|
HC BUR BARREL 6 FLUTE 5.5
|
Facility
|
IP
|
$426.37
|
|
| Hospital Charge Code |
41602504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.78 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$368.38
|
| Rate for Payer: Cash Price |
$255.82
|
| Rate for Payer: Cigna All Commercial |
$367.96
|
| Rate for Payer: CORVEL All Commercial |
$396.52
|
| Rate for Payer: Coventry All Commercial |
$375.21
|
| Rate for Payer: Encore All Commercial |
$392.47
|
| Rate for Payer: Frontpath All Commercial |
$392.26
|
| Rate for Payer: Humana ChoiceCare |
$368.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$383.73
|
| Rate for Payer: PHCS All Commercial |
$319.78
|
| Rate for Payer: PHP All Commercial |
$323.36
|
| Rate for Payer: Sagamore Health Network All Products |
$329.16
|
| Rate for Payer: Signature Care EPO |
$353.89
|
| Rate for Payer: Signature Care PPO |
$375.21
|
| Rate for Payer: United Healthcare Commercial |
$335.98
|
|
|
HC BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Facility
|
IP
|
$2,830.50
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
1649180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,122.88 |
| Max. Negotiated Rate |
$2,632.36 |
| Rate for Payer: Aetna Commercial |
$2,445.55
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cigna All Commercial |
$2,442.72
|
| Rate for Payer: CORVEL All Commercial |
$2,632.36
|
| Rate for Payer: Coventry All Commercial |
$2,490.84
|
| Rate for Payer: Encore All Commercial |
$2,605.48
|
| Rate for Payer: Frontpath All Commercial |
$2,604.06
|
| Rate for Payer: Humana ChoiceCare |
$2,444.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,547.45
|
| Rate for Payer: PHCS All Commercial |
$2,122.88
|
| Rate for Payer: PHP All Commercial |
$2,146.65
|
| Rate for Payer: Sagamore Health Network All Products |
$2,185.15
|
| Rate for Payer: Signature Care EPO |
$2,349.32
|
| Rate for Payer: Signature Care PPO |
$2,490.84
|
| Rate for Payer: United Healthcare Commercial |
$2,230.43
|
|
|
HC BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Facility
|
OP
|
$2,830.50
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
1649180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.54 |
| Max. Negotiated Rate |
$2,632.36 |
| Rate for Payer: Aetna Commercial |
$2,388.94
|
| Rate for Payer: Aetna Medicare |
$905.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$318.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$877.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,625.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,769.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$318.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,041.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$996.34
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Centivo All Commercial |
$1,539.79
|
| Rate for Payer: Cigna All Commercial |
$2,442.72
|
| Rate for Payer: CORVEL All Commercial |
$2,632.36
|
| Rate for Payer: Coventry All Commercial |
$2,490.84
|
| Rate for Payer: Encore All Commercial |
$2,605.48
|
| Rate for Payer: Frontpath All Commercial |
$2,604.06
|
| Rate for Payer: Humana ChoiceCare |
$2,444.70
|
| Rate for Payer: Humana Medicare |
$905.76
|
| Rate for Payer: Lucent All Commercial |
$1,539.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,547.45
|
| Rate for Payer: Managed Health Services Medicaid |
$318.54
|
| Rate for Payer: MDWise Medicaid |
$318.54
|
| Rate for Payer: PHCS All Commercial |
$2,122.88
|
| Rate for Payer: PHP All Commercial |
$2,146.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,103.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,185.15
|
| Rate for Payer: Signature Care EPO |
$2,349.32
|
| Rate for Payer: Signature Care PPO |
$2,490.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,405.93
|
| Rate for Payer: United Healthcare Commercial |
$2,230.43
|
| Rate for Payer: United Healthcare Medicare |
$905.76
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$6,783.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
1619081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,102.73 |
| Max. Negotiated Rate |
$6,308.19 |
| Rate for Payer: Aetna Commercial |
$5,724.85
|
| Rate for Payer: Aetna Medicare |
$2,170.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,102.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,895.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,240.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,496.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,387.62
|
| Rate for Payer: Cash Price |
$4,069.80
|
| Rate for Payer: Centivo All Commercial |
$3,689.95
|
| Rate for Payer: Cigna All Commercial |
$5,853.73
|
| Rate for Payer: CORVEL All Commercial |
$6,308.19
|
| Rate for Payer: Coventry All Commercial |
$5,969.04
|
| Rate for Payer: Encore All Commercial |
$6,243.75
|
| Rate for Payer: Frontpath All Commercial |
$6,240.36
|
| Rate for Payer: Humana ChoiceCare |
$5,858.48
|
| Rate for Payer: Humana Medicare |
$2,170.56
|
| Rate for Payer: Lucent All Commercial |
$3,689.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,104.70
|
| Rate for Payer: PHCS All Commercial |
$5,087.25
|
| Rate for Payer: PHP All Commercial |
$5,144.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,645.37
|
| Rate for Payer: Sagamore Health Network All Products |
$5,236.48
|
| Rate for Payer: Signature Care EPO |
$5,629.89
|
| Rate for Payer: Signature Care PPO |
$5,969.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,765.55
|
| Rate for Payer: United Healthcare Commercial |
$5,345.00
|
| Rate for Payer: United Healthcare Medicare |
$2,170.56
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$6,783.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
1619081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,087.25 |
| Max. Negotiated Rate |
$6,308.19 |
| Rate for Payer: Aetna Commercial |
$5,860.51
|
| Rate for Payer: Cash Price |
$4,069.80
|
| Rate for Payer: Cigna All Commercial |
$5,853.73
|
| Rate for Payer: CORVEL All Commercial |
$6,308.19
|
| Rate for Payer: Coventry All Commercial |
$5,969.04
|
| Rate for Payer: Encore All Commercial |
$6,243.75
|
| Rate for Payer: Frontpath All Commercial |
$6,240.36
|
| Rate for Payer: Humana ChoiceCare |
$5,858.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,104.70
|
| Rate for Payer: PHCS All Commercial |
$5,087.25
|
| Rate for Payer: PHP All Commercial |
$5,144.23
|
| Rate for Payer: Sagamore Health Network All Products |
$5,236.48
|
| Rate for Payer: Signature Care EPO |
$5,629.89
|
| Rate for Payer: Signature Care PPO |
$5,969.04
|
| Rate for Payer: United Healthcare Commercial |
$5,345.00
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$4,165.68
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
1619082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,124.26 |
| Max. Negotiated Rate |
$3,874.08 |
| Rate for Payer: Aetna Commercial |
$3,599.15
|
| Rate for Payer: Cash Price |
$2,499.41
|
| Rate for Payer: Cigna All Commercial |
$3,594.98
|
| Rate for Payer: CORVEL All Commercial |
$3,874.08
|
| Rate for Payer: Coventry All Commercial |
$3,665.80
|
| Rate for Payer: Encore All Commercial |
$3,834.51
|
| Rate for Payer: Frontpath All Commercial |
$3,832.43
|
| Rate for Payer: Humana ChoiceCare |
$3,597.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,749.11
|
| Rate for Payer: PHCS All Commercial |
$3,124.26
|
| Rate for Payer: PHP All Commercial |
$3,159.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,215.90
|
| Rate for Payer: Signature Care EPO |
$3,457.51
|
| Rate for Payer: Signature Care PPO |
$3,665.80
|
| Rate for Payer: United Healthcare Commercial |
$3,282.56
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$4,165.68
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
1619082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,291.36 |
| Max. Negotiated Rate |
$3,874.08 |
| Rate for Payer: Aetna Commercial |
$3,515.83
|
| Rate for Payer: Aetna Medicare |
$1,333.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,291.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,392.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,603.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,532.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,466.32
|
| Rate for Payer: Cash Price |
$2,499.41
|
| Rate for Payer: Centivo All Commercial |
$2,266.13
|
| Rate for Payer: Cigna All Commercial |
$3,594.98
|
| Rate for Payer: CORVEL All Commercial |
$3,874.08
|
| Rate for Payer: Coventry All Commercial |
$3,665.80
|
| Rate for Payer: Encore All Commercial |
$3,834.51
|
| Rate for Payer: Frontpath All Commercial |
$3,832.43
|
| Rate for Payer: Humana ChoiceCare |
$3,597.90
|
| Rate for Payer: Humana Medicare |
$1,333.02
|
| Rate for Payer: Lucent All Commercial |
$2,266.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,749.11
|
| Rate for Payer: PHCS All Commercial |
$3,124.26
|
| Rate for Payer: PHP All Commercial |
$3,159.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,624.62
|
| Rate for Payer: Sagamore Health Network All Products |
$3,215.90
|
| Rate for Payer: Signature Care EPO |
$3,457.51
|
| Rate for Payer: Signature Care PPO |
$3,665.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,540.83
|
| Rate for Payer: United Healthcare Commercial |
$3,282.56
|
| Rate for Payer: United Healthcare Medicare |
$1,333.02
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION MR IMAG
|
Facility
|
IP
|
$1,083.42
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
1579085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.57 |
| Max. Negotiated Rate |
$1,007.58 |
| Rate for Payer: Aetna Commercial |
$936.07
|
| Rate for Payer: Cash Price |
$650.05
|
| Rate for Payer: Cigna All Commercial |
$934.99
|
| Rate for Payer: CORVEL All Commercial |
$1,007.58
|
| Rate for Payer: Coventry All Commercial |
$953.41
|
| Rate for Payer: Encore All Commercial |
$997.29
|
| Rate for Payer: Frontpath All Commercial |
$996.75
|
| Rate for Payer: Humana ChoiceCare |
$935.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.08
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Sagamore Health Network All Products |
$836.40
|
| Rate for Payer: Signature Care EPO |
$899.24
|
| Rate for Payer: Signature Care PPO |
$953.41
|
| Rate for Payer: United Healthcare Commercial |
$853.73
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION MR IMAG
|
Facility
|
OP
|
$1,083.42
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
1579085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.86 |
| Max. Negotiated Rate |
$1,007.58 |
| Rate for Payer: Aetna Commercial |
$914.41
|
| Rate for Payer: Aetna Medicare |
$346.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$335.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$622.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$677.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.36
|
| Rate for Payer: Cash Price |
$650.05
|
| Rate for Payer: Centivo All Commercial |
$589.38
|
| Rate for Payer: Cigna All Commercial |
$934.99
|
| Rate for Payer: CORVEL All Commercial |
$1,007.58
|
| Rate for Payer: Coventry All Commercial |
$953.41
|
| Rate for Payer: Encore All Commercial |
$997.29
|
| Rate for Payer: Frontpath All Commercial |
$996.75
|
| Rate for Payer: Humana ChoiceCare |
$935.75
|
| Rate for Payer: Humana Medicare |
$346.69
|
| Rate for Payer: Lucent All Commercial |
$589.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.08
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$422.53
|
| Rate for Payer: Sagamore Health Network All Products |
$836.40
|
| Rate for Payer: Signature Care EPO |
$899.24
|
| Rate for Payer: Signature Care PPO |
$953.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$920.91
|
| Rate for Payer: United Healthcare Commercial |
$853.73
|
| Rate for Payer: United Healthcare Medicare |
$346.69
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION US IMAG
|
Facility
|
OP
|
$1,714.78
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
1649983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.58 |
| Max. Negotiated Rate |
$1,594.75 |
| Rate for Payer: Aetna Commercial |
$1,447.27
|
| Rate for Payer: Aetna Medicare |
$548.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$531.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$984.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,071.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$631.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$603.60
|
| Rate for Payer: Cash Price |
$1,028.87
|
| Rate for Payer: Centivo All Commercial |
$932.84
|
| Rate for Payer: Cigna All Commercial |
$1,479.86
|
| Rate for Payer: CORVEL All Commercial |
$1,594.75
|
| Rate for Payer: Coventry All Commercial |
$1,509.01
|
| Rate for Payer: Encore All Commercial |
$1,578.45
|
| Rate for Payer: Frontpath All Commercial |
$1,577.60
|
| Rate for Payer: Humana ChoiceCare |
$1,481.06
|
| Rate for Payer: Humana Medicare |
$548.73
|
| Rate for Payer: Lucent All Commercial |
$932.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,543.30
|
| Rate for Payer: PHCS All Commercial |
$1,286.09
|
| Rate for Payer: PHP All Commercial |
$1,300.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$668.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,323.81
|
| Rate for Payer: Signature Care EPO |
$1,423.27
|
| Rate for Payer: Signature Care PPO |
$1,509.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,457.56
|
| Rate for Payer: United Healthcare Commercial |
$1,351.25
|
| Rate for Payer: United Healthcare Medicare |
$548.73
|
|
|
HC BX BREAST PLCMNT DEV 1ST LESION US IMAG
|
Facility
|
IP
|
$1,714.78
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
1649983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,286.09 |
| Max. Negotiated Rate |
$1,594.75 |
| Rate for Payer: Aetna Commercial |
$1,481.57
|
| Rate for Payer: Cash Price |
$1,028.87
|
| Rate for Payer: Cigna All Commercial |
$1,479.86
|
| Rate for Payer: CORVEL All Commercial |
$1,594.75
|
| Rate for Payer: Coventry All Commercial |
$1,509.01
|
| Rate for Payer: Encore All Commercial |
$1,578.45
|
| Rate for Payer: Frontpath All Commercial |
$1,577.60
|
| Rate for Payer: Humana ChoiceCare |
$1,481.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,543.30
|
| Rate for Payer: PHCS All Commercial |
$1,286.09
|
| Rate for Payer: PHP All Commercial |
$1,300.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,323.81
|
| Rate for Payer: Signature Care EPO |
$1,423.27
|
| Rate for Payer: Signature Care PPO |
$1,509.01
|
| Rate for Payer: United Healthcare Commercial |
$1,351.25
|
|
|
HC BX BREAST,PLCMT DEV ADD LESION US IMAG
|
Facility
|
IP
|
$1,708.77
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
1649084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,281.58 |
| Max. Negotiated Rate |
$1,589.16 |
| Rate for Payer: Aetna Commercial |
$1,476.38
|
| Rate for Payer: Cash Price |
$1,025.26
|
| Rate for Payer: Cigna All Commercial |
$1,474.67
|
| Rate for Payer: CORVEL All Commercial |
$1,589.16
|
| Rate for Payer: Coventry All Commercial |
$1,503.72
|
| Rate for Payer: Encore All Commercial |
$1,572.92
|
| Rate for Payer: Frontpath All Commercial |
$1,572.07
|
| Rate for Payer: Humana ChoiceCare |
$1,475.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,537.89
|
| Rate for Payer: PHCS All Commercial |
$1,281.58
|
| Rate for Payer: PHP All Commercial |
$1,295.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,319.17
|
| Rate for Payer: Signature Care EPO |
$1,418.28
|
| Rate for Payer: Signature Care PPO |
$1,503.72
|
| Rate for Payer: United Healthcare Commercial |
$1,346.51
|
|
|
HC BX BREAST,PLCMT DEV ADD LESION US IMAG
|
Facility
|
OP
|
$1,708.77
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
1649084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$529.72 |
| Max. Negotiated Rate |
$1,589.16 |
| Rate for Payer: Aetna Commercial |
$1,442.20
|
| Rate for Payer: Aetna Medicare |
$546.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$529.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$981.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,068.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$628.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$601.49
|
| Rate for Payer: Cash Price |
$1,025.26
|
| Rate for Payer: Centivo All Commercial |
$929.57
|
| Rate for Payer: Cigna All Commercial |
$1,474.67
|
| Rate for Payer: CORVEL All Commercial |
$1,589.16
|
| Rate for Payer: Coventry All Commercial |
$1,503.72
|
| Rate for Payer: Encore All Commercial |
$1,572.92
|
| Rate for Payer: Frontpath All Commercial |
$1,572.07
|
| Rate for Payer: Humana ChoiceCare |
$1,475.86
|
| Rate for Payer: Humana Medicare |
$546.81
|
| Rate for Payer: Lucent All Commercial |
$929.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,537.89
|
| Rate for Payer: PHCS All Commercial |
$1,281.58
|
| Rate for Payer: PHP All Commercial |
$1,295.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$666.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,319.17
|
| Rate for Payer: Signature Care EPO |
$1,418.28
|
| Rate for Payer: Signature Care PPO |
$1,503.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,452.45
|
| Rate for Payer: United Healthcare Commercial |
$1,346.51
|
| Rate for Payer: United Healthcare Medicare |
$546.81
|
|
|
HC C0 DIFFUSE CAPACITY
|
Facility
|
OP
|
$273.92
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
1704729
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$254.75 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Medicare |
$87.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$157.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.42
|
| Rate for Payer: Cash Price |
$164.35
|
| Rate for Payer: Cash Price |
$164.35
|
| Rate for Payer: Centivo All Commercial |
$149.01
|
| Rate for Payer: Cigna All Commercial |
$236.39
|
| Rate for Payer: CORVEL All Commercial |
$254.75
|
| Rate for Payer: Coventry All Commercial |
$241.05
|
| Rate for Payer: Encore All Commercial |
$252.14
|
| Rate for Payer: Frontpath All Commercial |
$252.01
|
| Rate for Payer: Humana ChoiceCare |
$236.58
|
| Rate for Payer: Humana Medicare |
$87.65
|
| Rate for Payer: Lucent All Commercial |
$149.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.53
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$205.44
|
| Rate for Payer: PHP All Commercial |
$207.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.83
|
| Rate for Payer: Sagamore Health Network All Products |
$211.47
|
| Rate for Payer: Signature Care EPO |
$227.35
|
| Rate for Payer: Signature Care PPO |
$241.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.83
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
| Rate for Payer: United Healthcare Medicare |
$87.65
|
|
|
HC C0 DIFFUSE CAPACITY
|
Facility
|
IP
|
$273.92
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
1704729
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$205.44 |
| Max. Negotiated Rate |
$254.75 |
| Rate for Payer: Aetna Commercial |
$236.67
|
| Rate for Payer: Cash Price |
$164.35
|
| Rate for Payer: Cigna All Commercial |
$236.39
|
| Rate for Payer: CORVEL All Commercial |
$254.75
|
| Rate for Payer: Coventry All Commercial |
$241.05
|
| Rate for Payer: Encore All Commercial |
$252.14
|
| Rate for Payer: Frontpath All Commercial |
$252.01
|
| Rate for Payer: Humana ChoiceCare |
$236.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.53
|
| Rate for Payer: PHCS All Commercial |
$205.44
|
| Rate for Payer: PHP All Commercial |
$207.74
|
| Rate for Payer: Sagamore Health Network All Products |
$211.47
|
| Rate for Payer: Signature Care EPO |
$227.35
|
| Rate for Payer: Signature Care PPO |
$241.05
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
|
|
HC C-1-ESTERASE INHIBIT
|
Facility
|
IP
|
$67.16
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
63001870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.37 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cigna All Commercial |
$57.96
|
| Rate for Payer: CORVEL All Commercial |
$62.46
|
| Rate for Payer: Coventry All Commercial |
$59.10
|
| Rate for Payer: Encore All Commercial |
$61.82
|
| Rate for Payer: Frontpath All Commercial |
$61.79
|
| Rate for Payer: Humana ChoiceCare |
$58.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.44
|
| Rate for Payer: PHCS All Commercial |
$50.37
|
| Rate for Payer: PHP All Commercial |
$50.93
|
| Rate for Payer: Sagamore Health Network All Products |
$51.85
|
| Rate for Payer: Signature Care EPO |
$55.74
|
| Rate for Payer: Signature Care PPO |
$59.10
|
| Rate for Payer: United Healthcare Commercial |
$52.92
|
|
|
HC C-1-ESTERASE INHIBIT
|
Facility
|
OP
|
$67.16
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
63001870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna Commercial |
$56.68
|
| Rate for Payer: Aetna Medicare |
$21.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$30.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.64
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Centivo All Commercial |
$36.54
|
| Rate for Payer: Cigna All Commercial |
$57.96
|
| Rate for Payer: CORVEL All Commercial |
$62.46
|
| Rate for Payer: Coventry All Commercial |
$59.10
|
| Rate for Payer: Encore All Commercial |
$61.82
|
| Rate for Payer: Frontpath All Commercial |
$61.79
|
| Rate for Payer: Humana ChoiceCare |
$58.01
|
| Rate for Payer: Humana Medicare |
$21.49
|
| Rate for Payer: Lucent All Commercial |
$36.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.44
|
| Rate for Payer: Managed Health Services Medicaid |
$12.00
|
| Rate for Payer: MDWise Medicaid |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$50.37
|
| Rate for Payer: PHP All Commercial |
$50.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.19
|
| Rate for Payer: Sagamore Health Network All Products |
$51.85
|
| Rate for Payer: Signature Care EPO |
$55.74
|
| Rate for Payer: Signature Care PPO |
$59.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.09
|
| Rate for Payer: United Healthcare Commercial |
$52.92
|
| Rate for Payer: United Healthcare Medicare |
$21.49
|
|
|
HC CA-125
|
Facility
|
OP
|
$257.86
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
63001205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$239.81 |
| Rate for Payer: Aetna Commercial |
$217.63
|
| Rate for Payer: Aetna Medicare |
$82.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.77
|
| Rate for Payer: Cash Price |
$154.72
|
| Rate for Payer: Cash Price |
$154.72
|
| Rate for Payer: Centivo All Commercial |
$140.28
|
| Rate for Payer: Cigna All Commercial |
$222.53
|
| Rate for Payer: CORVEL All Commercial |
$239.81
|
| Rate for Payer: Coventry All Commercial |
$226.92
|
| Rate for Payer: Encore All Commercial |
$237.36
|
| Rate for Payer: Frontpath All Commercial |
$237.23
|
| Rate for Payer: Humana ChoiceCare |
$222.71
|
| Rate for Payer: Humana Medicare |
$82.52
|
| Rate for Payer: Lucent All Commercial |
$140.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.07
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$193.40
|
| Rate for Payer: PHP All Commercial |
$195.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.57
|
| Rate for Payer: Sagamore Health Network All Products |
$199.07
|
| Rate for Payer: Signature Care EPO |
$214.02
|
| Rate for Payer: Signature Care PPO |
$226.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$219.18
|
| Rate for Payer: United Healthcare Commercial |
$203.19
|
| Rate for Payer: United Healthcare Medicare |
$82.52
|
|
|
HC CA-125
|
Facility
|
IP
|
$257.86
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
63001205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.40 |
| Max. Negotiated Rate |
$239.81 |
| Rate for Payer: Aetna Commercial |
$222.79
|
| Rate for Payer: Cash Price |
$154.72
|
| Rate for Payer: Cigna All Commercial |
$222.53
|
| Rate for Payer: CORVEL All Commercial |
$239.81
|
| Rate for Payer: Coventry All Commercial |
$226.92
|
| Rate for Payer: Encore All Commercial |
$237.36
|
| Rate for Payer: Frontpath All Commercial |
$237.23
|
| Rate for Payer: Humana ChoiceCare |
$222.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.07
|
| Rate for Payer: PHCS All Commercial |
$193.40
|
| Rate for Payer: PHP All Commercial |
$195.56
|
| Rate for Payer: Sagamore Health Network All Products |
$199.07
|
| Rate for Payer: Signature Care EPO |
$214.02
|
| Rate for Payer: Signature Care PPO |
$226.92
|
| Rate for Payer: United Healthcare Commercial |
$203.19
|
|
|
HC CA 15-3
|
Facility
|
OP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$146.90
|
| Rate for Payer: Aetna Medicare |
$55.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.27
|
| Rate for Payer: Cash Price |
$104.43
|
| Rate for Payer: Cash Price |
$104.43
|
| Rate for Payer: Centivo All Commercial |
$94.68
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.16
|
| Rate for Payer: Encore All Commercial |
$160.21
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Humana Medicare |
$55.70
|
| Rate for Payer: Lucent All Commercial |
$94.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.88
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.94
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
| Rate for Payer: United Healthcare Medicare |
$55.70
|
|
|
HC CA 15-3
|
Facility
|
IP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.54 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Cash Price |
$104.43
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.16
|
| Rate for Payer: Encore All Commercial |
$160.21
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.16
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
|
|
HC CA-19-9
|
Facility
|
OP
|
$228.84
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
63001206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$212.82 |
| Rate for Payer: Aetna Commercial |
$193.14
|
| Rate for Payer: Aetna Medicare |
$73.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.55
|
| Rate for Payer: Cash Price |
$137.30
|
| Rate for Payer: Cash Price |
$137.30
|
| Rate for Payer: Centivo All Commercial |
$124.49
|
| Rate for Payer: Cigna All Commercial |
$197.49
|
| Rate for Payer: CORVEL All Commercial |
$212.82
|
| Rate for Payer: Coventry All Commercial |
$201.38
|
| Rate for Payer: Encore All Commercial |
$210.65
|
| Rate for Payer: Frontpath All Commercial |
$210.53
|
| Rate for Payer: Humana ChoiceCare |
$197.65
|
| Rate for Payer: Humana Medicare |
$73.23
|
| Rate for Payer: Lucent All Commercial |
$124.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.96
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$171.63
|
| Rate for Payer: PHP All Commercial |
$173.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.25
|
| Rate for Payer: Sagamore Health Network All Products |
$176.66
|
| Rate for Payer: Signature Care EPO |
$189.94
|
| Rate for Payer: Signature Care PPO |
$201.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.51
|
| Rate for Payer: United Healthcare Commercial |
$180.33
|
| Rate for Payer: United Healthcare Medicare |
$73.23
|
|
|
HC CA-19-9
|
Facility
|
IP
|
$228.84
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
63001206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.63 |
| Max. Negotiated Rate |
$212.82 |
| Rate for Payer: Aetna Commercial |
$197.72
|
| Rate for Payer: Cash Price |
$137.30
|
| Rate for Payer: Cigna All Commercial |
$197.49
|
| Rate for Payer: CORVEL All Commercial |
$212.82
|
| Rate for Payer: Coventry All Commercial |
$201.38
|
| Rate for Payer: Encore All Commercial |
$210.65
|
| Rate for Payer: Frontpath All Commercial |
$210.53
|
| Rate for Payer: Humana ChoiceCare |
$197.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.96
|
| Rate for Payer: PHCS All Commercial |
$171.63
|
| Rate for Payer: PHP All Commercial |
$173.55
|
| Rate for Payer: Sagamore Health Network All Products |
$176.66
|
| Rate for Payer: Signature Care EPO |
$189.94
|
| Rate for Payer: Signature Care PPO |
$201.38
|
| Rate for Payer: United Healthcare Commercial |
$180.33
|
|
|
HC CA 27-29
|
Facility
|
IP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.54 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Cash Price |
$104.43
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.16
|
| Rate for Payer: Encore All Commercial |
$160.21
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.16
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
|
|
HC CA 27-29
|
Facility
|
OP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$146.90
|
| Rate for Payer: Aetna Medicare |
$55.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.27
|
| Rate for Payer: Cash Price |
$104.43
|
| Rate for Payer: Cash Price |
$104.43
|
| Rate for Payer: Centivo All Commercial |
$94.68
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.16
|
| Rate for Payer: Encore All Commercial |
$160.21
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Humana Medicare |
$55.70
|
| Rate for Payer: Lucent All Commercial |
$94.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.88
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.94
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
| Rate for Payer: United Healthcare Medicare |
$55.70
|
|
