|
HC COMPRESSION SYSTEM COBAN 2LAYER
|
Facility
OP
|
$76.86
|
|
| Hospital Charge Code |
41601035
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$64.87
|
| Rate for Payer: Aetna Medicare |
$25.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.90
|
| Rate for Payer: Cash Price |
$47.65
|
| Rate for Payer: Cash Price |
$47.65
|
| Rate for Payer: Centivo All Commercial |
$39.20
|
| Rate for Payer: Cigna All Commercial |
$66.33
|
| Rate for Payer: CORVEL All Commercial |
$71.48
|
| Rate for Payer: Coventry All Commercial |
$67.64
|
| Rate for Payer: Encore All Commercial |
$70.75
|
| Rate for Payer: Frontpath All Commercial |
$70.71
|
| Rate for Payer: Humana ChoiceCare |
$66.38
|
| Rate for Payer: Humana Medicare |
$39.20
|
| Rate for Payer: Lucent All Commercial |
$39.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.17
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$57.64
|
| Rate for Payer: PHP All Commercial |
$58.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.98
|
| Rate for Payer: Sagamore Health Network All Products |
$59.34
|
| Rate for Payer: Signature Care EPO |
$63.79
|
| Rate for Payer: Signature Care PPO |
$67.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.33
|
| Rate for Payer: United Healthcare Commercial |
$60.57
|
| Rate for Payer: United Healthcare Medicare |
$25.36
|
|
|
HC COMPRESSION SYSTEM COBAN 2LAYER
|
Facility
IP
|
$76.86
|
|
| Hospital Charge Code |
41601035
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$71.48 |
| Rate for Payer: Aetna Commercial |
$66.41
|
| Rate for Payer: Cash Price |
$47.65
|
| Rate for Payer: Cigna All Commercial |
$66.33
|
| Rate for Payer: CORVEL All Commercial |
$71.48
|
| Rate for Payer: Coventry All Commercial |
$67.64
|
| Rate for Payer: Encore All Commercial |
$70.75
|
| Rate for Payer: Frontpath All Commercial |
$70.71
|
| Rate for Payer: Humana ChoiceCare |
$66.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.17
|
| Rate for Payer: PHCS All Commercial |
$57.64
|
| Rate for Payer: PHP All Commercial |
$58.29
|
| Rate for Payer: Sagamore Health Network All Products |
$59.34
|
| Rate for Payer: Signature Care EPO |
$63.79
|
| Rate for Payer: Signature Care PPO |
$67.64
|
| Rate for Payer: United Healthcare Commercial |
$60.57
|
|
|
HC COMPR RV SHLDR GUIDE
|
Facility
OP
|
$4,809.02
|
|
| Hospital Charge Code |
41606578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,058.81
|
| Rate for Payer: Aetna Medicare |
$1,586.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,586.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,761.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,006.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,825.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,745.67
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Centivo All Commercial |
$2,452.60
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Humana Medicare |
$2,452.60
|
| Rate for Payer: Lucent All Commercial |
$2,452.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,875.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,087.67
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
| Rate for Payer: United Healthcare Medicare |
$1,586.98
|
|
|
HC COMPR RV SHLDR GUIDE
|
Facility
IP
|
$4,809.02
|
|
| Hospital Charge Code |
41606578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,606.76 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,154.99
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
|
|
HC CONE/TUBE IRRIGATOR KIT
|
Facility
IP
|
$234.08
|
|
| Hospital Charge Code |
41601437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$217.69 |
| Rate for Payer: Aetna Commercial |
$202.25
|
| Rate for Payer: Cash Price |
$145.13
|
| Rate for Payer: Cigna All Commercial |
$202.01
|
| Rate for Payer: CORVEL All Commercial |
$217.69
|
| Rate for Payer: Coventry All Commercial |
$205.99
|
| Rate for Payer: Encore All Commercial |
$215.47
|
| Rate for Payer: Frontpath All Commercial |
$215.35
|
| Rate for Payer: Humana ChoiceCare |
$202.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.67
|
| Rate for Payer: PHCS All Commercial |
$175.56
|
| Rate for Payer: PHP All Commercial |
$177.53
|
| Rate for Payer: Sagamore Health Network All Products |
$180.71
|
| Rate for Payer: Signature Care EPO |
$194.29
|
| Rate for Payer: Signature Care PPO |
$205.99
|
| Rate for Payer: United Healthcare Commercial |
$184.46
|
|
|
HC CONE/TUBE IRRIGATOR KIT
|
Facility
OP
|
$234.08
|
|
| Hospital Charge Code |
41601437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$217.69 |
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna Medicare |
$77.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.97
|
| Rate for Payer: Cash Price |
$145.13
|
| Rate for Payer: Cash Price |
$145.13
|
| Rate for Payer: Centivo All Commercial |
$119.38
|
| Rate for Payer: Cigna All Commercial |
$202.01
|
| Rate for Payer: CORVEL All Commercial |
$217.69
|
| Rate for Payer: Coventry All Commercial |
$205.99
|
| Rate for Payer: Encore All Commercial |
$215.47
|
| Rate for Payer: Frontpath All Commercial |
$215.35
|
| Rate for Payer: Humana ChoiceCare |
$202.17
|
| Rate for Payer: Humana Medicare |
$119.38
|
| Rate for Payer: Lucent All Commercial |
$119.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.67
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$175.56
|
| Rate for Payer: PHP All Commercial |
$177.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.29
|
| Rate for Payer: Sagamore Health Network All Products |
$180.71
|
| Rate for Payer: Signature Care EPO |
$194.29
|
| Rate for Payer: Signature Care PPO |
$205.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.97
|
| Rate for Payer: United Healthcare Commercial |
$184.46
|
| Rate for Payer: United Healthcare Medicare |
$77.25
|
|
|
HC CONT BRONCHODILATOR EA ADD HOU
|
Facility
OP
|
$311.47
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
01704645
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$289.66 |
| Rate for Payer: Aetna Commercial |
$262.88
|
| Rate for Payer: Aetna Medicare |
$102.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$178.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.06
|
| Rate for Payer: Cash Price |
$193.11
|
| Rate for Payer: Cash Price |
$193.11
|
| Rate for Payer: Centivo All Commercial |
$158.85
|
| Rate for Payer: Cigna All Commercial |
$268.80
|
| Rate for Payer: CORVEL All Commercial |
$289.66
|
| Rate for Payer: Coventry All Commercial |
$274.09
|
| Rate for Payer: Encore All Commercial |
$286.71
|
| Rate for Payer: Frontpath All Commercial |
$286.55
|
| Rate for Payer: Humana ChoiceCare |
$269.01
|
| Rate for Payer: Humana Medicare |
$158.85
|
| Rate for Payer: Lucent All Commercial |
$158.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.32
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$233.60
|
| Rate for Payer: PHP All Commercial |
$236.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.47
|
| Rate for Payer: Sagamore Health Network All Products |
$240.45
|
| Rate for Payer: Signature Care EPO |
$258.52
|
| Rate for Payer: Signature Care PPO |
$274.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$264.75
|
| Rate for Payer: United Healthcare Commercial |
$245.44
|
| Rate for Payer: United Healthcare Medicare |
$102.78
|
|
|
HC CONT BRONCHODILATOR EA ADD HOU
|
Facility
IP
|
$311.47
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
01704645
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$289.66 |
| Rate for Payer: Aetna Commercial |
$269.11
|
| Rate for Payer: Cash Price |
$193.11
|
| Rate for Payer: Cigna All Commercial |
$268.80
|
| Rate for Payer: CORVEL All Commercial |
$289.66
|
| Rate for Payer: Coventry All Commercial |
$274.09
|
| Rate for Payer: Encore All Commercial |
$286.71
|
| Rate for Payer: Frontpath All Commercial |
$286.55
|
| Rate for Payer: Humana ChoiceCare |
$269.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.32
|
| Rate for Payer: PHCS All Commercial |
$233.60
|
| Rate for Payer: PHP All Commercial |
$236.22
|
| Rate for Payer: Sagamore Health Network All Products |
$240.45
|
| Rate for Payer: Signature Care EPO |
$258.52
|
| Rate for Payer: Signature Care PPO |
$274.09
|
| Rate for Payer: United Healthcare Commercial |
$245.44
|
|
|
HC CONT BRONCHODILATOR INIT HOUR
|
Facility
OP
|
$437.72
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
01704644
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$407.08 |
| Rate for Payer: Aetna Commercial |
$369.44
|
| Rate for Payer: Aetna Medicare |
$144.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$251.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$273.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.89
|
| Rate for Payer: Cash Price |
$271.39
|
| Rate for Payer: Cash Price |
$271.39
|
| Rate for Payer: Centivo All Commercial |
$223.24
|
| Rate for Payer: Cigna All Commercial |
$377.75
|
| Rate for Payer: CORVEL All Commercial |
$407.08
|
| Rate for Payer: Coventry All Commercial |
$385.20
|
| Rate for Payer: Encore All Commercial |
$402.92
|
| Rate for Payer: Frontpath All Commercial |
$402.70
|
| Rate for Payer: Humana ChoiceCare |
$378.06
|
| Rate for Payer: Humana Medicare |
$223.24
|
| Rate for Payer: Lucent All Commercial |
$223.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$393.95
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$328.29
|
| Rate for Payer: PHP All Commercial |
$331.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.71
|
| Rate for Payer: Sagamore Health Network All Products |
$337.92
|
| Rate for Payer: Signature Care EPO |
$363.31
|
| Rate for Payer: Signature Care PPO |
$385.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.06
|
| Rate for Payer: United Healthcare Commercial |
$344.93
|
| Rate for Payer: United Healthcare Medicare |
$144.45
|
|
|
HC CONT BRONCHODILATOR INIT HOUR
|
Facility
IP
|
$437.72
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
01704644
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$407.08 |
| Rate for Payer: Aetna Commercial |
$378.19
|
| Rate for Payer: Cash Price |
$271.39
|
| Rate for Payer: Cigna All Commercial |
$377.75
|
| Rate for Payer: CORVEL All Commercial |
$407.08
|
| Rate for Payer: Coventry All Commercial |
$385.20
|
| Rate for Payer: Encore All Commercial |
$402.92
|
| Rate for Payer: Frontpath All Commercial |
$402.70
|
| Rate for Payer: Humana ChoiceCare |
$378.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$393.95
|
| Rate for Payer: PHCS All Commercial |
$328.29
|
| Rate for Payer: PHP All Commercial |
$331.97
|
| Rate for Payer: Sagamore Health Network All Products |
$337.92
|
| Rate for Payer: Signature Care EPO |
$363.31
|
| Rate for Payer: Signature Care PPO |
$385.20
|
| Rate for Payer: United Healthcare Commercial |
$344.93
|
|
|
HC CONTINUED RADIATION PHYSICS
|
Facility
OP
|
$1,113.84
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
01547336
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$1,035.87 |
| Rate for Payer: Aetna Commercial |
$940.08
|
| Rate for Payer: Aetna Medicare |
$367.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$639.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$696.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$306.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$422.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.32
|
| Rate for Payer: Cash Price |
$690.58
|
| Rate for Payer: Cash Price |
$690.58
|
| Rate for Payer: Centivo All Commercial |
$568.06
|
| Rate for Payer: Cigna All Commercial |
$961.24
|
| Rate for Payer: CORVEL All Commercial |
$1,035.87
|
| Rate for Payer: Coventry All Commercial |
$980.18
|
| Rate for Payer: Encore All Commercial |
$1,025.29
|
| Rate for Payer: Frontpath All Commercial |
$1,024.73
|
| Rate for Payer: Humana ChoiceCare |
$962.02
|
| Rate for Payer: Humana Medicare |
$568.06
|
| Rate for Payer: Lucent All Commercial |
$568.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,002.46
|
| Rate for Payer: Managed Health Services Medicaid |
$306.85
|
| Rate for Payer: MDWise Medicaid |
$306.85
|
| Rate for Payer: PHCS All Commercial |
$835.38
|
| Rate for Payer: PHP All Commercial |
$844.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.40
|
| Rate for Payer: Sagamore Health Network All Products |
$859.88
|
| Rate for Payer: Signature Care EPO |
$924.49
|
| Rate for Payer: Signature Care PPO |
$980.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$946.76
|
| Rate for Payer: United Healthcare Commercial |
$877.71
|
| Rate for Payer: United Healthcare Medicare |
$367.57
|
|
|
HC CONTINUED RADIATION PHYSICS
|
Facility
IP
|
$1,113.84
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
01547336
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$835.38 |
| Max. Negotiated Rate |
$1,035.87 |
| Rate for Payer: Aetna Commercial |
$962.36
|
| Rate for Payer: Cash Price |
$690.58
|
| Rate for Payer: Cigna All Commercial |
$961.24
|
| Rate for Payer: CORVEL All Commercial |
$1,035.87
|
| Rate for Payer: Coventry All Commercial |
$980.18
|
| Rate for Payer: Encore All Commercial |
$1,025.29
|
| Rate for Payer: Frontpath All Commercial |
$1,024.73
|
| Rate for Payer: Humana ChoiceCare |
$962.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,002.46
|
| Rate for Payer: PHCS All Commercial |
$835.38
|
| Rate for Payer: PHP All Commercial |
$844.74
|
| Rate for Payer: Sagamore Health Network All Products |
$859.88
|
| Rate for Payer: Signature Care EPO |
$924.49
|
| Rate for Payer: Signature Care PPO |
$980.18
|
| Rate for Payer: United Healthcare Commercial |
$877.71
|
|
|
HC CONTRAST BATH/15 MIN-OT
|
Facility
OP
|
$192.63
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
01738012
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.57 |
| Max. Negotiated Rate |
$179.14 |
| Rate for Payer: Aetna Commercial |
$162.58
|
| Rate for Payer: Aetna Medicare |
$63.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$110.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.92
|
| Rate for Payer: Cash Price |
$119.43
|
| Rate for Payer: Centivo All Commercial |
$98.24
|
| Rate for Payer: Cigna All Commercial |
$166.24
|
| Rate for Payer: CORVEL All Commercial |
$179.14
|
| Rate for Payer: Coventry All Commercial |
$169.51
|
| Rate for Payer: Encore All Commercial |
$177.31
|
| Rate for Payer: Frontpath All Commercial |
$177.22
|
| Rate for Payer: Humana ChoiceCare |
$166.37
|
| Rate for Payer: Humana Medicare |
$98.24
|
| Rate for Payer: Lucent All Commercial |
$98.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.36
|
| Rate for Payer: PHCS All Commercial |
$144.47
|
| Rate for Payer: PHP All Commercial |
$146.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.12
|
| Rate for Payer: Sagamore Health Network All Products |
$148.71
|
| Rate for Payer: Signature Care EPO |
$159.88
|
| Rate for Payer: Signature Care PPO |
$169.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.73
|
| Rate for Payer: United Healthcare Commercial |
$151.79
|
| Rate for Payer: United Healthcare Medicare |
$63.57
|
|
|
HC CONTRAST BATH/15 MIN-OT
|
Facility
IP
|
$192.63
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
01738012
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$144.47 |
| Max. Negotiated Rate |
$179.14 |
| Rate for Payer: Aetna Commercial |
$166.43
|
| Rate for Payer: Cash Price |
$119.43
|
| Rate for Payer: Cigna All Commercial |
$166.24
|
| Rate for Payer: CORVEL All Commercial |
$179.14
|
| Rate for Payer: Coventry All Commercial |
$169.51
|
| Rate for Payer: Encore All Commercial |
$177.31
|
| Rate for Payer: Frontpath All Commercial |
$177.22
|
| Rate for Payer: Humana ChoiceCare |
$166.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.36
|
| Rate for Payer: PHCS All Commercial |
$144.47
|
| Rate for Payer: PHP All Commercial |
$146.09
|
| Rate for Payer: Sagamore Health Network All Products |
$148.71
|
| Rate for Payer: Signature Care EPO |
$159.88
|
| Rate for Payer: Signature Care PPO |
$169.51
|
| Rate for Payer: United Healthcare Commercial |
$151.79
|
|
|
HC CONVEX FLEXTEND COLOSTOMY DRESSING
|
Facility
IP
|
$60.38
|
|
| Hospital Charge Code |
41601407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.28 |
| Max. Negotiated Rate |
$56.15 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cigna All Commercial |
$52.11
|
| Rate for Payer: CORVEL All Commercial |
$56.15
|
| Rate for Payer: Coventry All Commercial |
$53.13
|
| Rate for Payer: Encore All Commercial |
$55.58
|
| Rate for Payer: Frontpath All Commercial |
$55.55
|
| Rate for Payer: Humana ChoiceCare |
$52.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.34
|
| Rate for Payer: PHCS All Commercial |
$45.28
|
| Rate for Payer: PHP All Commercial |
$45.79
|
| Rate for Payer: Sagamore Health Network All Products |
$46.61
|
| Rate for Payer: Signature Care EPO |
$50.12
|
| Rate for Payer: Signature Care PPO |
$53.13
|
| Rate for Payer: United Healthcare Commercial |
$47.58
|
|
|
HC CONVEX FLEXTEND COLOSTOMY DRESSING
|
Facility
OP
|
$60.38
|
|
| Hospital Charge Code |
41601407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$50.96
|
| Rate for Payer: Aetna Medicare |
$19.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.92
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Centivo All Commercial |
$30.79
|
| Rate for Payer: Cigna All Commercial |
$52.11
|
| Rate for Payer: CORVEL All Commercial |
$56.15
|
| Rate for Payer: Coventry All Commercial |
$53.13
|
| Rate for Payer: Encore All Commercial |
$55.58
|
| Rate for Payer: Frontpath All Commercial |
$55.55
|
| Rate for Payer: Humana ChoiceCare |
$52.15
|
| Rate for Payer: Humana Medicare |
$30.79
|
| Rate for Payer: Lucent All Commercial |
$30.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.34
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$45.28
|
| Rate for Payer: PHP All Commercial |
$45.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.55
|
| Rate for Payer: Sagamore Health Network All Products |
$46.61
|
| Rate for Payer: Signature Care EPO |
$50.12
|
| Rate for Payer: Signature Care PPO |
$53.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.32
|
| Rate for Payer: United Healthcare Commercial |
$47.58
|
| Rate for Payer: United Healthcare Medicare |
$19.93
|
|
|
HC COOLER & COLD PAD COMBO BREG
|
Facility
IP
|
$871.22
|
|
| Hospital Charge Code |
41607038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$653.42 |
| Max. Negotiated Rate |
$810.23 |
| Rate for Payer: Aetna Commercial |
$752.73
|
| Rate for Payer: Cash Price |
$540.16
|
| Rate for Payer: Cigna All Commercial |
$751.86
|
| Rate for Payer: CORVEL All Commercial |
$810.23
|
| Rate for Payer: Coventry All Commercial |
$766.67
|
| Rate for Payer: Encore All Commercial |
$801.96
|
| Rate for Payer: Frontpath All Commercial |
$801.52
|
| Rate for Payer: Humana ChoiceCare |
$752.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$784.10
|
| Rate for Payer: PHCS All Commercial |
$653.42
|
| Rate for Payer: PHP All Commercial |
$660.73
|
| Rate for Payer: Sagamore Health Network All Products |
$672.58
|
| Rate for Payer: Signature Care EPO |
$723.11
|
| Rate for Payer: Signature Care PPO |
$766.67
|
| Rate for Payer: United Healthcare Commercial |
$686.52
|
|
|
HC COOLER & COLD PAD COMBO BREG
|
Facility
OP
|
$871.22
|
|
| Hospital Charge Code |
41607038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$810.23 |
| Rate for Payer: Aetna Commercial |
$735.31
|
| Rate for Payer: Aetna Medicare |
$287.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$287.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$500.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$544.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$330.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$316.25
|
| Rate for Payer: Cash Price |
$540.16
|
| Rate for Payer: Cash Price |
$540.16
|
| Rate for Payer: Centivo All Commercial |
$444.32
|
| Rate for Payer: Cigna All Commercial |
$751.86
|
| Rate for Payer: CORVEL All Commercial |
$810.23
|
| Rate for Payer: Coventry All Commercial |
$766.67
|
| Rate for Payer: Encore All Commercial |
$801.96
|
| Rate for Payer: Frontpath All Commercial |
$801.52
|
| Rate for Payer: Humana ChoiceCare |
$752.47
|
| Rate for Payer: Humana Medicare |
$444.32
|
| Rate for Payer: Lucent All Commercial |
$444.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$784.10
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$653.42
|
| Rate for Payer: PHP All Commercial |
$660.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$339.78
|
| Rate for Payer: Sagamore Health Network All Products |
$672.58
|
| Rate for Payer: Signature Care EPO |
$723.11
|
| Rate for Payer: Signature Care PPO |
$766.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$740.54
|
| Rate for Payer: United Healthcare Commercial |
$686.52
|
| Rate for Payer: United Healthcare Medicare |
$287.50
|
|
|
HC COOMBS-DIRECT
|
Facility
OP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$83.82
|
| Rate for Payer: Aetna Medicare |
$32.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.05
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Centivo All Commercial |
$50.65
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.36
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Humana Medicare |
$50.65
|
| Rate for Payer: Lucent All Commercial |
$50.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.73
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.42
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.41
|
| Rate for Payer: United Healthcare Commercial |
$78.25
|
| Rate for Payer: United Healthcare Medicare |
$32.77
|
|
|
HC COOMBS-DIRECT
|
Facility
IP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.36
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.31
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.42
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: United Healthcare Commercial |
$78.25
|
|
|
HC COPPER SERUM
|
Facility
IP
|
$161.57
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$150.26 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Cash Price |
$100.17
|
| Rate for Payer: Cigna All Commercial |
$139.43
|
| Rate for Payer: CORVEL All Commercial |
$150.26
|
| Rate for Payer: Coventry All Commercial |
$142.18
|
| Rate for Payer: Encore All Commercial |
$148.72
|
| Rate for Payer: Frontpath All Commercial |
$148.64
|
| Rate for Payer: Humana ChoiceCare |
$139.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.41
|
| Rate for Payer: PHCS All Commercial |
$121.18
|
| Rate for Payer: PHP All Commercial |
$122.53
|
| Rate for Payer: Sagamore Health Network All Products |
$124.73
|
| Rate for Payer: Signature Care EPO |
$134.10
|
| Rate for Payer: Signature Care PPO |
$142.18
|
| Rate for Payer: United Healthcare Commercial |
$127.32
|
|
|
HC COPPER SERUM
|
Facility
OP
|
$161.57
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$150.26 |
| Rate for Payer: Aetna Commercial |
$136.36
|
| Rate for Payer: Aetna Medicare |
$53.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.65
|
| Rate for Payer: Cash Price |
$100.17
|
| Rate for Payer: Cash Price |
$100.17
|
| Rate for Payer: Centivo All Commercial |
$82.40
|
| Rate for Payer: Cigna All Commercial |
$139.43
|
| Rate for Payer: CORVEL All Commercial |
$150.26
|
| Rate for Payer: Coventry All Commercial |
$142.18
|
| Rate for Payer: Encore All Commercial |
$148.72
|
| Rate for Payer: Frontpath All Commercial |
$148.64
|
| Rate for Payer: Humana ChoiceCare |
$139.55
|
| Rate for Payer: Humana Medicare |
$82.40
|
| Rate for Payer: Lucent All Commercial |
$82.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.41
|
| Rate for Payer: Managed Health Services Medicaid |
$12.41
|
| Rate for Payer: MDWise Medicaid |
$12.41
|
| Rate for Payer: PHCS All Commercial |
$121.18
|
| Rate for Payer: PHP All Commercial |
$122.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.01
|
| Rate for Payer: Sagamore Health Network All Products |
$124.73
|
| Rate for Payer: Signature Care EPO |
$134.10
|
| Rate for Payer: Signature Care PPO |
$142.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.33
|
| Rate for Payer: United Healthcare Commercial |
$127.32
|
| Rate for Payer: United Healthcare Medicare |
$53.32
|
|
|
HC COPPER, URINE
|
Facility
OP
|
$34.30
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63044036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna Commercial |
$28.95
|
| Rate for Payer: Aetna Medicare |
$11.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.45
|
| Rate for Payer: Cash Price |
$21.27
|
| Rate for Payer: Cash Price |
$21.27
|
| Rate for Payer: Centivo All Commercial |
$17.49
|
| Rate for Payer: Cigna All Commercial |
$29.60
|
| Rate for Payer: CORVEL All Commercial |
$31.90
|
| Rate for Payer: Coventry All Commercial |
$30.19
|
| Rate for Payer: Encore All Commercial |
$31.58
|
| Rate for Payer: Frontpath All Commercial |
$31.56
|
| Rate for Payer: Humana ChoiceCare |
$29.63
|
| Rate for Payer: Humana Medicare |
$17.49
|
| Rate for Payer: Lucent All Commercial |
$17.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.87
|
| Rate for Payer: Managed Health Services Medicaid |
$12.41
|
| Rate for Payer: MDWise Medicaid |
$12.41
|
| Rate for Payer: PHCS All Commercial |
$25.73
|
| Rate for Payer: PHP All Commercial |
$26.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.38
|
| Rate for Payer: Sagamore Health Network All Products |
$26.48
|
| Rate for Payer: Signature Care EPO |
$28.47
|
| Rate for Payer: Signature Care PPO |
$30.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.16
|
| Rate for Payer: United Healthcare Commercial |
$27.03
|
| Rate for Payer: United Healthcare Medicare |
$11.32
|
|
|
HC COPPER, URINE
|
Facility
IP
|
$34.30
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63044036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Cash Price |
$21.27
|
| Rate for Payer: Cigna All Commercial |
$29.60
|
| Rate for Payer: CORVEL All Commercial |
$31.90
|
| Rate for Payer: Coventry All Commercial |
$30.19
|
| Rate for Payer: Encore All Commercial |
$31.58
|
| Rate for Payer: Frontpath All Commercial |
$31.56
|
| Rate for Payer: Humana ChoiceCare |
$29.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.87
|
| Rate for Payer: PHCS All Commercial |
$25.73
|
| Rate for Payer: PHP All Commercial |
$26.02
|
| Rate for Payer: Sagamore Health Network All Products |
$26.48
|
| Rate for Payer: Signature Care EPO |
$28.47
|
| Rate for Payer: Signature Care PPO |
$30.19
|
| Rate for Payer: United Healthcare Commercial |
$27.03
|
|
|
HC COPPER, URINE-B
|
Facility
IP
|
$34.30
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Cash Price |
$21.27
|
| Rate for Payer: Cigna All Commercial |
$29.60
|
| Rate for Payer: CORVEL All Commercial |
$31.90
|
| Rate for Payer: Coventry All Commercial |
$30.19
|
| Rate for Payer: Encore All Commercial |
$31.58
|
| Rate for Payer: Frontpath All Commercial |
$31.56
|
| Rate for Payer: Humana ChoiceCare |
$29.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.87
|
| Rate for Payer: PHCS All Commercial |
$25.73
|
| Rate for Payer: PHP All Commercial |
$26.02
|
| Rate for Payer: Sagamore Health Network All Products |
$26.48
|
| Rate for Payer: Signature Care EPO |
$28.47
|
| Rate for Payer: Signature Care PPO |
$30.19
|
| Rate for Payer: United Healthcare Commercial |
$27.03
|
|
