|
HC BURR OPHTHALMIC 1MM
|
Facility
OP
|
$45.14
|
|
| Hospital Charge Code |
41601822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$38.10
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.39
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Centivo All Commercial |
$23.02
|
| 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: Humana Medicare |
$23.02
|
| Rate for Payer: Lucent All Commercial |
$23.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$33.86
|
| Rate for Payer: PHP All Commercial |
$34.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.60
|
| 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: Three Rivers Preferred All Commercial |
$38.37
|
| Rate for Payer: United Healthcare Commercial |
$35.57
|
| Rate for Payer: United Healthcare Medicare |
$14.90
|
|
|
HC BUSSE CURETTE 10MM
|
Facility
OP
|
$8.43
|
|
| Hospital Charge Code |
41603510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Medicare |
$2.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.06
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Centivo All Commercial |
$4.30
|
| Rate for Payer: Cigna All Commercial |
$7.28
|
| Rate for Payer: CORVEL All Commercial |
$7.84
|
| Rate for Payer: Coventry All Commercial |
$7.42
|
| Rate for Payer: Encore All Commercial |
$7.76
|
| Rate for Payer: Frontpath All Commercial |
$7.76
|
| Rate for Payer: Humana ChoiceCare |
$7.28
|
| Rate for Payer: Humana Medicare |
$4.30
|
| Rate for Payer: Lucent All Commercial |
$4.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.32
|
| Rate for Payer: PHP All Commercial |
$6.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.29
|
| Rate for Payer: Sagamore Health Network All Products |
$6.51
|
| Rate for Payer: Signature Care EPO |
$7.00
|
| Rate for Payer: Signature Care PPO |
$7.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.17
|
| Rate for Payer: United Healthcare Commercial |
$6.64
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
|
|
HC BUSSE CURETTE 10MM
|
Facility
IP
|
$8.43
|
|
| Hospital Charge Code |
41603510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$7.84 |
| Rate for Payer: Aetna Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Cigna All Commercial |
$7.28
|
| Rate for Payer: CORVEL All Commercial |
$7.84
|
| Rate for Payer: Coventry All Commercial |
$7.42
|
| Rate for Payer: Encore All Commercial |
$7.76
|
| Rate for Payer: Frontpath All Commercial |
$7.76
|
| Rate for Payer: Humana ChoiceCare |
$7.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.59
|
| Rate for Payer: PHCS All Commercial |
$6.32
|
| Rate for Payer: PHP All Commercial |
$6.39
|
| Rate for Payer: Sagamore Health Network All Products |
$6.51
|
| Rate for Payer: Signature Care EPO |
$7.00
|
| Rate for Payer: Signature Care PPO |
$7.42
|
| Rate for Payer: United Healthcare Commercial |
$6.64
|
|
|
HC BUSSE CURETTE 12MM
|
Facility
OP
|
$9.48
|
|
| Hospital Charge Code |
41603509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: Aetna Medicare |
$3.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.44
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Centivo All Commercial |
$4.83
|
| Rate for Payer: Cigna All Commercial |
$8.18
|
| Rate for Payer: CORVEL All Commercial |
$8.82
|
| Rate for Payer: Coventry All Commercial |
$8.34
|
| Rate for Payer: Encore All Commercial |
$8.73
|
| Rate for Payer: Frontpath All Commercial |
$8.72
|
| Rate for Payer: Humana ChoiceCare |
$8.19
|
| Rate for Payer: Humana Medicare |
$4.83
|
| Rate for Payer: Lucent All Commercial |
$4.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.11
|
| Rate for Payer: PHP All Commercial |
$7.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.70
|
| Rate for Payer: Sagamore Health Network All Products |
$7.32
|
| Rate for Payer: Signature Care EPO |
$7.87
|
| Rate for Payer: Signature Care PPO |
$8.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.06
|
| Rate for Payer: United Healthcare Commercial |
$7.47
|
| Rate for Payer: United Healthcare Medicare |
$3.13
|
|
|
HC BUSSE CURETTE 12MM
|
Facility
IP
|
$9.48
|
|
| Hospital Charge Code |
41603509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$8.82 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Cigna All Commercial |
$8.18
|
| Rate for Payer: CORVEL All Commercial |
$8.82
|
| Rate for Payer: Coventry All Commercial |
$8.34
|
| Rate for Payer: Encore All Commercial |
$8.73
|
| Rate for Payer: Frontpath All Commercial |
$8.72
|
| Rate for Payer: Humana ChoiceCare |
$8.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.53
|
| Rate for Payer: PHCS All Commercial |
$7.11
|
| Rate for Payer: PHP All Commercial |
$7.19
|
| Rate for Payer: Sagamore Health Network All Products |
$7.32
|
| Rate for Payer: Signature Care EPO |
$7.87
|
| Rate for Payer: Signature Care PPO |
$8.34
|
| Rate for Payer: United Healthcare Commercial |
$7.47
|
|
|
HC BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Facility
IP
|
$2,830.50
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
01649180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,122.88 |
| Max. Negotiated Rate |
$2,632.36 |
| Rate for Payer: Aetna Commercial |
$2,445.55
|
| Rate for Payer: Cash Price |
$1,754.91
|
| Rate for Payer: Cigna All Commercial |
$2,442.72
|
| Rate for Payer: CORVEL All Commercial |
$2,632.36
|
| Rate for Payer: Coventry All Commercial |
$2,490.84
|
| Rate for Payer: Encore All Commercial |
$2,605.48
|
| Rate for Payer: Frontpath All Commercial |
$2,604.06
|
| Rate for Payer: Humana ChoiceCare |
$2,444.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,547.45
|
| Rate for Payer: PHCS All Commercial |
$2,122.88
|
| Rate for Payer: PHP All Commercial |
$2,146.65
|
| Rate for Payer: Sagamore Health Network All Products |
$2,185.15
|
| Rate for Payer: Signature Care EPO |
$2,349.32
|
| Rate for Payer: Signature Care PPO |
$2,490.84
|
| Rate for Payer: United Healthcare Commercial |
$2,230.43
|
|
|
HC BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Facility
OP
|
$2,830.50
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
01649180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$934.06 |
| Max. Negotiated Rate |
$2,632.36 |
| Rate for Payer: Aetna Commercial |
$2,388.94
|
| Rate for Payer: Aetna Medicare |
$934.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$934.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,625.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,769.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,242.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,074.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,027.47
|
| Rate for Payer: Cash Price |
$1,754.91
|
| Rate for Payer: Cash Price |
$1,754.91
|
| Rate for Payer: Centivo All Commercial |
$1,443.56
|
| Rate for Payer: Cigna All Commercial |
$2,442.72
|
| Rate for Payer: CORVEL All Commercial |
$2,632.36
|
| Rate for Payer: Coventry All Commercial |
$2,490.84
|
| Rate for Payer: Encore All Commercial |
$2,605.48
|
| Rate for Payer: Frontpath All Commercial |
$2,604.06
|
| Rate for Payer: Humana ChoiceCare |
$2,444.70
|
| Rate for Payer: Humana Medicare |
$1,443.56
|
| Rate for Payer: Lucent All Commercial |
$1,443.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,547.45
|
| Rate for Payer: Managed Health Services Medicaid |
$1,242.31
|
| Rate for Payer: MDWise Medicaid |
$1,242.31
|
| Rate for Payer: PHCS All Commercial |
$2,122.88
|
| Rate for Payer: PHP All Commercial |
$2,146.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,103.90
|
| Rate for Payer: Sagamore Health Network All Products |
$2,185.15
|
| Rate for Payer: Signature Care EPO |
$2,349.32
|
| Rate for Payer: Signature Care PPO |
$2,490.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,405.92
|
| Rate for Payer: United Healthcare Commercial |
$2,230.43
|
| Rate for Payer: United Healthcare Medicare |
$934.06
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
IP
|
$6,783.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
01619081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,087.25 |
| Max. Negotiated Rate |
$6,308.19 |
| Rate for Payer: Aetna Commercial |
$5,860.51
|
| Rate for Payer: Cash Price |
$4,205.46
|
| Rate for Payer: Cigna All Commercial |
$5,853.73
|
| Rate for Payer: CORVEL All Commercial |
$6,308.19
|
| Rate for Payer: Coventry All Commercial |
$5,969.04
|
| Rate for Payer: Encore All Commercial |
$6,243.75
|
| Rate for Payer: Frontpath All Commercial |
$6,240.36
|
| Rate for Payer: Humana ChoiceCare |
$5,858.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,104.70
|
| Rate for Payer: PHCS All Commercial |
$5,087.25
|
| Rate for Payer: PHP All Commercial |
$5,144.23
|
| Rate for Payer: Sagamore Health Network All Products |
$5,236.48
|
| Rate for Payer: Signature Care EPO |
$5,629.89
|
| Rate for Payer: Signature Care PPO |
$5,969.04
|
| Rate for Payer: United Healthcare Commercial |
$5,345.00
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
OP
|
$6,783.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
01619081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,238.39 |
| Max. Negotiated Rate |
$6,308.19 |
| Rate for Payer: Aetna Commercial |
$5,724.85
|
| Rate for Payer: Aetna Medicare |
$2,238.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,238.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,895.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,240.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,574.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,462.23
|
| Rate for Payer: Cash Price |
$4,205.46
|
| Rate for Payer: Centivo All Commercial |
$3,459.33
|
| Rate for Payer: Cigna All Commercial |
$5,853.73
|
| Rate for Payer: CORVEL All Commercial |
$6,308.19
|
| Rate for Payer: Coventry All Commercial |
$5,969.04
|
| Rate for Payer: Encore All Commercial |
$6,243.75
|
| Rate for Payer: Frontpath All Commercial |
$6,240.36
|
| Rate for Payer: Humana ChoiceCare |
$5,858.48
|
| Rate for Payer: Humana Medicare |
$3,459.33
|
| Rate for Payer: Lucent All Commercial |
$3,459.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,104.70
|
| Rate for Payer: PHCS All Commercial |
$5,087.25
|
| Rate for Payer: PHP All Commercial |
$5,144.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,645.37
|
| Rate for Payer: Sagamore Health Network All Products |
$5,236.48
|
| Rate for Payer: Signature Care EPO |
$5,629.89
|
| Rate for Payer: Signature Care PPO |
$5,969.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,765.55
|
| Rate for Payer: United Healthcare Commercial |
$5,345.00
|
| Rate for Payer: United Healthcare Medicare |
$2,238.39
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
IP
|
$4,165.68
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
01619082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,124.26 |
| Max. Negotiated Rate |
$3,874.08 |
| Rate for Payer: Aetna Commercial |
$3,599.15
|
| Rate for Payer: Cash Price |
$2,582.72
|
| Rate for Payer: Cigna All Commercial |
$3,594.98
|
| Rate for Payer: CORVEL All Commercial |
$3,874.08
|
| Rate for Payer: Coventry All Commercial |
$3,665.80
|
| Rate for Payer: Encore All Commercial |
$3,834.51
|
| Rate for Payer: Frontpath All Commercial |
$3,832.43
|
| Rate for Payer: Humana ChoiceCare |
$3,597.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,749.11
|
| Rate for Payer: PHCS All Commercial |
$3,124.26
|
| Rate for Payer: PHP All Commercial |
$3,159.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,215.90
|
| Rate for Payer: Signature Care EPO |
$3,457.51
|
| Rate for Payer: Signature Care PPO |
$3,665.80
|
| Rate for Payer: United Healthcare Commercial |
$3,282.56
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
OP
|
$4,165.68
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
01619082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,374.67 |
| Max. Negotiated Rate |
$3,874.08 |
| Rate for Payer: Aetna Commercial |
$3,515.83
|
| Rate for Payer: Aetna Medicare |
$1,374.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,374.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,392.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,603.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,580.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,512.14
|
| Rate for Payer: Cash Price |
$2,582.72
|
| Rate for Payer: Centivo All Commercial |
$2,124.50
|
| Rate for Payer: Cigna All Commercial |
$3,594.98
|
| Rate for Payer: CORVEL All Commercial |
$3,874.08
|
| Rate for Payer: Coventry All Commercial |
$3,665.80
|
| Rate for Payer: Encore All Commercial |
$3,834.51
|
| Rate for Payer: Frontpath All Commercial |
$3,832.43
|
| Rate for Payer: Humana ChoiceCare |
$3,597.90
|
| Rate for Payer: Humana Medicare |
$2,124.50
|
| Rate for Payer: Lucent All Commercial |
$2,124.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,749.11
|
| Rate for Payer: PHCS All Commercial |
$3,124.26
|
| Rate for Payer: PHP All Commercial |
$3,159.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,624.62
|
| Rate for Payer: Sagamore Health Network All Products |
$3,215.90
|
| Rate for Payer: Signature Care EPO |
$3,457.51
|
| Rate for Payer: Signature Care PPO |
$3,665.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,540.83
|
| Rate for Payer: United Healthcare Commercial |
$3,282.56
|
| Rate for Payer: United Healthcare Medicare |
$1,374.67
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION MR IMAG
|
Facility
IP
|
$1,083.42
|
|
| Hospital Charge Code |
01579085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.57 |
| Max. Negotiated Rate |
$1,007.58 |
| Rate for Payer: Aetna Commercial |
$936.08
|
| Rate for Payer: Cash Price |
$671.72
|
| Rate for Payer: Cigna All Commercial |
$934.99
|
| Rate for Payer: CORVEL All Commercial |
$1,007.58
|
| Rate for Payer: Coventry All Commercial |
$953.41
|
| Rate for Payer: Encore All Commercial |
$997.29
|
| Rate for Payer: Frontpath All Commercial |
$996.75
|
| Rate for Payer: Humana ChoiceCare |
$935.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.08
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Sagamore Health Network All Products |
$836.40
|
| Rate for Payer: Signature Care EPO |
$899.24
|
| Rate for Payer: Signature Care PPO |
$953.41
|
| Rate for Payer: United Healthcare Commercial |
$853.74
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION MR IMAG
|
Facility
OP
|
$1,083.42
|
|
| Hospital Charge Code |
01579085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.53 |
| Max. Negotiated Rate |
$1,007.58 |
| Rate for Payer: Aetna Commercial |
$914.41
|
| Rate for Payer: Aetna Medicare |
$357.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$622.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$677.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$411.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$393.28
|
| Rate for Payer: Cash Price |
$671.72
|
| Rate for Payer: Centivo All Commercial |
$552.55
|
| Rate for Payer: Cigna All Commercial |
$934.99
|
| Rate for Payer: CORVEL All Commercial |
$1,007.58
|
| Rate for Payer: Coventry All Commercial |
$953.41
|
| Rate for Payer: Encore All Commercial |
$997.29
|
| Rate for Payer: Frontpath All Commercial |
$996.75
|
| Rate for Payer: Humana ChoiceCare |
$935.75
|
| Rate for Payer: Humana Medicare |
$552.55
|
| Rate for Payer: Lucent All Commercial |
$552.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.08
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$422.54
|
| Rate for Payer: Sagamore Health Network All Products |
$836.40
|
| Rate for Payer: Signature Care EPO |
$899.24
|
| Rate for Payer: Signature Care PPO |
$953.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$920.91
|
| Rate for Payer: United Healthcare Commercial |
$853.74
|
| Rate for Payer: United Healthcare Medicare |
$357.53
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION US IMAG
|
Facility
OP
|
$1,714.78
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
01649983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$1,594.75 |
| Rate for Payer: Aetna Commercial |
$1,447.28
|
| Rate for Payer: Aetna Medicare |
$565.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$565.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$984.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,071.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$650.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$622.47
|
| Rate for Payer: Cash Price |
$1,063.17
|
| Rate for Payer: Centivo All Commercial |
$874.54
|
| Rate for Payer: Cigna All Commercial |
$1,479.86
|
| Rate for Payer: CORVEL All Commercial |
$1,594.75
|
| Rate for Payer: Coventry All Commercial |
$1,509.01
|
| Rate for Payer: Encore All Commercial |
$1,578.46
|
| Rate for Payer: Frontpath All Commercial |
$1,577.60
|
| Rate for Payer: Humana ChoiceCare |
$1,481.06
|
| Rate for Payer: Humana Medicare |
$874.54
|
| Rate for Payer: Lucent All Commercial |
$874.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,543.30
|
| Rate for Payer: PHCS All Commercial |
$1,286.09
|
| Rate for Payer: PHP All Commercial |
$1,300.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$668.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,323.81
|
| Rate for Payer: Signature Care EPO |
$1,423.27
|
| Rate for Payer: Signature Care PPO |
$1,509.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,457.57
|
| Rate for Payer: United Healthcare Commercial |
$1,351.25
|
| Rate for Payer: United Healthcare Medicare |
$565.88
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION US IMAG
|
Facility
IP
|
$1,714.78
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
01649983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,286.09 |
| Max. Negotiated Rate |
$1,594.75 |
| Rate for Payer: Aetna Commercial |
$1,481.57
|
| Rate for Payer: Cash Price |
$1,063.17
|
| Rate for Payer: Cigna All Commercial |
$1,479.86
|
| Rate for Payer: CORVEL All Commercial |
$1,594.75
|
| Rate for Payer: Coventry All Commercial |
$1,509.01
|
| Rate for Payer: Encore All Commercial |
$1,578.46
|
| Rate for Payer: Frontpath All Commercial |
$1,577.60
|
| Rate for Payer: Humana ChoiceCare |
$1,481.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,543.30
|
| Rate for Payer: PHCS All Commercial |
$1,286.09
|
| Rate for Payer: PHP All Commercial |
$1,300.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,323.81
|
| Rate for Payer: Signature Care EPO |
$1,423.27
|
| Rate for Payer: Signature Care PPO |
$1,509.01
|
| Rate for Payer: United Healthcare Commercial |
$1,351.25
|
|
|
HC BX BREAST PLCMNT DEV ADD LESION MR IMAG
|
Facility
IP
|
$1,083.42
|
|
| Hospital Charge Code |
01579086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.57 |
| Max. Negotiated Rate |
$1,007.58 |
| Rate for Payer: Aetna Commercial |
$936.08
|
| Rate for Payer: Cash Price |
$671.72
|
| Rate for Payer: Cigna All Commercial |
$934.99
|
| Rate for Payer: CORVEL All Commercial |
$1,007.58
|
| Rate for Payer: Coventry All Commercial |
$953.41
|
| Rate for Payer: Encore All Commercial |
$997.29
|
| Rate for Payer: Frontpath All Commercial |
$996.75
|
| Rate for Payer: Humana ChoiceCare |
$935.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.08
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Sagamore Health Network All Products |
$836.40
|
| Rate for Payer: Signature Care EPO |
$899.24
|
| Rate for Payer: Signature Care PPO |
$953.41
|
| Rate for Payer: United Healthcare Commercial |
$853.74
|
|
|
HC BX BREAST PLCMNT DEV ADD LESION MR IMAG
|
Facility
OP
|
$1,083.42
|
|
| Hospital Charge Code |
01579086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.53 |
| Max. Negotiated Rate |
$1,007.58 |
| Rate for Payer: Aetna Commercial |
$914.41
|
| Rate for Payer: Aetna Medicare |
$357.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$622.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$677.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$411.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$393.28
|
| Rate for Payer: Cash Price |
$671.72
|
| Rate for Payer: Centivo All Commercial |
$552.55
|
| Rate for Payer: Cigna All Commercial |
$934.99
|
| Rate for Payer: CORVEL All Commercial |
$1,007.58
|
| Rate for Payer: Coventry All Commercial |
$953.41
|
| Rate for Payer: Encore All Commercial |
$997.29
|
| Rate for Payer: Frontpath All Commercial |
$996.75
|
| Rate for Payer: Humana ChoiceCare |
$935.75
|
| Rate for Payer: Humana Medicare |
$552.55
|
| Rate for Payer: Lucent All Commercial |
$552.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.08
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$422.54
|
| Rate for Payer: Sagamore Health Network All Products |
$836.40
|
| Rate for Payer: Signature Care EPO |
$899.24
|
| Rate for Payer: Signature Care PPO |
$953.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$920.91
|
| Rate for Payer: United Healthcare Commercial |
$853.74
|
| Rate for Payer: United Healthcare Medicare |
$357.53
|
|
|
HC BX BREAST,PLCMT DEV ADD LESION US IMAG
|
Facility
IP
|
$1,708.77
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
01649084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,281.57 |
| Max. Negotiated Rate |
$1,589.15 |
| Rate for Payer: Aetna Commercial |
$1,476.37
|
| Rate for Payer: Cash Price |
$1,059.43
|
| Rate for Payer: Cigna All Commercial |
$1,474.66
|
| Rate for Payer: CORVEL All Commercial |
$1,589.15
|
| Rate for Payer: Coventry All Commercial |
$1,503.71
|
| Rate for Payer: Encore All Commercial |
$1,572.92
|
| Rate for Payer: Frontpath All Commercial |
$1,572.06
|
| Rate for Payer: Humana ChoiceCare |
$1,475.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,537.89
|
| Rate for Payer: PHCS All Commercial |
$1,281.57
|
| Rate for Payer: PHP All Commercial |
$1,295.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,319.17
|
| Rate for Payer: Signature Care EPO |
$1,418.28
|
| Rate for Payer: Signature Care PPO |
$1,503.71
|
| Rate for Payer: United Healthcare Commercial |
$1,346.51
|
|
|
HC BX BREAST,PLCMT DEV ADD LESION US IMAG
|
Facility
OP
|
$1,708.77
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
01649084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$563.89 |
| Max. Negotiated Rate |
$1,589.15 |
| Rate for Payer: Aetna Commercial |
$1,442.20
|
| Rate for Payer: Aetna Medicare |
$563.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$563.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$981.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,068.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$648.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$620.28
|
| Rate for Payer: Cash Price |
$1,059.43
|
| Rate for Payer: Centivo All Commercial |
$871.47
|
| Rate for Payer: Cigna All Commercial |
$1,474.66
|
| Rate for Payer: CORVEL All Commercial |
$1,589.15
|
| Rate for Payer: Coventry All Commercial |
$1,503.71
|
| Rate for Payer: Encore All Commercial |
$1,572.92
|
| Rate for Payer: Frontpath All Commercial |
$1,572.06
|
| Rate for Payer: Humana ChoiceCare |
$1,475.86
|
| Rate for Payer: Humana Medicare |
$871.47
|
| Rate for Payer: Lucent All Commercial |
$871.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,537.89
|
| Rate for Payer: PHCS All Commercial |
$1,281.57
|
| Rate for Payer: PHP All Commercial |
$1,295.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$666.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,319.17
|
| Rate for Payer: Signature Care EPO |
$1,418.28
|
| Rate for Payer: Signature Care PPO |
$1,503.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,452.45
|
| Rate for Payer: United Healthcare Commercial |
$1,346.51
|
| Rate for Payer: United Healthcare Medicare |
$563.89
|
|
|
HC C0 DIFFUSE CAPACITY
|
Facility
OP
|
$273.92
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
01704729
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$254.75 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Medicare |
$90.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$157.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.43
|
| Rate for Payer: Cash Price |
$169.83
|
| Rate for Payer: Cash Price |
$169.83
|
| Rate for Payer: Centivo All Commercial |
$139.70
|
| Rate for Payer: Cigna All Commercial |
$236.39
|
| Rate for Payer: CORVEL All Commercial |
$254.75
|
| Rate for Payer: Coventry All Commercial |
$241.05
|
| Rate for Payer: Encore All Commercial |
$252.14
|
| Rate for Payer: Frontpath All Commercial |
$252.01
|
| Rate for Payer: Humana ChoiceCare |
$236.59
|
| Rate for Payer: Humana Medicare |
$139.70
|
| Rate for Payer: Lucent All Commercial |
$139.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.53
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$205.44
|
| Rate for Payer: PHP All Commercial |
$207.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.83
|
| Rate for Payer: Sagamore Health Network All Products |
$211.47
|
| Rate for Payer: Signature Care EPO |
$227.35
|
| Rate for Payer: Signature Care PPO |
$241.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.83
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
| Rate for Payer: United Healthcare Medicare |
$90.39
|
|
|
HC C0 DIFFUSE CAPACITY
|
Facility
IP
|
$273.92
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
01704729
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$205.44 |
| Max. Negotiated Rate |
$254.75 |
| Rate for Payer: Aetna Commercial |
$236.67
|
| Rate for Payer: Cash Price |
$169.83
|
| Rate for Payer: Cigna All Commercial |
$236.39
|
| Rate for Payer: CORVEL All Commercial |
$254.75
|
| Rate for Payer: Coventry All Commercial |
$241.05
|
| Rate for Payer: Encore All Commercial |
$252.14
|
| Rate for Payer: Frontpath All Commercial |
$252.01
|
| Rate for Payer: Humana ChoiceCare |
$236.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.53
|
| Rate for Payer: PHCS All Commercial |
$205.44
|
| Rate for Payer: PHP All Commercial |
$207.74
|
| Rate for Payer: Sagamore Health Network All Products |
$211.47
|
| Rate for Payer: Signature Care EPO |
$227.35
|
| Rate for Payer: Signature Care PPO |
$241.05
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
|
|
HC C-1-ESTERASE INHIBIT
|
Facility
OP
|
$67.16
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
63001870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna Commercial |
$56.68
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.38
|
| Rate for Payer: Cash Price |
$41.64
|
| Rate for Payer: Cash Price |
$41.64
|
| Rate for Payer: Centivo All Commercial |
$34.25
|
| Rate for Payer: Cigna All Commercial |
$57.96
|
| Rate for Payer: CORVEL All Commercial |
$62.46
|
| Rate for Payer: Coventry All Commercial |
$59.10
|
| Rate for Payer: Encore All Commercial |
$61.82
|
| Rate for Payer: Frontpath All Commercial |
$61.78
|
| Rate for Payer: Humana ChoiceCare |
$58.00
|
| Rate for Payer: Humana Medicare |
$34.25
|
| Rate for Payer: Lucent All Commercial |
$34.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.44
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$50.37
|
| Rate for Payer: PHP All Commercial |
$50.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.19
|
| Rate for Payer: Sagamore Health Network All Products |
$51.85
|
| Rate for Payer: Signature Care EPO |
$55.74
|
| Rate for Payer: Signature Care PPO |
$59.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.08
|
| Rate for Payer: United Healthcare Commercial |
$52.92
|
| Rate for Payer: United Healthcare Medicare |
$22.16
|
|
|
HC C-1-ESTERASE INHIBIT
|
Facility
IP
|
$67.16
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
63001870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.37 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna Commercial |
$58.02
|
| Rate for Payer: Cash Price |
$41.64
|
| Rate for Payer: Cigna All Commercial |
$57.96
|
| Rate for Payer: CORVEL All Commercial |
$62.46
|
| Rate for Payer: Coventry All Commercial |
$59.10
|
| Rate for Payer: Encore All Commercial |
$61.82
|
| Rate for Payer: Frontpath All Commercial |
$61.78
|
| Rate for Payer: Humana ChoiceCare |
$58.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.44
|
| Rate for Payer: PHCS All Commercial |
$50.37
|
| Rate for Payer: PHP All Commercial |
$50.93
|
| Rate for Payer: Sagamore Health Network All Products |
$51.85
|
| Rate for Payer: Signature Care EPO |
$55.74
|
| Rate for Payer: Signature Care PPO |
$59.10
|
| Rate for Payer: United Healthcare Commercial |
$52.92
|
|
|
HC C1Q BINDING ASSAY
|
Facility
IP
|
$92.52
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
63001901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$86.05 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cigna All Commercial |
$79.85
|
| Rate for Payer: CORVEL All Commercial |
$86.05
|
| Rate for Payer: Coventry All Commercial |
$81.42
|
| Rate for Payer: Encore All Commercial |
$85.17
|
| Rate for Payer: Frontpath All Commercial |
$85.12
|
| Rate for Payer: Humana ChoiceCare |
$79.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.27
|
| Rate for Payer: PHCS All Commercial |
$69.39
|
| Rate for Payer: PHP All Commercial |
$70.17
|
| Rate for Payer: Sagamore Health Network All Products |
$71.43
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.42
|
| Rate for Payer: United Healthcare Commercial |
$72.91
|
|
|
HC C1Q BINDING ASSAY
|
Facility
OP
|
$92.52
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
63001901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$86.05 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare |
$30.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.59
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Centivo All Commercial |
$47.19
|
| Rate for Payer: Cigna All Commercial |
$79.85
|
| Rate for Payer: CORVEL All Commercial |
$86.05
|
| Rate for Payer: Coventry All Commercial |
$81.42
|
| Rate for Payer: Encore All Commercial |
$85.17
|
| Rate for Payer: Frontpath All Commercial |
$85.12
|
| Rate for Payer: Humana ChoiceCare |
$79.91
|
| Rate for Payer: Humana Medicare |
$47.19
|
| Rate for Payer: Lucent All Commercial |
$47.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.27
|
| Rate for Payer: Managed Health Services Medicaid |
$24.37
|
| Rate for Payer: MDWise Medicaid |
$24.37
|
| Rate for Payer: PHCS All Commercial |
$69.39
|
| Rate for Payer: PHP All Commercial |
$70.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.08
|
| Rate for Payer: Sagamore Health Network All Products |
$71.43
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.65
|
| Rate for Payer: United Healthcare Commercial |
$72.91
|
| Rate for Payer: United Healthcare Medicare |
$30.53
|
|
