|
HC ALT COMM DEV THER SVCS-30 M-SP
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01748004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC ALT COMM DEV THER SVCS-45 M-SP
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01748005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC ALT COMM DEV THER SVCS-45 M-SP
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01748005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC ALT COMM DEV THER SVCS-60 M-SP
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01748006
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC ALT COMM DEV THER SVCS-60 M-SP
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01748006
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC ALUMINUM SERUM
|
Facility
IP
|
$137.91
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
63001456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.44 |
| Max. Negotiated Rate |
$128.26 |
| Rate for Payer: Aetna Commercial |
$119.16
|
| Rate for Payer: Cash Price |
$85.51
|
| Rate for Payer: Cigna All Commercial |
$119.02
|
| Rate for Payer: CORVEL All Commercial |
$128.26
|
| Rate for Payer: Coventry All Commercial |
$121.36
|
| Rate for Payer: Encore All Commercial |
$126.95
|
| Rate for Payer: Frontpath All Commercial |
$126.88
|
| Rate for Payer: Humana ChoiceCare |
$119.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.12
|
| Rate for Payer: PHCS All Commercial |
$103.44
|
| Rate for Payer: PHP All Commercial |
$104.59
|
| Rate for Payer: Sagamore Health Network All Products |
$106.47
|
| Rate for Payer: Signature Care EPO |
$114.47
|
| Rate for Payer: Signature Care PPO |
$121.36
|
| Rate for Payer: United Healthcare Commercial |
$108.68
|
|
|
HC ALUMINUM SERUM
|
Facility
OP
|
$137.91
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
63001456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$128.26 |
| Rate for Payer: Aetna Commercial |
$116.40
|
| Rate for Payer: Aetna Medicare |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.06
|
| Rate for Payer: Cash Price |
$85.51
|
| Rate for Payer: Cash Price |
$85.51
|
| Rate for Payer: Centivo All Commercial |
$70.34
|
| Rate for Payer: Cigna All Commercial |
$119.02
|
| Rate for Payer: CORVEL All Commercial |
$128.26
|
| Rate for Payer: Coventry All Commercial |
$121.36
|
| Rate for Payer: Encore All Commercial |
$126.95
|
| Rate for Payer: Frontpath All Commercial |
$126.88
|
| Rate for Payer: Humana ChoiceCare |
$119.12
|
| Rate for Payer: Humana Medicare |
$70.34
|
| Rate for Payer: Lucent All Commercial |
$70.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.12
|
| Rate for Payer: Managed Health Services Medicaid |
$25.48
|
| Rate for Payer: MDWise Medicaid |
$25.48
|
| Rate for Payer: PHCS All Commercial |
$103.44
|
| Rate for Payer: PHP All Commercial |
$104.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.79
|
| Rate for Payer: Sagamore Health Network All Products |
$106.47
|
| Rate for Payer: Signature Care EPO |
$114.47
|
| Rate for Payer: Signature Care PPO |
$121.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.23
|
| Rate for Payer: United Healthcare Commercial |
$108.68
|
| Rate for Payer: United Healthcare Medicare |
$45.51
|
|
|
HC AMIKACIN PEAK
|
Facility
IP
|
$184.17
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
63001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.13 |
| Max. Negotiated Rate |
$171.28 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Cash Price |
$114.19
|
| Rate for Payer: Cigna All Commercial |
$158.94
|
| Rate for Payer: CORVEL All Commercial |
$171.28
|
| Rate for Payer: Coventry All Commercial |
$162.07
|
| Rate for Payer: Encore All Commercial |
$169.53
|
| Rate for Payer: Frontpath All Commercial |
$169.44
|
| Rate for Payer: Humana ChoiceCare |
$159.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.75
|
| Rate for Payer: PHCS All Commercial |
$138.13
|
| Rate for Payer: PHP All Commercial |
$139.68
|
| Rate for Payer: Sagamore Health Network All Products |
$142.18
|
| Rate for Payer: Signature Care EPO |
$152.86
|
| Rate for Payer: Signature Care PPO |
$162.07
|
| Rate for Payer: United Healthcare Commercial |
$145.13
|
|
|
HC AMIKACIN PEAK
|
Facility
OP
|
$184.17
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
63001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$171.28 |
| Rate for Payer: Aetna Commercial |
$155.44
|
| Rate for Payer: Aetna Medicare |
$60.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.85
|
| Rate for Payer: Cash Price |
$114.19
|
| Rate for Payer: Cash Price |
$114.19
|
| Rate for Payer: Centivo All Commercial |
$93.93
|
| Rate for Payer: Cigna All Commercial |
$158.94
|
| Rate for Payer: CORVEL All Commercial |
$171.28
|
| Rate for Payer: Coventry All Commercial |
$162.07
|
| Rate for Payer: Encore All Commercial |
$169.53
|
| Rate for Payer: Frontpath All Commercial |
$169.44
|
| Rate for Payer: Humana ChoiceCare |
$159.07
|
| Rate for Payer: Humana Medicare |
$93.93
|
| Rate for Payer: Lucent All Commercial |
$93.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.75
|
| Rate for Payer: Managed Health Services Medicaid |
$15.08
|
| Rate for Payer: MDWise Medicaid |
$15.08
|
| Rate for Payer: PHCS All Commercial |
$138.13
|
| Rate for Payer: PHP All Commercial |
$139.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.83
|
| Rate for Payer: Sagamore Health Network All Products |
$142.18
|
| Rate for Payer: Signature Care EPO |
$152.86
|
| Rate for Payer: Signature Care PPO |
$162.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.55
|
| Rate for Payer: United Healthcare Commercial |
$145.13
|
| Rate for Payer: United Healthcare Medicare |
$60.78
|
|
|
HC AMIKACIN TROUGH
|
Facility
OP
|
$184.17
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
63001107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$171.28 |
| Rate for Payer: Aetna Commercial |
$155.44
|
| Rate for Payer: Aetna Medicare |
$60.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.85
|
| Rate for Payer: Cash Price |
$114.19
|
| Rate for Payer: Cash Price |
$114.19
|
| Rate for Payer: Centivo All Commercial |
$93.93
|
| Rate for Payer: Cigna All Commercial |
$158.94
|
| Rate for Payer: CORVEL All Commercial |
$171.28
|
| Rate for Payer: Coventry All Commercial |
$162.07
|
| Rate for Payer: Encore All Commercial |
$169.53
|
| Rate for Payer: Frontpath All Commercial |
$169.44
|
| Rate for Payer: Humana ChoiceCare |
$159.07
|
| Rate for Payer: Humana Medicare |
$93.93
|
| Rate for Payer: Lucent All Commercial |
$93.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.75
|
| Rate for Payer: Managed Health Services Medicaid |
$15.08
|
| Rate for Payer: MDWise Medicaid |
$15.08
|
| Rate for Payer: PHCS All Commercial |
$138.13
|
| Rate for Payer: PHP All Commercial |
$139.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.83
|
| Rate for Payer: Sagamore Health Network All Products |
$142.18
|
| Rate for Payer: Signature Care EPO |
$152.86
|
| Rate for Payer: Signature Care PPO |
$162.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.55
|
| Rate for Payer: United Healthcare Commercial |
$145.13
|
| Rate for Payer: United Healthcare Medicare |
$60.78
|
|
|
HC AMIKACIN TROUGH
|
Facility
IP
|
$184.17
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
63001107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.13 |
| Max. Negotiated Rate |
$171.28 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Cash Price |
$114.19
|
| Rate for Payer: Cigna All Commercial |
$158.94
|
| Rate for Payer: CORVEL All Commercial |
$171.28
|
| Rate for Payer: Coventry All Commercial |
$162.07
|
| Rate for Payer: Encore All Commercial |
$169.53
|
| Rate for Payer: Frontpath All Commercial |
$169.44
|
| Rate for Payer: Humana ChoiceCare |
$159.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.75
|
| Rate for Payer: PHCS All Commercial |
$138.13
|
| Rate for Payer: PHP All Commercial |
$139.68
|
| Rate for Payer: Sagamore Health Network All Products |
$142.18
|
| Rate for Payer: Signature Care EPO |
$152.86
|
| Rate for Payer: Signature Care PPO |
$162.07
|
| Rate for Payer: United Healthcare Commercial |
$145.13
|
|
|
HC AMINO ACID QT PLASMA
|
Facility
IP
|
$503.91
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
63001458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$377.93 |
| Max. Negotiated Rate |
$468.64 |
| Rate for Payer: Aetna Commercial |
$435.38
|
| Rate for Payer: Cash Price |
$312.43
|
| Rate for Payer: Cigna All Commercial |
$434.87
|
| Rate for Payer: CORVEL All Commercial |
$468.64
|
| Rate for Payer: Coventry All Commercial |
$443.44
|
| Rate for Payer: Encore All Commercial |
$463.85
|
| Rate for Payer: Frontpath All Commercial |
$463.60
|
| Rate for Payer: Humana ChoiceCare |
$435.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.52
|
| Rate for Payer: PHCS All Commercial |
$377.93
|
| Rate for Payer: PHP All Commercial |
$382.17
|
| Rate for Payer: Sagamore Health Network All Products |
$389.02
|
| Rate for Payer: Signature Care EPO |
$418.25
|
| Rate for Payer: Signature Care PPO |
$443.44
|
| Rate for Payer: United Healthcare Commercial |
$397.08
|
|
|
HC AMINO ACID QT PLASMA
|
Facility
OP
|
$503.91
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
63001458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$468.64 |
| Rate for Payer: Aetna Commercial |
$425.30
|
| Rate for Payer: Aetna Medicare |
$166.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$166.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$289.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$314.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.92
|
| Rate for Payer: Cash Price |
$312.43
|
| Rate for Payer: Cash Price |
$312.43
|
| Rate for Payer: Centivo All Commercial |
$256.99
|
| Rate for Payer: Cigna All Commercial |
$434.87
|
| Rate for Payer: CORVEL All Commercial |
$468.64
|
| Rate for Payer: Coventry All Commercial |
$443.44
|
| Rate for Payer: Encore All Commercial |
$463.85
|
| Rate for Payer: Frontpath All Commercial |
$463.60
|
| Rate for Payer: Humana ChoiceCare |
$435.23
|
| Rate for Payer: Humana Medicare |
$256.99
|
| Rate for Payer: Lucent All Commercial |
$256.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.52
|
| Rate for Payer: Managed Health Services Medicaid |
$16.87
|
| Rate for Payer: MDWise Medicaid |
$16.87
|
| Rate for Payer: PHCS All Commercial |
$377.93
|
| Rate for Payer: PHP All Commercial |
$382.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.53
|
| Rate for Payer: Sagamore Health Network All Products |
$389.02
|
| Rate for Payer: Signature Care EPO |
$418.25
|
| Rate for Payer: Signature Care PPO |
$443.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$428.32
|
| Rate for Payer: United Healthcare Commercial |
$397.08
|
| Rate for Payer: United Healthcare Medicare |
$166.29
|
|
|
HC AMINO ACID QT UR
|
Facility
OP
|
$348.29
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
63001459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$323.91 |
| Rate for Payer: Aetna Commercial |
$293.96
|
| Rate for Payer: Aetna Medicare |
$114.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$200.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$217.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.43
|
| Rate for Payer: Cash Price |
$215.94
|
| Rate for Payer: Cash Price |
$215.94
|
| Rate for Payer: Centivo All Commercial |
$177.63
|
| Rate for Payer: Cigna All Commercial |
$300.57
|
| Rate for Payer: CORVEL All Commercial |
$323.91
|
| Rate for Payer: Coventry All Commercial |
$306.49
|
| Rate for Payer: Encore All Commercial |
$320.60
|
| Rate for Payer: Frontpath All Commercial |
$320.43
|
| Rate for Payer: Humana ChoiceCare |
$300.82
|
| Rate for Payer: Humana Medicare |
$177.63
|
| Rate for Payer: Lucent All Commercial |
$177.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.46
|
| Rate for Payer: Managed Health Services Medicaid |
$16.87
|
| Rate for Payer: MDWise Medicaid |
$16.87
|
| Rate for Payer: PHCS All Commercial |
$261.22
|
| Rate for Payer: PHP All Commercial |
$264.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.83
|
| Rate for Payer: Sagamore Health Network All Products |
$268.88
|
| Rate for Payer: Signature Care EPO |
$289.08
|
| Rate for Payer: Signature Care PPO |
$306.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$296.05
|
| Rate for Payer: United Healthcare Commercial |
$274.45
|
| Rate for Payer: United Healthcare Medicare |
$114.94
|
|
|
HC AMINO ACID QT UR
|
Facility
IP
|
$348.29
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
63001459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$261.22 |
| Max. Negotiated Rate |
$323.91 |
| Rate for Payer: Aetna Commercial |
$300.92
|
| Rate for Payer: Cash Price |
$215.94
|
| Rate for Payer: Cigna All Commercial |
$300.57
|
| Rate for Payer: CORVEL All Commercial |
$323.91
|
| Rate for Payer: Coventry All Commercial |
$306.49
|
| Rate for Payer: Encore All Commercial |
$320.60
|
| Rate for Payer: Frontpath All Commercial |
$320.43
|
| Rate for Payer: Humana ChoiceCare |
$300.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.46
|
| Rate for Payer: PHCS All Commercial |
$261.22
|
| Rate for Payer: PHP All Commercial |
$264.14
|
| Rate for Payer: Sagamore Health Network All Products |
$268.88
|
| Rate for Payer: Signature Care EPO |
$289.08
|
| Rate for Payer: Signature Care PPO |
$306.49
|
| Rate for Payer: United Healthcare Commercial |
$274.45
|
|
|
HC AMINOLEVULINIC AC UR
|
Facility
IP
|
$153.01
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
63001457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$142.30 |
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Cash Price |
$94.87
|
| Rate for Payer: Cigna All Commercial |
$132.05
|
| Rate for Payer: CORVEL All Commercial |
$142.30
|
| Rate for Payer: Coventry All Commercial |
$134.65
|
| Rate for Payer: Encore All Commercial |
$140.85
|
| Rate for Payer: Frontpath All Commercial |
$140.77
|
| Rate for Payer: Humana ChoiceCare |
$132.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.71
|
| Rate for Payer: PHCS All Commercial |
$114.76
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| Rate for Payer: Sagamore Health Network All Products |
$118.12
|
| Rate for Payer: Signature Care EPO |
$127.00
|
| Rate for Payer: Signature Care PPO |
$134.65
|
| Rate for Payer: United Healthcare Commercial |
$120.57
|
|
|
HC AMINOLEVULINIC AC UR
|
Facility
OP
|
$153.01
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
63001457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$142.30 |
| Rate for Payer: Aetna Commercial |
$129.14
|
| Rate for Payer: Aetna Medicare |
$50.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.54
|
| Rate for Payer: Cash Price |
$94.87
|
| Rate for Payer: Cash Price |
$94.87
|
| Rate for Payer: Centivo All Commercial |
$78.04
|
| Rate for Payer: Cigna All Commercial |
$132.05
|
| Rate for Payer: CORVEL All Commercial |
$142.30
|
| Rate for Payer: Coventry All Commercial |
$134.65
|
| Rate for Payer: Encore All Commercial |
$140.85
|
| Rate for Payer: Frontpath All Commercial |
$140.77
|
| Rate for Payer: Humana ChoiceCare |
$132.15
|
| Rate for Payer: Humana Medicare |
$78.04
|
| Rate for Payer: Lucent All Commercial |
$78.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.71
|
| Rate for Payer: Managed Health Services Medicaid |
$16.45
|
| Rate for Payer: MDWise Medicaid |
$16.45
|
| Rate for Payer: PHCS All Commercial |
$114.76
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.67
|
| Rate for Payer: Sagamore Health Network All Products |
$118.12
|
| Rate for Payer: Signature Care EPO |
$127.00
|
| Rate for Payer: Signature Care PPO |
$134.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.06
|
| Rate for Payer: United Healthcare Commercial |
$120.57
|
| Rate for Payer: United Healthcare Medicare |
$50.49
|
|
|
HC AMIODARONE
|
Facility
IP
|
$371.06
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$278.29 |
| Max. Negotiated Rate |
$345.08 |
| Rate for Payer: Aetna Commercial |
$320.59
|
| Rate for Payer: Cash Price |
$230.05
|
| Rate for Payer: Cigna All Commercial |
$320.22
|
| Rate for Payer: CORVEL All Commercial |
$345.08
|
| Rate for Payer: Coventry All Commercial |
$326.53
|
| Rate for Payer: Encore All Commercial |
$341.56
|
| Rate for Payer: Frontpath All Commercial |
$341.37
|
| Rate for Payer: Humana ChoiceCare |
$320.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.95
|
| Rate for Payer: PHCS All Commercial |
$278.29
|
| Rate for Payer: PHP All Commercial |
$281.41
|
| Rate for Payer: Sagamore Health Network All Products |
$286.45
|
| Rate for Payer: Signature Care EPO |
$307.98
|
| Rate for Payer: Signature Care PPO |
$326.53
|
| Rate for Payer: United Healthcare Commercial |
$292.39
|
|
|
HC AMIODARONE
|
Facility
OP
|
$371.06
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$345.08 |
| Rate for Payer: Aetna Commercial |
$313.17
|
| Rate for Payer: Aetna Medicare |
$122.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$213.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.69
|
| Rate for Payer: Cash Price |
$230.05
|
| Rate for Payer: Cash Price |
$230.05
|
| Rate for Payer: Centivo All Commercial |
$189.24
|
| Rate for Payer: Cigna All Commercial |
$320.22
|
| Rate for Payer: CORVEL All Commercial |
$345.08
|
| Rate for Payer: Coventry All Commercial |
$326.53
|
| Rate for Payer: Encore All Commercial |
$341.56
|
| Rate for Payer: Frontpath All Commercial |
$341.37
|
| Rate for Payer: Humana ChoiceCare |
$320.48
|
| Rate for Payer: Humana Medicare |
$189.24
|
| Rate for Payer: Lucent All Commercial |
$189.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.95
|
| Rate for Payer: Managed Health Services Medicaid |
$18.64
|
| Rate for Payer: MDWise Medicaid |
$18.64
|
| Rate for Payer: PHCS All Commercial |
$278.29
|
| Rate for Payer: PHP All Commercial |
$281.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.71
|
| Rate for Payer: Sagamore Health Network All Products |
$286.45
|
| Rate for Payer: Signature Care EPO |
$307.98
|
| Rate for Payer: Signature Care PPO |
$326.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$315.40
|
| Rate for Payer: United Healthcare Commercial |
$292.39
|
| Rate for Payer: United Healthcare Medicare |
$122.45
|
|
|
HC AMMONIA
|
Facility
OP
|
$230.01
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
63001149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$213.91 |
| Rate for Payer: Aetna Commercial |
$194.13
|
| Rate for Payer: Aetna Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.49
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Centivo All Commercial |
$117.31
|
| Rate for Payer: Cigna All Commercial |
$198.50
|
| Rate for Payer: CORVEL All Commercial |
$213.91
|
| Rate for Payer: Coventry All Commercial |
$202.41
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.61
|
| Rate for Payer: Humana ChoiceCare |
$198.66
|
| Rate for Payer: Humana Medicare |
$117.31
|
| Rate for Payer: Lucent All Commercial |
$117.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.01
|
| Rate for Payer: Managed Health Services Medicaid |
$14.57
|
| Rate for Payer: MDWise Medicaid |
$14.57
|
| Rate for Payer: PHCS All Commercial |
$172.51
|
| Rate for Payer: PHP All Commercial |
$174.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.70
|
| Rate for Payer: Sagamore Health Network All Products |
$177.57
|
| Rate for Payer: Signature Care EPO |
$190.91
|
| Rate for Payer: Signature Care PPO |
$202.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.51
|
| Rate for Payer: United Healthcare Commercial |
$181.25
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
|
|
HC AMMONIA
|
Facility
IP
|
$230.01
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
63001149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.51 |
| Max. Negotiated Rate |
$213.91 |
| Rate for Payer: Aetna Commercial |
$198.73
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cigna All Commercial |
$198.50
|
| Rate for Payer: CORVEL All Commercial |
$213.91
|
| Rate for Payer: Coventry All Commercial |
$202.41
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.61
|
| Rate for Payer: Humana ChoiceCare |
$198.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.01
|
| Rate for Payer: PHCS All Commercial |
$172.51
|
| Rate for Payer: PHP All Commercial |
$174.44
|
| Rate for Payer: Sagamore Health Network All Products |
$177.57
|
| Rate for Payer: Signature Care EPO |
$190.91
|
| Rate for Payer: Signature Care PPO |
$202.41
|
| Rate for Payer: United Healthcare Commercial |
$181.25
|
|
|
HC AMNIOHEAL PLUS PATCH SZ 10 DISC
|
Facility
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
41602564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,069.25 |
| Rate for Payer: Aetna Commercial |
$1,877.90
|
| Rate for Payer: Aetna Medicare |
$734.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$734.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,277.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,390.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$844.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$807.68
|
| Rate for Payer: Cash Price |
$1,379.50
|
| Rate for Payer: Cash Price |
$1,379.50
|
| Rate for Payer: Centivo All Commercial |
$1,134.75
|
| Rate for Payer: Cigna All Commercial |
$1,920.18
|
| Rate for Payer: CORVEL All Commercial |
$2,069.25
|
| Rate for Payer: Coventry All Commercial |
$1,958.00
|
| Rate for Payer: Encore All Commercial |
$2,048.11
|
| Rate for Payer: Frontpath All Commercial |
$2,047.00
|
| Rate for Payer: Humana ChoiceCare |
$1,921.73
|
| Rate for Payer: Humana Medicare |
$1,134.75
|
| Rate for Payer: Lucent All Commercial |
$1,134.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,668.75
|
| Rate for Payer: PHP All Commercial |
$1,687.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$867.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.70
|
| Rate for Payer: Signature Care EPO |
$1,846.75
|
| Rate for Payer: Signature Care PPO |
$1,958.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,891.25
|
| Rate for Payer: United Healthcare Commercial |
$1,753.30
|
| Rate for Payer: United Healthcare Medicare |
$734.25
|
|
|
HC AMNIOHEAL PLUS PATCH SZ 10 DISC
|
Facility
IP
|
$2,225.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
41602564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$2,069.25 |
| Rate for Payer: Aetna Commercial |
$1,922.40
|
| Rate for Payer: Cash Price |
$1,379.50
|
| Rate for Payer: Cigna All Commercial |
$1,920.18
|
| Rate for Payer: CORVEL All Commercial |
$2,069.25
|
| Rate for Payer: Coventry All Commercial |
$1,958.00
|
| Rate for Payer: Encore All Commercial |
$2,048.11
|
| Rate for Payer: Frontpath All Commercial |
$2,047.00
|
| Rate for Payer: Humana ChoiceCare |
$1,921.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.50
|
| Rate for Payer: PHCS All Commercial |
$1,668.75
|
| Rate for Payer: PHP All Commercial |
$1,687.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.70
|
| Rate for Payer: Signature Care EPO |
$1,846.75
|
| Rate for Payer: Signature Care PPO |
$1,958.00
|
| Rate for Payer: United Healthcare Commercial |
$1,753.30
|
|
|
HC AMNIOHEAL PLUS PATCH SZ 16 DISC
|
Facility
IP
|
$2,502.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
41602565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,876.50 |
| Max. Negotiated Rate |
$2,326.86 |
| Rate for Payer: Aetna Commercial |
$2,161.73
|
| Rate for Payer: Cash Price |
$1,551.24
|
| Rate for Payer: Cigna All Commercial |
$2,159.23
|
| Rate for Payer: CORVEL All Commercial |
$2,326.86
|
| Rate for Payer: Coventry All Commercial |
$2,201.76
|
| Rate for Payer: Encore All Commercial |
$2,303.09
|
| Rate for Payer: Frontpath All Commercial |
$2,301.84
|
| Rate for Payer: Humana ChoiceCare |
$2,160.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,251.80
|
| Rate for Payer: PHCS All Commercial |
$1,876.50
|
| Rate for Payer: PHP All Commercial |
$1,897.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,931.54
|
| Rate for Payer: Signature Care EPO |
$2,076.66
|
| Rate for Payer: Signature Care PPO |
$2,201.76
|
| Rate for Payer: United Healthcare Commercial |
$1,971.58
|
|
|
HC AMNIOHEAL PLUS PATCH SZ 16 DISC
|
Facility
OP
|
$2,502.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
41602565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,326.86 |
| Rate for Payer: Aetna Commercial |
$2,111.69
|
| Rate for Payer: Aetna Medicare |
$825.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$825.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,436.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,564.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$949.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$908.23
|
| Rate for Payer: Cash Price |
$1,551.24
|
| Rate for Payer: Cash Price |
$1,551.24
|
| Rate for Payer: Centivo All Commercial |
$1,276.02
|
| Rate for Payer: Cigna All Commercial |
$2,159.23
|
| Rate for Payer: CORVEL All Commercial |
$2,326.86
|
| Rate for Payer: Coventry All Commercial |
$2,201.76
|
| Rate for Payer: Encore All Commercial |
$2,303.09
|
| Rate for Payer: Frontpath All Commercial |
$2,301.84
|
| Rate for Payer: Humana ChoiceCare |
$2,160.98
|
| Rate for Payer: Humana Medicare |
$1,276.02
|
| Rate for Payer: Lucent All Commercial |
$1,276.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,251.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,876.50
|
| Rate for Payer: PHP All Commercial |
$1,897.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,931.54
|
| Rate for Payer: Signature Care EPO |
$2,076.66
|
| Rate for Payer: Signature Care PPO |
$2,201.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,126.70
|
| Rate for Payer: United Healthcare Commercial |
$1,971.58
|
| Rate for Payer: United Healthcare Medicare |
$825.66
|
|
