|
HC DERMABOND PRINEO 42CM
|
Facility
OP
|
$772.98
|
|
| Hospital Charge Code |
41607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$718.87 |
| Rate for Payer: Aetna Commercial |
$652.40
|
| Rate for Payer: Aetna Medicare |
$255.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$443.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$483.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.59
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Centivo All Commercial |
$394.22
|
| Rate for Payer: Cigna All Commercial |
$667.08
|
| Rate for Payer: CORVEL All Commercial |
$718.87
|
| Rate for Payer: Coventry All Commercial |
$680.22
|
| Rate for Payer: Encore All Commercial |
$711.53
|
| Rate for Payer: Frontpath All Commercial |
$711.14
|
| Rate for Payer: Humana ChoiceCare |
$667.62
|
| Rate for Payer: Humana Medicare |
$394.22
|
| Rate for Payer: Lucent All Commercial |
$394.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$579.74
|
| Rate for Payer: PHP All Commercial |
$586.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$301.46
|
| Rate for Payer: Sagamore Health Network All Products |
$596.74
|
| Rate for Payer: Signature Care EPO |
$641.57
|
| Rate for Payer: Signature Care PPO |
$680.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$657.03
|
| Rate for Payer: United Healthcare Commercial |
$609.11
|
| Rate for Payer: United Healthcare Medicare |
$255.08
|
|
|
HC DERMABOND PRINEO 42CM
|
Facility
IP
|
$772.98
|
|
| Hospital Charge Code |
41607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.74 |
| Max. Negotiated Rate |
$718.87 |
| Rate for Payer: Aetna Commercial |
$667.85
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cigna All Commercial |
$667.08
|
| Rate for Payer: CORVEL All Commercial |
$718.87
|
| Rate for Payer: Coventry All Commercial |
$680.22
|
| Rate for Payer: Encore All Commercial |
$711.53
|
| Rate for Payer: Frontpath All Commercial |
$711.14
|
| Rate for Payer: Humana ChoiceCare |
$667.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.68
|
| Rate for Payer: PHCS All Commercial |
$579.74
|
| Rate for Payer: PHP All Commercial |
$586.23
|
| Rate for Payer: Sagamore Health Network All Products |
$596.74
|
| Rate for Payer: Signature Care EPO |
$641.57
|
| Rate for Payer: Signature Care PPO |
$680.22
|
| Rate for Payer: United Healthcare Commercial |
$609.11
|
|
|
HC DERMABOND PRO PEN
|
Facility
IP
|
$134.35
|
|
| Hospital Charge Code |
41601087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: Cigna All Commercial |
$115.94
|
| Rate for Payer: CORVEL All Commercial |
$124.95
|
| Rate for Payer: Coventry All Commercial |
$118.23
|
| Rate for Payer: Encore All Commercial |
$123.67
|
| Rate for Payer: Frontpath All Commercial |
$123.60
|
| Rate for Payer: Humana ChoiceCare |
$116.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.92
|
| Rate for Payer: PHCS All Commercial |
$100.76
|
| Rate for Payer: PHP All Commercial |
$101.89
|
| Rate for Payer: Sagamore Health Network All Products |
$103.72
|
| Rate for Payer: Signature Care EPO |
$111.51
|
| Rate for Payer: Signature Care PPO |
$118.23
|
| Rate for Payer: United Healthcare Commercial |
$105.87
|
|
|
HC DERMABOND PRO PEN
|
Facility
OP
|
$134.35
|
|
| Hospital Charge Code |
41601087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Aetna Commercial |
$113.39
|
| Rate for Payer: Aetna Medicare |
$44.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.77
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: Centivo All Commercial |
$68.52
|
| Rate for Payer: Cigna All Commercial |
$115.94
|
| Rate for Payer: CORVEL All Commercial |
$124.95
|
| Rate for Payer: Coventry All Commercial |
$118.23
|
| Rate for Payer: Encore All Commercial |
$123.67
|
| Rate for Payer: Frontpath All Commercial |
$123.60
|
| Rate for Payer: Humana ChoiceCare |
$116.04
|
| Rate for Payer: Humana Medicare |
$68.52
|
| Rate for Payer: Lucent All Commercial |
$68.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$100.76
|
| Rate for Payer: PHP All Commercial |
$101.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.40
|
| Rate for Payer: Sagamore Health Network All Products |
$103.72
|
| Rate for Payer: Signature Care EPO |
$111.51
|
| Rate for Payer: Signature Care PPO |
$118.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.20
|
| Rate for Payer: United Healthcare Commercial |
$105.87
|
| Rate for Payer: United Healthcare Medicare |
$44.34
|
|
|
HC DERMACARRIER 1.5-1
|
Facility
IP
|
$113.88
|
|
| Hospital Charge Code |
41602321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$98.39
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.21
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.21
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
|
|
HC DERMACARRIER 1.5-1
|
Facility
OP
|
$113.88
|
|
| Hospital Charge Code |
41602321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$96.11
|
| Rate for Payer: Aetna Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.34
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Centivo All Commercial |
$58.08
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.21
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Humana Medicare |
$58.08
|
| Rate for Payer: Lucent All Commercial |
$58.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.41
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.80
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
| Rate for Payer: United Healthcare Medicare |
$37.58
|
|
|
HC DERMACARRIER 3:1
|
Facility
OP
|
$113.88
|
|
| Hospital Charge Code |
41602320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$96.11
|
| Rate for Payer: Aetna Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.34
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Centivo All Commercial |
$58.08
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.21
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Humana Medicare |
$58.08
|
| Rate for Payer: Lucent All Commercial |
$58.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.41
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.80
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
| Rate for Payer: United Healthcare Medicare |
$37.58
|
|
|
HC DERMACARRIER 3:1
|
Facility
IP
|
$113.88
|
|
| Hospital Charge Code |
41602320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$98.39
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cigna All Commercial |
$98.28
|
| Rate for Payer: CORVEL All Commercial |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$100.21
|
| Rate for Payer: Encore All Commercial |
$104.83
|
| Rate for Payer: Frontpath All Commercial |
$104.77
|
| Rate for Payer: Humana ChoiceCare |
$98.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.49
|
| Rate for Payer: PHCS All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$86.37
|
| Rate for Payer: Sagamore Health Network All Products |
$87.92
|
| Rate for Payer: Signature Care EPO |
$94.52
|
| Rate for Payer: Signature Care PPO |
$100.21
|
| Rate for Payer: United Healthcare Commercial |
$89.74
|
|
|
HC DESIGN MOLDS/MASK - COMPLEX
|
Facility
IP
|
$1,379.04
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
01547334
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,034.28 |
| Max. Negotiated Rate |
$1,282.51 |
| Rate for Payer: Aetna Commercial |
$1,191.49
|
| Rate for Payer: Cash Price |
$855.01
|
| Rate for Payer: Cigna All Commercial |
$1,190.11
|
| Rate for Payer: CORVEL All Commercial |
$1,282.51
|
| Rate for Payer: Coventry All Commercial |
$1,213.56
|
| Rate for Payer: Encore All Commercial |
$1,269.41
|
| Rate for Payer: Frontpath All Commercial |
$1,268.72
|
| Rate for Payer: Humana ChoiceCare |
$1,191.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,241.14
|
| Rate for Payer: PHCS All Commercial |
$1,034.28
|
| Rate for Payer: PHP All Commercial |
$1,045.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,064.62
|
| Rate for Payer: Signature Care EPO |
$1,144.60
|
| Rate for Payer: Signature Care PPO |
$1,213.56
|
| Rate for Payer: United Healthcare Commercial |
$1,086.68
|
|
|
HC DESIGN MOLDS/MASK - COMPLEX
|
Facility
OP
|
$1,379.04
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
01547334
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$232.52 |
| Max. Negotiated Rate |
$1,282.51 |
| Rate for Payer: Aetna Commercial |
$1,163.91
|
| Rate for Payer: Aetna Medicare |
$455.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$455.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$791.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$862.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$232.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$523.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$500.59
|
| Rate for Payer: Cash Price |
$855.01
|
| Rate for Payer: Cash Price |
$855.01
|
| Rate for Payer: Centivo All Commercial |
$703.31
|
| Rate for Payer: Cigna All Commercial |
$1,190.11
|
| Rate for Payer: CORVEL All Commercial |
$1,282.51
|
| Rate for Payer: Coventry All Commercial |
$1,213.56
|
| Rate for Payer: Encore All Commercial |
$1,269.41
|
| Rate for Payer: Frontpath All Commercial |
$1,268.72
|
| Rate for Payer: Humana ChoiceCare |
$1,191.08
|
| Rate for Payer: Humana Medicare |
$703.31
|
| Rate for Payer: Lucent All Commercial |
$703.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,241.14
|
| Rate for Payer: Managed Health Services Medicaid |
$232.52
|
| Rate for Payer: MDWise Medicaid |
$232.52
|
| Rate for Payer: PHCS All Commercial |
$1,034.28
|
| Rate for Payer: PHP All Commercial |
$1,045.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$537.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,064.62
|
| Rate for Payer: Signature Care EPO |
$1,144.60
|
| Rate for Payer: Signature Care PPO |
$1,213.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,172.18
|
| Rate for Payer: United Healthcare Commercial |
$1,086.68
|
| Rate for Payer: United Healthcare Medicare |
$455.08
|
|
|
HC DESIGN MOLDS/MASK-INTERM
|
Facility
OP
|
$1,166.88
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
01547333
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$1,085.20 |
| Rate for Payer: Aetna Commercial |
$984.85
|
| Rate for Payer: Aetna Medicare |
$385.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$385.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$670.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$729.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$423.58
|
| Rate for Payer: Cash Price |
$723.47
|
| Rate for Payer: Cash Price |
$723.47
|
| Rate for Payer: Centivo All Commercial |
$595.11
|
| Rate for Payer: Cigna All Commercial |
$1,007.02
|
| Rate for Payer: CORVEL All Commercial |
$1,085.20
|
| Rate for Payer: Coventry All Commercial |
$1,026.85
|
| Rate for Payer: Encore All Commercial |
$1,074.11
|
| Rate for Payer: Frontpath All Commercial |
$1,073.53
|
| Rate for Payer: Humana ChoiceCare |
$1,007.83
|
| Rate for Payer: Humana Medicare |
$595.11
|
| Rate for Payer: Lucent All Commercial |
$595.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.19
|
| Rate for Payer: Managed Health Services Medicaid |
$24.80
|
| Rate for Payer: MDWise Medicaid |
$24.80
|
| Rate for Payer: PHCS All Commercial |
$875.16
|
| Rate for Payer: PHP All Commercial |
$884.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$455.08
|
| Rate for Payer: Sagamore Health Network All Products |
$900.83
|
| Rate for Payer: Signature Care EPO |
$968.51
|
| Rate for Payer: Signature Care PPO |
$1,026.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$991.85
|
| Rate for Payer: United Healthcare Commercial |
$919.50
|
| Rate for Payer: United Healthcare Medicare |
$385.07
|
|
|
HC DESIGN MOLDS/MASK-INTERM
|
Facility
IP
|
$1,166.88
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
01547333
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$875.16 |
| Max. Negotiated Rate |
$1,085.20 |
| Rate for Payer: Aetna Commercial |
$1,008.18
|
| Rate for Payer: Cash Price |
$723.47
|
| Rate for Payer: Cigna All Commercial |
$1,007.02
|
| Rate for Payer: CORVEL All Commercial |
$1,085.20
|
| Rate for Payer: Coventry All Commercial |
$1,026.85
|
| Rate for Payer: Encore All Commercial |
$1,074.11
|
| Rate for Payer: Frontpath All Commercial |
$1,073.53
|
| Rate for Payer: Humana ChoiceCare |
$1,007.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.19
|
| Rate for Payer: PHCS All Commercial |
$875.16
|
| Rate for Payer: PHP All Commercial |
$884.96
|
| Rate for Payer: Sagamore Health Network All Products |
$900.83
|
| Rate for Payer: Signature Care EPO |
$968.51
|
| Rate for Payer: Signature Care PPO |
$1,026.85
|
| Rate for Payer: United Healthcare Commercial |
$919.50
|
|
|
HC DESIGN MOLDS/MASK - SIMPLE
|
Facility
IP
|
$689.52
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
01547332
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$517.14 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$595.75
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna All Commercial |
$595.06
|
| Rate for Payer: CORVEL All Commercial |
$641.25
|
| Rate for Payer: Coventry All Commercial |
$606.78
|
| Rate for Payer: Encore All Commercial |
$634.70
|
| Rate for Payer: Frontpath All Commercial |
$634.36
|
| Rate for Payer: Humana ChoiceCare |
$595.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$620.57
|
| Rate for Payer: PHCS All Commercial |
$517.14
|
| Rate for Payer: PHP All Commercial |
$522.93
|
| Rate for Payer: Sagamore Health Network All Products |
$532.31
|
| Rate for Payer: Signature Care EPO |
$572.30
|
| Rate for Payer: Signature Care PPO |
$606.78
|
| Rate for Payer: United Healthcare Commercial |
$543.34
|
|
|
HC DESIGN MOLDS/MASK - SIMPLE
|
Facility
OP
|
$689.52
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
01547332
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$140.71 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$581.95
|
| Rate for Payer: Aetna Medicare |
$227.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$227.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$395.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$431.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$140.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$261.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$250.30
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Centivo All Commercial |
$351.66
|
| Rate for Payer: Cigna All Commercial |
$595.06
|
| Rate for Payer: CORVEL All Commercial |
$641.25
|
| Rate for Payer: Coventry All Commercial |
$606.78
|
| Rate for Payer: Encore All Commercial |
$634.70
|
| Rate for Payer: Frontpath All Commercial |
$634.36
|
| Rate for Payer: Humana ChoiceCare |
$595.54
|
| Rate for Payer: Humana Medicare |
$351.66
|
| Rate for Payer: Lucent All Commercial |
$351.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$620.57
|
| Rate for Payer: Managed Health Services Medicaid |
$140.71
|
| Rate for Payer: MDWise Medicaid |
$140.71
|
| Rate for Payer: PHCS All Commercial |
$517.14
|
| Rate for Payer: PHP All Commercial |
$522.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$268.91
|
| Rate for Payer: Sagamore Health Network All Products |
$532.31
|
| Rate for Payer: Signature Care EPO |
$572.30
|
| Rate for Payer: Signature Care PPO |
$606.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$586.09
|
| Rate for Payer: United Healthcare Commercial |
$543.34
|
| Rate for Payer: United Healthcare Medicare |
$227.54
|
|
|
HC DEXA-BONE DENSITY PERIPHERAL
|
Facility
OP
|
$394.85
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
01616076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$367.21 |
| Rate for Payer: Aetna Commercial |
$333.26
|
| Rate for Payer: Aetna Medicare |
$130.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$45.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.33
|
| Rate for Payer: Cash Price |
$244.81
|
| Rate for Payer: Cash Price |
$244.81
|
| Rate for Payer: Centivo All Commercial |
$201.37
|
| Rate for Payer: Cigna All Commercial |
$340.76
|
| Rate for Payer: CORVEL All Commercial |
$367.21
|
| Rate for Payer: Coventry All Commercial |
$347.47
|
| Rate for Payer: Encore All Commercial |
$363.46
|
| Rate for Payer: Frontpath All Commercial |
$363.26
|
| Rate for Payer: Humana ChoiceCare |
$341.03
|
| Rate for Payer: Humana Medicare |
$201.37
|
| Rate for Payer: Lucent All Commercial |
$201.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.37
|
| Rate for Payer: Managed Health Services Medicaid |
$45.08
|
| Rate for Payer: MDWise Medicaid |
$45.08
|
| Rate for Payer: PHCS All Commercial |
$296.14
|
| Rate for Payer: PHP All Commercial |
$299.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.99
|
| Rate for Payer: Sagamore Health Network All Products |
$304.83
|
| Rate for Payer: Signature Care EPO |
$327.73
|
| Rate for Payer: Signature Care PPO |
$347.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.62
|
| Rate for Payer: United Healthcare Commercial |
$311.14
|
| Rate for Payer: United Healthcare Medicare |
$130.30
|
|
|
HC DEXA-BONE DENSITY PERIPHERAL
|
Facility
IP
|
$394.85
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
01616076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.14 |
| Max. Negotiated Rate |
$367.21 |
| Rate for Payer: Aetna Commercial |
$341.15
|
| Rate for Payer: Cash Price |
$244.81
|
| Rate for Payer: Cigna All Commercial |
$340.76
|
| Rate for Payer: CORVEL All Commercial |
$367.21
|
| Rate for Payer: Coventry All Commercial |
$347.47
|
| Rate for Payer: Encore All Commercial |
$363.46
|
| Rate for Payer: Frontpath All Commercial |
$363.26
|
| Rate for Payer: Humana ChoiceCare |
$341.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.37
|
| Rate for Payer: PHCS All Commercial |
$296.14
|
| Rate for Payer: PHP All Commercial |
$299.46
|
| Rate for Payer: Sagamore Health Network All Products |
$304.83
|
| Rate for Payer: Signature Care EPO |
$327.73
|
| Rate for Payer: Signature Care PPO |
$347.47
|
| Rate for Payer: United Healthcare Commercial |
$311.14
|
|
|
HC DEXA-BONE MINERAL ANALYSIS
|
Facility
OP
|
$754.39
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
00740063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.99 |
| Max. Negotiated Rate |
$701.58 |
| Rate for Payer: Aetna Commercial |
$636.71
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$433.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$104.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$286.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$273.84
|
| Rate for Payer: Cash Price |
$467.72
|
| Rate for Payer: Cash Price |
$467.72
|
| Rate for Payer: Centivo All Commercial |
$384.74
|
| Rate for Payer: Cigna All Commercial |
$651.04
|
| Rate for Payer: CORVEL All Commercial |
$701.58
|
| Rate for Payer: Coventry All Commercial |
$663.86
|
| Rate for Payer: Encore All Commercial |
$694.42
|
| Rate for Payer: Frontpath All Commercial |
$694.04
|
| Rate for Payer: Humana ChoiceCare |
$651.57
|
| Rate for Payer: Humana Medicare |
$384.74
|
| Rate for Payer: Lucent All Commercial |
$384.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$678.95
|
| Rate for Payer: Managed Health Services Medicaid |
$104.99
|
| Rate for Payer: MDWise Medicaid |
$104.99
|
| Rate for Payer: PHCS All Commercial |
$565.79
|
| Rate for Payer: PHP All Commercial |
$572.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$294.21
|
| Rate for Payer: Sagamore Health Network All Products |
$582.39
|
| Rate for Payer: Signature Care EPO |
$626.15
|
| Rate for Payer: Signature Care PPO |
$663.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$641.23
|
| Rate for Payer: United Healthcare Commercial |
$594.46
|
| Rate for Payer: United Healthcare Medicare |
$248.95
|
|
|
HC DEXA-BONE MINERAL ANALYSIS
|
Facility
IP
|
$754.39
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
00740063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$565.79 |
| Max. Negotiated Rate |
$701.58 |
| Rate for Payer: Aetna Commercial |
$651.79
|
| Rate for Payer: Cash Price |
$467.72
|
| Rate for Payer: Cigna All Commercial |
$651.04
|
| Rate for Payer: CORVEL All Commercial |
$701.58
|
| Rate for Payer: Coventry All Commercial |
$663.86
|
| Rate for Payer: Encore All Commercial |
$694.42
|
| Rate for Payer: Frontpath All Commercial |
$694.04
|
| Rate for Payer: Humana ChoiceCare |
$651.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$678.95
|
| Rate for Payer: PHCS All Commercial |
$565.79
|
| Rate for Payer: PHP All Commercial |
$572.13
|
| Rate for Payer: Sagamore Health Network All Products |
$582.39
|
| Rate for Payer: Signature Care EPO |
$626.15
|
| Rate for Payer: Signature Care PPO |
$663.86
|
| Rate for Payer: United Healthcare Commercial |
$594.46
|
|
|
HC DEXAMETHASONE AM
|
Facility
OP
|
$185.60
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001503
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$172.61 |
| Rate for Payer: Aetna Commercial |
$156.65
|
| Rate for Payer: Aetna Medicare |
$61.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.37
|
| Rate for Payer: Cash Price |
$115.07
|
| Rate for Payer: Cash Price |
$115.07
|
| Rate for Payer: Centivo All Commercial |
$94.66
|
| Rate for Payer: Cigna All Commercial |
$160.17
|
| Rate for Payer: CORVEL All Commercial |
$172.61
|
| Rate for Payer: Coventry All Commercial |
$163.33
|
| Rate for Payer: Encore All Commercial |
$170.84
|
| Rate for Payer: Frontpath All Commercial |
$170.75
|
| Rate for Payer: Humana ChoiceCare |
$160.30
|
| Rate for Payer: Humana Medicare |
$94.66
|
| Rate for Payer: Lucent All Commercial |
$94.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.04
|
| Rate for Payer: Managed Health Services Medicaid |
$16.30
|
| Rate for Payer: MDWise Medicaid |
$16.30
|
| Rate for Payer: PHCS All Commercial |
$139.20
|
| Rate for Payer: PHP All Commercial |
$140.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.38
|
| Rate for Payer: Sagamore Health Network All Products |
$143.28
|
| Rate for Payer: Signature Care EPO |
$154.05
|
| Rate for Payer: Signature Care PPO |
$163.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.76
|
| Rate for Payer: United Healthcare Commercial |
$146.25
|
| Rate for Payer: United Healthcare Medicare |
$61.25
|
|
|
HC DEXAMETHASONE AM
|
Facility
IP
|
$185.60
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001503
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$172.61 |
| Rate for Payer: Aetna Commercial |
$160.36
|
| Rate for Payer: Cash Price |
$115.07
|
| Rate for Payer: Cigna All Commercial |
$160.17
|
| Rate for Payer: CORVEL All Commercial |
$172.61
|
| Rate for Payer: Coventry All Commercial |
$163.33
|
| Rate for Payer: Encore All Commercial |
$170.84
|
| Rate for Payer: Frontpath All Commercial |
$170.75
|
| Rate for Payer: Humana ChoiceCare |
$160.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.04
|
| Rate for Payer: PHCS All Commercial |
$139.20
|
| Rate for Payer: PHP All Commercial |
$140.76
|
| Rate for Payer: Sagamore Health Network All Products |
$143.28
|
| Rate for Payer: Signature Care EPO |
$154.05
|
| Rate for Payer: Signature Care PPO |
$163.33
|
| Rate for Payer: United Healthcare Commercial |
$146.25
|
|
|
HC DEXAMETHASONE PM
|
Facility
OP
|
$185.60
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$172.61 |
| Rate for Payer: Aetna Commercial |
$156.65
|
| Rate for Payer: Aetna Medicare |
$61.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.37
|
| Rate for Payer: Cash Price |
$115.07
|
| Rate for Payer: Cash Price |
$115.07
|
| Rate for Payer: Centivo All Commercial |
$94.66
|
| Rate for Payer: Cigna All Commercial |
$160.17
|
| Rate for Payer: CORVEL All Commercial |
$172.61
|
| Rate for Payer: Coventry All Commercial |
$163.33
|
| Rate for Payer: Encore All Commercial |
$170.84
|
| Rate for Payer: Frontpath All Commercial |
$170.75
|
| Rate for Payer: Humana ChoiceCare |
$160.30
|
| Rate for Payer: Humana Medicare |
$94.66
|
| Rate for Payer: Lucent All Commercial |
$94.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.04
|
| Rate for Payer: Managed Health Services Medicaid |
$16.30
|
| Rate for Payer: MDWise Medicaid |
$16.30
|
| Rate for Payer: PHCS All Commercial |
$139.20
|
| Rate for Payer: PHP All Commercial |
$140.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.38
|
| Rate for Payer: Sagamore Health Network All Products |
$143.28
|
| Rate for Payer: Signature Care EPO |
$154.05
|
| Rate for Payer: Signature Care PPO |
$163.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.76
|
| Rate for Payer: United Healthcare Commercial |
$146.25
|
| Rate for Payer: United Healthcare Medicare |
$61.25
|
|
|
HC DEXAMETHASONE PM
|
Facility
IP
|
$185.60
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$172.61 |
| Rate for Payer: Aetna Commercial |
$160.36
|
| Rate for Payer: Cash Price |
$115.07
|
| Rate for Payer: Cigna All Commercial |
$160.17
|
| Rate for Payer: CORVEL All Commercial |
$172.61
|
| Rate for Payer: Coventry All Commercial |
$163.33
|
| Rate for Payer: Encore All Commercial |
$170.84
|
| Rate for Payer: Frontpath All Commercial |
$170.75
|
| Rate for Payer: Humana ChoiceCare |
$160.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.04
|
| Rate for Payer: PHCS All Commercial |
$139.20
|
| Rate for Payer: PHP All Commercial |
$140.76
|
| Rate for Payer: Sagamore Health Network All Products |
$143.28
|
| Rate for Payer: Signature Care EPO |
$154.05
|
| Rate for Payer: Signature Care PPO |
$163.33
|
| Rate for Payer: United Healthcare Commercial |
$146.25
|
|
|
HC DEXAMETHASONE-SINGLE LEVEL
|
Facility
OP
|
$169.28
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$157.43 |
| Rate for Payer: Aetna Commercial |
$142.87
|
| Rate for Payer: Aetna Medicare |
$55.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.45
|
| Rate for Payer: Cash Price |
$104.95
|
| Rate for Payer: Cash Price |
$104.95
|
| Rate for Payer: Centivo All Commercial |
$86.33
|
| Rate for Payer: Cigna All Commercial |
$146.09
|
| Rate for Payer: CORVEL All Commercial |
$157.43
|
| Rate for Payer: Coventry All Commercial |
$148.97
|
| Rate for Payer: Encore All Commercial |
$155.82
|
| Rate for Payer: Frontpath All Commercial |
$155.74
|
| Rate for Payer: Humana ChoiceCare |
$146.21
|
| Rate for Payer: Humana Medicare |
$86.33
|
| Rate for Payer: Lucent All Commercial |
$86.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.35
|
| Rate for Payer: Managed Health Services Medicaid |
$16.30
|
| Rate for Payer: MDWise Medicaid |
$16.30
|
| Rate for Payer: PHCS All Commercial |
$126.96
|
| Rate for Payer: PHP All Commercial |
$128.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.02
|
| Rate for Payer: Sagamore Health Network All Products |
$130.68
|
| Rate for Payer: Signature Care EPO |
$140.50
|
| Rate for Payer: Signature Care PPO |
$148.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.89
|
| Rate for Payer: United Healthcare Commercial |
$133.39
|
| Rate for Payer: United Healthcare Medicare |
$55.86
|
|
|
HC DEXAMETHASONE-SINGLE LEVEL
|
Facility
IP
|
$169.28
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.96 |
| Max. Negotiated Rate |
$157.43 |
| Rate for Payer: Aetna Commercial |
$146.26
|
| Rate for Payer: Cash Price |
$104.95
|
| Rate for Payer: Cigna All Commercial |
$146.09
|
| Rate for Payer: CORVEL All Commercial |
$157.43
|
| Rate for Payer: Coventry All Commercial |
$148.97
|
| Rate for Payer: Encore All Commercial |
$155.82
|
| Rate for Payer: Frontpath All Commercial |
$155.74
|
| Rate for Payer: Humana ChoiceCare |
$146.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.35
|
| Rate for Payer: PHCS All Commercial |
$126.96
|
| Rate for Payer: PHP All Commercial |
$128.38
|
| Rate for Payer: Sagamore Health Network All Products |
$130.68
|
| Rate for Payer: Signature Care EPO |
$140.50
|
| Rate for Payer: Signature Care PPO |
$148.97
|
| Rate for Payer: United Healthcare Commercial |
$133.39
|
|
|
HC DHEA
|
Facility
OP
|
$396.07
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
63001528
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$368.34 |
| Rate for Payer: Aetna Commercial |
$334.28
|
| Rate for Payer: Aetna Medicare |
$130.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$227.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$247.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.77
|
| Rate for Payer: Cash Price |
$245.56
|
| Rate for Payer: Cash Price |
$245.56
|
| Rate for Payer: Centivo All Commercial |
$201.99
|
| Rate for Payer: Cigna All Commercial |
$341.80
|
| Rate for Payer: CORVEL All Commercial |
$368.34
|
| Rate for Payer: Coventry All Commercial |
$348.54
|
| Rate for Payer: Encore All Commercial |
$364.58
|
| Rate for Payer: Frontpath All Commercial |
$364.38
|
| Rate for Payer: Humana ChoiceCare |
$342.08
|
| Rate for Payer: Humana Medicare |
$201.99
|
| Rate for Payer: Lucent All Commercial |
$201.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$356.46
|
| Rate for Payer: Managed Health Services Medicaid |
$25.27
|
| Rate for Payer: MDWise Medicaid |
$25.27
|
| Rate for Payer: PHCS All Commercial |
$297.05
|
| Rate for Payer: PHP All Commercial |
$300.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.47
|
| Rate for Payer: Sagamore Health Network All Products |
$305.76
|
| Rate for Payer: Signature Care EPO |
$328.73
|
| Rate for Payer: Signature Care PPO |
$348.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$336.66
|
| Rate for Payer: United Healthcare Commercial |
$312.10
|
| Rate for Payer: United Healthcare Medicare |
$130.70
|
|
