|
HC BLANKET BAIR HUGGER UPPER BODY
|
Facility
|
OP
|
$43.18
|
|
| Hospital Charge Code |
41604333
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$40.16 |
| Rate for Payer: Aetna Commercial |
$36.44
|
| Rate for Payer: Aetna Medicare |
$13.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Centivo All Commercial |
$23.49
|
| Rate for Payer: Cigna All Commercial |
$37.26
|
| Rate for Payer: CORVEL All Commercial |
$40.16
|
| Rate for Payer: Coventry All Commercial |
$38.00
|
| Rate for Payer: Encore All Commercial |
$39.75
|
| Rate for Payer: Frontpath All Commercial |
$39.73
|
| Rate for Payer: Humana ChoiceCare |
$37.29
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: Lucent All Commercial |
$23.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.86
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$32.38
|
| Rate for Payer: PHP All Commercial |
$32.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.84
|
| Rate for Payer: Sagamore Health Network All Products |
$33.33
|
| Rate for Payer: Signature Care EPO |
$35.84
|
| Rate for Payer: Signature Care PPO |
$38.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.70
|
| Rate for Payer: United Healthcare Commercial |
$34.03
|
| Rate for Payer: United Healthcare Medicare |
$13.82
|
|
|
HC BLANKET BAIR HUGGER UPPER BODY
|
Facility
|
IP
|
$43.18
|
|
| Hospital Charge Code |
41604333
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$40.16 |
| Rate for Payer: Aetna Commercial |
$37.31
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Cigna All Commercial |
$37.26
|
| Rate for Payer: CORVEL All Commercial |
$40.16
|
| Rate for Payer: Coventry All Commercial |
$38.00
|
| Rate for Payer: Encore All Commercial |
$39.75
|
| Rate for Payer: Frontpath All Commercial |
$39.73
|
| Rate for Payer: Humana ChoiceCare |
$37.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.86
|
| Rate for Payer: PHCS All Commercial |
$32.38
|
| Rate for Payer: PHP All Commercial |
$32.75
|
| Rate for Payer: Sagamore Health Network All Products |
$33.33
|
| Rate for Payer: Signature Care EPO |
$35.84
|
| Rate for Payer: Signature Care PPO |
$38.00
|
| Rate for Payer: United Healthcare Commercial |
$34.03
|
|
|
HC BLANKET HYPOTHERMIA
|
Facility
|
OP
|
$91.21
|
|
| Hospital Charge Code |
41601010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$84.83 |
| Rate for Payer: Aetna Commercial |
$76.98
|
| Rate for Payer: Aetna Medicare |
$29.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.11
|
| Rate for Payer: Cash Price |
$54.73
|
| Rate for Payer: Cash Price |
$54.73
|
| Rate for Payer: Centivo All Commercial |
$49.62
|
| Rate for Payer: Cigna All Commercial |
$78.71
|
| Rate for Payer: CORVEL All Commercial |
$84.83
|
| Rate for Payer: Coventry All Commercial |
$80.26
|
| Rate for Payer: Encore All Commercial |
$83.96
|
| Rate for Payer: Frontpath All Commercial |
$83.91
|
| Rate for Payer: Humana ChoiceCare |
$78.78
|
| Rate for Payer: Humana Medicare |
$29.19
|
| Rate for Payer: Lucent All Commercial |
$49.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.09
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$68.41
|
| Rate for Payer: PHP All Commercial |
$69.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.57
|
| Rate for Payer: Sagamore Health Network All Products |
$70.41
|
| Rate for Payer: Signature Care EPO |
$75.70
|
| Rate for Payer: Signature Care PPO |
$80.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.53
|
| Rate for Payer: United Healthcare Commercial |
$71.87
|
| Rate for Payer: United Healthcare Medicare |
$29.19
|
|
|
HC BLANKET HYPOTHERMIA
|
Facility
|
IP
|
$91.21
|
|
| Hospital Charge Code |
41601010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.41 |
| Max. Negotiated Rate |
$84.83 |
| Rate for Payer: Aetna Commercial |
$78.81
|
| Rate for Payer: Cash Price |
$54.73
|
| Rate for Payer: Cigna All Commercial |
$78.71
|
| Rate for Payer: CORVEL All Commercial |
$84.83
|
| Rate for Payer: Coventry All Commercial |
$80.26
|
| Rate for Payer: Encore All Commercial |
$83.96
|
| Rate for Payer: Frontpath All Commercial |
$83.91
|
| Rate for Payer: Humana ChoiceCare |
$78.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.09
|
| Rate for Payer: PHCS All Commercial |
$68.41
|
| Rate for Payer: PHP All Commercial |
$69.17
|
| Rate for Payer: Sagamore Health Network All Products |
$70.41
|
| Rate for Payer: Signature Care EPO |
$75.70
|
| Rate for Payer: Signature Care PPO |
$80.26
|
| Rate for Payer: United Healthcare Commercial |
$71.87
|
|
|
HC BLANKET MULTI ACCESS
|
Facility
|
OP
|
$31.29
|
|
| Hospital Charge Code |
41601877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Centivo All Commercial |
$17.02
|
| Rate for Payer: Cigna All Commercial |
$27.00
|
| Rate for Payer: CORVEL All Commercial |
$29.10
|
| Rate for Payer: Coventry All Commercial |
$27.54
|
| Rate for Payer: Encore All Commercial |
$28.80
|
| Rate for Payer: Frontpath All Commercial |
$28.79
|
| Rate for Payer: Humana ChoiceCare |
$27.03
|
| Rate for Payer: Humana Medicare |
$10.01
|
| Rate for Payer: Lucent All Commercial |
$17.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.16
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$23.47
|
| Rate for Payer: PHP All Commercial |
$23.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.20
|
| Rate for Payer: Sagamore Health Network All Products |
$24.16
|
| Rate for Payer: Signature Care EPO |
$25.97
|
| Rate for Payer: Signature Care PPO |
$27.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.60
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
| Rate for Payer: United Healthcare Medicare |
$10.01
|
|
|
HC BLANKET MULTI ACCESS
|
Facility
|
IP
|
$31.29
|
|
| Hospital Charge Code |
41601877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Aetna Commercial |
$27.03
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cigna All Commercial |
$27.00
|
| Rate for Payer: CORVEL All Commercial |
$29.10
|
| Rate for Payer: Coventry All Commercial |
$27.54
|
| Rate for Payer: Encore All Commercial |
$28.80
|
| Rate for Payer: Frontpath All Commercial |
$28.79
|
| Rate for Payer: Humana ChoiceCare |
$27.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.16
|
| Rate for Payer: PHCS All Commercial |
$23.47
|
| Rate for Payer: PHP All Commercial |
$23.73
|
| Rate for Payer: Sagamore Health Network All Products |
$24.16
|
| Rate for Payer: Signature Care EPO |
$25.97
|
| Rate for Payer: Signature Care PPO |
$27.54
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
|
|
HC BLASTOMYCES AB - CF
|
Facility
|
OP
|
$125.66
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
63001922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$116.86 |
| Rate for Payer: Aetna Commercial |
$106.06
|
| Rate for Payer: Aetna Medicare |
$40.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$57.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.23
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Centivo All Commercial |
$68.36
|
| Rate for Payer: Cigna All Commercial |
$108.44
|
| Rate for Payer: CORVEL All Commercial |
$116.86
|
| Rate for Payer: Coventry All Commercial |
$110.58
|
| Rate for Payer: Encore All Commercial |
$115.67
|
| Rate for Payer: Frontpath All Commercial |
$115.61
|
| Rate for Payer: Humana ChoiceCare |
$108.53
|
| Rate for Payer: Humana Medicare |
$40.21
|
| Rate for Payer: Lucent All Commercial |
$68.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.09
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: MDWise Medicaid |
$12.90
|
| Rate for Payer: PHCS All Commercial |
$94.25
|
| Rate for Payer: PHP All Commercial |
$95.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.01
|
| Rate for Payer: Sagamore Health Network All Products |
$97.01
|
| Rate for Payer: Signature Care EPO |
$104.30
|
| Rate for Payer: Signature Care PPO |
$110.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.81
|
| Rate for Payer: United Healthcare Commercial |
$99.02
|
| Rate for Payer: United Healthcare Medicare |
$40.21
|
|
|
HC BLASTOMYCES AB - CF
|
Facility
|
IP
|
$125.66
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
63001922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$116.86 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cigna All Commercial |
$108.44
|
| Rate for Payer: CORVEL All Commercial |
$116.86
|
| Rate for Payer: Coventry All Commercial |
$110.58
|
| Rate for Payer: Encore All Commercial |
$115.67
|
| Rate for Payer: Frontpath All Commercial |
$115.61
|
| Rate for Payer: Humana ChoiceCare |
$108.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.09
|
| Rate for Payer: PHCS All Commercial |
$94.25
|
| Rate for Payer: PHP All Commercial |
$95.30
|
| Rate for Payer: Sagamore Health Network All Products |
$97.01
|
| Rate for Payer: Signature Care EPO |
$104.30
|
| Rate for Payer: Signature Care PPO |
$110.58
|
| Rate for Payer: United Healthcare Commercial |
$99.02
|
|
|
HC BLASTOMYCES QUANTITATIVE ANTIGEN BY EIA (MIRAVISTA)
|
Facility
|
OP
|
$187.81
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
63044066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$174.66 |
| Rate for Payer: Aetna Commercial |
$158.51
|
| Rate for Payer: Aetna Medicare |
$60.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.11
|
| Rate for Payer: Cash Price |
$112.69
|
| Rate for Payer: Cash Price |
$112.69
|
| Rate for Payer: Centivo All Commercial |
$102.17
|
| Rate for Payer: Cigna All Commercial |
$162.08
|
| Rate for Payer: CORVEL All Commercial |
$174.66
|
| Rate for Payer: Coventry All Commercial |
$165.27
|
| Rate for Payer: Encore All Commercial |
$172.88
|
| Rate for Payer: Frontpath All Commercial |
$172.79
|
| Rate for Payer: Humana ChoiceCare |
$162.21
|
| Rate for Payer: Humana Medicare |
$60.10
|
| Rate for Payer: Lucent All Commercial |
$102.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.03
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$140.86
|
| Rate for Payer: PHP All Commercial |
$142.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.25
|
| Rate for Payer: Sagamore Health Network All Products |
$144.99
|
| Rate for Payer: Signature Care EPO |
$155.88
|
| Rate for Payer: Signature Care PPO |
$165.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.64
|
| Rate for Payer: United Healthcare Commercial |
$147.99
|
| Rate for Payer: United Healthcare Medicare |
$60.10
|
|
|
HC BLASTOMYCES QUANTITATIVE ANTIGEN BY EIA (MIRAVISTA)
|
Facility
|
IP
|
$187.81
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
63044066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.86 |
| Max. Negotiated Rate |
$174.66 |
| Rate for Payer: Aetna Commercial |
$162.27
|
| Rate for Payer: Cash Price |
$112.69
|
| Rate for Payer: Cigna All Commercial |
$162.08
|
| Rate for Payer: CORVEL All Commercial |
$174.66
|
| Rate for Payer: Coventry All Commercial |
$165.27
|
| Rate for Payer: Encore All Commercial |
$172.88
|
| Rate for Payer: Frontpath All Commercial |
$172.79
|
| Rate for Payer: Humana ChoiceCare |
$162.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.03
|
| Rate for Payer: PHCS All Commercial |
$140.86
|
| Rate for Payer: PHP All Commercial |
$142.44
|
| Rate for Payer: Sagamore Health Network All Products |
$144.99
|
| Rate for Payer: Signature Care EPO |
$155.88
|
| Rate for Payer: Signature Care PPO |
$165.27
|
| Rate for Payer: United Healthcare Commercial |
$147.99
|
|
|
HC BLOOD CULTURE
|
Facility
|
IP
|
$268.16
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
63001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.12 |
| Max. Negotiated Rate |
$249.39 |
| Rate for Payer: Aetna Commercial |
$231.69
|
| Rate for Payer: Cash Price |
$160.90
|
| Rate for Payer: Cigna All Commercial |
$231.42
|
| Rate for Payer: CORVEL All Commercial |
$249.39
|
| Rate for Payer: Coventry All Commercial |
$235.98
|
| Rate for Payer: Encore All Commercial |
$246.84
|
| Rate for Payer: Frontpath All Commercial |
$246.71
|
| Rate for Payer: Humana ChoiceCare |
$231.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.34
|
| Rate for Payer: PHCS All Commercial |
$201.12
|
| Rate for Payer: PHP All Commercial |
$203.37
|
| Rate for Payer: Sagamore Health Network All Products |
$207.02
|
| Rate for Payer: Signature Care EPO |
$222.57
|
| Rate for Payer: Signature Care PPO |
$235.98
|
| Rate for Payer: United Healthcare Commercial |
$211.31
|
|
|
HC BLOOD CULTURE
|
Facility
|
OP
|
$268.16
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
63001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$249.39 |
| Rate for Payer: Aetna Commercial |
$226.33
|
| Rate for Payer: Aetna Medicare |
$85.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$123.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.39
|
| Rate for Payer: Cash Price |
$160.90
|
| Rate for Payer: Cash Price |
$160.90
|
| Rate for Payer: Centivo All Commercial |
$145.88
|
| Rate for Payer: Cigna All Commercial |
$231.42
|
| Rate for Payer: CORVEL All Commercial |
$249.39
|
| Rate for Payer: Coventry All Commercial |
$235.98
|
| Rate for Payer: Encore All Commercial |
$246.84
|
| Rate for Payer: Frontpath All Commercial |
$246.71
|
| Rate for Payer: Humana ChoiceCare |
$231.61
|
| Rate for Payer: Humana Medicare |
$85.81
|
| Rate for Payer: Lucent All Commercial |
$145.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.34
|
| Rate for Payer: Managed Health Services Medicaid |
$10.32
|
| Rate for Payer: MDWise Medicaid |
$10.32
|
| Rate for Payer: PHCS All Commercial |
$201.12
|
| Rate for Payer: PHP All Commercial |
$203.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.58
|
| Rate for Payer: Sagamore Health Network All Products |
$207.02
|
| Rate for Payer: Signature Care EPO |
$222.57
|
| Rate for Payer: Signature Care PPO |
$235.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$227.94
|
| Rate for Payer: United Healthcare Commercial |
$211.31
|
| Rate for Payer: United Healthcare Medicare |
$85.81
|
|
|
HC BLOOD TRANSFUSION
|
Facility
|
OP
|
$1,626.02
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
526435
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$98.31 |
| Max. Negotiated Rate |
$1,512.20 |
| Rate for Payer: Aetna Commercial |
$1,372.36
|
| Rate for Payer: Aetna Medicare |
$520.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$98.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$504.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$933.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,016.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$598.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$572.36
|
| Rate for Payer: Cash Price |
$975.61
|
| Rate for Payer: Cash Price |
$975.61
|
| Rate for Payer: Centivo All Commercial |
$884.55
|
| Rate for Payer: Cigna All Commercial |
$1,403.26
|
| Rate for Payer: CORVEL All Commercial |
$1,512.20
|
| Rate for Payer: Coventry All Commercial |
$1,430.90
|
| Rate for Payer: Encore All Commercial |
$1,496.75
|
| Rate for Payer: Frontpath All Commercial |
$1,495.94
|
| Rate for Payer: Humana ChoiceCare |
$1,404.39
|
| Rate for Payer: Humana Medicare |
$520.33
|
| Rate for Payer: Lucent All Commercial |
$884.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,463.42
|
| Rate for Payer: Managed Health Services Medicaid |
$98.31
|
| Rate for Payer: MDWise Medicaid |
$98.31
|
| Rate for Payer: PHCS All Commercial |
$1,219.52
|
| Rate for Payer: PHP All Commercial |
$1,233.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$634.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,255.29
|
| Rate for Payer: Signature Care EPO |
$1,349.60
|
| Rate for Payer: Signature Care PPO |
$1,430.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,382.12
|
| Rate for Payer: United Healthcare Commercial |
$1,281.30
|
| Rate for Payer: United Healthcare Medicare |
$520.33
|
|
|
HC BLOOD TRANSFUSION
|
Facility
|
IP
|
$1,626.02
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
526435
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1,219.52 |
| Max. Negotiated Rate |
$1,512.20 |
| Rate for Payer: Aetna Commercial |
$1,404.88
|
| Rate for Payer: Cash Price |
$975.61
|
| Rate for Payer: Cigna All Commercial |
$1,403.26
|
| Rate for Payer: CORVEL All Commercial |
$1,512.20
|
| Rate for Payer: Coventry All Commercial |
$1,430.90
|
| Rate for Payer: Encore All Commercial |
$1,496.75
|
| Rate for Payer: Frontpath All Commercial |
$1,495.94
|
| Rate for Payer: Humana ChoiceCare |
$1,404.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,463.42
|
| Rate for Payer: PHCS All Commercial |
$1,219.52
|
| Rate for Payer: PHP All Commercial |
$1,233.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,255.29
|
| Rate for Payer: Signature Care EPO |
$1,349.60
|
| Rate for Payer: Signature Care PPO |
$1,430.90
|
| Rate for Payer: United Healthcare Commercial |
$1,281.30
|
|
|
HC BLOOD TYPING ABO
|
Facility
|
IP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
|
|
HC BLOOD TYPING ABO
|
Facility
|
OP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$71.38
|
| Rate for Payer: Aetna Medicare |
$27.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.77
|
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: Centivo All Commercial |
$46.01
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Humana Medicare |
$27.06
|
| Rate for Payer: Lucent All Commercial |
$46.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: Managed Health Services Medicaid |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.98
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.88
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
| Rate for Payer: United Healthcare Medicare |
$27.06
|
|
|
HC B NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$326.70
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
63001147
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$303.83 |
| Rate for Payer: Aetna Commercial |
$275.73
|
| Rate for Payer: Aetna Medicare |
$104.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$39.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$39.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.00
|
| Rate for Payer: Cash Price |
$196.02
|
| Rate for Payer: Cash Price |
$196.02
|
| Rate for Payer: Centivo All Commercial |
$177.72
|
| Rate for Payer: Cigna All Commercial |
$281.94
|
| Rate for Payer: CORVEL All Commercial |
$303.83
|
| Rate for Payer: Coventry All Commercial |
$287.50
|
| Rate for Payer: Encore All Commercial |
$300.73
|
| Rate for Payer: Frontpath All Commercial |
$300.56
|
| Rate for Payer: Humana ChoiceCare |
$282.17
|
| Rate for Payer: Humana Medicare |
$104.54
|
| Rate for Payer: Lucent All Commercial |
$177.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.03
|
| Rate for Payer: Managed Health Services Medicaid |
$39.26
|
| Rate for Payer: MDWise Medicaid |
$39.26
|
| Rate for Payer: PHCS All Commercial |
$245.03
|
| Rate for Payer: PHP All Commercial |
$247.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.41
|
| Rate for Payer: Sagamore Health Network All Products |
$252.21
|
| Rate for Payer: Signature Care EPO |
$271.16
|
| Rate for Payer: Signature Care PPO |
$287.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$277.69
|
| Rate for Payer: United Healthcare Commercial |
$257.44
|
| Rate for Payer: United Healthcare Medicare |
$104.54
|
|
|
HC B NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$326.70
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
63001147
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.03 |
| Max. Negotiated Rate |
$303.83 |
| Rate for Payer: Aetna Commercial |
$282.27
|
| Rate for Payer: Cash Price |
$196.02
|
| Rate for Payer: Cigna All Commercial |
$281.94
|
| Rate for Payer: CORVEL All Commercial |
$303.83
|
| Rate for Payer: Coventry All Commercial |
$287.50
|
| Rate for Payer: Encore All Commercial |
$300.73
|
| Rate for Payer: Frontpath All Commercial |
$300.56
|
| Rate for Payer: Humana ChoiceCare |
$282.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.03
|
| Rate for Payer: PHCS All Commercial |
$245.03
|
| Rate for Payer: PHP All Commercial |
$247.77
|
| Rate for Payer: Sagamore Health Network All Products |
$252.21
|
| Rate for Payer: Signature Care EPO |
$271.16
|
| Rate for Payer: Signature Care PPO |
$287.50
|
| Rate for Payer: United Healthcare Commercial |
$257.44
|
|
|
HC BONE BX SYSTEM 13G.6
|
Facility
|
IP
|
$810.00
|
|
| Hospital Charge Code |
41607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$607.50 |
| Max. Negotiated Rate |
$753.30 |
| Rate for Payer: Aetna Commercial |
$699.84
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna All Commercial |
$699.03
|
| Rate for Payer: CORVEL All Commercial |
$753.30
|
| Rate for Payer: Coventry All Commercial |
$712.80
|
| Rate for Payer: Encore All Commercial |
$745.61
|
| Rate for Payer: Frontpath All Commercial |
$745.20
|
| Rate for Payer: Humana ChoiceCare |
$699.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$729.00
|
| Rate for Payer: PHCS All Commercial |
$607.50
|
| Rate for Payer: PHP All Commercial |
$614.30
|
| Rate for Payer: Sagamore Health Network All Products |
$625.32
|
| Rate for Payer: Signature Care EPO |
$672.30
|
| Rate for Payer: Signature Care PPO |
$712.80
|
| Rate for Payer: United Healthcare Commercial |
$638.28
|
|
|
HC BONE BX SYSTEM 13G.6
|
Facility
|
OP
|
$810.00
|
|
| Hospital Charge Code |
41607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$753.30 |
| Rate for Payer: Aetna Commercial |
$683.64
|
| Rate for Payer: Aetna Medicare |
$259.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$465.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$506.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$298.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$285.12
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Centivo All Commercial |
$440.64
|
| Rate for Payer: Cigna All Commercial |
$699.03
|
| Rate for Payer: CORVEL All Commercial |
$753.30
|
| Rate for Payer: Coventry All Commercial |
$712.80
|
| Rate for Payer: Encore All Commercial |
$745.61
|
| Rate for Payer: Frontpath All Commercial |
$745.20
|
| Rate for Payer: Humana ChoiceCare |
$699.60
|
| Rate for Payer: Humana Medicare |
$259.20
|
| Rate for Payer: Lucent All Commercial |
$440.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$729.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$607.50
|
| Rate for Payer: PHP All Commercial |
$614.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$315.90
|
| Rate for Payer: Sagamore Health Network All Products |
$625.32
|
| Rate for Payer: Signature Care EPO |
$672.30
|
| Rate for Payer: Signature Care PPO |
$712.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$688.50
|
| Rate for Payer: United Healthcare Commercial |
$638.28
|
| Rate for Payer: United Healthcare Medicare |
$259.20
|
|
|
HC BONE IMAGING (SPECT)
|
Facility
|
IP
|
$1,786.18
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
1638320
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,339.63 |
| Max. Negotiated Rate |
$1,661.15 |
| Rate for Payer: Aetna Commercial |
$1,543.26
|
| Rate for Payer: Cash Price |
$1,071.71
|
| Rate for Payer: Cigna All Commercial |
$1,541.47
|
| Rate for Payer: CORVEL All Commercial |
$1,661.15
|
| Rate for Payer: Coventry All Commercial |
$1,571.84
|
| Rate for Payer: Encore All Commercial |
$1,644.18
|
| Rate for Payer: Frontpath All Commercial |
$1,643.29
|
| Rate for Payer: Humana ChoiceCare |
$1,542.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,607.56
|
| Rate for Payer: PHCS All Commercial |
$1,339.63
|
| Rate for Payer: PHP All Commercial |
$1,354.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.93
|
| Rate for Payer: Signature Care EPO |
$1,482.53
|
| Rate for Payer: Signature Care PPO |
$1,571.84
|
| Rate for Payer: United Healthcare Commercial |
$1,407.51
|
|
|
HC BONE IMAGING (SPECT)
|
Facility
|
OP
|
$1,786.18
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
1638320
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.13 |
| Max. Negotiated Rate |
$1,661.15 |
| Rate for Payer: Aetna Commercial |
$1,507.54
|
| Rate for Payer: Aetna Medicare |
$571.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$203.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$553.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,025.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,116.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$203.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$657.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$628.74
|
| Rate for Payer: Cash Price |
$1,071.71
|
| Rate for Payer: Cash Price |
$1,071.71
|
| Rate for Payer: Centivo All Commercial |
$971.68
|
| Rate for Payer: Cigna All Commercial |
$1,541.47
|
| Rate for Payer: CORVEL All Commercial |
$1,661.15
|
| Rate for Payer: Coventry All Commercial |
$1,571.84
|
| Rate for Payer: Encore All Commercial |
$1,644.18
|
| Rate for Payer: Frontpath All Commercial |
$1,643.29
|
| Rate for Payer: Humana ChoiceCare |
$1,542.72
|
| Rate for Payer: Humana Medicare |
$571.58
|
| Rate for Payer: Lucent All Commercial |
$971.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,607.56
|
| Rate for Payer: Managed Health Services Medicaid |
$203.13
|
| Rate for Payer: MDWise Medicaid |
$203.13
|
| Rate for Payer: PHCS All Commercial |
$1,339.63
|
| Rate for Payer: PHP All Commercial |
$1,354.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$696.61
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.93
|
| Rate for Payer: Signature Care EPO |
$1,482.53
|
| Rate for Payer: Signature Care PPO |
$1,571.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,518.25
|
| Rate for Payer: United Healthcare Commercial |
$1,407.51
|
| Rate for Payer: United Healthcare Medicare |
$571.58
|
|
|
HC BONE SCAN - MULTIPLE AREAS
|
Facility
|
OP
|
$1,707.27
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
1638305
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$1,587.76 |
| Rate for Payer: Aetna Commercial |
$1,440.94
|
| Rate for Payer: Aetna Medicare |
$546.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$529.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$980.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,067.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$628.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$600.96
|
| Rate for Payer: Cash Price |
$1,024.36
|
| Rate for Payer: Cash Price |
$1,024.36
|
| Rate for Payer: Centivo All Commercial |
$928.75
|
| Rate for Payer: Cigna All Commercial |
$1,473.37
|
| Rate for Payer: CORVEL All Commercial |
$1,587.76
|
| Rate for Payer: Coventry All Commercial |
$1,502.40
|
| Rate for Payer: Encore All Commercial |
$1,571.54
|
| Rate for Payer: Frontpath All Commercial |
$1,570.69
|
| Rate for Payer: Humana ChoiceCare |
$1,474.57
|
| Rate for Payer: Humana Medicare |
$546.33
|
| Rate for Payer: Lucent All Commercial |
$928.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,536.54
|
| Rate for Payer: Managed Health Services Medicaid |
$134.01
|
| Rate for Payer: MDWise Medicaid |
$134.01
|
| Rate for Payer: PHCS All Commercial |
$1,280.45
|
| Rate for Payer: PHP All Commercial |
$1,294.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$665.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,318.01
|
| Rate for Payer: Signature Care EPO |
$1,417.03
|
| Rate for Payer: Signature Care PPO |
$1,502.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,451.18
|
| Rate for Payer: United Healthcare Commercial |
$1,345.33
|
| Rate for Payer: United Healthcare Medicare |
$546.33
|
|
|
HC BONE SCAN - MULTIPLE AREAS
|
Facility
|
IP
|
$1,707.27
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
1638305
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,280.45 |
| Max. Negotiated Rate |
$1,587.76 |
| Rate for Payer: Aetna Commercial |
$1,475.08
|
| Rate for Payer: Cash Price |
$1,024.36
|
| Rate for Payer: Cigna All Commercial |
$1,473.37
|
| Rate for Payer: CORVEL All Commercial |
$1,587.76
|
| Rate for Payer: Coventry All Commercial |
$1,502.40
|
| Rate for Payer: Encore All Commercial |
$1,571.54
|
| Rate for Payer: Frontpath All Commercial |
$1,570.69
|
| Rate for Payer: Humana ChoiceCare |
$1,474.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,536.54
|
| Rate for Payer: PHCS All Commercial |
$1,280.45
|
| Rate for Payer: PHP All Commercial |
$1,294.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,318.01
|
| Rate for Payer: Signature Care EPO |
$1,417.03
|
| Rate for Payer: Signature Care PPO |
$1,502.40
|
| Rate for Payer: United Healthcare Commercial |
$1,345.33
|
|
|
HC BONE SCAN - SINGLE AREA
|
Facility
|
IP
|
$1,497.45
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
1638300
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,123.09 |
| Max. Negotiated Rate |
$1,392.63 |
| Rate for Payer: Aetna Commercial |
$1,293.80
|
| Rate for Payer: Cash Price |
$898.47
|
| Rate for Payer: Cigna All Commercial |
$1,292.30
|
| Rate for Payer: CORVEL All Commercial |
$1,392.63
|
| Rate for Payer: Coventry All Commercial |
$1,317.76
|
| Rate for Payer: Encore All Commercial |
$1,378.40
|
| Rate for Payer: Frontpath All Commercial |
$1,377.65
|
| Rate for Payer: Humana ChoiceCare |
$1,293.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,347.70
|
| Rate for Payer: PHCS All Commercial |
$1,123.09
|
| Rate for Payer: PHP All Commercial |
$1,135.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.03
|
| Rate for Payer: Signature Care EPO |
$1,242.88
|
| Rate for Payer: Signature Care PPO |
$1,317.76
|
| Rate for Payer: United Healthcare Commercial |
$1,179.99
|
|
