|
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
|
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| 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
|
OP
|
$91.80
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
1299005
|
|
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 PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$94.90
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
1689112
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$88.26 |
| Rate for Payer: Aetna Commercial |
$81.99
|
| Rate for Payer: Cash Price |
$56.94
|
| Rate for Payer: Cigna All Commercial |
$81.90
|
| Rate for Payer: CORVEL All Commercial |
$88.26
|
| Rate for Payer: Coventry All Commercial |
$83.51
|
| Rate for Payer: Encore All Commercial |
$87.36
|
| Rate for Payer: Frontpath All Commercial |
$87.31
|
| Rate for Payer: Humana ChoiceCare |
$81.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.41
|
| Rate for Payer: PHCS All Commercial |
$71.17
|
| Rate for Payer: PHP All Commercial |
$71.97
|
| Rate for Payer: Sagamore Health Network All Products |
$73.26
|
| Rate for Payer: Signature Care EPO |
$78.77
|
| Rate for Payer: Signature Care PPO |
$83.51
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$94.90
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
1689112
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$88.26 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Medicare |
$30.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.40
|
| Rate for Payer: Cash Price |
$56.94
|
| Rate for Payer: Centivo All Commercial |
$51.63
|
| Rate for Payer: Cigna All Commercial |
$81.90
|
| Rate for Payer: CORVEL All Commercial |
$88.26
|
| Rate for Payer: Coventry All Commercial |
$83.51
|
| Rate for Payer: Encore All Commercial |
$87.36
|
| Rate for Payer: Frontpath All Commercial |
$87.31
|
| Rate for Payer: Humana ChoiceCare |
$81.97
|
| Rate for Payer: Humana Medicare |
$30.37
|
| Rate for Payer: Lucent All Commercial |
$51.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.41
|
| Rate for Payer: PHCS All Commercial |
$71.17
|
| Rate for Payer: PHP All Commercial |
$71.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.01
|
| Rate for Payer: Sagamore Health Network All Products |
$73.26
|
| Rate for Payer: Signature Care EPO |
$78.77
|
| Rate for Payer: Signature Care PPO |
$83.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.67
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
| Rate for Payer: United Healthcare Medicare |
$30.37
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1299003
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1299003
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
1299006
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1299006
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1299006
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
1299003
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
1299003
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
1299006
|
|
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 ADMN RSV MONOC ANTB IM CNSL
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
526380
|
|
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 ADMN RSV MONOC ANTB IM CNSL
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
526380
|
|
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 ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
520480
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.22
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.18
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Centivo All Commercial |
$11.10
|
| Rate for Payer: Cigna All Commercial |
$17.61
|
| Rate for Payer: CORVEL All Commercial |
$18.97
|
| Rate for Payer: Coventry All Commercial |
$17.95
|
| Rate for Payer: Encore All Commercial |
$18.78
|
| Rate for Payer: Frontpath All Commercial |
$18.77
|
| Rate for Payer: Humana ChoiceCare |
$17.62
|
| Rate for Payer: Humana Medicare |
$6.53
|
| Rate for Payer: Lucent All Commercial |
$11.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.36
|
| Rate for Payer: PHCS All Commercial |
$15.30
|
| Rate for Payer: PHP All Commercial |
$15.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.96
|
| Rate for Payer: Sagamore Health Network All Products |
$15.75
|
| Rate for Payer: Signature Care EPO |
$16.93
|
| Rate for Payer: Signature Care PPO |
$17.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.34
|
| Rate for Payer: United Healthcare Commercial |
$16.08
|
| Rate for Payer: United Healthcare Medicare |
$6.53
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
520480
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cigna All Commercial |
$17.61
|
| Rate for Payer: CORVEL All Commercial |
$18.97
|
| Rate for Payer: Coventry All Commercial |
$17.95
|
| Rate for Payer: Encore All Commercial |
$18.78
|
| Rate for Payer: Frontpath All Commercial |
$18.77
|
| Rate for Payer: Humana ChoiceCare |
$17.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.36
|
| Rate for Payer: PHCS All Commercial |
$15.30
|
| Rate for Payer: PHP All Commercial |
$15.47
|
| Rate for Payer: Sagamore Health Network All Products |
$15.75
|
| Rate for Payer: Signature Care EPO |
$16.93
|
| Rate for Payer: Signature Care PPO |
$17.95
|
| Rate for Payer: United Healthcare Commercial |
$16.08
|
|
|
HC AEROBIC BACTERIA ID
|
Facility
|
OP
|
$123.74
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$115.08 |
| Rate for Payer: Aetna Commercial |
$104.44
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.56
|
| Rate for Payer: Cash Price |
$74.24
|
| Rate for Payer: Cash Price |
$74.24
|
| Rate for Payer: Centivo All Commercial |
$67.31
|
| Rate for Payer: Cigna All Commercial |
$106.79
|
| Rate for Payer: CORVEL All Commercial |
$115.08
|
| Rate for Payer: Coventry All Commercial |
$108.89
|
| Rate for Payer: Encore All Commercial |
$113.90
|
| Rate for Payer: Frontpath All Commercial |
$113.84
|
| Rate for Payer: Humana ChoiceCare |
$106.87
|
| Rate for Payer: Humana Medicare |
$39.60
|
| Rate for Payer: Lucent All Commercial |
$67.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.37
|
| Rate for Payer: Managed Health Services Medicaid |
$8.08
|
| Rate for Payer: MDWise Medicaid |
$8.08
|
| Rate for Payer: PHCS All Commercial |
$92.81
|
| Rate for Payer: PHP All Commercial |
$93.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.26
|
| Rate for Payer: Sagamore Health Network All Products |
$95.53
|
| Rate for Payer: Signature Care EPO |
$102.70
|
| Rate for Payer: Signature Care PPO |
$108.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.18
|
| Rate for Payer: United Healthcare Commercial |
$97.51
|
| Rate for Payer: United Healthcare Medicare |
$39.60
|
|
|
HC AEROBIC BACTERIA ID
|
Facility
|
IP
|
$123.74
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.81 |
| Max. Negotiated Rate |
$115.08 |
| Rate for Payer: Aetna Commercial |
$106.91
|
| Rate for Payer: Cash Price |
$74.24
|
| Rate for Payer: Cigna All Commercial |
$106.79
|
| Rate for Payer: CORVEL All Commercial |
$115.08
|
| Rate for Payer: Coventry All Commercial |
$108.89
|
| Rate for Payer: Encore All Commercial |
$113.90
|
| Rate for Payer: Frontpath All Commercial |
$113.84
|
| Rate for Payer: Humana ChoiceCare |
$106.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.37
|
| Rate for Payer: PHCS All Commercial |
$92.81
|
| Rate for Payer: PHP All Commercial |
$93.84
|
| Rate for Payer: Sagamore Health Network All Products |
$95.53
|
| Rate for Payer: Signature Care EPO |
$102.70
|
| Rate for Payer: Signature Care PPO |
$108.89
|
| Rate for Payer: United Healthcare Commercial |
$97.51
|
|
|
HC AEROBIKA OSCILLATING POSITIVE EXPIRATORY
|
Facility
|
IP
|
$330.02
|
|
| Hospital Charge Code |
41601818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$247.51 |
| Max. Negotiated Rate |
$306.92 |
| Rate for Payer: Aetna Commercial |
$285.14
|
| Rate for Payer: Cash Price |
$198.01
|
| Rate for Payer: Cigna All Commercial |
$284.81
|
| Rate for Payer: CORVEL All Commercial |
$306.92
|
| Rate for Payer: Coventry All Commercial |
$290.42
|
| Rate for Payer: Encore All Commercial |
$303.78
|
| Rate for Payer: Frontpath All Commercial |
$303.62
|
| Rate for Payer: Humana ChoiceCare |
$285.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.02
|
| Rate for Payer: PHCS All Commercial |
$247.51
|
| Rate for Payer: PHP All Commercial |
$250.29
|
| Rate for Payer: Sagamore Health Network All Products |
$254.78
|
| Rate for Payer: Signature Care EPO |
$273.92
|
| Rate for Payer: Signature Care PPO |
$290.42
|
| Rate for Payer: United Healthcare Commercial |
$260.06
|
|
|
HC AEROBIKA OSCILLATING POSITIVE EXPIRATORY
|
Facility
|
OP
|
$330.02
|
|
| Hospital Charge Code |
41601818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$306.92 |
| Rate for Payer: Aetna Commercial |
$278.54
|
| Rate for Payer: Aetna Medicare |
$105.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$189.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.17
|
| Rate for Payer: Cash Price |
$198.01
|
| Rate for Payer: Cash Price |
$198.01
|
| Rate for Payer: Centivo All Commercial |
$179.53
|
| Rate for Payer: Cigna All Commercial |
$284.81
|
| Rate for Payer: CORVEL All Commercial |
$306.92
|
| Rate for Payer: Coventry All Commercial |
$290.42
|
| Rate for Payer: Encore All Commercial |
$303.78
|
| Rate for Payer: Frontpath All Commercial |
$303.62
|
| Rate for Payer: Humana ChoiceCare |
$285.04
|
| Rate for Payer: Humana Medicare |
$105.61
|
| Rate for Payer: Lucent All Commercial |
$179.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.02
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$247.51
|
| Rate for Payer: PHP All Commercial |
$250.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.71
|
| Rate for Payer: Sagamore Health Network All Products |
$254.78
|
| Rate for Payer: Signature Care EPO |
$273.92
|
| Rate for Payer: Signature Care PPO |
$290.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$280.52
|
| Rate for Payer: United Healthcare Commercial |
$260.06
|
| Rate for Payer: United Healthcare Medicare |
$105.61
|
|
|
HC AEROCHAMBER ADULT
|
Facility
|
OP
|
$27.04
|
|
| Hospital Charge Code |
41601210
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$25.15 |
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: Aetna Medicare |
$8.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.52
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Centivo All Commercial |
$14.71
|
| Rate for Payer: Cigna All Commercial |
$23.34
|
| Rate for Payer: CORVEL All Commercial |
$25.15
|
| Rate for Payer: Coventry All Commercial |
$23.80
|
| Rate for Payer: Encore All Commercial |
$24.89
|
| Rate for Payer: Frontpath All Commercial |
$24.88
|
| Rate for Payer: Humana ChoiceCare |
$23.35
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: Lucent All Commercial |
$14.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.34
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$20.28
|
| Rate for Payer: PHP All Commercial |
$20.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.55
|
| Rate for Payer: Sagamore Health Network All Products |
$20.87
|
| Rate for Payer: Signature Care EPO |
$22.44
|
| Rate for Payer: Signature Care PPO |
$23.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.98
|
| Rate for Payer: United Healthcare Commercial |
$21.31
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
|
|
HC AEROCHAMBER ADULT
|
Facility
|
IP
|
$27.04
|
|
| Hospital Charge Code |
41601210
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$25.15 |
| Rate for Payer: Aetna Commercial |
$23.36
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cigna All Commercial |
$23.34
|
| Rate for Payer: CORVEL All Commercial |
$25.15
|
| Rate for Payer: Coventry All Commercial |
$23.80
|
| Rate for Payer: Encore All Commercial |
$24.89
|
| Rate for Payer: Frontpath All Commercial |
$24.88
|
| Rate for Payer: Humana ChoiceCare |
$23.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.34
|
| Rate for Payer: PHCS All Commercial |
$20.28
|
| Rate for Payer: PHP All Commercial |
$20.51
|
| Rate for Payer: Sagamore Health Network All Products |
$20.87
|
| Rate for Payer: Signature Care EPO |
$22.44
|
| Rate for Payer: Signature Care PPO |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$21.31
|
|
|
HC AEROCHAMBER PEDIATRIC
|
Facility
|
OP
|
$91.52
|
|
| Hospital Charge Code |
41601211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$85.11 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$29.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.22
|
| Rate for Payer: Cash Price |
$54.91
|
| Rate for Payer: Cash Price |
$54.91
|
| Rate for Payer: Centivo All Commercial |
$49.79
|
| Rate for Payer: Cigna All Commercial |
$78.98
|
| Rate for Payer: CORVEL All Commercial |
$85.11
|
| Rate for Payer: Coventry All Commercial |
$80.54
|
| Rate for Payer: Encore All Commercial |
$84.24
|
| Rate for Payer: Frontpath All Commercial |
$84.20
|
| Rate for Payer: Humana ChoiceCare |
$79.05
|
| Rate for Payer: Humana Medicare |
$29.29
|
| Rate for Payer: Lucent All Commercial |
$49.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.37
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$68.64
|
| Rate for Payer: PHP All Commercial |
$69.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.69
|
| Rate for Payer: Sagamore Health Network All Products |
$70.65
|
| Rate for Payer: Signature Care EPO |
$75.96
|
| Rate for Payer: Signature Care PPO |
$80.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.79
|
| Rate for Payer: United Healthcare Commercial |
$72.12
|
| Rate for Payer: United Healthcare Medicare |
$29.29
|
|
|
HC AEROCHAMBER PEDIATRIC
|
Facility
|
IP
|
$91.52
|
|
| Hospital Charge Code |
41601211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$85.11 |
| Rate for Payer: Aetna Commercial |
$79.07
|
| Rate for Payer: Cash Price |
$54.91
|
| Rate for Payer: Cigna All Commercial |
$78.98
|
| Rate for Payer: CORVEL All Commercial |
$85.11
|
| Rate for Payer: Coventry All Commercial |
$80.54
|
| Rate for Payer: Encore All Commercial |
$84.24
|
| Rate for Payer: Frontpath All Commercial |
$84.20
|
| Rate for Payer: Humana ChoiceCare |
$79.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.37
|
| Rate for Payer: PHCS All Commercial |
$68.64
|
| Rate for Payer: PHP All Commercial |
$69.41
|
| Rate for Payer: Sagamore Health Network All Products |
$70.65
|
| Rate for Payer: Signature Care EPO |
$75.96
|
| Rate for Payer: Signature Care PPO |
$80.54
|
| Rate for Payer: United Healthcare Commercial |
$72.12
|
|
