|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$945.00
|
|
| Hospital Charge Code |
41607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$797.58
|
| Rate for Payer: Aetna Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.04
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Centivo All Commercial |
$481.95
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Humana Medicare |
$481.95
|
| Rate for Payer: Lucent All Commercial |
$481.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.55
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$803.25
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
| Rate for Payer: United Healthcare Medicare |
$311.85
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$1,530.00
|
|
| Hospital Charge Code |
41608308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,291.32
|
| Rate for Payer: Aetna Medicare |
$504.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$504.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$878.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$956.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$580.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$555.39
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Centivo All Commercial |
$780.30
|
| Rate for Payer: Cigna All Commercial |
$1,320.39
|
| Rate for Payer: CORVEL All Commercial |
$1,422.90
|
| Rate for Payer: Coventry All Commercial |
$1,346.40
|
| Rate for Payer: Encore All Commercial |
$1,408.36
|
| Rate for Payer: Frontpath All Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$1,321.46
|
| Rate for Payer: Humana Medicare |
$780.30
|
| Rate for Payer: Lucent All Commercial |
$780.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,377.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,147.50
|
| Rate for Payer: PHP All Commercial |
$1,160.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$596.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,181.16
|
| Rate for Payer: Signature Care EPO |
$1,269.90
|
| Rate for Payer: Signature Care PPO |
$1,346.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Commercial |
$1,205.64
|
| Rate for Payer: United Healthcare Medicare |
$504.90
|
|
|
HC COBALT SERUM
|
Facility
OP
|
$233.38
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$77.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.72
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Centivo All Commercial |
$119.02
|
| Rate for Payer: Cigna All Commercial |
$201.40
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.82
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Humana Medicare |
$119.02
|
| Rate for Payer: Lucent All Commercial |
$119.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: Managed Health Services Medicaid |
$12.48
|
| Rate for Payer: MDWise Medicaid |
$12.48
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$176.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.02
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.70
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
| Rate for Payer: United Healthcare Medicare |
$77.01
|
|
|
HC COBALT SERUM
|
Facility
IP
|
$233.38
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$201.64
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Cigna All Commercial |
$201.40
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.82
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$176.99
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.70
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
|
|
HC COCAINE QTMS
|
Facility
OP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$131.97
|
| Rate for Payer: Aetna Medicare |
$51.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.76
|
| Rate for Payer: Cash Price |
$96.95
|
| Rate for Payer: Cash Price |
$96.95
|
| Rate for Payer: Centivo All Commercial |
$79.75
|
| Rate for Payer: Cigna All Commercial |
$134.94
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.60
|
| Rate for Payer: Encore All Commercial |
$143.93
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.05
|
| Rate for Payer: Humana Medicare |
$79.75
|
| Rate for Payer: Lucent All Commercial |
$79.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$117.27
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.98
|
| Rate for Payer: Sagamore Health Network All Products |
$120.71
|
| Rate for Payer: Signature Care EPO |
$129.78
|
| Rate for Payer: Signature Care PPO |
$137.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
| Rate for Payer: United Healthcare Medicare |
$51.60
|
|
|
HC COCAINE QTMS
|
Facility
IP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.27 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$135.10
|
| Rate for Payer: Cash Price |
$96.95
|
| Rate for Payer: Cigna All Commercial |
$134.94
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.60
|
| Rate for Payer: Encore All Commercial |
$143.93
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.27
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Sagamore Health Network All Products |
$120.71
|
| Rate for Payer: Signature Care EPO |
$129.78
|
| Rate for Payer: Signature Care PPO |
$137.60
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
|
|
HC COCCIDIODES AB - CF
|
Facility
IP
|
$88.08
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
63001934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$81.91 |
| Rate for Payer: Aetna Commercial |
$76.10
|
| Rate for Payer: Cash Price |
$54.61
|
| Rate for Payer: Cigna All Commercial |
$76.01
|
| Rate for Payer: CORVEL All Commercial |
$81.91
|
| Rate for Payer: Coventry All Commercial |
$77.51
|
| Rate for Payer: Encore All Commercial |
$81.07
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$76.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.27
|
| Rate for Payer: PHCS All Commercial |
$66.06
|
| Rate for Payer: PHP All Commercial |
$66.80
|
| Rate for Payer: Sagamore Health Network All Products |
$68.00
|
| Rate for Payer: Signature Care EPO |
$73.10
|
| Rate for Payer: Signature Care PPO |
$77.51
|
| Rate for Payer: United Healthcare Commercial |
$69.40
|
|
|
HC COCCIDIODES AB - CF
|
Facility
OP
|
$88.08
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
63001934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$81.91 |
| Rate for Payer: Aetna Commercial |
$74.34
|
| Rate for Payer: Aetna Medicare |
$29.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.97
|
| Rate for Payer: Cash Price |
$54.61
|
| Rate for Payer: Cash Price |
$54.61
|
| Rate for Payer: Centivo All Commercial |
$44.92
|
| Rate for Payer: Cigna All Commercial |
$76.01
|
| Rate for Payer: CORVEL All Commercial |
$81.91
|
| Rate for Payer: Coventry All Commercial |
$77.51
|
| Rate for Payer: Encore All Commercial |
$81.07
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$76.07
|
| Rate for Payer: Humana Medicare |
$44.92
|
| Rate for Payer: Lucent All Commercial |
$44.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.27
|
| Rate for Payer: Managed Health Services Medicaid |
$11.47
|
| Rate for Payer: MDWise Medicaid |
$11.47
|
| Rate for Payer: PHCS All Commercial |
$66.06
|
| Rate for Payer: PHP All Commercial |
$66.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.35
|
| Rate for Payer: Sagamore Health Network All Products |
$68.00
|
| Rate for Payer: Signature Care EPO |
$73.10
|
| Rate for Payer: Signature Care PPO |
$77.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.87
|
| Rate for Payer: United Healthcare Commercial |
$69.40
|
| Rate for Payer: United Healthcare Medicare |
$29.07
|
|
|
HC COGNITIVE PERF EVAL STND - OT
|
Facility
OP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GO
|
| Hospital Charge Code |
01732006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.12
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Centivo All Commercial |
$212.31
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$212.31
|
| Rate for Payer: Lucent All Commercial |
$212.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
| Rate for Payer: United Healthcare Medicare |
$137.38
|
|
|
HC COGNITIVE PERF EVAL STND - OT
|
Facility
IP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GO
|
| Hospital Charge Code |
01732006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.69
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
|
|
HC COGNITIVE TEST BY HC PRO PER HOUR
|
Facility
IP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
01746125
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.69
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
|
|
HC COGNITIVE TEST BY HC PRO PER HOUR
|
Facility
OP
|
$416.30
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
01746125
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.12
|
| Rate for Payer: Cash Price |
$258.11
|
| Rate for Payer: Centivo All Commercial |
$212.31
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.35
|
| Rate for Payer: Encore All Commercial |
$383.21
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$212.31
|
| Rate for Payer: Lucent All Commercial |
$212.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.39
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.05
|
| Rate for Payer: United Healthcare Medicare |
$137.38
|
|
|
HC COLD AGGLUTININS
|
Facility
IP
|
$84.15
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
63001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.11 |
| Max. Negotiated Rate |
$78.26 |
| Rate for Payer: Aetna Commercial |
$72.71
|
| Rate for Payer: Cash Price |
$52.17
|
| Rate for Payer: Cigna All Commercial |
$72.62
|
| Rate for Payer: CORVEL All Commercial |
$78.26
|
| Rate for Payer: Coventry All Commercial |
$74.05
|
| Rate for Payer: Encore All Commercial |
$77.46
|
| Rate for Payer: Frontpath All Commercial |
$77.42
|
| Rate for Payer: Humana ChoiceCare |
$72.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.74
|
| Rate for Payer: PHCS All Commercial |
$63.11
|
| Rate for Payer: PHP All Commercial |
$63.82
|
| Rate for Payer: Sagamore Health Network All Products |
$64.96
|
| Rate for Payer: Signature Care EPO |
$69.84
|
| Rate for Payer: Signature Care PPO |
$74.05
|
| Rate for Payer: United Healthcare Commercial |
$66.31
|
|
|
HC COLD AGGLUTININS
|
Facility
OP
|
$84.15
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
63001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$78.26 |
| Rate for Payer: Aetna Commercial |
$71.02
|
| Rate for Payer: Aetna Medicare |
$27.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$52.17
|
| Rate for Payer: Cash Price |
$52.17
|
| Rate for Payer: Centivo All Commercial |
$42.92
|
| Rate for Payer: Cigna All Commercial |
$72.62
|
| Rate for Payer: CORVEL All Commercial |
$78.26
|
| Rate for Payer: Coventry All Commercial |
$74.05
|
| Rate for Payer: Encore All Commercial |
$77.46
|
| Rate for Payer: Frontpath All Commercial |
$77.42
|
| Rate for Payer: Humana ChoiceCare |
$72.68
|
| Rate for Payer: Humana Medicare |
$42.92
|
| Rate for Payer: Lucent All Commercial |
$42.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.74
|
| Rate for Payer: Managed Health Services Medicaid |
$7.73
|
| Rate for Payer: MDWise Medicaid |
$7.73
|
| Rate for Payer: PHCS All Commercial |
$63.11
|
| Rate for Payer: PHP All Commercial |
$63.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.82
|
| Rate for Payer: Sagamore Health Network All Products |
$64.96
|
| Rate for Payer: Signature Care EPO |
$69.84
|
| Rate for Payer: Signature Care PPO |
$74.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.53
|
| Rate for Payer: United Healthcare Commercial |
$66.31
|
| Rate for Payer: United Healthcare Medicare |
$27.77
|
|
