|
HC CEMENT PALACOS R + G
|
Facility
OP
|
$1,475.00
|
|
| Hospital Charge Code |
41602440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.75 |
| Max. Negotiated Rate |
$1,371.75 |
| Rate for Payer: Aetna Commercial |
$1,244.90
|
| Rate for Payer: Aetna Medicare |
$486.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$486.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$847.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$922.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$559.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$535.42
|
| Rate for Payer: Cash Price |
$914.50
|
| Rate for Payer: Cash Price |
$914.50
|
| Rate for Payer: Centivo All Commercial |
$752.25
|
| Rate for Payer: Cigna All Commercial |
$1,272.92
|
| Rate for Payer: CORVEL All Commercial |
$1,371.75
|
| Rate for Payer: Coventry All Commercial |
$1,298.00
|
| Rate for Payer: Encore All Commercial |
$1,357.74
|
| Rate for Payer: Frontpath All Commercial |
$1,357.00
|
| Rate for Payer: Humana ChoiceCare |
$1,273.96
|
| Rate for Payer: Humana Medicare |
$752.25
|
| Rate for Payer: Lucent All Commercial |
$752.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,327.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,106.25
|
| Rate for Payer: PHP All Commercial |
$1,118.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$575.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,138.70
|
| Rate for Payer: Signature Care EPO |
$1,224.25
|
| Rate for Payer: Signature Care PPO |
$1,298.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,253.75
|
| Rate for Payer: United Healthcare Commercial |
$1,162.30
|
| Rate for Payer: United Healthcare Medicare |
$486.75
|
|
|
HC CEMENT PALACOS R + G
|
Facility
IP
|
$1,475.00
|
|
| Hospital Charge Code |
41602440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$1,371.75 |
| Rate for Payer: Aetna Commercial |
$1,274.40
|
| Rate for Payer: Cash Price |
$914.50
|
| Rate for Payer: Cigna All Commercial |
$1,272.92
|
| Rate for Payer: CORVEL All Commercial |
$1,371.75
|
| Rate for Payer: Coventry All Commercial |
$1,298.00
|
| Rate for Payer: Encore All Commercial |
$1,357.74
|
| Rate for Payer: Frontpath All Commercial |
$1,357.00
|
| Rate for Payer: Humana ChoiceCare |
$1,273.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,327.50
|
| Rate for Payer: PHCS All Commercial |
$1,106.25
|
| Rate for Payer: PHP All Commercial |
$1,118.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,138.70
|
| Rate for Payer: Signature Care EPO |
$1,224.25
|
| Rate for Payer: Signature Care PPO |
$1,298.00
|
| Rate for Payer: United Healthcare Commercial |
$1,162.30
|
|
|
HC CENTRAL LINE INSERTION
|
Facility
OP
|
$1,266.25
|
|
| Hospital Charge Code |
01682005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$417.86 |
| Max. Negotiated Rate |
$1,177.61 |
| Rate for Payer: Aetna Commercial |
$1,068.71
|
| Rate for Payer: Aetna Medicare |
$417.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$417.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$727.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$791.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$480.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$459.65
|
| Rate for Payer: Cash Price |
$785.07
|
| Rate for Payer: Centivo All Commercial |
$645.79
|
| Rate for Payer: Cigna All Commercial |
$1,092.77
|
| Rate for Payer: CORVEL All Commercial |
$1,177.61
|
| Rate for Payer: Coventry All Commercial |
$1,114.30
|
| Rate for Payer: Encore All Commercial |
$1,165.58
|
| Rate for Payer: Frontpath All Commercial |
$1,164.95
|
| Rate for Payer: Humana ChoiceCare |
$1,093.66
|
| Rate for Payer: Humana Medicare |
$645.79
|
| Rate for Payer: Lucent All Commercial |
$645.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,139.62
|
| Rate for Payer: PHCS All Commercial |
$949.69
|
| Rate for Payer: PHP All Commercial |
$960.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$493.84
|
| Rate for Payer: Sagamore Health Network All Products |
$977.54
|
| Rate for Payer: Signature Care EPO |
$1,050.99
|
| Rate for Payer: Signature Care PPO |
$1,114.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,076.31
|
| Rate for Payer: United Healthcare Commercial |
$997.80
|
| Rate for Payer: United Healthcare Medicare |
$417.86
|
|
|
HC CENTRAL LINE INSERTION
|
Facility
IP
|
$1,266.25
|
|
| Hospital Charge Code |
01682005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$949.69 |
| Max. Negotiated Rate |
$1,177.61 |
| Rate for Payer: Aetna Commercial |
$1,094.04
|
| Rate for Payer: Cash Price |
$785.07
|
| Rate for Payer: Cigna All Commercial |
$1,092.77
|
| Rate for Payer: CORVEL All Commercial |
$1,177.61
|
| Rate for Payer: Coventry All Commercial |
$1,114.30
|
| Rate for Payer: Encore All Commercial |
$1,165.58
|
| Rate for Payer: Frontpath All Commercial |
$1,164.95
|
| Rate for Payer: Humana ChoiceCare |
$1,093.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,139.62
|
| Rate for Payer: PHCS All Commercial |
$949.69
|
| Rate for Payer: PHP All Commercial |
$960.32
|
| Rate for Payer: Sagamore Health Network All Products |
$977.54
|
| Rate for Payer: Signature Care EPO |
$1,050.99
|
| Rate for Payer: Signature Care PPO |
$1,114.30
|
| Rate for Payer: United Healthcare Commercial |
$997.80
|
|
|
HC CENTRAL/PICC LINE D
|
Facility
OP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
00526592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.76
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$81.15
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$52.51
|
|
|
HC CENTRAL/PICC LINE D
|
Facility
IP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
00526592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC CENTRAL/PICC LINE DRAW
|
Facility
IP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
01266592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC CENTRAL/PICC LINE DRAW
|
Facility
OP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
01266592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.76
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$81.15
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$52.51
|
|
|
HC CERENE CRYOTHERAPY DEVICE
|
Facility
OP
|
$4,320.00
|
|
| Hospital Charge Code |
41607039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Aetna Commercial |
$3,646.08
|
| Rate for Payer: Aetna Medicare |
$1,425.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,425.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,480.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,700.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,639.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,568.16
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Centivo All Commercial |
$2,203.20
|
| Rate for Payer: Cigna All Commercial |
$3,728.16
|
| Rate for Payer: CORVEL All Commercial |
$4,017.60
|
| Rate for Payer: Coventry All Commercial |
$3,801.60
|
| Rate for Payer: Encore All Commercial |
$3,976.56
|
| Rate for Payer: Frontpath All Commercial |
$3,974.40
|
| Rate for Payer: Humana ChoiceCare |
$3,731.18
|
| Rate for Payer: Humana Medicare |
$2,203.20
|
| Rate for Payer: Lucent All Commercial |
$2,203.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,888.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,240.00
|
| Rate for Payer: PHP All Commercial |
$3,276.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,684.80
|
| Rate for Payer: Sagamore Health Network All Products |
$3,335.04
|
| Rate for Payer: Signature Care EPO |
$3,585.60
|
| Rate for Payer: Signature Care PPO |
$3,801.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,672.00
|
| Rate for Payer: United Healthcare Commercial |
$3,404.16
|
| Rate for Payer: United Healthcare Medicare |
$1,425.60
|
|
|
HC CERENE CRYOTHERAPY DEVICE
|
Facility
IP
|
$4,320.00
|
|
| Hospital Charge Code |
41607039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Aetna Commercial |
$3,732.48
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna All Commercial |
$3,728.16
|
| Rate for Payer: CORVEL All Commercial |
$4,017.60
|
| Rate for Payer: Coventry All Commercial |
$3,801.60
|
| Rate for Payer: Encore All Commercial |
$3,976.56
|
| Rate for Payer: Frontpath All Commercial |
$3,974.40
|
| Rate for Payer: Humana ChoiceCare |
$3,731.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,888.00
|
| Rate for Payer: PHCS All Commercial |
$3,240.00
|
| Rate for Payer: PHP All Commercial |
$3,276.29
|
| Rate for Payer: Sagamore Health Network All Products |
$3,335.04
|
| Rate for Payer: Signature Care EPO |
$3,585.60
|
| Rate for Payer: Signature Care PPO |
$3,801.60
|
| Rate for Payer: United Healthcare Commercial |
$3,404.16
|
|
|
HC CERULOPLASMIN
|
Facility
OP
|
$165.93
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
63001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$154.32 |
| Rate for Payer: Aetna Commercial |
$140.05
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.23
|
| Rate for Payer: Cash Price |
$102.88
|
| Rate for Payer: Cash Price |
$102.88
|
| Rate for Payer: Centivo All Commercial |
$84.63
|
| Rate for Payer: Cigna All Commercial |
$143.20
|
| Rate for Payer: CORVEL All Commercial |
$154.32
|
| Rate for Payer: Coventry All Commercial |
$146.02
|
| Rate for Payer: Encore All Commercial |
$152.74
|
| Rate for Payer: Frontpath All Commercial |
$152.66
|
| Rate for Payer: Humana ChoiceCare |
$143.32
|
| Rate for Payer: Humana Medicare |
$84.63
|
| Rate for Payer: Lucent All Commercial |
$84.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.34
|
| Rate for Payer: Managed Health Services Medicaid |
$10.74
|
| Rate for Payer: MDWise Medicaid |
$10.74
|
| Rate for Payer: PHCS All Commercial |
$124.45
|
| Rate for Payer: PHP All Commercial |
$125.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.71
|
| Rate for Payer: Sagamore Health Network All Products |
$128.10
|
| Rate for Payer: Signature Care EPO |
$137.72
|
| Rate for Payer: Signature Care PPO |
$146.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.04
|
| Rate for Payer: United Healthcare Commercial |
$130.76
|
| Rate for Payer: United Healthcare Medicare |
$54.76
|
|
|
HC CERULOPLASMIN
|
Facility
IP
|
$165.93
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
63001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.45 |
| Max. Negotiated Rate |
$154.32 |
| Rate for Payer: Aetna Commercial |
$143.37
|
| Rate for Payer: Cash Price |
$102.88
|
| Rate for Payer: Cigna All Commercial |
$143.20
|
| Rate for Payer: CORVEL All Commercial |
$154.32
|
| Rate for Payer: Coventry All Commercial |
$146.02
|
| Rate for Payer: Encore All Commercial |
$152.74
|
| Rate for Payer: Frontpath All Commercial |
$152.66
|
| Rate for Payer: Humana ChoiceCare |
$143.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.34
|
| Rate for Payer: PHCS All Commercial |
$124.45
|
| Rate for Payer: PHP All Commercial |
$125.84
|
| Rate for Payer: Sagamore Health Network All Products |
$128.10
|
| Rate for Payer: Signature Care EPO |
$137.72
|
| Rate for Payer: Signature Care PPO |
$146.02
|
| Rate for Payer: United Healthcare Commercial |
$130.76
|
|
|
HC CHEMO INF EA ADDL 31-60 MIN
|
Facility
OP
|
$408.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
00526412
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$117.82 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$344.35
|
| Rate for Payer: Aetna Medicare |
$134.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$234.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$117.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.10
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Centivo All Commercial |
$208.08
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Humana Medicare |
$208.08
|
| Rate for Payer: Lucent All Commercial |
$208.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: Managed Health Services Medicaid |
$117.82
|
| Rate for Payer: MDWise Medicaid |
$117.82
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.12
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.80
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
| Rate for Payer: United Healthcare Medicare |
$134.64
|
|
|
HC CHEMO INF EA ADDL 31-60 MIN
|
Facility
IP
|
$408.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
00526412
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$352.51
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
|
|
HC CHEMO INFUS INIT 16-60 MIN
|
Facility
IP
|
$848.64
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
00526410
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$636.48 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$733.22
|
| Rate for Payer: Cash Price |
$526.16
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
|
|
HC CHEMO INFUS INIT 16-60 MIN
|
Facility
OP
|
$848.64
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
00526410
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$280.05 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$716.25
|
| Rate for Payer: Aetna Medicare |
$280.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$487.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$324.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.06
|
| Rate for Payer: Cash Price |
$526.16
|
| Rate for Payer: Cash Price |
$526.16
|
| Rate for Payer: Centivo All Commercial |
$432.81
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Humana Medicare |
$432.81
|
| Rate for Payer: Lucent All Commercial |
$432.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: Managed Health Services Medicaid |
$324.60
|
| Rate for Payer: MDWise Medicaid |
$324.60
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.97
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.34
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
| Rate for Payer: United Healthcare Medicare |
$280.05
|
|
|
HC CHEST DRAIN PLEUREVAC
|
Facility
OP
|
$262.54
|
|
| Hospital Charge Code |
41601037
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.64 |
| Max. Negotiated Rate |
$244.16 |
| Rate for Payer: Aetna Commercial |
$221.58
|
| Rate for Payer: Aetna Medicare |
$86.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$150.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.30
|
| Rate for Payer: Cash Price |
$162.78
|
| Rate for Payer: Cash Price |
$162.78
|
| Rate for Payer: Centivo All Commercial |
$133.90
|
| Rate for Payer: Cigna All Commercial |
$226.57
|
| Rate for Payer: CORVEL All Commercial |
$244.16
|
| Rate for Payer: Coventry All Commercial |
$231.04
|
| Rate for Payer: Encore All Commercial |
$241.67
|
| Rate for Payer: Frontpath All Commercial |
$241.54
|
| Rate for Payer: Humana ChoiceCare |
$226.76
|
| Rate for Payer: Humana Medicare |
$133.90
|
| Rate for Payer: Lucent All Commercial |
$133.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$236.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$196.90
|
| Rate for Payer: PHP All Commercial |
$199.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.39
|
| Rate for Payer: Sagamore Health Network All Products |
$202.68
|
| Rate for Payer: Signature Care EPO |
$217.91
|
| Rate for Payer: Signature Care PPO |
$231.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$223.16
|
| Rate for Payer: United Healthcare Commercial |
$206.88
|
| Rate for Payer: United Healthcare Medicare |
$86.64
|
|
|
HC CHEST DRAIN PLEUREVAC
|
Facility
IP
|
$262.54
|
|
| Hospital Charge Code |
41601037
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.90 |
| Max. Negotiated Rate |
$244.16 |
| Rate for Payer: Aetna Commercial |
$226.83
|
| Rate for Payer: Cash Price |
$162.78
|
| Rate for Payer: Cigna All Commercial |
$226.57
|
| Rate for Payer: CORVEL All Commercial |
$244.16
|
| Rate for Payer: Coventry All Commercial |
$231.04
|
| Rate for Payer: Encore All Commercial |
$241.67
|
| Rate for Payer: Frontpath All Commercial |
$241.54
|
| Rate for Payer: Humana ChoiceCare |
$226.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$236.29
|
| Rate for Payer: PHCS All Commercial |
$196.90
|
| Rate for Payer: PHP All Commercial |
$199.11
|
| Rate for Payer: Sagamore Health Network All Products |
$202.68
|
| Rate for Payer: Signature Care EPO |
$217.91
|
| Rate for Payer: Signature Care PPO |
$231.04
|
| Rate for Payer: United Healthcare Commercial |
$206.88
|
|
|
HC CHEST TUBE INSERTION
|
Facility
OP
|
$420.86
|
|
| Hospital Charge Code |
01682006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.88 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$355.21
|
| Rate for Payer: Aetna Medicare |
$138.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.77
|
| Rate for Payer: Cash Price |
$260.94
|
| Rate for Payer: Centivo All Commercial |
$214.64
|
| Rate for Payer: Cigna All Commercial |
$363.20
|
| Rate for Payer: CORVEL All Commercial |
$391.40
|
| Rate for Payer: Coventry All Commercial |
$370.36
|
| Rate for Payer: Encore All Commercial |
$387.40
|
| Rate for Payer: Frontpath All Commercial |
$387.19
|
| Rate for Payer: Humana ChoiceCare |
$363.50
|
| Rate for Payer: Humana Medicare |
$214.64
|
| Rate for Payer: Lucent All Commercial |
$214.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.78
|
| Rate for Payer: PHCS All Commercial |
$315.65
|
| Rate for Payer: PHP All Commercial |
$319.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.14
|
| Rate for Payer: Sagamore Health Network All Products |
$324.91
|
| Rate for Payer: Signature Care EPO |
$349.32
|
| Rate for Payer: Signature Care PPO |
$370.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.73
|
| Rate for Payer: United Healthcare Commercial |
$331.64
|
| Rate for Payer: United Healthcare Medicare |
$138.88
|
|
|
HC CHEST TUBE INSERTION
|
Facility
IP
|
$420.86
|
|
| Hospital Charge Code |
01682006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.65 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$363.62
|
| Rate for Payer: Cash Price |
$260.94
|
| Rate for Payer: Cigna All Commercial |
$363.20
|
| Rate for Payer: CORVEL All Commercial |
$391.40
|
| Rate for Payer: Coventry All Commercial |
$370.36
|
| Rate for Payer: Encore All Commercial |
$387.40
|
| Rate for Payer: Frontpath All Commercial |
$387.19
|
| Rate for Payer: Humana ChoiceCare |
$363.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.78
|
| Rate for Payer: PHCS All Commercial |
$315.65
|
| Rate for Payer: PHP All Commercial |
$319.18
|
| Rate for Payer: Sagamore Health Network All Products |
$324.91
|
| Rate for Payer: Signature Care EPO |
$349.32
|
| Rate for Payer: Signature Care PPO |
$370.36
|
| Rate for Payer: United Healthcare Commercial |
$331.64
|
|
|
HC CHG ONLY MARIJUANA CONFIRM
|
Facility
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
|
|
HC CHG ONLY MARIJUANA CONFIRM
|
Facility
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$127.74
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Centivo All Commercial |
$77.19
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Humana Medicare |
$77.19
|
| Rate for Payer: Lucent All Commercial |
$77.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.03
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.65
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
| Rate for Payer: United Healthcare Medicare |
$49.94
|
|
|
HC CHG ONLY PROPOXYPHENE GCMS CONFIRM
|
Facility
OP
|
$179.11
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Aetna Commercial |
$151.17
|
| Rate for Payer: Aetna Medicare |
$59.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.02
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Centivo All Commercial |
$91.35
|
| Rate for Payer: Cigna All Commercial |
$154.57
|
| Rate for Payer: CORVEL All Commercial |
$166.57
|
| Rate for Payer: Coventry All Commercial |
$157.62
|
| Rate for Payer: Encore All Commercial |
$164.87
|
| Rate for Payer: Frontpath All Commercial |
$164.78
|
| Rate for Payer: Humana ChoiceCare |
$154.70
|
| Rate for Payer: Humana Medicare |
$91.35
|
| Rate for Payer: Lucent All Commercial |
$91.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.20
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$134.33
|
| Rate for Payer: PHP All Commercial |
$135.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.85
|
| Rate for Payer: Sagamore Health Network All Products |
$138.27
|
| Rate for Payer: Signature Care EPO |
$148.66
|
| Rate for Payer: Signature Care PPO |
$157.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.25
|
| Rate for Payer: United Healthcare Commercial |
$141.14
|
| Rate for Payer: United Healthcare Medicare |
$59.11
|
|
|
HC CHG ONLY PROPOXYPHENE GCMS CONFIRM
|
Facility
IP
|
$179.11
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Aetna Commercial |
$154.75
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Cigna All Commercial |
$154.57
|
| Rate for Payer: CORVEL All Commercial |
$166.57
|
| Rate for Payer: Coventry All Commercial |
$157.62
|
| Rate for Payer: Encore All Commercial |
$164.87
|
| Rate for Payer: Frontpath All Commercial |
$164.78
|
| Rate for Payer: Humana ChoiceCare |
$154.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.20
|
| Rate for Payer: PHCS All Commercial |
$134.33
|
| Rate for Payer: PHP All Commercial |
$135.84
|
| Rate for Payer: Sagamore Health Network All Products |
$138.27
|
| Rate for Payer: Signature Care EPO |
$148.66
|
| Rate for Payer: Signature Care PPO |
$157.62
|
| Rate for Payer: United Healthcare Commercial |
$141.14
|
|
|
HC CHLAMYDIA
|
Facility
OP
|
$155.93
|
|
|
Service Code
|
CPT 87810
|
| Hospital Charge Code |
63002055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$145.01 |
| Rate for Payer: Aetna Commercial |
$131.60
|
| Rate for Payer: Aetna Medicare |
$51.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.60
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Centivo All Commercial |
$79.52
|
| Rate for Payer: Cigna All Commercial |
$134.57
|
| Rate for Payer: CORVEL All Commercial |
$145.01
|
| Rate for Payer: Coventry All Commercial |
$137.22
|
| Rate for Payer: Encore All Commercial |
$143.53
|
| Rate for Payer: Frontpath All Commercial |
$143.45
|
| Rate for Payer: Humana ChoiceCare |
$134.67
|
| Rate for Payer: Humana Medicare |
$79.52
|
| Rate for Payer: Lucent All Commercial |
$79.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.33
|
| Rate for Payer: Managed Health Services Medicaid |
$16.32
|
| Rate for Payer: MDWise Medicaid |
$16.32
|
| Rate for Payer: PHCS All Commercial |
$116.95
|
| Rate for Payer: PHP All Commercial |
$118.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.81
|
| Rate for Payer: Sagamore Health Network All Products |
$120.38
|
| Rate for Payer: Signature Care EPO |
$129.42
|
| Rate for Payer: Signature Care PPO |
$137.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.54
|
| Rate for Payer: United Healthcare Commercial |
$122.87
|
| Rate for Payer: United Healthcare Medicare |
$51.46
|
|
