|
HC BART HENSELAE ABS
|
Facility
IP
|
$407.27
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
63001921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$305.45 |
| Max. Negotiated Rate |
$378.76 |
| Rate for Payer: Aetna Commercial |
$351.88
|
| Rate for Payer: Cash Price |
$252.51
|
| Rate for Payer: Cigna All Commercial |
$351.47
|
| Rate for Payer: CORVEL All Commercial |
$378.76
|
| Rate for Payer: Coventry All Commercial |
$358.39
|
| Rate for Payer: Encore All Commercial |
$374.89
|
| Rate for Payer: Frontpath All Commercial |
$374.68
|
| Rate for Payer: Humana ChoiceCare |
$351.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$366.54
|
| Rate for Payer: PHCS All Commercial |
$305.45
|
| Rate for Payer: PHP All Commercial |
$308.87
|
| Rate for Payer: Sagamore Health Network All Products |
$314.41
|
| Rate for Payer: Signature Care EPO |
$338.03
|
| Rate for Payer: Signature Care PPO |
$358.39
|
| Rate for Payer: United Healthcare Commercial |
$320.93
|
|
|
HC BART HENSELAE ABS
|
Facility
OP
|
$407.27
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
63001921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$378.76 |
| Rate for Payer: Aetna Commercial |
$343.73
|
| Rate for Payer: Aetna Medicare |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$233.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$254.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$147.84
|
| Rate for Payer: Cash Price |
$252.51
|
| Rate for Payer: Cash Price |
$252.51
|
| Rate for Payer: Centivo All Commercial |
$207.71
|
| Rate for Payer: Cigna All Commercial |
$351.47
|
| Rate for Payer: CORVEL All Commercial |
$378.76
|
| Rate for Payer: Coventry All Commercial |
$358.39
|
| Rate for Payer: Encore All Commercial |
$374.89
|
| Rate for Payer: Frontpath All Commercial |
$374.68
|
| Rate for Payer: Humana ChoiceCare |
$351.76
|
| Rate for Payer: Humana Medicare |
$207.71
|
| Rate for Payer: Lucent All Commercial |
$207.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$366.54
|
| Rate for Payer: Managed Health Services Medicaid |
$10.18
|
| Rate for Payer: MDWise Medicaid |
$10.18
|
| Rate for Payer: PHCS All Commercial |
$305.45
|
| Rate for Payer: PHP All Commercial |
$308.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.83
|
| Rate for Payer: Sagamore Health Network All Products |
$314.41
|
| Rate for Payer: Signature Care EPO |
$338.03
|
| Rate for Payer: Signature Care PPO |
$358.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.18
|
| Rate for Payer: United Healthcare Commercial |
$320.93
|
| Rate for Payer: United Healthcare Medicare |
$134.40
|
|
|
HC BASIC METABOLIC-CA TOTAL
|
Facility
OP
|
$110.42
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
63001088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$102.69 |
| Rate for Payer: Aetna Commercial |
$93.19
|
| Rate for Payer: Aetna Medicare |
$36.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.08
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Centivo All Commercial |
$56.31
|
| Rate for Payer: Cigna All Commercial |
$95.29
|
| Rate for Payer: CORVEL All Commercial |
$102.69
|
| Rate for Payer: Coventry All Commercial |
$97.17
|
| Rate for Payer: Encore All Commercial |
$101.64
|
| Rate for Payer: Frontpath All Commercial |
$101.58
|
| Rate for Payer: Humana ChoiceCare |
$95.37
|
| Rate for Payer: Humana Medicare |
$56.31
|
| Rate for Payer: Lucent All Commercial |
$56.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.37
|
| Rate for Payer: Managed Health Services Medicaid |
$8.46
|
| Rate for Payer: MDWise Medicaid |
$8.46
|
| Rate for Payer: PHCS All Commercial |
$82.81
|
| Rate for Payer: PHP All Commercial |
$83.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.06
|
| Rate for Payer: Sagamore Health Network All Products |
$85.24
|
| Rate for Payer: Signature Care EPO |
$91.64
|
| Rate for Payer: Signature Care PPO |
$97.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.85
|
| Rate for Payer: United Healthcare Commercial |
$87.01
|
| Rate for Payer: United Healthcare Medicare |
$36.44
|
|
|
HC BASIC METABOLIC-CA TOTAL
|
Facility
IP
|
$110.42
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
63001088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$102.69 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cigna All Commercial |
$95.29
|
| Rate for Payer: CORVEL All Commercial |
$102.69
|
| Rate for Payer: Coventry All Commercial |
$97.17
|
| Rate for Payer: Encore All Commercial |
$101.64
|
| Rate for Payer: Frontpath All Commercial |
$101.58
|
| Rate for Payer: Humana ChoiceCare |
$95.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.37
|
| Rate for Payer: PHCS All Commercial |
$82.81
|
| Rate for Payer: PHP All Commercial |
$83.74
|
| Rate for Payer: Sagamore Health Network All Products |
$85.24
|
| Rate for Payer: Signature Care EPO |
$91.64
|
| Rate for Payer: Signature Care PPO |
$97.17
|
| Rate for Payer: United Healthcare Commercial |
$87.01
|
|
|
HC BASIC METABOLIC W/IONIZED CALCIUM
|
Facility
OP
|
$664.71
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
63001360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$618.18 |
| Rate for Payer: Aetna Commercial |
$561.02
|
| Rate for Payer: Aetna Medicare |
$219.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$219.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$381.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$415.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$252.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$241.29
|
| Rate for Payer: Cash Price |
$412.12
|
| Rate for Payer: Cash Price |
$412.12
|
| Rate for Payer: Centivo All Commercial |
$339.00
|
| Rate for Payer: Cigna All Commercial |
$573.65
|
| Rate for Payer: CORVEL All Commercial |
$618.18
|
| Rate for Payer: Coventry All Commercial |
$584.95
|
| Rate for Payer: Encore All Commercial |
$611.87
|
| Rate for Payer: Frontpath All Commercial |
$611.54
|
| Rate for Payer: Humana ChoiceCare |
$574.11
|
| Rate for Payer: Humana Medicare |
$339.00
|
| Rate for Payer: Lucent All Commercial |
$339.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$598.24
|
| Rate for Payer: Managed Health Services Medicaid |
$8.69
|
| Rate for Payer: MDWise Medicaid |
$8.69
|
| Rate for Payer: PHCS All Commercial |
$498.54
|
| Rate for Payer: PHP All Commercial |
$504.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$259.24
|
| Rate for Payer: Sagamore Health Network All Products |
$513.16
|
| Rate for Payer: Signature Care EPO |
$551.71
|
| Rate for Payer: Signature Care PPO |
$584.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$565.01
|
| Rate for Payer: United Healthcare Commercial |
$523.79
|
| Rate for Payer: United Healthcare Medicare |
$219.36
|
|
|
HC BASIC METABOLIC W/IONIZED CALCIUM
|
Facility
IP
|
$664.71
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
63001360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$498.54 |
| Max. Negotiated Rate |
$618.18 |
| Rate for Payer: Aetna Commercial |
$574.31
|
| Rate for Payer: Cash Price |
$412.12
|
| Rate for Payer: Cigna All Commercial |
$573.65
|
| Rate for Payer: CORVEL All Commercial |
$618.18
|
| Rate for Payer: Coventry All Commercial |
$584.95
|
| Rate for Payer: Encore All Commercial |
$611.87
|
| Rate for Payer: Frontpath All Commercial |
$611.54
|
| Rate for Payer: Humana ChoiceCare |
$574.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$598.24
|
| Rate for Payer: PHCS All Commercial |
$498.54
|
| Rate for Payer: PHP All Commercial |
$504.12
|
| Rate for Payer: Sagamore Health Network All Products |
$513.16
|
| Rate for Payer: Signature Care EPO |
$551.71
|
| Rate for Payer: Signature Care PPO |
$584.95
|
| Rate for Payer: United Healthcare Commercial |
$523.79
|
|
|
HC BASKET BRONCH 4 WIRE
|
Facility
OP
|
$1,090.90
|
|
| Hospital Charge Code |
41602258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,014.54 |
| Rate for Payer: Aetna Commercial |
$920.72
|
| Rate for Payer: Aetna Medicare |
$360.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$360.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$626.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$681.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$414.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$396.00
|
| Rate for Payer: Cash Price |
$676.36
|
| Rate for Payer: Cash Price |
$676.36
|
| Rate for Payer: Centivo All Commercial |
$556.36
|
| Rate for Payer: Cigna All Commercial |
$941.45
|
| Rate for Payer: CORVEL All Commercial |
$1,014.54
|
| Rate for Payer: Coventry All Commercial |
$959.99
|
| Rate for Payer: Encore All Commercial |
$1,004.17
|
| Rate for Payer: Frontpath All Commercial |
$1,003.63
|
| Rate for Payer: Humana ChoiceCare |
$942.21
|
| Rate for Payer: Humana Medicare |
$556.36
|
| Rate for Payer: Lucent All Commercial |
$556.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$818.18
|
| Rate for Payer: PHP All Commercial |
$827.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.45
|
| Rate for Payer: Sagamore Health Network All Products |
$842.17
|
| Rate for Payer: Signature Care EPO |
$905.45
|
| Rate for Payer: Signature Care PPO |
$959.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$927.26
|
| Rate for Payer: United Healthcare Commercial |
$859.63
|
| Rate for Payer: United Healthcare Medicare |
$360.00
|
|
|
HC BASKET BRONCH 4 WIRE
|
Facility
IP
|
$1,090.90
|
|
| Hospital Charge Code |
41602258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$818.18 |
| Max. Negotiated Rate |
$1,014.54 |
| Rate for Payer: Aetna Commercial |
$942.54
|
| Rate for Payer: Cash Price |
$676.36
|
| Rate for Payer: Cigna All Commercial |
$941.45
|
| Rate for Payer: CORVEL All Commercial |
$1,014.54
|
| Rate for Payer: Coventry All Commercial |
$959.99
|
| Rate for Payer: Encore All Commercial |
$1,004.17
|
| Rate for Payer: Frontpath All Commercial |
$1,003.63
|
| Rate for Payer: Humana ChoiceCare |
$942.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.81
|
| Rate for Payer: PHCS All Commercial |
$818.18
|
| Rate for Payer: PHP All Commercial |
$827.34
|
| Rate for Payer: Sagamore Health Network All Products |
$842.17
|
| Rate for Payer: Signature Care EPO |
$905.45
|
| Rate for Payer: Signature Care PPO |
$959.99
|
| Rate for Payer: United Healthcare Commercial |
$859.63
|
|
|
HC BASKET NGAGE
|
Facility
OP
|
$1,151.90
|
|
| Hospital Charge Code |
41603400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,071.27 |
| Rate for Payer: Aetna Commercial |
$972.20
|
| Rate for Payer: Aetna Medicare |
$380.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$380.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$661.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$720.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$437.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$418.14
|
| Rate for Payer: Cash Price |
$714.18
|
| Rate for Payer: Cash Price |
$714.18
|
| Rate for Payer: Centivo All Commercial |
$587.47
|
| Rate for Payer: Cigna All Commercial |
$994.09
|
| Rate for Payer: CORVEL All Commercial |
$1,071.27
|
| Rate for Payer: Coventry All Commercial |
$1,013.67
|
| Rate for Payer: Encore All Commercial |
$1,060.32
|
| Rate for Payer: Frontpath All Commercial |
$1,059.75
|
| Rate for Payer: Humana ChoiceCare |
$994.90
|
| Rate for Payer: Humana Medicare |
$587.47
|
| Rate for Payer: Lucent All Commercial |
$587.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,036.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$863.92
|
| Rate for Payer: PHP All Commercial |
$873.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$449.24
|
| Rate for Payer: Sagamore Health Network All Products |
$889.27
|
| Rate for Payer: Signature Care EPO |
$956.08
|
| Rate for Payer: Signature Care PPO |
$1,013.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$979.12
|
| Rate for Payer: United Healthcare Commercial |
$907.70
|
| Rate for Payer: United Healthcare Medicare |
$380.13
|
|
|
HC BASKET NGAGE
|
Facility
IP
|
$1,151.90
|
|
| Hospital Charge Code |
41603400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$863.92 |
| Max. Negotiated Rate |
$1,071.27 |
| Rate for Payer: Aetna Commercial |
$995.24
|
| Rate for Payer: Cash Price |
$714.18
|
| Rate for Payer: Cigna All Commercial |
$994.09
|
| Rate for Payer: CORVEL All Commercial |
$1,071.27
|
| Rate for Payer: Coventry All Commercial |
$1,013.67
|
| Rate for Payer: Encore All Commercial |
$1,060.32
|
| Rate for Payer: Frontpath All Commercial |
$1,059.75
|
| Rate for Payer: Humana ChoiceCare |
$994.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,036.71
|
| Rate for Payer: PHCS All Commercial |
$863.92
|
| Rate for Payer: PHP All Commercial |
$873.60
|
| Rate for Payer: Sagamore Health Network All Products |
$889.27
|
| Rate for Payer: Signature Care EPO |
$956.08
|
| Rate for Payer: Signature Care PPO |
$1,013.67
|
| Rate for Payer: United Healthcare Commercial |
$907.70
|
|
|
HC BATH SALTS PANEL-URINE
|
Facility
OP
|
$194.22
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.09 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$64.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.50
|
| Rate for Payer: Cash Price |
$120.42
|
| Rate for Payer: Cash Price |
$120.42
|
| Rate for Payer: Centivo All Commercial |
$99.05
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Humana Medicare |
$99.05
|
| Rate for Payer: Lucent All Commercial |
$99.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.09
|
| Rate for Payer: United Healthcare Commercial |
$153.04
|
| Rate for Payer: United Healthcare Medicare |
$64.09
|
|
|
HC BATH SALTS PANEL-URINE
|
Facility
IP
|
$194.22
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.66 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$167.80
|
| Rate for Payer: Cash Price |
$120.42
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: United Healthcare Commercial |
$153.04
|
|
|
HC BB TAKS NON THREADED ACFS
|
Facility
OP
|
$584.50
|
|
| Hospital Charge Code |
41601268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.88 |
| Max. Negotiated Rate |
$543.58 |
| Rate for Payer: Aetna Commercial |
$493.32
|
| Rate for Payer: Aetna Medicare |
$192.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$335.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$212.17
|
| Rate for Payer: Cash Price |
$362.39
|
| Rate for Payer: Cash Price |
$362.39
|
| Rate for Payer: Centivo All Commercial |
$298.10
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.58
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Humana Medicare |
$298.10
|
| Rate for Payer: Lucent All Commercial |
$298.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.96
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.14
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$496.82
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
| Rate for Payer: United Healthcare Medicare |
$192.88
|
|
|
HC BB TAKS NON THREADED ACFS
|
Facility
IP
|
$584.50
|
|
| Hospital Charge Code |
41601268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$543.58 |
| Rate for Payer: Aetna Commercial |
$505.01
|
| Rate for Payer: Cash Price |
$362.39
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.58
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.14
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
|
|
HC BB TAKS THREADED ACFS
|
Facility
IP
|
$654.50
|
|
| Hospital Charge Code |
41602182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$565.49
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
|
|
HC BB TAKS THREADED ACFS
|
Facility
OP
|
$654.50
|
|
| Hospital Charge Code |
41602182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$215.98 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$552.40
|
| Rate for Payer: Aetna Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$375.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.58
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Centivo All Commercial |
$333.80
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Humana Medicare |
$333.80
|
| Rate for Payer: Lucent All Commercial |
$333.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.26
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.32
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
| Rate for Payer: United Healthcare Medicare |
$215.98
|
|
|
HC BCR/ABL FISH 100-300 CELL
|
Facility
OP
|
$626.45
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$582.60 |
| Rate for Payer: Aetna Commercial |
$528.73
|
| Rate for Payer: Aetna Medicare |
$206.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$359.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$391.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$51.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.40
|
| Rate for Payer: Cash Price |
$388.40
|
| Rate for Payer: Cash Price |
$388.40
|
| Rate for Payer: Centivo All Commercial |
$319.49
|
| Rate for Payer: Cigna All Commercial |
$540.63
|
| Rate for Payer: CORVEL All Commercial |
$582.60
|
| Rate for Payer: Coventry All Commercial |
$551.28
|
| Rate for Payer: Encore All Commercial |
$576.65
|
| Rate for Payer: Frontpath All Commercial |
$576.34
|
| Rate for Payer: Humana ChoiceCare |
$541.07
|
| Rate for Payer: Humana Medicare |
$319.49
|
| Rate for Payer: Lucent All Commercial |
$319.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.81
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: MDWise Medicaid |
$51.19
|
| Rate for Payer: PHCS All Commercial |
$469.84
|
| Rate for Payer: PHP All Commercial |
$475.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.32
|
| Rate for Payer: Sagamore Health Network All Products |
$483.62
|
| Rate for Payer: Signature Care EPO |
$519.96
|
| Rate for Payer: Signature Care PPO |
$551.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$532.49
|
| Rate for Payer: United Healthcare Commercial |
$493.65
|
| Rate for Payer: United Healthcare Medicare |
$206.73
|
|
|
HC BCR/ABL FISH 100-300 CELL
|
Facility
IP
|
$626.45
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$582.60 |
| Rate for Payer: Aetna Commercial |
$541.26
|
| Rate for Payer: Cash Price |
$388.40
|
| Rate for Payer: Cigna All Commercial |
$540.63
|
| Rate for Payer: CORVEL All Commercial |
$582.60
|
| Rate for Payer: Coventry All Commercial |
$551.28
|
| Rate for Payer: Encore All Commercial |
$576.65
|
| Rate for Payer: Frontpath All Commercial |
$576.34
|
| Rate for Payer: Humana ChoiceCare |
$541.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.81
|
| Rate for Payer: PHCS All Commercial |
$469.84
|
| Rate for Payer: PHP All Commercial |
$475.10
|
| Rate for Payer: Sagamore Health Network All Products |
$483.62
|
| Rate for Payer: Signature Care EPO |
$519.96
|
| Rate for Payer: Signature Care PPO |
$551.28
|
| Rate for Payer: United Healthcare Commercial |
$493.65
|
|
|
HC BCR/ABL FISH-DNA PROBE EA
|
Facility
IP
|
$76.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$70.99 |
| Rate for Payer: Aetna Commercial |
$65.95
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cigna All Commercial |
$65.88
|
| Rate for Payer: CORVEL All Commercial |
$70.99
|
| Rate for Payer: Coventry All Commercial |
$67.18
|
| Rate for Payer: Encore All Commercial |
$70.27
|
| Rate for Payer: Frontpath All Commercial |
$70.23
|
| Rate for Payer: Humana ChoiceCare |
$65.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.70
|
| Rate for Payer: PHCS All Commercial |
$57.25
|
| Rate for Payer: PHP All Commercial |
$57.89
|
| Rate for Payer: Sagamore Health Network All Products |
$58.93
|
| Rate for Payer: Signature Care EPO |
$63.36
|
| Rate for Payer: Signature Care PPO |
$67.18
|
| Rate for Payer: United Healthcare Commercial |
$60.15
|
|
|
HC BCR/ABL FISH-DNA PROBE EA
|
Facility
OP
|
$76.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$70.99 |
| Rate for Payer: Aetna Commercial |
$64.43
|
| Rate for Payer: Aetna Medicare |
$25.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.71
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Centivo All Commercial |
$38.93
|
| Rate for Payer: Cigna All Commercial |
$65.88
|
| Rate for Payer: CORVEL All Commercial |
$70.99
|
| Rate for Payer: Coventry All Commercial |
$67.18
|
| Rate for Payer: Encore All Commercial |
$70.27
|
| Rate for Payer: Frontpath All Commercial |
$70.23
|
| Rate for Payer: Humana ChoiceCare |
$65.93
|
| Rate for Payer: Humana Medicare |
$38.93
|
| Rate for Payer: Lucent All Commercial |
$38.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.70
|
| Rate for Payer: Managed Health Services Medicaid |
$19.70
|
| Rate for Payer: MDWise Medicaid |
$19.70
|
| Rate for Payer: PHCS All Commercial |
$57.25
|
| Rate for Payer: PHP All Commercial |
$57.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.77
|
| Rate for Payer: Sagamore Health Network All Products |
$58.93
|
| Rate for Payer: Signature Care EPO |
$63.36
|
| Rate for Payer: Signature Care PPO |
$67.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.89
|
| Rate for Payer: United Healthcare Commercial |
$60.15
|
| Rate for Payer: United Healthcare Medicare |
$25.19
|
|
|
HC BCR/ABL MAJOR BREAKPOINT, QUANT PCR
|
Facility
IP
|
$465.63
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
63001433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$349.22 |
| Max. Negotiated Rate |
$433.04 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Cash Price |
$288.69
|
| Rate for Payer: Cigna All Commercial |
$401.84
|
| Rate for Payer: CORVEL All Commercial |
$433.04
|
| Rate for Payer: Coventry All Commercial |
$409.75
|
| Rate for Payer: Encore All Commercial |
$428.61
|
| Rate for Payer: Frontpath All Commercial |
$428.38
|
| Rate for Payer: Humana ChoiceCare |
$402.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.07
|
| Rate for Payer: PHCS All Commercial |
$349.22
|
| Rate for Payer: PHP All Commercial |
$353.13
|
| Rate for Payer: Sagamore Health Network All Products |
$359.47
|
| Rate for Payer: Signature Care EPO |
$386.47
|
| Rate for Payer: Signature Care PPO |
$409.75
|
| Rate for Payer: United Healthcare Commercial |
$366.92
|
|
|
HC BCR/ABL MAJOR BREAKPOINT, QUANT PCR
|
Facility
OP
|
$465.63
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
63001433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.66 |
| Max. Negotiated Rate |
$433.04 |
| Rate for Payer: Aetna Commercial |
$392.99
|
| Rate for Payer: Aetna Medicare |
$153.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$267.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$291.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$163.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$169.02
|
| Rate for Payer: Cash Price |
$288.69
|
| Rate for Payer: Cash Price |
$288.69
|
| Rate for Payer: Centivo All Commercial |
$237.47
|
| Rate for Payer: Cigna All Commercial |
$401.84
|
| Rate for Payer: CORVEL All Commercial |
$433.04
|
| Rate for Payer: Coventry All Commercial |
$409.75
|
| Rate for Payer: Encore All Commercial |
$428.61
|
| Rate for Payer: Frontpath All Commercial |
$428.38
|
| Rate for Payer: Humana ChoiceCare |
$402.16
|
| Rate for Payer: Humana Medicare |
$237.47
|
| Rate for Payer: Lucent All Commercial |
$237.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.07
|
| Rate for Payer: Managed Health Services Medicaid |
$163.96
|
| Rate for Payer: MDWise Medicaid |
$163.96
|
| Rate for Payer: PHCS All Commercial |
$349.22
|
| Rate for Payer: PHP All Commercial |
$353.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.60
|
| Rate for Payer: Sagamore Health Network All Products |
$359.47
|
| Rate for Payer: Signature Care EPO |
$386.47
|
| Rate for Payer: Signature Care PPO |
$409.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$395.79
|
| Rate for Payer: United Healthcare Commercial |
$366.92
|
| Rate for Payer: United Healthcare Medicare |
$153.66
|
|
|
HC BEBTELOVIMAB INJECTION
|
Facility
IP
|
$743.62
|
|
|
Service Code
|
CPT M0222
|
| Hospital Charge Code |
00520222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$557.72 |
| Max. Negotiated Rate |
$691.57 |
| Rate for Payer: Aetna Commercial |
$642.49
|
| Rate for Payer: Cash Price |
$461.05
|
| Rate for Payer: Cigna All Commercial |
$641.74
|
| Rate for Payer: CORVEL All Commercial |
$691.57
|
| Rate for Payer: Coventry All Commercial |
$654.39
|
| Rate for Payer: Encore All Commercial |
$684.50
|
| Rate for Payer: Frontpath All Commercial |
$684.13
|
| Rate for Payer: Humana ChoiceCare |
$642.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$669.26
|
| Rate for Payer: PHCS All Commercial |
$557.72
|
| Rate for Payer: PHP All Commercial |
$563.96
|
| Rate for Payer: Sagamore Health Network All Products |
$574.08
|
| Rate for Payer: Signature Care EPO |
$617.21
|
| Rate for Payer: Signature Care PPO |
$654.39
|
| Rate for Payer: United Healthcare Commercial |
$585.97
|
|
|
HC BEBTELOVIMAB INJECTION
|
Facility
OP
|
$743.62
|
|
|
Service Code
|
CPT M0222
|
| Hospital Charge Code |
00520222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$245.39 |
| Max. Negotiated Rate |
$691.57 |
| Rate for Payer: Aetna Commercial |
$627.62
|
| Rate for Payer: Aetna Medicare |
$245.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$245.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$427.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$464.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$282.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.93
|
| Rate for Payer: Cash Price |
$461.05
|
| Rate for Payer: Centivo All Commercial |
$379.25
|
| Rate for Payer: Cigna All Commercial |
$641.74
|
| Rate for Payer: CORVEL All Commercial |
$691.57
|
| Rate for Payer: Coventry All Commercial |
$654.39
|
| Rate for Payer: Encore All Commercial |
$684.50
|
| Rate for Payer: Frontpath All Commercial |
$684.13
|
| Rate for Payer: Humana ChoiceCare |
$642.27
|
| Rate for Payer: Humana Medicare |
$379.25
|
| Rate for Payer: Lucent All Commercial |
$379.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$669.26
|
| Rate for Payer: PHCS All Commercial |
$557.72
|
| Rate for Payer: PHP All Commercial |
$563.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$290.01
|
| Rate for Payer: Sagamore Health Network All Products |
$574.08
|
| Rate for Payer: Signature Care EPO |
$617.21
|
| Rate for Payer: Signature Care PPO |
$654.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$632.08
|
| Rate for Payer: United Healthcare Commercial |
$585.97
|
| Rate for Payer: United Healthcare Medicare |
$245.39
|
|
|
HC BEDDED OUTPATIENT EACH ADDITIONAL HOUR
|
Facility
IP
|
$19.27
|
|
| Hospital Charge Code |
01681007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
