All Products |
$696.44
|
| Rate for Payer: Signature Care EPO |
$748.76
|
| Rate for Payer: Signature Care PPO |
$793.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$766.80
|
| Rate for Payer: United Healthcare Commercial |
$710.87
|
| Rate for Payer: United Healthcare Medicare |
$297.70
|
|
|
HC U/S VENOUS IMAGING LOW EXT UNI
|
Facility
|
OP
|
$1,026.96
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
01649642
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$338.90 |
| Max. Negotiated Rate |
$955.07 |
| Rate for Payer: Aetna Commercial |
$866.75
|
| Rate for Payer: Aetna Medicare |
$338.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$589.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$525.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.79
|
| Rate for Payer: Cash Price |
$636.71
|
| Rate for Payer: Cash Price |
$636.71
|
| Rate for Payer: Centivo All Commercial |
$523.75
|
| Rate for Payer: Cigna All Commercial |
$886.26
|
| Rate for Payer: CORVEL All Commercial |
$955.07
|
| Rate for Payer: Coventry All Commercial |
$903.72
|
| Rate for Payer: Encore All Commercial |
$945.31
|
| Rate for Payer: Frontpath All Commercial |
$944.80
|
| Rate for Payer: Humana ChoiceCare |
$886.98
|
| Rate for Payer: Humana Medicare |
$523.75
|
| Rate for Payer: Lucent All Commercial |
$523.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$924.26
|
| Rate for Payer: Managed Health Services Medicaid |
$525.92
|
| Rate for Payer: MDWise Medicaid |
$525.92
|
| Rate for Payer: PHCS All Commercial |
$770.22
|
| Rate for Payer: PHP All Commercial |
$778.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$400.51
|
| Rate for Payer: Sagamore Health Network All Products |
$792.81
|
| Rate for Payer: Signature Care EPO |
$852.37
|
| Rate for Payer: Signature Care PPO |
$903.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$872.91
|
| Rate for Payer: United Healthcare Commercial |
$809.24
|
| Rate for Payer: United Healthcare Medicare |
$338.90
|
|
|
HC U/S VENOUS IMAGING LOW EXT UNI
|
Facility
|
IP
|
$1,026.96
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
01649642
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$770.22 |
| Max. Negotiated Rate |
$955.07 |
| Rate for Payer: Aetna Commercial |
$887.29
|
| Rate for Payer: Cash Price |
$636.71
|
| Rate for Payer: Cigna All Commercial |
$886.26
|
| Rate for Payer: CORVEL All Commercial |
$955.07
|
| Rate for Payer: Coventry All Commercial |
$903.72
|
| Rate for Payer: Encore All Commercial |
$945.31
|
| Rate for Payer: Frontpath All Commercial |
$944.80
|
| Rate for Payer: Humana ChoiceCare |
$886.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$924.26
|
| Rate for Payer: PHCS All Commercial |
$770.22
|
| Rate for Payer: PHP All Commercial |
$778.84
|
| Rate for Payer: Sagamore Health Network All Products |
$792.81
|
| Rate for Payer: Signature Care EPO |
$852.37
|
| Rate for Payer: Signature Care PPO |
$903.72
|
| Rate for Payer: United Healthcare Commercial |
$809.24
|
|
|
HC U/S VENOUS IMAGING LWR EXT BIL
|
Facility
|
IP
|
$1,716.16
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
01643979
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,287.12 |
| Max. Negotiated Rate |
$1,596.03 |
| Rate for Payer: Aetna Commercial |
$1,482.76
|
| Rate for Payer: Cash Price |
$1,064.02
|
| Rate for Payer: Cigna All Commercial |
$1,481.05
|
| Rate for Payer: CORVEL All Commercial |
$1,596.03
|
| Rate for Payer: Coventry All Commercial |
$1,510.22
|
| Rate for Payer: Encore All Commercial |
$1,579.73
|
| Rate for Payer: Frontpath All Commercial |
$1,578.87
|
| Rate for Payer: Humana ChoiceCare |
$1,482.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,544.54
|
| Rate for Payer: PHCS All Commercial |
$1,287.12
|
| Rate for Payer: PHP All Commercial |
$1,301.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,324.88
|
| Rate for Payer: Signature Care EPO |
$1,424.41
|
| Rate for Payer: Signature Care PPO |
$1,510.22
|
| Rate for Payer: United Healthcare Commercial |
$1,352.33
|
|
|
HC U/S VENOUS IMAGING LWR EXT BIL
|
Facility
|
OP
|
$1,716.16
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
01643979
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$566.33 |
| Max. Negotiated Rate |
$1,596.03 |
| Rate for Payer: Aetna Commercial |
$1,448.44
|
| Rate for Payer: Aetna Medicare |
$566.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$566.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$985.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$739.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$651.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$622.97
|
| Rate for Payer: Cash Price |
$1,064.02
|
| Rate for Payer: Cash Price |
$1,064.02
|
| Rate for Payer: Centivo All Commercial |
$875.24
|
| Rate for Payer: Cigna All Commercial |
$1,481.05
|
| Rate for Payer: CORVEL All Commercial |
$1,596.03
|
| Rate for Payer: Coventry All Commercial |
$1,510.22
|
| Rate for Payer: Encore All Commercial |
$1,579.73
|
| Rate for Payer: Frontpath All Commercial |
$1,578.87
|
| Rate for Payer: Humana ChoiceCare |
$1,482.25
|
| Rate for Payer: Humana Medicare |
$875.24
|
| Rate for Payer: Lucent All Commercial |
$875.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,544.54
|
| Rate for Payer: Managed Health Services Medicaid |
$739.52
|
| Rate for Payer: MDWise Medicaid |
$739.52
|
| Rate for Payer: PHCS All Commercial |
$1,287.12
|
| Rate for Payer: PHP All Commercial |
$1,301.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$669.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,324.88
|
| Rate for Payer: Signature Care EPO |
$1,424.41
|
| Rate for Payer: Signature Care PPO |
$1,510.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,458.74
|
| Rate for Payer: United Healthcare Commercial |
$1,352.33
|
| Rate for Payer: United Healthcare Medicare |
$566.33
|
|
|
HC U/S VENOUS IMAGING UP EXT BIL
|
Facility
|
IP
|
$1,716.16
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
01643970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,287.12 |
| Max. Negotiated Rate |
$1,596.03 |
| Rate for Payer: Aetna Commercial |
$1,482.76
|
| Rate for Payer: Cash Price |
$1,064.02
|
| Rate for Payer: Cigna All Commercial |
$1,481.05
|
| Rate for Payer: CORVEL All Commercial |
$1,596.03
|
| Rate for Payer: Coventry All Commercial |
$1,510.22
|
| Rate for Payer: Encore All Commercial |
$1,579.73
|
| Rate for Payer: Frontpath All Commercial |
$1,578.87
|
| Rate for Payer: Humana ChoiceCare |
$1,482.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,544.54
|
| Rate for Payer: PHCS All Commercial |
$1,287.12
|
| Rate for Payer: PHP All Commercial |
$1,301.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,324.88
|
| Rate for Payer: Signature Care EPO |
$1,424.41
|
| Rate for Payer: Signature Care PPO |
$1,510.22
|
| Rate for Payer: United Healthcare Commercial |
$1,352.33
|
|
|
HC U/S VENOUS IMAGING UP EXT BIL
|
Facility
|
OP
|
$1,716.16
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
01643970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$566.33 |
| Max. Negotiated Rate |
$1,596.03 |
| Rate for Payer: Aetna Commercial |
$1,448.44
|
| Rate for Payer: Aetna Medicare |
$566.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$566.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$985.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$739.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$651.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$622.97
|
| Rate for Payer: Cash Price |
$1,064.02
|
| Rate for Payer: Cash Price |
$1,064.02
|
| Rate for Payer: Centivo All Commercial |
$875.24
|
| Rate for Payer: Cigna All Commercial |
$1,481.05
|
| Rate for Payer: CORVEL All Commercial |
$1,596.03
|
| Rate for Payer: Coventry All Commercial |
$1,510.22
|
| Rate for Payer: Encore All Commercial |
$1,579.73
|
| Rate for Payer: Frontpath All Commercial |
$1,578.87
|
| Rate for Payer: Humana ChoiceCare |
$1,482.25
|
| Rate for Payer: Humana Medicare |
$875.24
|
| Rate for Payer: Lucent All Commercial |
$875.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,544.54
|
| Rate for Payer: Managed Health Services Medicaid |
$739.52
|
| Rate for Payer: MDWise Medicaid |
$739.52
|
| Rate for Payer: PHCS All Commercial |
$1,287.12
|
| Rate for Payer: PHP All Commercial |
$1,301.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$669.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,324.88
|
| Rate for Payer: Signature Care EPO |
$1,424.41
|
| Rate for Payer: Signature Care PPO |
$1,510.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,458.74
|
| Rate for Payer: United Healthcare Commercial |
$1,352.33
|
| Rate for Payer: United Healthcare Medicare |
$566.33
|
|
|
HC U/S VENOUS IMAGING UP EXT UNI
|
Facility
|
OP
|
$1,026.96
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
01643971
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$338.90 |
| Max. Negotiated Rate |
$955.07 |
| Rate for Payer: Aetna Commercial |
$866.75
|
| Rate for Payer: Aetna Medicare |
$338.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$589.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$525.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.79
|
| Rate for Payer: Cash Price |
$636.71
|
| Rate for Payer: Cash Price |
$636.71
|
| Rate for Payer: Centivo All Commercial |
$523.75
|
| Rate for Payer: Cigna All Commercial |
$886.26
|
| Rate for Payer: CORVEL All Commercial |
$955.07
|
| Rate for Payer: Coventry All Commercial |
$903.72
|
| Rate for Payer: Encore All Commercial |
$945.31
|
| Rate for Payer: Frontpath All Commercial |
$944.80
|
| Rate for Payer: Humana ChoiceCare |
$886.98
|
| Rate for Payer: Humana Medicare |
$523.75
|
| Rate for Payer: Lucent All Commercial |
$523.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$924.26
|
| Rate for Payer: Managed Health Services Medicaid |
$525.92
|
| Rate for Payer: MDWise Medicaid |
$525.92
|
| Rate for Payer: PHCS All Commercial |
$770.22
|
| Rate for Payer: PHP All Commercial |
$778.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$400.51
|
| Rate for Payer: Sagamore Health Network All Products |
$792.81
|
| Rate for Payer: Signature Care EPO |
$852.37
|
| Rate for Payer: Signature Care PPO |
$903.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$872.91
|
| Rate for Payer: United Healthcare Commercial |
$809.24
|
| Rate for Payer: United Healthcare Medicare |
$338.90
|
|
|
HC U/S VENOUS IMAGING UP EXT UNI
|
Facility
|
IP
|
$1,026.96
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
01643971
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$770.22 |
| Max. Negotiated Rate |
$955.07 |
| Rate for Payer: Aetna Commercial |
$887.29
|
| Rate for Payer: Cash Price |
$636.71
|
| Rate for Payer: Cigna All Commercial |
$886.26
|
| Rate for Payer: CORVEL All Commercial |
$955.07
|
| Rate for Payer: Coventry All Commercial |
$903.72
|
| Rate for Payer: Encore All Commercial |
$945.31
|
| Rate for Payer: Frontpath All Commercial |
$944.80
|
| Rate for Payer: Humana ChoiceCare |
$886.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$924.26
|
| Rate for Payer: PHCS All Commercial |
$770.22
|
| Rate for Payer: PHP All Commercial |
$778.84
|
| Rate for Payer: Sagamore Health Network All Products |
$792.81
|
| Rate for Payer: Signature Care EPO |
$852.37
|
| Rate for Payer: Signature Care PPO |
$903.72
|
| Rate for Payer: United Healthcare Commercial |
$809.24
|
|
|
HC U/S VENOUS REFLUX STUDY
|
Facility
|
IP
|
$912.53
|
|
|
Service Code
|
CPT 93998
|
| Hospital Charge Code |
01643965
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$684.40 |
| Max. Negotiated Rate |
$848.66 |
| Rate for Payer: Aetna Commercial |
$788.43
|
| Rate for Payer: Cash Price |
$565.77
|
| Rate for Payer: Cigna All Commercial |
$787.52
|
| Rate for Payer: CORVEL All Commercial |
$848.66
|
| Rate for Payer: Coventry All Commercial |
$803.03
|
| Rate for Payer: Encore All Commercial |
$839.99
|
| Rate for Payer: Frontpath All Commercial |
$839.53
|
| Rate for Payer: Humana ChoiceCare |
$788.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$821.28
|
| Rate for Payer: PHCS All Commercial |
$684.40
|
| Rate for Payer: PHP All Commercial |
$692.06
|
| Rate for Payer: Sagamore Health Network All Products |
$704.48
|
| Rate for Payer: Signature Care EPO |
$757.40
|
| Rate for Payer: Signature Care PPO |
$803.03
|
| Rate for Payer: United Healthcare Commercial |
$719.08
|
|
|
HC U/S VENOUS REFLUX STUDY
|
Facility
|
OP
|
$912.53
|
|
|
Service Code
|
CPT 93998
|
| Hospital Charge Code |
01643965
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$301.14 |
| Max. Negotiated Rate |
$848.66 |
| Rate for Payer: Aetna Commercial |
$770.18
|
| Rate for Payer: Aetna Medicare |
$301.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$570.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.25
|
| Rate for Payer: Cash Price |
$565.77
|
| Rate for Payer: Centivo All Commercial |
$465.39
|
| Rate for Payer: Cigna All Commercial |
$787.52
|
| Rate for Payer: CORVEL All Commercial |
$848.66
|
| Rate for Payer: Coventry All Commercial |
$803.03
|
| Rate for Payer: Encore All Commercial |
$839.99
|
| Rate for Payer: Frontpath All Commercial |
$839.53
|
| Rate for Payer: Humana ChoiceCare |
$788.15
|
| Rate for Payer: Humana Medicare |
$465.39
|
| Rate for Payer: Lucent All Commercial |
$465.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$821.28
|
| Rate for Payer: PHCS All Commercial |
$684.40
|
| Rate for Payer: PHP All Commercial |
$692.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$355.89
|
| Rate for Payer: Sagamore Health Network All Products |
$704.48
|
| Rate for Payer: Signature Care EPO |
$757.40
|
| Rate for Payer: Signature Care PPO |
$803.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$775.65
|
| Rate for Payer: United Healthcare Commercial |
$719.08
|
| Rate for Payer: United Healthcare Medicare |
$301.14
|
|
|
HC UTERINE MANIPULATOR KRONNER
|
Facility
|
IP
|
$333.20
|
|
| Hospital Charge Code |
41601197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$309.88 |
| Rate for Payer: Aetna Commercial |
$287.88
|
| Rate for Payer: Cash Price |
$206.58
|
| Rate for Payer: Cigna All Commercial |
$287.55
|
| Rate for Payer: CORVEL All Commercial |
$309.88
|
| Rate for Payer: Coventry All Commercial |
$293.22
|
| Rate for Payer: Encore All Commercial |
$306.71
|
| Rate for Payer: Frontpath All Commercial |
$306.54
|
| Rate for Payer: Humana ChoiceCare |
$287.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$299.88
|
| Rate for Payer: PHCS All Commercial |
$249.90
|
| Rate for Payer: PHP All Commercial |
$252.70
|
| Rate for Payer: Sagamore Health Network All Products |
$257.23
|
| Rate for Payer: Signature Care EPO |
$276.56
|
| Rate for Payer: Signature Care PPO |
$293.22
|
| Rate for Payer: United Healthcare Commercial |
$262.56
|
|
|
HC UTERINE MANIPULATOR KRONNER
|
Facility
|
OP
|
$333.20
|
|
| Hospital Charge Code |
41601197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$309.88 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare |
$109.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$191.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.95
|
| Rate for Payer: Cash Price |
$206.58
|
| Rate for Payer: Cash Price |
$206.58
|
| Rate for Payer: Centivo All Commercial |
$169.93
|
| Rate for Payer: Cigna All Commercial |
$287.55
|
| Rate for Payer: CORVEL All Commercial |
$309.88
|
| Rate for Payer: Coventry All Commercial |
$293.22
|
| Rate for Payer: Encore All Commercial |
$306.71
|
| Rate for Payer: Frontpath All Commercial |
$306.54
|
| Rate for Payer: Humana ChoiceCare |
$287.78
|
| Rate for Payer: Humana Medicare |
$169.93
|
| Rate for Payer: Lucent All Commercial |
$169.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$299.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$249.90
|
| Rate for Payer: PHP All Commercial |
$252.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.95
|
| Rate for Payer: Sagamore Health Network All Products |
$257.23
|
| Rate for Payer: Signature Care EPO |
$276.56
|
| Rate for Payer: Signature Care PPO |
$293.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$283.22
|
| Rate for Payer: United Healthcare Commercial |
$262.56
|
| Rate for Payer: United Healthcare Medicare |
$109.96
|
|
|
HC UV LIGHT THERAPY - PT
|
Facility
|
IP
|
$122.42
|
|
|
Service Code
|
CPT 97028 GP
|
| Hospital Charge Code |
01722015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: PHCS All Commercial |
$91.82
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
|
