|
HC DRESSING XEROFORM 5X9
|
Facility
OP
|
$6.65
|
|
| Hospital Charge Code |
41603450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.41
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Centivo All Commercial |
$3.39
|
| Rate for Payer: Cigna All Commercial |
$5.74
|
| Rate for Payer: CORVEL All Commercial |
$6.18
|
| Rate for Payer: Coventry All Commercial |
$5.85
|
| Rate for Payer: Encore All Commercial |
$6.12
|
| Rate for Payer: Frontpath All Commercial |
$6.12
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare |
$3.39
|
| Rate for Payer: Lucent All Commercial |
$3.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$4.99
|
| Rate for Payer: PHP All Commercial |
$5.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.59
|
| Rate for Payer: Sagamore Health Network All Products |
$5.13
|
| Rate for Payer: Signature Care EPO |
$5.52
|
| Rate for Payer: Signature Care PPO |
$5.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.65
|
| Rate for Payer: United Healthcare Commercial |
$5.24
|
| Rate for Payer: United Healthcare Medicare |
$2.19
|
|
|
HC DRILL BIT 1.7 MM ACFS
|
Facility
OP
|
$608.30
|
|
| Hospital Charge Code |
41601269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$565.72 |
| Rate for Payer: Aetna Commercial |
$513.41
|
| Rate for Payer: Aetna Medicare |
$200.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$349.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$380.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.81
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Centivo All Commercial |
$310.23
|
| Rate for Payer: Cigna All Commercial |
$524.96
|
| Rate for Payer: CORVEL All Commercial |
$565.72
|
| Rate for Payer: Coventry All Commercial |
$535.30
|
| Rate for Payer: Encore All Commercial |
$559.94
|
| Rate for Payer: Frontpath All Commercial |
$559.64
|
| Rate for Payer: Humana ChoiceCare |
$525.39
|
| Rate for Payer: Humana Medicare |
$310.23
|
| Rate for Payer: Lucent All Commercial |
$310.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$547.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$456.22
|
| Rate for Payer: PHP All Commercial |
$461.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$237.24
|
| Rate for Payer: Sagamore Health Network All Products |
$469.61
|
| Rate for Payer: Signature Care EPO |
$504.89
|
| Rate for Payer: Signature Care PPO |
$535.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$517.06
|
| Rate for Payer: United Healthcare Commercial |
$479.34
|
| Rate for Payer: United Healthcare Medicare |
$200.74
|
|
|
HC DRILL BIT 1.7 MM ACFS
|
Facility
IP
|
$608.30
|
|
| Hospital Charge Code |
41601269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.22 |
| Max. Negotiated Rate |
$565.72 |
| Rate for Payer: Aetna Commercial |
$525.57
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cigna All Commercial |
$524.96
|
| Rate for Payer: CORVEL All Commercial |
$565.72
|
| Rate for Payer: Coventry All Commercial |
$535.30
|
| Rate for Payer: Encore All Commercial |
$559.94
|
| Rate for Payer: Frontpath All Commercial |
$559.64
|
| Rate for Payer: Humana ChoiceCare |
$525.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$547.47
|
| Rate for Payer: PHCS All Commercial |
$456.22
|
| Rate for Payer: PHP All Commercial |
$461.33
|
| Rate for Payer: Sagamore Health Network All Products |
$469.61
|
| Rate for Payer: Signature Care EPO |
$504.89
|
| Rate for Payer: Signature Care PPO |
$535.30
|
| Rate for Payer: United Healthcare Commercial |
$479.34
|
|
|
HC DRILL BIT 2.0 MM (AO) ACFS
|
Facility
OP
|
$654.50
|
|
| Hospital Charge Code |
41601270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$552.40
|
| Rate for Payer: Aetna Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$375.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.58
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Centivo All Commercial |
$333.80
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Humana Medicare |
$333.80
|
| Rate for Payer: Lucent All Commercial |
$333.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.26
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.32
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
| Rate for Payer: United Healthcare Medicare |
$215.98
|
|
|
HC DRILL BIT 2.0 MM (AO) ACFS
|
Facility
IP
|
$654.50
|
|
| Hospital Charge Code |
41601270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$565.49
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
|
|
HC DRILL BIT 2.4 MM ACFS
|
Facility
OP
|
$1,072.50
|
|
| Hospital Charge Code |
41601271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$905.19
|
| Rate for Payer: Aetna Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$670.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$389.32
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Centivo All Commercial |
$546.98
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Humana Medicare |
$546.98
|
| Rate for Payer: Lucent All Commercial |
$546.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$418.28
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$911.62
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
| Rate for Payer: United Healthcare Medicare |
$353.92
|
|
|
HC DRILL BIT 2.4 MM ACFS
|
Facility
IP
|
$1,072.50
|
|
| Hospital Charge Code |
41601271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.38 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$926.64
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
|
|
HC DRILL BIT 2.7 MM MINI MAG
|
Facility
OP
|
$1,260.00
|
|
| Hospital Charge Code |
41601230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,063.44
|
| Rate for Payer: Aetna Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$723.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$787.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$478.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$457.38
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Centivo All Commercial |
$642.60
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Humana Medicare |
$642.60
|
| Rate for Payer: Lucent All Commercial |
$642.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$491.40
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
| Rate for Payer: United Healthcare Medicare |
$415.80
|
|
|
HC DRILL BIT 2.7 MM MINI MAG
|
Facility
IP
|
$1,260.00
|
|
| Hospital Charge Code |
41601230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,088.64
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
|
|
HC DRILL BIT 3.0 MM ACFS
|
Facility
IP
|
$608.30
|
|
| Hospital Charge Code |
41601272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.22 |
| Max. Negotiated Rate |
$565.72 |
| Rate for Payer: Aetna Commercial |
$525.57
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cigna All Commercial |
$524.96
|
| Rate for Payer: CORVEL All Commercial |
$565.72
|
| Rate for Payer: Coventry All Commercial |
$535.30
|
| Rate for Payer: Encore All Commercial |
$559.94
|
| Rate for Payer: Frontpath All Commercial |
$559.64
|
| Rate for Payer: Humana ChoiceCare |
$525.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$547.47
|
| Rate for Payer: PHCS All Commercial |
$456.22
|
| Rate for Payer: PHP All Commercial |
$461.33
|
| Rate for Payer: Sagamore Health Network All Products |
$469.61
|
| Rate for Payer: Signature Care EPO |
$504.89
|
| Rate for Payer: Signature Care PPO |
$535.30
|
| Rate for Payer: United Healthcare Commercial |
$479.34
|
|
|
HC DRILL BIT 3.0 MM ACFS
|
Facility
OP
|
$608.30
|
|
| Hospital Charge Code |
41601272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$565.72 |
| Rate for Payer: Aetna Commercial |
$513.41
|
| Rate for Payer: Aetna Medicare |
$200.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$349.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$380.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.81
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Centivo All Commercial |
$310.23
|
| Rate for Payer: Cigna All Commercial |
$524.96
|
| Rate for Payer: CORVEL All Commercial |
$565.72
|
| Rate for Payer: Coventry All Commercial |
$535.30
|
| Rate for Payer: Encore All Commercial |
$559.94
|
| Rate for Payer: Frontpath All Commercial |
$559.64
|
| Rate for Payer: Humana ChoiceCare |
$525.39
|
| Rate for Payer: Humana Medicare |
$310.23
|
| Rate for Payer: Lucent All Commercial |
$310.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$547.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$456.22
|
| Rate for Payer: PHP All Commercial |
$461.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$237.24
|
| Rate for Payer: Sagamore Health Network All Products |
$469.61
|
| Rate for Payer: Signature Care EPO |
$504.89
|
| Rate for Payer: Signature Care PPO |
$535.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$517.06
|
| Rate for Payer: United Healthcare Commercial |
$479.34
|
| Rate for Payer: United Healthcare Medicare |
$200.74
|
|
|
HC DRILL BIT 3.5 MM MINI MAG
|
Facility
OP
|
$1,260.00
|
|
| Hospital Charge Code |
41601231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,063.44
|
| Rate for Payer: Aetna Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$723.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$787.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$478.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$457.38
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Centivo All Commercial |
$642.60
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Humana Medicare |
$642.60
|
| Rate for Payer: Lucent All Commercial |
$642.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$491.40
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
| Rate for Payer: United Healthcare Medicare |
$415.80
|
|
|
HC DRILL BIT 3.5 MM MINI MAG
|
Facility
IP
|
$1,260.00
|
|
| Hospital Charge Code |
41601231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,088.64
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
|
|
HC DRUG ABUSE CLASS EA-NEC
|
Facility
IP
|
$8.62
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna All Commercial |
$7.44
|
| Rate for Payer: CORVEL All Commercial |
$8.02
|
| Rate for Payer: Coventry All Commercial |
$7.58
|
| Rate for Payer: Encore All Commercial |
$7.93
|
| Rate for Payer: Frontpath All Commercial |
$7.93
|
| Rate for Payer: Humana ChoiceCare |
$7.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.76
|
| Rate for Payer: PHCS All Commercial |
$6.46
|
| Rate for Payer: PHP All Commercial |
$6.54
|
| Rate for Payer: Sagamore Health Network All Products |
$6.65
|
| Rate for Payer: Signature Care EPO |
$7.15
|
| Rate for Payer: Signature Care PPO |
$7.58
|
| Rate for Payer: United Healthcare Commercial |
$6.79
|
|
|
HC DRUG ABUSE CLASS EA-NEC
|
Facility
OP
|
$8.62
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$62.14 |
| Rate for Payer: Aetna Commercial |
$7.27
|
| Rate for Payer: Aetna Medicare |
$2.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.13
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Centivo All Commercial |
$4.40
|
| Rate for Payer: Cigna All Commercial |
$7.44
|
| Rate for Payer: CORVEL All Commercial |
$8.02
|
| Rate for Payer: Coventry All Commercial |
$7.58
|
| Rate for Payer: Encore All Commercial |
$7.93
|
| Rate for Payer: Frontpath All Commercial |
$7.93
|
| Rate for Payer: Humana ChoiceCare |
$7.44
|
| Rate for Payer: Humana Medicare |
$4.40
|
| Rate for Payer: Lucent All Commercial |
$4.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.76
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$6.46
|
| Rate for Payer: PHP All Commercial |
$6.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.36
|
| Rate for Payer: Sagamore Health Network All Products |
$6.65
|
| Rate for Payer: Signature Care EPO |
$7.15
|
| Rate for Payer: Signature Care PPO |
$7.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.33
|
| Rate for Payer: United Healthcare Commercial |
$6.79
|
| Rate for Payer: United Healthcare Medicare |
$2.84
|
|
|
HC DRUG ABUSE SCREEN 10 - URINE RANDOM
|
Facility
IP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$161.48
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.47
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
|
|
HC DRUG ABUSE SCREEN 10 - URINE RANDOM
|
Facility
OP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$157.74
|
| Rate for Payer: Aetna Medicare |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.84
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Centivo All Commercial |
$95.32
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Humana Medicare |
$95.32
|
| Rate for Payer: Lucent All Commercial |
$95.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.89
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.86
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
| Rate for Payer: United Healthcare Medicare |
$61.68
|
|
|
HC DRUG ADMINISTRATION - H. PYLORI TESTING
|
Facility
OP
|
$72.74
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
63001052
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$67.64 |
| Rate for Payer: Aetna Commercial |
$61.39
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Centivo All Commercial |
$37.10
|
| Rate for Payer: Cigna All Commercial |
$62.77
|
| Rate for Payer: CORVEL All Commercial |
$67.64
|
| Rate for Payer: Coventry All Commercial |
$64.01
|
| Rate for Payer: Encore All Commercial |
$66.95
|
| Rate for Payer: Frontpath All Commercial |
$66.92
|
| Rate for Payer: Humana ChoiceCare |
$62.82
|
| Rate for Payer: Humana Medicare |
$37.10
|
| Rate for Payer: Lucent All Commercial |
$37.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.46
|
| Rate for Payer: Managed Health Services Medicaid |
$7.86
|
| Rate for Payer: MDWise Medicaid |
$7.86
|
| Rate for Payer: PHCS All Commercial |
$54.55
|
| Rate for Payer: PHP All Commercial |
$55.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.37
|
| Rate for Payer: Sagamore Health Network All Products |
$56.15
|
| Rate for Payer: Signature Care EPO |
$60.37
|
| Rate for Payer: Signature Care PPO |
$64.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.83
|
| Rate for Payer: United Healthcare Commercial |
$57.32
|
| Rate for Payer: United Healthcare Medicare |
$24.00
|
|
|
HC DRUG ADMINISTRATION - H. PYLORI TESTING
|
Facility
IP
|
$72.74
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
63001052
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$67.64 |
| Rate for Payer: Aetna Commercial |
$62.84
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna All Commercial |
$62.77
|
| Rate for Payer: CORVEL All Commercial |
$67.64
|
| Rate for Payer: Coventry All Commercial |
$64.01
|
| Rate for Payer: Encore All Commercial |
$66.95
|
| Rate for Payer: Frontpath All Commercial |
$66.92
|
| Rate for Payer: Humana ChoiceCare |
$62.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.46
|
| Rate for Payer: PHCS All Commercial |
$54.55
|
| Rate for Payer: PHP All Commercial |
$55.16
|
| Rate for Payer: Sagamore Health Network All Products |
$56.15
|
| Rate for Payer: Signature Care EPO |
$60.37
|
| Rate for Payer: Signature Care PPO |
$64.01
|
| Rate for Payer: United Healthcare Commercial |
$57.32
|
|
|
HC DRUG AEROSOL
|
Facility
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
01706479
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.47
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centivo All Commercial |
$86.36
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Humana Medicare |
$86.36
|
| Rate for Payer: Lucent All Commercial |
$86.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.04
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
| Rate for Payer: United Healthcare Medicare |
$55.88
|
|
|
HC DRUG AEROSOL
|
Facility
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
01706479
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2
|
Facility
OP
|
$196.86
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63080329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$166.15
|
| Rate for Payer: Aetna Medicare |
$64.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.46
|
| Rate for Payer: Cash Price |
$122.05
|
| Rate for Payer: Cash Price |
$122.05
|
| Rate for Payer: Centivo All Commercial |
$100.40
|
| Rate for Payer: Cigna All Commercial |
$169.89
|
| Rate for Payer: CORVEL All Commercial |
$183.08
|
| Rate for Payer: Coventry All Commercial |
$173.24
|
| Rate for Payer: Encore All Commercial |
$181.21
|
| Rate for Payer: Frontpath All Commercial |
$181.11
|
| Rate for Payer: Humana ChoiceCare |
$170.03
|
| Rate for Payer: Humana Medicare |
$100.40
|
| Rate for Payer: Lucent All Commercial |
$100.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.17
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$147.64
|
| Rate for Payer: PHP All Commercial |
$149.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.78
|
| Rate for Payer: Sagamore Health Network All Products |
$151.98
|
| Rate for Payer: Signature Care EPO |
$163.39
|
| Rate for Payer: Signature Care PPO |
$173.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.33
|
| Rate for Payer: United Healthcare Commercial |
$155.13
|
| Rate for Payer: United Healthcare Medicare |
$64.96
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2
|
Facility
IP
|
$196.86
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63080329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.64 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$170.09
|
| Rate for Payer: Cash Price |
$122.05
|
| Rate for Payer: Cigna All Commercial |
$169.89
|
| Rate for Payer: CORVEL All Commercial |
$183.08
|
| Rate for Payer: Coventry All Commercial |
$173.24
|
| Rate for Payer: Encore All Commercial |
$181.21
|
| Rate for Payer: Frontpath All Commercial |
$181.11
|
| Rate for Payer: Humana ChoiceCare |
$170.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.17
|
| Rate for Payer: PHCS All Commercial |
$147.64
|
| Rate for Payer: PHP All Commercial |
$149.30
|
| Rate for Payer: Sagamore Health Network All Products |
$151.98
|
| Rate for Payer: Signature Care EPO |
$163.39
|
| Rate for Payer: Signature Care PPO |
$173.24
|
| Rate for Payer: United Healthcare Commercial |
$155.13
|
|
|
HC DRUG SCREEN - NIDA
|
Facility
OP
|
$69.81
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
63001384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$64.92 |
| Rate for Payer: Aetna Commercial |
$58.92
|
| Rate for Payer: Aetna Medicare |
$23.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.34
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Centivo All Commercial |
$35.60
|
| Rate for Payer: Cigna All Commercial |
$60.24
|
| Rate for Payer: CORVEL All Commercial |
$64.92
|
| Rate for Payer: Coventry All Commercial |
$61.43
|
| Rate for Payer: Encore All Commercial |
$64.26
|
| Rate for Payer: Frontpath All Commercial |
$64.22
|
| Rate for Payer: Humana ChoiceCare |
$60.29
|
| Rate for Payer: Humana Medicare |
$35.60
|
| Rate for Payer: Lucent All Commercial |
$35.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.83
|
| Rate for Payer: Managed Health Services Medicaid |
$12.60
|
| Rate for Payer: MDWise Medicaid |
$12.60
|
| Rate for Payer: PHCS All Commercial |
$52.36
|
| Rate for Payer: PHP All Commercial |
$52.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.23
|
| Rate for Payer: Sagamore Health Network All Products |
$53.89
|
| Rate for Payer: Signature Care EPO |
$57.94
|
| Rate for Payer: Signature Care PPO |
$61.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.34
|
| Rate for Payer: United Healthcare Commercial |
$55.01
|
| Rate for Payer: United Healthcare Medicare |
$23.04
|
|
|
HC DRUG SCREEN - NIDA
|
Facility
IP
|
$69.81
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
63001384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$64.92 |
| Rate for Payer: Aetna Commercial |
$60.31
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cigna All Commercial |
$60.24
|
| Rate for Payer: CORVEL All Commercial |
$64.92
|
| Rate for Payer: Coventry All Commercial |
$61.43
|
| Rate for Payer: Encore All Commercial |
$64.26
|
| Rate for Payer: Frontpath All Commercial |
$64.22
|
| Rate for Payer: Humana ChoiceCare |
$60.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.83
|
| Rate for Payer: PHCS All Commercial |
$52.36
|
| Rate for Payer: PHP All Commercial |
$52.94
|
| Rate for Payer: Sagamore Health Network All Products |
$53.89
|
| Rate for Payer: Signature Care EPO |
$57.94
|
| Rate for Payer: Signature Care PPO |
$61.43
|
| Rate for Payer: United Healthcare Commercial |
$55.01
|
|
