|
HC BRONCHOSPASM EVAL; SPIROMETRY
|
Facility
IP
|
$761.58
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
01704060
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$571.19 |
| Max. Negotiated Rate |
$708.27 |
| Rate for Payer: Aetna Commercial |
$658.01
|
| Rate for Payer: Cash Price |
$472.18
|
| Rate for Payer: Cigna All Commercial |
$657.25
|
| Rate for Payer: CORVEL All Commercial |
$708.27
|
| Rate for Payer: Coventry All Commercial |
$670.19
|
| Rate for Payer: Encore All Commercial |
$701.04
|
| Rate for Payer: Frontpath All Commercial |
$700.66
|
| Rate for Payer: Humana ChoiceCare |
$657.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.42
|
| Rate for Payer: PHCS All Commercial |
$571.19
|
| Rate for Payer: PHP All Commercial |
$577.58
|
| Rate for Payer: Sagamore Health Network All Products |
$587.94
|
| Rate for Payer: Signature Care EPO |
$632.11
|
| Rate for Payer: Signature Care PPO |
$670.19
|
| Rate for Payer: United Healthcare Commercial |
$600.13
|
|
|
HC BRONCHOSPASM EVAL; SPIROMETRY
|
Facility
OP
|
$761.58
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
01704060
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$708.27 |
| Rate for Payer: Aetna Commercial |
$642.78
|
| Rate for Payer: Aetna Medicare |
$251.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$251.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$437.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$476.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$289.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$276.45
|
| Rate for Payer: Cash Price |
$472.18
|
| Rate for Payer: Cash Price |
$472.18
|
| Rate for Payer: Centivo All Commercial |
$388.41
|
| Rate for Payer: Cigna All Commercial |
$657.25
|
| Rate for Payer: CORVEL All Commercial |
$708.27
|
| Rate for Payer: Coventry All Commercial |
$670.19
|
| Rate for Payer: Encore All Commercial |
$701.04
|
| Rate for Payer: Frontpath All Commercial |
$700.66
|
| Rate for Payer: Humana ChoiceCare |
$657.78
|
| Rate for Payer: Humana Medicare |
$388.41
|
| Rate for Payer: Lucent All Commercial |
$388.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.42
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$571.19
|
| Rate for Payer: PHP All Commercial |
$577.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$297.02
|
| Rate for Payer: Sagamore Health Network All Products |
$587.94
|
| Rate for Payer: Signature Care EPO |
$632.11
|
| Rate for Payer: Signature Care PPO |
$670.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$647.35
|
| Rate for Payer: United Healthcare Commercial |
$600.13
|
| Rate for Payer: United Healthcare Medicare |
$251.32
|
|
|
HC BRUSH CYTOLOGY
|
Facility
OP
|
$111.35
|
|
| Hospital Charge Code |
41602262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$93.98
|
| Rate for Payer: Aetna Medicare |
$36.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.42
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Centivo All Commercial |
$56.79
|
| Rate for Payer: Cigna All Commercial |
$96.10
|
| Rate for Payer: CORVEL All Commercial |
$103.56
|
| Rate for Payer: Coventry All Commercial |
$97.99
|
| Rate for Payer: Encore All Commercial |
$102.50
|
| Rate for Payer: Frontpath All Commercial |
$102.44
|
| Rate for Payer: Humana ChoiceCare |
$96.17
|
| Rate for Payer: Humana Medicare |
$56.79
|
| Rate for Payer: Lucent All Commercial |
$56.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$83.51
|
| Rate for Payer: PHP All Commercial |
$84.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.43
|
| Rate for Payer: Sagamore Health Network All Products |
$85.96
|
| Rate for Payer: Signature Care EPO |
$92.42
|
| Rate for Payer: Signature Care PPO |
$97.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.65
|
| Rate for Payer: United Healthcare Commercial |
$87.74
|
| Rate for Payer: United Healthcare Medicare |
$36.75
|
|
|
HC BRUSH CYTOLOGY
|
Facility
IP
|
$111.35
|
|
| Hospital Charge Code |
41602262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.51 |
| Max. Negotiated Rate |
$103.56 |
| Rate for Payer: Aetna Commercial |
$96.21
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cigna All Commercial |
$96.10
|
| Rate for Payer: CORVEL All Commercial |
$103.56
|
| Rate for Payer: Coventry All Commercial |
$97.99
|
| Rate for Payer: Encore All Commercial |
$102.50
|
| Rate for Payer: Frontpath All Commercial |
$102.44
|
| Rate for Payer: Humana ChoiceCare |
$96.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.22
|
| Rate for Payer: PHCS All Commercial |
$83.51
|
| Rate for Payer: PHP All Commercial |
$84.45
|
| Rate for Payer: Sagamore Health Network All Products |
$85.96
|
| Rate for Payer: Signature Care EPO |
$92.42
|
| Rate for Payer: Signature Care PPO |
$97.99
|
| Rate for Payer: United Healthcare Commercial |
$87.74
|
|
|
HC BS KIT UROMAX BALLOON 15F 10CM
|
Facility
OP
|
$1,381.70
|
|
| Hospital Charge Code |
41603484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,166.15
|
| Rate for Payer: Aetna Medicare |
$455.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$455.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$793.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$863.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$524.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$501.56
|
| Rate for Payer: Cash Price |
$856.65
|
| Rate for Payer: Cash Price |
$856.65
|
| Rate for Payer: Centivo All Commercial |
$704.67
|
| Rate for Payer: Cigna All Commercial |
$1,192.41
|
| Rate for Payer: CORVEL All Commercial |
$1,284.98
|
| Rate for Payer: Coventry All Commercial |
$1,215.90
|
| Rate for Payer: Encore All Commercial |
$1,271.85
|
| Rate for Payer: Frontpath All Commercial |
$1,271.16
|
| Rate for Payer: Humana ChoiceCare |
$1,193.37
|
| Rate for Payer: Humana Medicare |
$704.67
|
| Rate for Payer: Lucent All Commercial |
$704.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,243.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,036.28
|
| Rate for Payer: PHP All Commercial |
$1,047.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$538.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,066.67
|
| Rate for Payer: Signature Care EPO |
$1,146.81
|
| Rate for Payer: Signature Care PPO |
$1,215.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,174.44
|
| Rate for Payer: United Healthcare Commercial |
$1,088.78
|
| Rate for Payer: United Healthcare Medicare |
$455.96
|
|
|
HC BS KIT UROMAX BALLOON 15F 10CM
|
Facility
IP
|
$1,381.70
|
|
| Hospital Charge Code |
41603484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.28 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,193.79
|
| Rate for Payer: Cash Price |
$856.65
|
| Rate for Payer: Cigna All Commercial |
$1,192.41
|
| Rate for Payer: CORVEL All Commercial |
$1,284.98
|
| Rate for Payer: Coventry All Commercial |
$1,215.90
|
| Rate for Payer: Encore All Commercial |
$1,271.85
|
| Rate for Payer: Frontpath All Commercial |
$1,271.16
|
| Rate for Payer: Humana ChoiceCare |
$1,193.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,243.53
|
| Rate for Payer: PHCS All Commercial |
$1,036.28
|
| Rate for Payer: PHP All Commercial |
$1,047.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,066.67
|
| Rate for Payer: Signature Care EPO |
$1,146.81
|
| Rate for Payer: Signature Care PPO |
$1,215.90
|
| Rate for Payer: United Healthcare Commercial |
$1,088.78
|
|
|
HC BS KIT UROMAX BALLOON 18F 4CM
|
Facility
OP
|
$1,381.70
|
|
| Hospital Charge Code |
41603483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,166.15
|
| Rate for Payer: Aetna Medicare |
$455.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$455.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$793.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$863.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$524.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$501.56
|
| Rate for Payer: Cash Price |
$856.65
|
| Rate for Payer: Cash Price |
$856.65
|
| Rate for Payer: Centivo All Commercial |
$704.67
|
| Rate for Payer: Cigna All Commercial |
$1,192.41
|
| Rate for Payer: CORVEL All Commercial |
$1,284.98
|
| Rate for Payer: Coventry All Commercial |
$1,215.90
|
| Rate for Payer: Encore All Commercial |
$1,271.85
|
| Rate for Payer: Frontpath All Commercial |
$1,271.16
|
| Rate for Payer: Humana ChoiceCare |
$1,193.37
|
| Rate for Payer: Humana Medicare |
$704.67
|
| Rate for Payer: Lucent All Commercial |
$704.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,243.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,036.28
|
| Rate for Payer: PHP All Commercial |
$1,047.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$538.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,066.67
|
| Rate for Payer: Signature Care EPO |
$1,146.81
|
| Rate for Payer: Signature Care PPO |
$1,215.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,174.44
|
| Rate for Payer: United Healthcare Commercial |
$1,088.78
|
| Rate for Payer: United Healthcare Medicare |
$455.96
|
|
|
HC BS KIT UROMAX BALLOON 18F 4CM
|
Facility
IP
|
$1,381.70
|
|
| Hospital Charge Code |
41603483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.28 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,193.79
|
| Rate for Payer: Cash Price |
$856.65
|
| Rate for Payer: Cigna All Commercial |
$1,192.41
|
| Rate for Payer: CORVEL All Commercial |
$1,284.98
|
| Rate for Payer: Coventry All Commercial |
$1,215.90
|
| Rate for Payer: Encore All Commercial |
$1,271.85
|
| Rate for Payer: Frontpath All Commercial |
$1,271.16
|
| Rate for Payer: Humana ChoiceCare |
$1,193.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,243.53
|
| Rate for Payer: PHCS All Commercial |
$1,036.28
|
| Rate for Payer: PHP All Commercial |
$1,047.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,066.67
|
| Rate for Payer: Signature Care EPO |
$1,146.81
|
| Rate for Payer: Signature Care PPO |
$1,215.90
|
| Rate for Payer: United Healthcare Commercial |
$1,088.78
|
|
|
HC BUN
|
Facility
OP
|
$40.39
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
63001103
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$34.09
|
| Rate for Payer: Aetna Medicare |
$13.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.66
|
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Centivo All Commercial |
$20.60
|
| Rate for Payer: Cigna All Commercial |
$34.86
|
| Rate for Payer: CORVEL All Commercial |
$37.56
|
| Rate for Payer: Coventry All Commercial |
$35.54
|
| Rate for Payer: Encore All Commercial |
$37.18
|
| Rate for Payer: Frontpath All Commercial |
$37.16
|
| Rate for Payer: Humana ChoiceCare |
$34.89
|
| Rate for Payer: Humana Medicare |
$20.60
|
| Rate for Payer: Lucent All Commercial |
$20.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.35
|
| Rate for Payer: Managed Health Services Medicaid |
$3.95
|
| Rate for Payer: MDWise Medicaid |
$3.95
|
| Rate for Payer: PHCS All Commercial |
$30.29
|
| Rate for Payer: PHP All Commercial |
$30.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.75
|
| Rate for Payer: Sagamore Health Network All Products |
$31.18
|
| Rate for Payer: Signature Care EPO |
$33.53
|
| Rate for Payer: Signature Care PPO |
$35.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.33
|
| Rate for Payer: United Healthcare Commercial |
$31.83
|
| Rate for Payer: United Healthcare Medicare |
$13.33
|
|
|
HC BUN
|
Facility
IP
|
$40.39
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
63001103
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Cigna All Commercial |
$34.86
|
| Rate for Payer: CORVEL All Commercial |
$37.56
|
| Rate for Payer: Coventry All Commercial |
$35.54
|
| Rate for Payer: Encore All Commercial |
$37.18
|
| Rate for Payer: Frontpath All Commercial |
$37.16
|
| Rate for Payer: Humana ChoiceCare |
$34.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.35
|
| Rate for Payer: PHCS All Commercial |
$30.29
|
| Rate for Payer: PHP All Commercial |
$30.63
|
| Rate for Payer: Sagamore Health Network All Products |
$31.18
|
| Rate for Payer: Signature Care EPO |
$33.53
|
| Rate for Payer: Signature Care PPO |
$35.54
|
| Rate for Payer: United Healthcare Commercial |
$31.83
|
|
|
HC BUN-PRECONTRAST
|
Facility
OP
|
$49.90
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
63001704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$46.41 |
| Rate for Payer: Aetna Commercial |
$42.11
|
| Rate for Payer: Aetna Medicare |
$16.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.11
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Centivo All Commercial |
$25.45
|
| Rate for Payer: Cigna All Commercial |
$43.06
|
| Rate for Payer: CORVEL All Commercial |
$46.41
|
| Rate for Payer: Coventry All Commercial |
$43.91
|
| Rate for Payer: Encore All Commercial |
$45.93
|
| Rate for Payer: Frontpath All Commercial |
$45.91
|
| Rate for Payer: Humana ChoiceCare |
$43.10
|
| Rate for Payer: Humana Medicare |
$25.45
|
| Rate for Payer: Lucent All Commercial |
$25.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.91
|
| Rate for Payer: Managed Health Services Medicaid |
$3.95
|
| Rate for Payer: MDWise Medicaid |
$3.95
|
| Rate for Payer: PHCS All Commercial |
$37.42
|
| Rate for Payer: PHP All Commercial |
$37.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.46
|
| Rate for Payer: Sagamore Health Network All Products |
$38.52
|
| Rate for Payer: Signature Care EPO |
$41.42
|
| Rate for Payer: Signature Care PPO |
$43.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.41
|
| Rate for Payer: United Healthcare Commercial |
$39.32
|
| Rate for Payer: United Healthcare Medicare |
$16.47
|
|
|
HC BUN-PRECONTRAST
|
Facility
IP
|
$49.90
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
63001704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.42 |
| Max. Negotiated Rate |
$46.41 |
| Rate for Payer: Aetna Commercial |
$43.11
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cigna All Commercial |
$43.06
|
| Rate for Payer: CORVEL All Commercial |
$46.41
|
| Rate for Payer: Coventry All Commercial |
$43.91
|
| Rate for Payer: Encore All Commercial |
$45.93
|
| Rate for Payer: Frontpath All Commercial |
$45.91
|
| Rate for Payer: Humana ChoiceCare |
$43.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.91
|
| Rate for Payer: PHCS All Commercial |
$37.42
|
| Rate for Payer: PHP All Commercial |
$37.84
|
| Rate for Payer: Sagamore Health Network All Products |
$38.52
|
| Rate for Payer: Signature Care EPO |
$41.42
|
| Rate for Payer: Signature Care PPO |
$43.91
|
| Rate for Payer: United Healthcare Commercial |
$39.32
|
|
|
HC BUPRENORPHINE CONFIRMATION, URINE
|
Facility
OP
|
$93.33
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$78.77
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.88
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Centivo All Commercial |
$47.60
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Lucent All Commercial |
$47.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.40
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.33
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
| Rate for Payer: United Healthcare Medicare |
$30.80
|
|
|
HC BUPRENORPHINE CONFIRMATION, URINE
|
Facility
IP
|
$93.33
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$80.64
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
|
|
HC BUR 4.0 OVAL
|
Facility
OP
|
$253.82
|
|
| Hospital Charge Code |
41601241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.76 |
| Max. Negotiated Rate |
$236.05 |
| Rate for Payer: Aetna Commercial |
$214.22
|
| Rate for Payer: Aetna Medicare |
$83.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$145.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$158.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.14
|
| Rate for Payer: Cash Price |
$157.37
|
| Rate for Payer: Cash Price |
$157.37
|
| Rate for Payer: Centivo All Commercial |
$129.45
|
| Rate for Payer: Cigna All Commercial |
$219.05
|
| Rate for Payer: CORVEL All Commercial |
$236.05
|
| Rate for Payer: Coventry All Commercial |
$223.36
|
| Rate for Payer: Encore All Commercial |
$233.64
|
| Rate for Payer: Frontpath All Commercial |
$233.51
|
| Rate for Payer: Humana ChoiceCare |
$219.22
|
| Rate for Payer: Humana Medicare |
$129.45
|
| Rate for Payer: Lucent All Commercial |
$129.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$190.36
|
| Rate for Payer: PHP All Commercial |
$192.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.99
|
| Rate for Payer: Sagamore Health Network All Products |
$195.95
|
| Rate for Payer: Signature Care EPO |
$210.67
|
| Rate for Payer: Signature Care PPO |
$223.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.75
|
| Rate for Payer: United Healthcare Commercial |
$200.01
|
| Rate for Payer: United Healthcare Medicare |
$83.76
|
|
|
HC BUR 4.0 OVAL
|
Facility
IP
|
$253.82
|
|
| Hospital Charge Code |
41601241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.36 |
| Max. Negotiated Rate |
$236.05 |
| Rate for Payer: Aetna Commercial |
$219.30
|
| Rate for Payer: Cash Price |
$157.37
|
| Rate for Payer: Cigna All Commercial |
$219.05
|
| Rate for Payer: CORVEL All Commercial |
$236.05
|
| Rate for Payer: Coventry All Commercial |
$223.36
|
| Rate for Payer: Encore All Commercial |
$233.64
|
| Rate for Payer: Frontpath All Commercial |
$233.51
|
| Rate for Payer: Humana ChoiceCare |
$219.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.44
|
| Rate for Payer: PHCS All Commercial |
$190.36
|
| Rate for Payer: PHP All Commercial |
$192.50
|
| Rate for Payer: Sagamore Health Network All Products |
$195.95
|
| Rate for Payer: Signature Care EPO |
$210.67
|
| Rate for Payer: Signature Care PPO |
$223.36
|
| Rate for Payer: United Healthcare Commercial |
$200.01
|
|
|
HC BUR BARREL 5.0
|
Facility
OP
|
$1,003.24
|
|
| Hospital Charge Code |
41601242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$933.01 |
| Rate for Payer: Aetna Commercial |
$846.73
|
| Rate for Payer: Aetna Medicare |
$331.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$576.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$627.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$364.18
|
| Rate for Payer: Cash Price |
$622.01
|
| Rate for Payer: Cash Price |
$622.01
|
| Rate for Payer: Centivo All Commercial |
$511.65
|
| Rate for Payer: Cigna All Commercial |
$865.80
|
| Rate for Payer: CORVEL All Commercial |
$933.01
|
| Rate for Payer: Coventry All Commercial |
$882.85
|
| Rate for Payer: Encore All Commercial |
$923.48
|
| Rate for Payer: Frontpath All Commercial |
$922.98
|
| Rate for Payer: Humana ChoiceCare |
$866.50
|
| Rate for Payer: Humana Medicare |
$511.65
|
| Rate for Payer: Lucent All Commercial |
$511.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$902.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$752.43
|
| Rate for Payer: PHP All Commercial |
$760.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$391.26
|
| Rate for Payer: Sagamore Health Network All Products |
$774.50
|
| Rate for Payer: Signature Care EPO |
$832.69
|
| Rate for Payer: Signature Care PPO |
$882.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$852.75
|
| Rate for Payer: United Healthcare Commercial |
$790.55
|
| Rate for Payer: United Healthcare Medicare |
$331.07
|
|
|
HC BUR BARREL 5.0
|
Facility
IP
|
$1,003.24
|
|
| Hospital Charge Code |
41601242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.43 |
| Max. Negotiated Rate |
$933.01 |
| Rate for Payer: Aetna Commercial |
$866.80
|
| Rate for Payer: Cash Price |
$622.01
|
| Rate for Payer: Cigna All Commercial |
$865.80
|
| Rate for Payer: CORVEL All Commercial |
$933.01
|
| Rate for Payer: Coventry All Commercial |
$882.85
|
| Rate for Payer: Encore All Commercial |
$923.48
|
| Rate for Payer: Frontpath All Commercial |
$922.98
|
| Rate for Payer: Humana ChoiceCare |
$866.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$902.92
|
| Rate for Payer: PHCS All Commercial |
$752.43
|
| Rate for Payer: PHP All Commercial |
$760.86
|
| Rate for Payer: Sagamore Health Network All Products |
$774.50
|
| Rate for Payer: Signature Care EPO |
$832.69
|
| Rate for Payer: Signature Care PPO |
$882.85
|
| Rate for Payer: United Healthcare Commercial |
$790.55
|
|
|
HC BUR BARREL 6 FLUTE 5.0
|
Facility
OP
|
$362.57
|
|
| Hospital Charge Code |
41602503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$337.19 |
| Rate for Payer: Aetna Commercial |
$306.01
|
| Rate for Payer: Aetna Medicare |
$119.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$208.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.61
|
| Rate for Payer: Cash Price |
$224.79
|
| Rate for Payer: Cash Price |
$224.79
|
| Rate for Payer: Centivo All Commercial |
$184.91
|
| Rate for Payer: Cigna All Commercial |
$312.90
|
| Rate for Payer: CORVEL All Commercial |
$337.19
|
| Rate for Payer: Coventry All Commercial |
$319.06
|
| Rate for Payer: Encore All Commercial |
$333.75
|
| Rate for Payer: Frontpath All Commercial |
$333.56
|
| Rate for Payer: Humana ChoiceCare |
$313.15
|
| Rate for Payer: Humana Medicare |
$184.91
|
| Rate for Payer: Lucent All Commercial |
$184.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$326.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$271.93
|
| Rate for Payer: PHP All Commercial |
$274.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.40
|
| Rate for Payer: Sagamore Health Network All Products |
$279.90
|
| Rate for Payer: Signature Care EPO |
$300.93
|
| Rate for Payer: Signature Care PPO |
$319.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$308.18
|
| Rate for Payer: United Healthcare Commercial |
$285.71
|
| Rate for Payer: United Healthcare Medicare |
$119.65
|
|
|
HC BUR BARREL 6 FLUTE 5.0
|
Facility
IP
|
$362.57
|
|
| Hospital Charge Code |
41602503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.93 |
| Max. Negotiated Rate |
$337.19 |
| Rate for Payer: Aetna Commercial |
$313.26
|
| Rate for Payer: Cash Price |
$224.79
|
| Rate for Payer: Cigna All Commercial |
$312.90
|
| Rate for Payer: CORVEL All Commercial |
$337.19
|
| Rate for Payer: Coventry All Commercial |
$319.06
|
| Rate for Payer: Encore All Commercial |
$333.75
|
| Rate for Payer: Frontpath All Commercial |
$333.56
|
| Rate for Payer: Humana ChoiceCare |
$313.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$326.31
|
| Rate for Payer: PHCS All Commercial |
$271.93
|
| Rate for Payer: PHP All Commercial |
$274.97
|
| Rate for Payer: Sagamore Health Network All Products |
$279.90
|
| Rate for Payer: Signature Care EPO |
$300.93
|
| Rate for Payer: Signature Care PPO |
$319.06
|
| Rate for Payer: United Healthcare Commercial |
$285.71
|
|
|
HC BUR BARREL 6 FLUTE 5.5
|
Facility
OP
|
$426.37
|
|
| Hospital Charge Code |
41602504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$359.86
|
| Rate for Payer: Aetna Medicare |
$140.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$266.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.77
|
| Rate for Payer: Cash Price |
$264.35
|
| Rate for Payer: Cash Price |
$264.35
|
| Rate for Payer: Centivo All Commercial |
$217.45
|
| Rate for Payer: Cigna All Commercial |
$367.96
|
| Rate for Payer: CORVEL All Commercial |
$396.52
|
| Rate for Payer: Coventry All Commercial |
$375.21
|
| Rate for Payer: Encore All Commercial |
$392.47
|
| Rate for Payer: Frontpath All Commercial |
$392.26
|
| Rate for Payer: Humana ChoiceCare |
$368.26
|
| Rate for Payer: Humana Medicare |
$217.45
|
| Rate for Payer: Lucent All Commercial |
$217.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$383.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$319.78
|
| Rate for Payer: PHP All Commercial |
$323.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.28
|
| Rate for Payer: Sagamore Health Network All Products |
$329.16
|
| Rate for Payer: Signature Care EPO |
$353.89
|
| Rate for Payer: Signature Care PPO |
$375.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$362.41
|
| Rate for Payer: United Healthcare Commercial |
$335.98
|
| Rate for Payer: United Healthcare Medicare |
$140.70
|
|
|
HC BUR BARREL 6 FLUTE 5.5
|
Facility
IP
|
$426.37
|
|
| Hospital Charge Code |
41602504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.78 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$368.38
|
| Rate for Payer: Cash Price |
$264.35
|
| Rate for Payer: Cigna All Commercial |
$367.96
|
| Rate for Payer: CORVEL All Commercial |
$396.52
|
| Rate for Payer: Coventry All Commercial |
$375.21
|
| Rate for Payer: Encore All Commercial |
$392.47
|
| Rate for Payer: Frontpath All Commercial |
$392.26
|
| Rate for Payer: Humana ChoiceCare |
$368.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$383.73
|
| Rate for Payer: PHCS All Commercial |
$319.78
|
| Rate for Payer: PHP All Commercial |
$323.36
|
| Rate for Payer: Sagamore Health Network All Products |
$329.16
|
| Rate for Payer: Signature Care EPO |
$353.89
|
| Rate for Payer: Signature Care PPO |
$375.21
|
| Rate for Payer: United Healthcare Commercial |
$335.98
|
|
|
HC BURR EGG 4.0MM
|
Facility
OP
|
$921.55
|
|
| Hospital Charge Code |
41601823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$857.04 |
| Rate for Payer: Aetna Commercial |
$777.79
|
| Rate for Payer: Aetna Medicare |
$304.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$529.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$576.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.52
|
| Rate for Payer: Cash Price |
$571.36
|
| Rate for Payer: Cash Price |
$571.36
|
| Rate for Payer: Centivo All Commercial |
$469.99
|
| Rate for Payer: Cigna All Commercial |
$795.30
|
| Rate for Payer: CORVEL All Commercial |
$857.04
|
| Rate for Payer: Coventry All Commercial |
$810.96
|
| Rate for Payer: Encore All Commercial |
$848.29
|
| Rate for Payer: Frontpath All Commercial |
$847.83
|
| Rate for Payer: Humana ChoiceCare |
$795.94
|
| Rate for Payer: Humana Medicare |
$469.99
|
| Rate for Payer: Lucent All Commercial |
$469.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$829.40
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$691.16
|
| Rate for Payer: PHP All Commercial |
$698.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$359.40
|
| Rate for Payer: Sagamore Health Network All Products |
$711.44
|
| Rate for Payer: Signature Care EPO |
$764.89
|
| Rate for Payer: Signature Care PPO |
$810.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$783.32
|
| Rate for Payer: United Healthcare Commercial |
$726.18
|
| Rate for Payer: United Healthcare Medicare |
$304.11
|
|
|
HC BURR EGG 4.0MM
|
Facility
IP
|
$921.55
|
|
| Hospital Charge Code |
41601823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$691.16 |
| Max. Negotiated Rate |
$857.04 |
| Rate for Payer: Aetna Commercial |
$796.22
|
| Rate for Payer: Cash Price |
$571.36
|
| Rate for Payer: Cigna All Commercial |
$795.30
|
| Rate for Payer: CORVEL All Commercial |
$857.04
|
| Rate for Payer: Coventry All Commercial |
$810.96
|
| Rate for Payer: Encore All Commercial |
$848.29
|
| Rate for Payer: Frontpath All Commercial |
$847.83
|
| Rate for Payer: Humana ChoiceCare |
$795.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$829.40
|
| Rate for Payer: PHCS All Commercial |
$691.16
|
| Rate for Payer: PHP All Commercial |
$698.90
|
| Rate for Payer: Sagamore Health Network All Products |
$711.44
|
| Rate for Payer: Signature Care EPO |
$764.89
|
| Rate for Payer: Signature Care PPO |
$810.96
|
| Rate for Payer: United Healthcare Commercial |
$726.18
|
|
|
HC BURR OPHTHALMIC 1MM
|
Facility
IP
|
$45.14
|
|
| Hospital Charge Code |
41601822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$41.98 |
| Rate for Payer: Aetna Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Cigna All Commercial |
$38.96
|
| Rate for Payer: CORVEL All Commercial |
$41.98
|
| Rate for Payer: Coventry All Commercial |
$39.72
|
| Rate for Payer: Encore All Commercial |
$41.55
|
| Rate for Payer: Frontpath All Commercial |
$41.53
|
| Rate for Payer: Humana ChoiceCare |
$38.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.63
|
| Rate for Payer: PHCS All Commercial |
$33.86
|
| Rate for Payer: PHP All Commercial |
$34.23
|
| Rate for Payer: Sagamore Health Network All Products |
$34.85
|
| Rate for Payer: Signature Care EPO |
$37.47
|
| Rate for Payer: Signature Care PPO |
$39.72
|
| Rate for Payer: United Healthcare Commercial |
$35.57
|
|
