|
HC CATH TROCAR 20FR
|
Facility
|
OP
|
$160.51
|
|
| Hospital Charge Code |
41601031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$149.27 |
| Rate for Payer: Aetna Commercial |
$135.47
|
| Rate for Payer: Aetna Medicare |
$51.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.50
|
| Rate for Payer: Cash Price |
$96.31
|
| Rate for Payer: Cash Price |
$96.31
|
| Rate for Payer: Centivo All Commercial |
$87.32
|
| Rate for Payer: Cigna All Commercial |
$138.52
|
| Rate for Payer: CORVEL All Commercial |
$149.27
|
| Rate for Payer: Coventry All Commercial |
$141.25
|
| Rate for Payer: Encore All Commercial |
$147.75
|
| Rate for Payer: Frontpath All Commercial |
$147.67
|
| Rate for Payer: Humana ChoiceCare |
$138.63
|
| Rate for Payer: Humana Medicare |
$51.36
|
| Rate for Payer: Lucent All Commercial |
$87.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$120.38
|
| Rate for Payer: PHP All Commercial |
$121.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.60
|
| Rate for Payer: Sagamore Health Network All Products |
$123.91
|
| Rate for Payer: Signature Care EPO |
$133.22
|
| Rate for Payer: Signature Care PPO |
$141.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.43
|
| Rate for Payer: United Healthcare Commercial |
$126.48
|
| Rate for Payer: United Healthcare Medicare |
$51.36
|
|
|
HC CATH TROCAR 20FR
|
Facility
|
IP
|
$160.51
|
|
| Hospital Charge Code |
41601031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$149.27 |
| Rate for Payer: Aetna Commercial |
$138.68
|
| Rate for Payer: Cash Price |
$96.31
|
| Rate for Payer: Cigna All Commercial |
$138.52
|
| Rate for Payer: CORVEL All Commercial |
$149.27
|
| Rate for Payer: Coventry All Commercial |
$141.25
|
| Rate for Payer: Encore All Commercial |
$147.75
|
| Rate for Payer: Frontpath All Commercial |
$147.67
|
| Rate for Payer: Humana ChoiceCare |
$138.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.46
|
| Rate for Payer: PHCS All Commercial |
$120.38
|
| Rate for Payer: PHP All Commercial |
$121.73
|
| Rate for Payer: Sagamore Health Network All Products |
$123.91
|
| Rate for Payer: Signature Care EPO |
$133.22
|
| Rate for Payer: Signature Care PPO |
$141.25
|
| Rate for Payer: United Healthcare Commercial |
$126.48
|
|
|
HC CATH TROCAR 28FR
|
Facility
|
OP
|
$168.29
|
|
| Hospital Charge Code |
41601032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$142.04
|
| Rate for Payer: Aetna Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$96.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.24
|
| Rate for Payer: Cash Price |
$100.97
|
| Rate for Payer: Cash Price |
$100.97
|
| Rate for Payer: Centivo All Commercial |
$91.55
|
| Rate for Payer: Cigna All Commercial |
$145.23
|
| Rate for Payer: CORVEL All Commercial |
$156.51
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.91
|
| Rate for Payer: Frontpath All Commercial |
$154.83
|
| Rate for Payer: Humana ChoiceCare |
$145.35
|
| Rate for Payer: Humana Medicare |
$53.85
|
| Rate for Payer: Lucent All Commercial |
$91.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.63
|
| Rate for Payer: Sagamore Health Network All Products |
$129.92
|
| Rate for Payer: Signature Care EPO |
$139.68
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.05
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
| Rate for Payer: United Healthcare Medicare |
$53.85
|
|
|
HC CATH TROCAR 28FR
|
Facility
|
IP
|
$168.29
|
|
| Hospital Charge Code |
41601032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$145.40
|
| Rate for Payer: Cash Price |
$100.97
|
| Rate for Payer: Cigna All Commercial |
$145.23
|
| Rate for Payer: CORVEL All Commercial |
$156.51
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.91
|
| Rate for Payer: Frontpath All Commercial |
$154.83
|
| Rate for Payer: Humana ChoiceCare |
$145.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.46
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.63
|
| Rate for Payer: Sagamore Health Network All Products |
$129.92
|
| Rate for Payer: Signature Care EPO |
$139.68
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
|
|
HC CAT PUPIL EXPANDER / MALYUGIN RING 6.25
|
Facility
|
IP
|
$962.50
|
|
| Hospital Charge Code |
41602072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC CAT PUPIL EXPANDER / MALYUGIN RING 6.25
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
41602072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$308.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.80
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Centivo All Commercial |
$523.60
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$308.00
|
| Rate for Payer: Lucent All Commercial |
$523.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$308.00
|
|
|
HC CAUTERY ELECTRODE BALL 5 INCH
|
Facility
|
OP
|
$61.27
|
|
| Hospital Charge Code |
41601821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$56.98 |
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.57
|
| Rate for Payer: Cash Price |
$36.76
|
| Rate for Payer: Cash Price |
$36.76
|
| Rate for Payer: Centivo All Commercial |
$33.33
|
| Rate for Payer: Cigna All Commercial |
$52.88
|
| Rate for Payer: CORVEL All Commercial |
$56.98
|
| Rate for Payer: Coventry All Commercial |
$53.92
|
| Rate for Payer: Encore All Commercial |
$56.40
|
| Rate for Payer: Frontpath All Commercial |
$56.37
|
| Rate for Payer: Humana ChoiceCare |
$52.92
|
| Rate for Payer: Humana Medicare |
$19.61
|
| Rate for Payer: Lucent All Commercial |
$33.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.14
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$45.95
|
| Rate for Payer: PHP All Commercial |
$46.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.90
|
| Rate for Payer: Sagamore Health Network All Products |
$47.30
|
| Rate for Payer: Signature Care EPO |
$50.85
|
| Rate for Payer: Signature Care PPO |
$53.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.08
|
| Rate for Payer: United Healthcare Commercial |
$48.28
|
| Rate for Payer: United Healthcare Medicare |
$19.61
|
|
|
HC CAUTERY ELECTRODE BALL 5 INCH
|
Facility
|
IP
|
$61.27
|
|
| Hospital Charge Code |
41601821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$56.98 |
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: Cash Price |
$36.76
|
| Rate for Payer: Cigna All Commercial |
$52.88
|
| Rate for Payer: CORVEL All Commercial |
$56.98
|
| Rate for Payer: Coventry All Commercial |
$53.92
|
| Rate for Payer: Encore All Commercial |
$56.40
|
| Rate for Payer: Frontpath All Commercial |
$56.37
|
| Rate for Payer: Humana ChoiceCare |
$52.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.14
|
| Rate for Payer: PHCS All Commercial |
$45.95
|
| Rate for Payer: PHP All Commercial |
$46.47
|
| Rate for Payer: Sagamore Health Network All Products |
$47.30
|
| Rate for Payer: Signature Care EPO |
$50.85
|
| Rate for Payer: Signature Care PPO |
$53.92
|
| Rate for Payer: United Healthcare Commercial |
$48.28
|
|
|
HC CAUTERY ELECTRODE EXTENDED BLADE 6.5 IN
|
Facility
|
OP
|
$46.04
|
|
| Hospital Charge Code |
41601814
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Aetna Commercial |
$38.86
|
| Rate for Payer: Aetna Medicare |
$14.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.21
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Centivo All Commercial |
$25.05
|
| Rate for Payer: Cigna All Commercial |
$39.73
|
| Rate for Payer: CORVEL All Commercial |
$42.82
|
| Rate for Payer: Coventry All Commercial |
$40.52
|
| Rate for Payer: Encore All Commercial |
$42.38
|
| Rate for Payer: Frontpath All Commercial |
$42.36
|
| Rate for Payer: Humana ChoiceCare |
$39.76
|
| Rate for Payer: Humana Medicare |
$14.73
|
| Rate for Payer: Lucent All Commercial |
$25.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.44
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$34.53
|
| Rate for Payer: PHP All Commercial |
$34.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.96
|
| Rate for Payer: Sagamore Health Network All Products |
$35.54
|
| Rate for Payer: Signature Care EPO |
$38.21
|
| Rate for Payer: Signature Care PPO |
$40.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.13
|
| Rate for Payer: United Healthcare Commercial |
$36.28
|
| Rate for Payer: United Healthcare Medicare |
$14.73
|
|
|
HC CAUTERY ELECTRODE EXTENDED BLADE 6.5 IN
|
Facility
|
IP
|
$46.04
|
|
| Hospital Charge Code |
41601814
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Aetna Commercial |
$39.78
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Cigna All Commercial |
$39.73
|
| Rate for Payer: CORVEL All Commercial |
$42.82
|
| Rate for Payer: Coventry All Commercial |
$40.52
|
| Rate for Payer: Encore All Commercial |
$42.38
|
| Rate for Payer: Frontpath All Commercial |
$42.36
|
| Rate for Payer: Humana ChoiceCare |
$39.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.44
|
| Rate for Payer: PHCS All Commercial |
$34.53
|
| Rate for Payer: PHP All Commercial |
$34.92
|
| Rate for Payer: Sagamore Health Network All Products |
$35.54
|
| Rate for Payer: Signature Care EPO |
$38.21
|
| Rate for Payer: Signature Care PPO |
$40.52
|
| Rate for Payer: United Healthcare Commercial |
$36.28
|
|
|
HC CAUTERY EXTEND 6.5
|
Facility
|
IP
|
$30.22
|
|
| Hospital Charge Code |
41608108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Aetna Commercial |
$26.11
|
| Rate for Payer: Cash Price |
$18.13
|
| Rate for Payer: Cigna All Commercial |
$26.08
|
| Rate for Payer: CORVEL All Commercial |
$28.10
|
| Rate for Payer: Coventry All Commercial |
$26.59
|
| Rate for Payer: Encore All Commercial |
$27.82
|
| Rate for Payer: Frontpath All Commercial |
$27.80
|
| Rate for Payer: Humana ChoiceCare |
$26.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.20
|
| Rate for Payer: PHCS All Commercial |
$22.66
|
| Rate for Payer: PHP All Commercial |
$22.92
|
| Rate for Payer: Sagamore Health Network All Products |
$23.33
|
| Rate for Payer: Signature Care EPO |
$25.08
|
| Rate for Payer: Signature Care PPO |
$26.59
|
| Rate for Payer: United Healthcare Commercial |
$23.81
|
|
|
HC CAUTERY EXTEND 6.5
|
Facility
|
OP
|
$30.22
|
|
| Hospital Charge Code |
41608108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$25.51
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.64
|
| Rate for Payer: Cash Price |
$18.13
|
| Rate for Payer: Cash Price |
$18.13
|
| Rate for Payer: Centivo All Commercial |
$16.44
|
| Rate for Payer: Cigna All Commercial |
$26.08
|
| Rate for Payer: CORVEL All Commercial |
$28.10
|
| Rate for Payer: Coventry All Commercial |
$26.59
|
| Rate for Payer: Encore All Commercial |
$27.82
|
| Rate for Payer: Frontpath All Commercial |
$27.80
|
| Rate for Payer: Humana ChoiceCare |
$26.10
|
| Rate for Payer: Humana Medicare |
$9.67
|
| Rate for Payer: Lucent All Commercial |
$16.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$22.66
|
| Rate for Payer: PHP All Commercial |
$22.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.79
|
| Rate for Payer: Sagamore Health Network All Products |
$23.33
|
| Rate for Payer: Signature Care EPO |
$25.08
|
| Rate for Payer: Signature Care PPO |
$26.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.69
|
| Rate for Payer: United Healthcare Commercial |
$23.81
|
| Rate for Payer: United Healthcare Medicare |
$9.67
|
|
|
HC CBC/AUTO
|
Facility
|
OP
|
$80.82
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Aetna Commercial |
$68.21
|
| Rate for Payer: Aetna Medicare |
$25.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.45
|
| Rate for Payer: Cash Price |
$48.49
|
| Rate for Payer: Cash Price |
$48.49
|
| Rate for Payer: Centivo All Commercial |
$43.97
|
| Rate for Payer: Cigna All Commercial |
$69.75
|
| Rate for Payer: CORVEL All Commercial |
$75.16
|
| Rate for Payer: Coventry All Commercial |
$71.12
|
| Rate for Payer: Encore All Commercial |
$74.39
|
| Rate for Payer: Frontpath All Commercial |
$74.35
|
| Rate for Payer: Humana ChoiceCare |
$69.80
|
| Rate for Payer: Humana Medicare |
$25.86
|
| Rate for Payer: Lucent All Commercial |
$43.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.74
|
| Rate for Payer: Managed Health Services Medicaid |
$7.77
|
| Rate for Payer: MDWise Medicaid |
$7.77
|
| Rate for Payer: PHCS All Commercial |
$60.62
|
| Rate for Payer: PHP All Commercial |
$61.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.52
|
| Rate for Payer: Sagamore Health Network All Products |
$62.39
|
| Rate for Payer: Signature Care EPO |
$67.08
|
| Rate for Payer: Signature Care PPO |
$71.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.70
|
| Rate for Payer: United Healthcare Commercial |
$63.69
|
| Rate for Payer: United Healthcare Medicare |
$25.86
|
|
|
HC CBC/AUTO
|
Facility
|
IP
|
$80.82
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Aetna Commercial |
$69.83
|
| Rate for Payer: Cash Price |
$48.49
|
| Rate for Payer: Cigna All Commercial |
$69.75
|
| Rate for Payer: CORVEL All Commercial |
$75.16
|
| Rate for Payer: Coventry All Commercial |
$71.12
|
| Rate for Payer: Encore All Commercial |
$74.39
|
| Rate for Payer: Frontpath All Commercial |
$74.35
|
| Rate for Payer: Humana ChoiceCare |
$69.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.74
|
| Rate for Payer: PHCS All Commercial |
$60.62
|
| Rate for Payer: PHP All Commercial |
$61.29
|
| Rate for Payer: Sagamore Health Network All Products |
$62.39
|
| Rate for Payer: Signature Care EPO |
$67.08
|
| Rate for Payer: Signature Care PPO |
$71.12
|
| Rate for Payer: United Healthcare Commercial |
$63.69
|
|
|
HC CBC W/OUT DIFF
|
Facility
|
IP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$50.47
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Cigna All Commercial |
$50.41
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.77
|
| Rate for Payer: Frontpath All Commercial |
$53.74
|
| Rate for Payer: Humana ChoiceCare |
$50.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.57
|
| Rate for Payer: PHCS All Commercial |
$43.81
|
| Rate for Payer: PHP All Commercial |
$44.30
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: United Healthcare Commercial |
$46.03
|
|
|
HC CBC W/OUT DIFF
|
Facility
|
OP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna Medicare |
$18.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.56
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Centivo All Commercial |
$31.78
|
| Rate for Payer: Cigna All Commercial |
$50.41
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.77
|
| Rate for Payer: Frontpath All Commercial |
$53.74
|
| Rate for Payer: Humana ChoiceCare |
$50.45
|
| Rate for Payer: Humana Medicare |
$18.69
|
| Rate for Payer: Lucent All Commercial |
$31.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.57
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$43.81
|
| Rate for Payer: PHP All Commercial |
$44.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.78
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.65
|
| Rate for Payer: United Healthcare Commercial |
$46.03
|
| Rate for Payer: United Healthcare Medicare |
$18.69
|
|
|
HC CBC W/OUT DIFFERENTIAL
|
Facility
|
OP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna Medicare |
$18.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.56
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Centivo All Commercial |
$31.78
|
| Rate for Payer: Cigna All Commercial |
$50.41
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.77
|
| Rate for Payer: Frontpath All Commercial |
$53.74
|
| Rate for Payer: Humana ChoiceCare |
$50.45
|
| Rate for Payer: Humana Medicare |
$18.69
|
| Rate for Payer: Lucent All Commercial |
$31.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.57
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$43.81
|
| Rate for Payer: PHP All Commercial |
$44.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.78
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.65
|
| Rate for Payer: United Healthcare Commercial |
$46.03
|
| Rate for Payer: United Healthcare Medicare |
$18.69
|
|
|
HC CBC W/OUT DIFFERENTIAL
|
Facility
|
IP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$50.47
|
| Rate for Payer: Cash Price |
$35.05
|
| Rate for Payer: Cigna All Commercial |
$50.41
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.77
|
| Rate for Payer: Frontpath All Commercial |
$53.74
|
| Rate for Payer: Humana ChoiceCare |
$50.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.57
|
| Rate for Payer: PHCS All Commercial |
$43.81
|
| Rate for Payer: PHP All Commercial |
$44.30
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: United Healthcare Commercial |
$46.03
|
|
|
HC CCCMCH - RESPIRATORY PANEL (COV2, FLU A/B, RSV) BY PCR
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
63087637
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$255.75 |
| Rate for Payer: Aetna Commercial |
$232.10
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$142.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$126.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$126.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$142.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.80
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Centivo All Commercial |
$149.60
|
| Rate for Payer: Cigna All Commercial |
$237.32
|
| Rate for Payer: CORVEL All Commercial |
$255.75
|
| Rate for Payer: Coventry All Commercial |
$242.00
|
| Rate for Payer: Encore All Commercial |
$253.14
|
| Rate for Payer: Frontpath All Commercial |
$253.00
|
| Rate for Payer: Humana ChoiceCare |
$237.52
|
| Rate for Payer: Humana Medicare |
$88.00
|
| Rate for Payer: Lucent All Commercial |
$149.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.50
|
| Rate for Payer: Managed Health Services Medicaid |
$142.63
|
| Rate for Payer: MDWise Medicaid |
$142.63
|
| Rate for Payer: PHCS All Commercial |
$206.25
|
| Rate for Payer: PHP All Commercial |
$208.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.25
|
| Rate for Payer: Sagamore Health Network All Products |
$212.30
|
| Rate for Payer: Signature Care EPO |
$228.25
|
| Rate for Payer: Signature Care PPO |
$242.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$233.75
|
| Rate for Payer: United Healthcare Commercial |
$216.70
|
| Rate for Payer: United Healthcare Medicare |
$88.00
|
|
|
HC CCCMCH - RESPIRATORY PANEL (COV2, FLU A/B, RSV) BY PCR
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
63087637
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$255.75 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna All Commercial |
$237.32
|
| Rate for Payer: CORVEL All Commercial |
$255.75
|
| Rate for Payer: Coventry All Commercial |
$242.00
|
| Rate for Payer: Encore All Commercial |
$253.14
|
| Rate for Payer: Frontpath All Commercial |
$253.00
|
| Rate for Payer: Humana ChoiceCare |
$237.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.50
|
| Rate for Payer: PHCS All Commercial |
$206.25
|
| Rate for Payer: PHP All Commercial |
$208.56
|
| Rate for Payer: Sagamore Health Network All Products |
$212.30
|
| Rate for Payer: Signature Care EPO |
$228.25
|
| Rate for Payer: Signature Care PPO |
$242.00
|
| Rate for Payer: United Healthcare Commercial |
$216.70
|
|
|
HC CD4&TCELL LYMPHS
|
Facility
|
OP
|
$206.08
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
63001046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$191.65 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: Aetna Medicare |
$65.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.54
|
| Rate for Payer: Cash Price |
$123.65
|
| Rate for Payer: Cash Price |
$123.65
|
| Rate for Payer: Centivo All Commercial |
$112.11
|
| Rate for Payer: Cigna All Commercial |
$177.85
|
| Rate for Payer: CORVEL All Commercial |
$191.65
|
| Rate for Payer: Coventry All Commercial |
$181.35
|
| Rate for Payer: Encore All Commercial |
$189.70
|
| Rate for Payer: Frontpath All Commercial |
$189.59
|
| Rate for Payer: Humana ChoiceCare |
$177.99
|
| Rate for Payer: Humana Medicare |
$65.95
|
| Rate for Payer: Lucent All Commercial |
$112.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.47
|
| Rate for Payer: Managed Health Services Medicaid |
$26.78
|
| Rate for Payer: MDWise Medicaid |
$26.78
|
| Rate for Payer: PHCS All Commercial |
$154.56
|
| Rate for Payer: PHP All Commercial |
$156.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.37
|
| Rate for Payer: Sagamore Health Network All Products |
$159.09
|
| Rate for Payer: Signature Care EPO |
$171.05
|
| Rate for Payer: Signature Care PPO |
$181.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.17
|
| Rate for Payer: United Healthcare Commercial |
$162.39
|
| Rate for Payer: United Healthcare Medicare |
$65.95
|
|
|
HC CD4&TCELL LYMPHS
|
Facility
|
IP
|
$206.08
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
63001046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$191.65 |
| Rate for Payer: Aetna Commercial |
$178.05
|
| Rate for Payer: Cash Price |
$123.65
|
| Rate for Payer: Cigna All Commercial |
$177.85
|
| Rate for Payer: CORVEL All Commercial |
$191.65
|
| Rate for Payer: Coventry All Commercial |
$181.35
|
| Rate for Payer: Encore All Commercial |
$189.70
|
| Rate for Payer: Frontpath All Commercial |
$189.59
|
| Rate for Payer: Humana ChoiceCare |
$177.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.47
|
| Rate for Payer: PHCS All Commercial |
$154.56
|
| Rate for Payer: PHP All Commercial |
$156.29
|
| Rate for Payer: Sagamore Health Network All Products |
$159.09
|
| Rate for Payer: Signature Care EPO |
$171.05
|
| Rate for Payer: Signature Care PPO |
$181.35
|
| Rate for Payer: United Healthcare Commercial |
$162.39
|
|
|
HC C DIFF AG TOXIN A & B-FECES, NAA IF IND
|
Facility
|
OP
|
$52.47
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
63001083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$44.28
|
| Rate for Payer: Aetna Medicare |
$16.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.47
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Centivo All Commercial |
$28.54
|
| Rate for Payer: Cigna All Commercial |
$45.28
|
| Rate for Payer: CORVEL All Commercial |
$48.80
|
| Rate for Payer: Coventry All Commercial |
$46.17
|
| Rate for Payer: Encore All Commercial |
$48.30
|
| Rate for Payer: Frontpath All Commercial |
$48.27
|
| Rate for Payer: Humana ChoiceCare |
$45.32
|
| Rate for Payer: Humana Medicare |
$16.79
|
| Rate for Payer: Lucent All Commercial |
$28.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.22
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$39.35
|
| Rate for Payer: PHP All Commercial |
$39.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.46
|
| Rate for Payer: Sagamore Health Network All Products |
$40.51
|
| Rate for Payer: Signature Care EPO |
$43.55
|
| Rate for Payer: Signature Care PPO |
$46.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.60
|
| Rate for Payer: United Healthcare Commercial |
$41.35
|
| Rate for Payer: United Healthcare Medicare |
$16.79
|
|
|
HC C DIFF AG TOXIN A & B-FECES, NAA IF IND
|
Facility
|
IP
|
$52.47
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
63001083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.35 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$45.33
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Cigna All Commercial |
$45.28
|
| Rate for Payer: CORVEL All Commercial |
$48.80
|
| Rate for Payer: Coventry All Commercial |
$46.17
|
| Rate for Payer: Encore All Commercial |
$48.30
|
| Rate for Payer: Frontpath All Commercial |
$48.27
|
| Rate for Payer: Humana ChoiceCare |
$45.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.22
|
| Rate for Payer: PHCS All Commercial |
$39.35
|
| Rate for Payer: PHP All Commercial |
$39.79
|
| Rate for Payer: Sagamore Health Network All Products |
$40.51
|
| Rate for Payer: Signature Care EPO |
$43.55
|
| Rate for Payer: Signature Care PPO |
$46.17
|
| Rate for Payer: United Healthcare Commercial |
$41.35
|
|
|
HC C DIFFICILE TOXIN A/B BY DNA
|
Facility
|
IP
|
$230.01
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
63001008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.51 |
| Max. Negotiated Rate |
$213.91 |
| Rate for Payer: Aetna Commercial |
$198.73
|
| Rate for Payer: Cash Price |
$138.01
|
| Rate for Payer: Cigna All Commercial |
$198.50
|
| Rate for Payer: CORVEL All Commercial |
$213.91
|
| Rate for Payer: Coventry All Commercial |
$202.41
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.61
|
| Rate for Payer: Humana ChoiceCare |
$198.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.01
|
| Rate for Payer: PHCS All Commercial |
$172.51
|
| Rate for Payer: PHP All Commercial |
$174.44
|
| Rate for Payer: Sagamore Health Network All Products |
$177.57
|
| Rate for Payer: Signature Care EPO |
$190.91
|
| Rate for Payer: Signature Care PPO |
$202.41
|
| Rate for Payer: United Healthcare Commercial |
$181.25
|
|
