|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$261.53
|
| Rate for Payer: Aetna Medicare |
$99.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$142.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.07
|
| Rate for Payer: Cash Price |
$185.92
|
| Rate for Payer: Cash Price |
$185.92
|
| Rate for Payer: Centivo All Commercial |
$168.57
|
| Rate for Payer: Cigna All Commercial |
$267.42
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.69
|
| Rate for Payer: Encore All Commercial |
$285.24
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Humana Medicare |
$99.16
|
| Rate for Payer: Lucent All Commercial |
$168.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.85
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263.39
|
| Rate for Payer: United Healthcare Commercial |
$244.18
|
| Rate for Payer: United Healthcare Medicare |
$99.16
|
|
|
HC ACUTE CARE ROOM
|
Facility
|
IP
|
$1,644.24
|
|
| Hospital Charge Code |
10010051
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,233.18 |
| Max. Negotiated Rate |
$6,636.80 |
| Rate for Payer: Aetna Commercial |
$1,420.62
|
| Rate for Payer: Aetna Medicare |
$3,904.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,864.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,489.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,294.40
|
| Rate for Payer: Cash Price |
$986.54
|
| Rate for Payer: Cash Price |
$986.54
|
| Rate for Payer: Centivo All Commercial |
$6,636.80
|
| Rate for Payer: Cigna All Commercial |
$1,418.98
|
| Rate for Payer: CORVEL All Commercial |
$1,529.14
|
| Rate for Payer: Coventry All Commercial |
$1,446.93
|
| Rate for Payer: Encore All Commercial |
$1,513.52
|
| Rate for Payer: Frontpath All Commercial |
$1,512.70
|
| Rate for Payer: Humana ChoiceCare |
$1,420.13
|
| Rate for Payer: Humana Medicare |
$3,904.00
|
| Rate for Payer: Lucent All Commercial |
$6,636.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,479.82
|
| Rate for Payer: PHCS All Commercial |
$1,233.18
|
| Rate for Payer: PHP All Commercial |
$1,246.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,269.35
|
| Rate for Payer: Signature Care EPO |
$1,364.72
|
| Rate for Payer: Signature Care PPO |
$1,446.93
|
| Rate for Payer: United Healthcare Commercial |
$1,295.66
|
| Rate for Payer: United Healthcare Medicare |
$3,904.00
|
|
|
HC ADDL HIGH RESOLUTION
|
Facility
|
IP
|
$174.19
|
|
|
Service Code
|
CPT 88289
|
| Hospital Charge Code |
63002094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.64 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$150.50
|
| Rate for Payer: Cash Price |
$104.51
|
| Rate for Payer: Cigna All Commercial |
$150.33
|
| Rate for Payer: CORVEL All Commercial |
$162.00
|
| Rate for Payer: Coventry All Commercial |
$153.29
|
| Rate for Payer: Encore All Commercial |
$160.34
|
| Rate for Payer: Frontpath All Commercial |
$160.25
|
| Rate for Payer: Humana ChoiceCare |
$150.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.77
|
| Rate for Payer: PHCS All Commercial |
$130.64
|
| Rate for Payer: PHP All Commercial |
$132.11
|
| Rate for Payer: Sagamore Health Network All Products |
$134.47
|
| Rate for Payer: Signature Care EPO |
$144.58
|
| Rate for Payer: Signature Care PPO |
$153.29
|
| Rate for Payer: United Healthcare Commercial |
$137.26
|
|
|
HC ADDL HIGH RESOLUTION
|
Facility
|
OP
|
$174.19
|
|
|
Service Code
|
CPT 88289
|
| Hospital Charge Code |
63002094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$147.02
|
| Rate for Payer: Aetna Medicare |
$55.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.31
|
| Rate for Payer: Cash Price |
$104.51
|
| Rate for Payer: Cash Price |
$104.51
|
| Rate for Payer: Centivo All Commercial |
$94.76
|
| Rate for Payer: Cigna All Commercial |
$150.33
|
| Rate for Payer: CORVEL All Commercial |
$162.00
|
| Rate for Payer: Coventry All Commercial |
$153.29
|
| Rate for Payer: Encore All Commercial |
$160.34
|
| Rate for Payer: Frontpath All Commercial |
$160.25
|
| Rate for Payer: Humana ChoiceCare |
$150.45
|
| Rate for Payer: Humana Medicare |
$55.74
|
| Rate for Payer: Lucent All Commercial |
$94.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.77
|
| Rate for Payer: Managed Health Services Medicaid |
$34.43
|
| Rate for Payer: MDWise Medicaid |
$34.43
|
| Rate for Payer: PHCS All Commercial |
$130.64
|
| Rate for Payer: PHP All Commercial |
$132.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.93
|
| Rate for Payer: Sagamore Health Network All Products |
$134.47
|
| Rate for Payer: Signature Care EPO |
$144.58
|
| Rate for Payer: Signature Care PPO |
$153.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148.06
|
| Rate for Payer: United Healthcare Commercial |
$137.26
|
| Rate for Payer: United Healthcare Medicare |
$55.74
|
|
|
HC ADL/SELF CARE/15 MIN-OT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1738000
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$118.16
|
| Rate for Payer: Aetna Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.28
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Centivo All Commercial |
$76.16
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Humana Medicare |
$44.80
|
| Rate for Payer: Lucent All Commercial |
$76.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
| Rate for Payer: United Healthcare Medicare |
$44.80
|
|
|
HC ADL/SELF CARE/15 MIN-OT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1738000
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$120.96
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
|
|
HC ADL/SELF CARE/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
1728000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC ADL/SELF CARE/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
1728000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
HC ADMIN HEPATITIS B VACCINE
|
Facility
|
IP
|
$95.47
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
1290010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$88.79 |
| Rate for Payer: Aetna Commercial |
$82.49
|
| Rate for Payer: Cash Price |
$57.28
|
| Rate for Payer: Cigna All Commercial |
$82.39
|
| Rate for Payer: CORVEL All Commercial |
$88.79
|
| Rate for Payer: Coventry All Commercial |
$84.01
|
| Rate for Payer: Encore All Commercial |
$87.88
|
| Rate for Payer: Frontpath All Commercial |
$87.83
|
| Rate for Payer: Humana ChoiceCare |
$82.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.92
|
| Rate for Payer: PHCS All Commercial |
$71.60
|
| Rate for Payer: PHP All Commercial |
$72.40
|
| Rate for Payer: Sagamore Health Network All Products |
$73.70
|
| Rate for Payer: Signature Care EPO |
$79.24
|
| Rate for Payer: Signature Care PPO |
$84.01
|
| Rate for Payer: United Healthcare Commercial |
$75.23
|
|
|
HC ADMIN HEPATITIS B VACCINE
|
Facility
|
OP
|
$95.47
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
1290010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$88.79 |
| Rate for Payer: Aetna Commercial |
$80.58
|
| Rate for Payer: Aetna Medicare |
$30.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.61
|
| Rate for Payer: Cash Price |
$57.28
|
| Rate for Payer: Centivo All Commercial |
$51.94
|
| Rate for Payer: Cigna All Commercial |
$82.39
|
| Rate for Payer: CORVEL All Commercial |
$88.79
|
| Rate for Payer: Coventry All Commercial |
$84.01
|
| Rate for Payer: Encore All Commercial |
$87.88
|
| Rate for Payer: Frontpath All Commercial |
$87.83
|
| Rate for Payer: Humana ChoiceCare |
$82.46
|
| Rate for Payer: Humana Medicare |
$30.55
|
| Rate for Payer: Lucent All Commercial |
$51.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.92
|
| Rate for Payer: PHCS All Commercial |
$71.60
|
| Rate for Payer: PHP All Commercial |
$72.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.23
|
| Rate for Payer: Sagamore Health Network All Products |
$73.70
|
| Rate for Payer: Signature Care EPO |
$79.24
|
| Rate for Payer: Signature Care PPO |
$84.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.15
|
| Rate for Payer: United Healthcare Commercial |
$75.23
|
| Rate for Payer: United Healthcare Medicare |
$30.55
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1299001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
1299001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
1299001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1299004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Centivo All Commercial |
$49.94
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$29.38
|
| Rate for Payer: Lucent All Commercial |
$49.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$29.38
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1299004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
1299004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1299001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
1299004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Centivo All Commercial |
$49.94
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$29.38
|
| Rate for Payer: Lucent All Commercial |
$49.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$29.38
|
|
|
HC ADMIN INFLUENZA VACCINE
|
Facility
|
IP
|
$95.08
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
1689111
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.31 |
| Max. Negotiated Rate |
$88.42 |
| Rate for Payer: Aetna Commercial |
$82.15
|
| Rate for Payer: Cash Price |
$57.05
|
| Rate for Payer: Cigna All Commercial |
$82.05
|
| Rate for Payer: CORVEL All Commercial |
$88.42
|
| Rate for Payer: Coventry All Commercial |
$83.67
|
| Rate for Payer: Encore All Commercial |
$87.52
|
| Rate for Payer: Frontpath All Commercial |
$87.47
|
| Rate for Payer: Humana ChoiceCare |
$82.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.57
|
| Rate for Payer: PHCS All Commercial |
$71.31
|
| Rate for Payer: PHP All Commercial |
$72.11
|
| Rate for Payer: Sagamore Health Network All Products |
$73.40
|
| Rate for Payer: Signature Care EPO |
$78.92
|
| Rate for Payer: Signature Care PPO |
$83.67
|
| Rate for Payer: United Healthcare Commercial |
$74.92
|
|
|
HC ADMIN INFLUENZA VACCINE
|
Facility
|
OP
|
$95.08
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
1689111
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$88.42 |
| Rate for Payer: Aetna Commercial |
$80.25
|
| Rate for Payer: Aetna Medicare |
$30.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.47
|
| Rate for Payer: Cash Price |
$57.05
|
| Rate for Payer: Centivo All Commercial |
$51.72
|
| Rate for Payer: Cigna All Commercial |
$82.05
|
| Rate for Payer: CORVEL All Commercial |
$88.42
|
| Rate for Payer: Coventry All Commercial |
$83.67
|
| Rate for Payer: Encore All Commercial |
$87.52
|
| Rate for Payer: Frontpath All Commercial |
$87.47
|
| Rate for Payer: Humana ChoiceCare |
$82.12
|
| Rate for Payer: Humana Medicare |
$30.43
|
| Rate for Payer: Lucent All Commercial |
$51.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.57
|
| Rate for Payer: PHCS All Commercial |
$71.31
|
| Rate for Payer: PHP All Commercial |
$72.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.08
|
| Rate for Payer: Sagamore Health Network All Products |
$73.40
|
| Rate for Payer: Signature Care EPO |
$78.92
|
| Rate for Payer: Signature Care PPO |
$83.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.82
|
| Rate for Payer: United Healthcare Commercial |
$74.92
|
| Rate for Payer: United Healthcare Medicare |
$30.43
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
1299002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
1299005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
1299002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1299005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1299002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
