|
HC DRUG SCREEN - RAPID
|
Facility
OP
|
$81.35
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
63001318
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$75.65 |
| Rate for Payer: Aetna Commercial |
$68.66
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.53
|
| Rate for Payer: Cash Price |
$50.43
|
| Rate for Payer: Cash Price |
$50.43
|
| Rate for Payer: Centivo All Commercial |
$41.49
|
| Rate for Payer: Cigna All Commercial |
$70.20
|
| Rate for Payer: CORVEL All Commercial |
$75.65
|
| Rate for Payer: Coventry All Commercial |
$71.58
|
| Rate for Payer: Encore All Commercial |
$74.88
|
| Rate for Payer: Frontpath All Commercial |
$74.84
|
| Rate for Payer: Humana ChoiceCare |
$70.26
|
| Rate for Payer: Humana Medicare |
$41.49
|
| Rate for Payer: Lucent All Commercial |
$41.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.21
|
| Rate for Payer: Managed Health Services Medicaid |
$12.60
|
| Rate for Payer: MDWise Medicaid |
$12.60
|
| Rate for Payer: PHCS All Commercial |
$61.01
|
| Rate for Payer: PHP All Commercial |
$61.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.72
|
| Rate for Payer: Sagamore Health Network All Products |
$62.80
|
| Rate for Payer: Signature Care EPO |
$67.52
|
| Rate for Payer: Signature Care PPO |
$71.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69.14
|
| Rate for Payer: United Healthcare Commercial |
$64.10
|
| Rate for Payer: United Healthcare Medicare |
$26.84
|
|
|
HC DRUG SCREEN - RAPID
|
Facility
IP
|
$81.35
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
63001318
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$75.65 |
| Rate for Payer: Aetna Commercial |
$70.28
|
| Rate for Payer: Cash Price |
$50.43
|
| Rate for Payer: Cigna All Commercial |
$70.20
|
| Rate for Payer: CORVEL All Commercial |
$75.65
|
| Rate for Payer: Coventry All Commercial |
$71.58
|
| Rate for Payer: Encore All Commercial |
$74.88
|
| Rate for Payer: Frontpath All Commercial |
$74.84
|
| Rate for Payer: Humana ChoiceCare |
$70.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.21
|
| Rate for Payer: PHCS All Commercial |
$61.01
|
| Rate for Payer: PHP All Commercial |
$61.69
|
| Rate for Payer: Sagamore Health Network All Products |
$62.80
|
| Rate for Payer: Signature Care EPO |
$67.52
|
| Rate for Payer: Signature Care PPO |
$71.58
|
| Rate for Payer: United Healthcare Commercial |
$64.10
|
|
|
HC DRUG SCREEN-SERUM-9 PANEL
|
Facility
OP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001392
|
|
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 SCREEN-SERUM-9 PANEL
|
Facility
IP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001392
|
|
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 SCREEN - STAT
|
Facility
OP
|
$404.28
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
63001385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$375.98 |
| Rate for Payer: Aetna Commercial |
$341.21
|
| Rate for Payer: Aetna Medicare |
$133.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$133.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.75
|
| Rate for Payer: Cash Price |
$250.65
|
| Rate for Payer: Cash Price |
$250.65
|
| Rate for Payer: Centivo All Commercial |
$206.18
|
| Rate for Payer: Cigna All Commercial |
$348.89
|
| Rate for Payer: CORVEL All Commercial |
$375.98
|
| Rate for Payer: Coventry All Commercial |
$355.76
|
| Rate for Payer: Encore All Commercial |
$372.14
|
| Rate for Payer: Frontpath All Commercial |
$371.93
|
| Rate for Payer: Humana ChoiceCare |
$349.17
|
| Rate for Payer: Humana Medicare |
$206.18
|
| Rate for Payer: Lucent All Commercial |
$206.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.85
|
| Rate for Payer: Managed Health Services Medicaid |
$12.60
|
| Rate for Payer: MDWise Medicaid |
$12.60
|
| Rate for Payer: PHCS All Commercial |
$303.21
|
| Rate for Payer: PHP All Commercial |
$306.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.67
|
| Rate for Payer: Sagamore Health Network All Products |
$312.10
|
| Rate for Payer: Signature Care EPO |
$335.55
|
| Rate for Payer: Signature Care PPO |
$355.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$343.64
|
| Rate for Payer: United Healthcare Commercial |
$318.57
|
| Rate for Payer: United Healthcare Medicare |
$133.41
|
|
|
HC DRUG SCREEN - STAT
|
Facility
IP
|
$404.28
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
63001385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$303.21 |
| Max. Negotiated Rate |
$375.98 |
| Rate for Payer: Aetna Commercial |
$349.30
|
| Rate for Payer: Cash Price |
$250.65
|
| Rate for Payer: Cigna All Commercial |
$348.89
|
| Rate for Payer: CORVEL All Commercial |
$375.98
|
| Rate for Payer: Coventry All Commercial |
$355.76
|
| Rate for Payer: Encore All Commercial |
$372.14
|
| Rate for Payer: Frontpath All Commercial |
$371.93
|
| Rate for Payer: Humana ChoiceCare |
$349.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.85
|
| Rate for Payer: PHCS All Commercial |
$303.21
|
| Rate for Payer: PHP All Commercial |
$306.60
|
| Rate for Payer: Sagamore Health Network All Products |
$312.10
|
| Rate for Payer: Signature Care EPO |
$335.55
|
| Rate for Payer: Signature Care PPO |
$355.76
|
| Rate for Payer: United Healthcare Commercial |
$318.57
|
|
|
HC DRUG SCREEN - URINE
|
Facility
IP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001391
|
|
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 SCREEN - URINE
|
Facility
OP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001391
|
|
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 DRY NEEDLE INSJ W/O NJX 1 OR 2 MUSC
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
CPT 20560 GP
|
| Hospital Charge Code |
01720560
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Aetna Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna All Commercial |
$8.80
|
| Rate for Payer: CORVEL All Commercial |
$9.49
|
| Rate for Payer: Coventry All Commercial |
$8.98
|
| Rate for Payer: Encore All Commercial |
$9.39
|
| Rate for Payer: Frontpath All Commercial |
$9.38
|
| Rate for Payer: Humana ChoiceCare |
$8.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.18
|
| Rate for Payer: PHCS All Commercial |
$7.65
|
| Rate for Payer: PHP All Commercial |
$7.74
|
| Rate for Payer: Sagamore Health Network All Products |
$7.87
|
| Rate for Payer: Signature Care EPO |
$8.47
|
| Rate for Payer: Signature Care PPO |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$8.04
|
|
|
HC DRY NEEDLE INSJ W/O NJX 1 OR 2 MUSC
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
CPT 20560 GP
|
| Hospital Charge Code |
01720560
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.70
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Centivo All Commercial |
$5.20
|
| Rate for Payer: Cigna All Commercial |
$8.80
|
| Rate for Payer: CORVEL All Commercial |
$9.49
|
| Rate for Payer: Coventry All Commercial |
$8.98
|
| Rate for Payer: Encore All Commercial |
$9.39
|
| Rate for Payer: Frontpath All Commercial |
$9.38
|
| Rate for Payer: Humana ChoiceCare |
$8.81
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Lucent All Commercial |
$5.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.18
|
| Rate for Payer: PHCS All Commercial |
$7.65
|
| Rate for Payer: PHP All Commercial |
$7.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.98
|
| Rate for Payer: Sagamore Health Network All Products |
$7.87
|
| Rate for Payer: Signature Care EPO |
$8.47
|
| Rate for Payer: Signature Care PPO |
$8.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.67
|
| Rate for Payer: United Healthcare Commercial |
$8.04
|
| Rate for Payer: United Healthcare Medicare |
$3.37
|
|
|
HC DRY NEEDLE INSJ W/O NJX 3+ MUSC
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
CPT 20561 GP
|
| Hospital Charge Code |
01720561
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Aetna Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna All Commercial |
$8.80
|
| Rate for Payer: CORVEL All Commercial |
$9.49
|
| Rate for Payer: Coventry All Commercial |
$8.98
|
| Rate for Payer: Encore All Commercial |
$9.39
|
| Rate for Payer: Frontpath All Commercial |
$9.38
|
| Rate for Payer: Humana ChoiceCare |
$8.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.18
|
| Rate for Payer: PHCS All Commercial |
$7.65
|
| Rate for Payer: PHP All Commercial |
$7.74
|
| Rate for Payer: Sagamore Health Network All Products |
$7.87
|
| Rate for Payer: Signature Care EPO |
$8.47
|
| Rate for Payer: Signature Care PPO |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$8.04
|
|
|
HC DRY NEEDLE INSJ W/O NJX 3+ MUSC
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
CPT 20561 GP
|
| Hospital Charge Code |
01720561
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.70
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Centivo All Commercial |
$5.20
|
| Rate for Payer: Cigna All Commercial |
$8.80
|
| Rate for Payer: CORVEL All Commercial |
$9.49
|
| Rate for Payer: Coventry All Commercial |
$8.98
|
| Rate for Payer: Encore All Commercial |
$9.39
|
| Rate for Payer: Frontpath All Commercial |
$9.38
|
| Rate for Payer: Humana ChoiceCare |
$8.81
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Lucent All Commercial |
$5.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.18
|
| Rate for Payer: PHCS All Commercial |
$7.65
|
| Rate for Payer: PHP All Commercial |
$7.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.98
|
| Rate for Payer: Sagamore Health Network All Products |
$7.87
|
| Rate for Payer: Signature Care EPO |
$8.47
|
| Rate for Payer: Signature Care PPO |
$8.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.67
|
| Rate for Payer: United Healthcare Commercial |
$8.04
|
| Rate for Payer: United Healthcare Medicare |
$3.37
|
|
|
HC DS CABLE GRIP W/CRIMP 1.7X750
|
Facility
OP
|
$2,597.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,415.92 |
| Rate for Payer: Aetna Commercial |
$2,192.51
|
| Rate for Payer: Aetna Medicare |
$857.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$857.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,491.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,623.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$985.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$942.99
|
| Rate for Payer: Cash Price |
$1,610.61
|
| Rate for Payer: Cash Price |
$1,610.61
|
| Rate for Payer: Centivo All Commercial |
$1,324.86
|
| Rate for Payer: Cigna All Commercial |
$2,241.87
|
| Rate for Payer: CORVEL All Commercial |
$2,415.92
|
| Rate for Payer: Coventry All Commercial |
$2,286.03
|
| Rate for Payer: Encore All Commercial |
$2,391.24
|
| Rate for Payer: Frontpath All Commercial |
$2,389.94
|
| Rate for Payer: Humana ChoiceCare |
$2,243.69
|
| Rate for Payer: Humana Medicare |
$1,324.86
|
| Rate for Payer: Lucent All Commercial |
$1,324.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,337.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,948.32
|
| Rate for Payer: PHP All Commercial |
$1,970.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,013.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2,005.47
|
| Rate for Payer: Signature Care EPO |
$2,156.14
|
| Rate for Payer: Signature Care PPO |
$2,286.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,208.10
|
| Rate for Payer: United Healthcare Commercial |
$2,047.03
|
| Rate for Payer: United Healthcare Medicare |
$857.26
|
|
|
HC DS CABLE GRIP W/CRIMP 1.7X750
|
Facility
IP
|
$2,597.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,948.32 |
| Max. Negotiated Rate |
$2,415.92 |
| Rate for Payer: Aetna Commercial |
$2,244.46
|
| Rate for Payer: Cash Price |
$1,610.61
|
| Rate for Payer: Cigna All Commercial |
$2,241.87
|
| Rate for Payer: CORVEL All Commercial |
$2,415.92
|
| Rate for Payer: Coventry All Commercial |
$2,286.03
|
| Rate for Payer: Encore All Commercial |
$2,391.24
|
| Rate for Payer: Frontpath All Commercial |
$2,389.94
|
| Rate for Payer: Humana ChoiceCare |
$2,243.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,337.98
|
| Rate for Payer: PHCS All Commercial |
$1,948.32
|
| Rate for Payer: PHP All Commercial |
$1,970.14
|
| Rate for Payer: Sagamore Health Network All Products |
$2,005.47
|
| Rate for Payer: Signature Care EPO |
$2,156.14
|
| Rate for Payer: Signature Care PPO |
$2,286.03
|
| Rate for Payer: United Healthcare Commercial |
$2,047.03
|
|
|
HC DS CERCLAGE PIN 3.5
|
Facility
IP
|
$1,348.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,253.64 |
| Rate for Payer: Aetna Commercial |
$1,164.67
|
| Rate for Payer: Cash Price |
$835.76
|
| Rate for Payer: Cigna All Commercial |
$1,163.32
|
| Rate for Payer: CORVEL All Commercial |
$1,253.64
|
| Rate for Payer: Coventry All Commercial |
$1,186.24
|
| Rate for Payer: Encore All Commercial |
$1,240.83
|
| Rate for Payer: Frontpath All Commercial |
$1,240.16
|
| Rate for Payer: Humana ChoiceCare |
$1,164.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,213.20
|
| Rate for Payer: PHCS All Commercial |
$1,011.00
|
| Rate for Payer: PHP All Commercial |
$1,022.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,040.66
|
| Rate for Payer: Signature Care EPO |
$1,118.84
|
| Rate for Payer: Signature Care PPO |
$1,186.24
|
| Rate for Payer: United Healthcare Commercial |
$1,062.22
|
|
|
HC DS CERCLAGE PIN 3.5
|
Facility
OP
|
$1,348.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.84 |
| Max. Negotiated Rate |
$1,253.64 |
| Rate for Payer: Aetna Commercial |
$1,137.71
|
| Rate for Payer: Aetna Medicare |
$444.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$444.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$774.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$842.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$511.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$489.32
|
| Rate for Payer: Cash Price |
$835.76
|
| Rate for Payer: Cash Price |
$835.76
|
| Rate for Payer: Centivo All Commercial |
$687.48
|
| Rate for Payer: Cigna All Commercial |
$1,163.32
|
| Rate for Payer: CORVEL All Commercial |
$1,253.64
|
| Rate for Payer: Coventry All Commercial |
$1,186.24
|
| Rate for Payer: Encore All Commercial |
$1,240.83
|
| Rate for Payer: Frontpath All Commercial |
$1,240.16
|
| Rate for Payer: Humana ChoiceCare |
$1,164.27
|
| Rate for Payer: Humana Medicare |
$687.48
|
| Rate for Payer: Lucent All Commercial |
$687.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,213.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,011.00
|
| Rate for Payer: PHP All Commercial |
$1,022.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$525.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,040.66
|
| Rate for Payer: Signature Care EPO |
$1,118.84
|
| Rate for Payer: Signature Care PPO |
$1,186.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,145.80
|
| Rate for Payer: United Healthcare Commercial |
$1,062.22
|
| Rate for Payer: United Healthcare Medicare |
$444.84
|
|
|
HC DS-DNA AB
|
Facility
OP
|
$92.53
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$86.06 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: Aetna Medicare |
$30.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.59
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Centivo All Commercial |
$47.19
|
| Rate for Payer: Cigna All Commercial |
$79.86
|
| Rate for Payer: CORVEL All Commercial |
$86.06
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Encore All Commercial |
$85.18
|
| Rate for Payer: Frontpath All Commercial |
$85.13
|
| Rate for Payer: Humana ChoiceCare |
$79.92
|
| Rate for Payer: Humana Medicare |
$47.19
|
| Rate for Payer: Lucent All Commercial |
$47.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.28
|
| Rate for Payer: Managed Health Services Medicaid |
$13.74
|
| Rate for Payer: MDWise Medicaid |
$13.74
|
| Rate for Payer: PHCS All Commercial |
$69.40
|
| Rate for Payer: PHP All Commercial |
$70.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.09
|
| Rate for Payer: Sagamore Health Network All Products |
$71.44
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.65
|
| Rate for Payer: United Healthcare Commercial |
$72.92
|
| Rate for Payer: United Healthcare Medicare |
$30.54
|
|
|
HC DS-DNA AB
|
Facility
IP
|
$92.53
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$86.06 |
| Rate for Payer: Aetna Commercial |
$79.95
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cigna All Commercial |
$79.86
|
| Rate for Payer: CORVEL All Commercial |
$86.06
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Encore All Commercial |
$85.18
|
| Rate for Payer: Frontpath All Commercial |
$85.13
|
| Rate for Payer: Humana ChoiceCare |
$79.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.28
|
| Rate for Payer: PHCS All Commercial |
$69.40
|
| Rate for Payer: PHP All Commercial |
$70.18
|
| Rate for Payer: Sagamore Health Network All Products |
$71.44
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.43
|
| Rate for Payer: United Healthcare Commercial |
$72.92
|
|
|
HC DS DRIL BIT 2.5/250/95
|
Facility
OP
|
$972.00
|
|
| Hospital Charge Code |
41606342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$903.96 |
| Rate for Payer: Aetna Commercial |
$820.37
|
| Rate for Payer: Aetna Medicare |
$320.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$558.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$607.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.84
|
| Rate for Payer: Cash Price |
$602.64
|
| Rate for Payer: Cash Price |
$602.64
|
| Rate for Payer: Centivo All Commercial |
$495.72
|
| Rate for Payer: Cigna All Commercial |
$838.84
|
| Rate for Payer: CORVEL All Commercial |
$903.96
|
| Rate for Payer: Coventry All Commercial |
$855.36
|
| Rate for Payer: Encore All Commercial |
$894.73
|
| Rate for Payer: Frontpath All Commercial |
$894.24
|
| Rate for Payer: Humana ChoiceCare |
$839.52
|
| Rate for Payer: Humana Medicare |
$495.72
|
| Rate for Payer: Lucent All Commercial |
$495.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$874.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$729.00
|
| Rate for Payer: PHP All Commercial |
$737.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$379.08
|
| Rate for Payer: Sagamore Health Network All Products |
$750.38
|
| Rate for Payer: Signature Care EPO |
$806.76
|
| Rate for Payer: Signature Care PPO |
$855.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$826.20
|
| Rate for Payer: United Healthcare Commercial |
$765.94
|
| Rate for Payer: United Healthcare Medicare |
$320.76
|
|
|
HC DS DRIL BIT 2.5/250/95
|
Facility
IP
|
$972.00
|
|
| Hospital Charge Code |
41606342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$903.96 |
| Rate for Payer: Aetna Commercial |
$839.81
|
| Rate for Payer: Cash Price |
$602.64
|
| Rate for Payer: Cigna All Commercial |
$838.84
|
| Rate for Payer: CORVEL All Commercial |
$903.96
|
| Rate for Payer: Coventry All Commercial |
$855.36
|
| Rate for Payer: Encore All Commercial |
$894.73
|
| Rate for Payer: Frontpath All Commercial |
$894.24
|
| Rate for Payer: Humana ChoiceCare |
$839.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$874.80
|
| Rate for Payer: PHCS All Commercial |
$729.00
|
| Rate for Payer: PHP All Commercial |
$737.16
|
| Rate for Payer: Sagamore Health Network All Products |
$750.38
|
| Rate for Payer: Signature Care EPO |
$806.76
|
| Rate for Payer: Signature Care PPO |
$855.36
|
| Rate for Payer: United Healthcare Commercial |
$765.94
|
|
|
HC DS DRILL BIT 2.0 125 QC
|
Facility
OP
|
$994.00
|
|
| Hospital Charge Code |
41603966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$838.94
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$506.94
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Humana Medicare |
$506.94
|
| Rate for Payer: Lucent All Commercial |
$506.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.90
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC DS DRILL BIT 2.0 125 QC
|
Facility
IP
|
$994.00
|
|
| Hospital Charge Code |
41603966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$858.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
|
|
HC DS DRILL BIT 2.0X140
|
Facility
OP
|
$1,108.00
|
|
| Hospital Charge Code |
41606939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,030.44 |
| Rate for Payer: Aetna Commercial |
$935.15
|
| Rate for Payer: Aetna Medicare |
$365.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$365.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$636.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$692.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$420.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$402.20
|
| Rate for Payer: Cash Price |
$686.96
|
| Rate for Payer: Cash Price |
$686.96
|
| Rate for Payer: Centivo All Commercial |
$565.08
|
| Rate for Payer: Cigna All Commercial |
$956.20
|
| Rate for Payer: CORVEL All Commercial |
$1,030.44
|
| Rate for Payer: Coventry All Commercial |
$975.04
|
| Rate for Payer: Encore All Commercial |
$1,019.91
|
| Rate for Payer: Frontpath All Commercial |
$1,019.36
|
| Rate for Payer: Humana ChoiceCare |
$956.98
|
| Rate for Payer: Humana Medicare |
$565.08
|
| Rate for Payer: Lucent All Commercial |
$565.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$997.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$831.00
|
| Rate for Payer: PHP All Commercial |
$840.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$432.12
|
| Rate for Payer: Sagamore Health Network All Products |
$855.38
|
| Rate for Payer: Signature Care EPO |
$919.64
|
| Rate for Payer: Signature Care PPO |
$975.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$941.80
|
| Rate for Payer: United Healthcare Commercial |
$873.10
|
| Rate for Payer: United Healthcare Medicare |
$365.64
|
|
|
HC DS DRILL BIT 2.0X140
|
Facility
IP
|
$1,108.00
|
|
| Hospital Charge Code |
41606939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$1,030.44 |
| Rate for Payer: Aetna Commercial |
$957.31
|
| Rate for Payer: Cash Price |
$686.96
|
| Rate for Payer: Cigna All Commercial |
$956.20
|
| Rate for Payer: CORVEL All Commercial |
$1,030.44
|
| Rate for Payer: Coventry All Commercial |
$975.04
|
| Rate for Payer: Encore All Commercial |
$1,019.91
|
| Rate for Payer: Frontpath All Commercial |
$1,019.36
|
| Rate for Payer: Humana ChoiceCare |
$956.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$997.20
|
| Rate for Payer: PHCS All Commercial |
$831.00
|
| Rate for Payer: PHP All Commercial |
$840.31
|
| Rate for Payer: Sagamore Health Network All Products |
$855.38
|
| Rate for Payer: Signature Care EPO |
$919.64
|
| Rate for Payer: Signature Care PPO |
$975.04
|
| Rate for Payer: United Healthcare Commercial |
$873.10
|
|
|
HC DS DRILL BIT 2.5 110 QC GOLD
|
Facility
IP
|
$882.00
|
|
| Hospital Charge Code |
41603968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$820.26 |
| Rate for Payer: Aetna Commercial |
$762.05
|
| Rate for Payer: Cash Price |
$546.84
|
| Rate for Payer: Cigna All Commercial |
$761.17
|
| Rate for Payer: CORVEL All Commercial |
$820.26
|
| Rate for Payer: Coventry All Commercial |
$776.16
|
| Rate for Payer: Encore All Commercial |
$811.88
|
| Rate for Payer: Frontpath All Commercial |
$811.44
|
| Rate for Payer: Humana ChoiceCare |
$761.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$793.80
|
| Rate for Payer: PHCS All Commercial |
$661.50
|
| Rate for Payer: PHP All Commercial |
$668.91
|
| Rate for Payer: Sagamore Health Network All Products |
$680.90
|
| Rate for Payer: Signature Care EPO |
$732.06
|
| Rate for Payer: Signature Care PPO |
$776.16
|
| Rate for Payer: United Healthcare Commercial |
$695.02
|
|
