|
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
|
|
|
HC CEA
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
63001337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$200.25 |
| Max. Negotiated Rate |
$248.31 |
| Rate for Payer: Aetna Commercial |
$230.69
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna All Commercial |
$230.42
|
| Rate for Payer: CORVEL All Commercial |
$248.31
|
| Rate for Payer: Coventry All Commercial |
$234.96
|
| Rate for Payer: Encore All Commercial |
$245.77
|
| Rate for Payer: Frontpath All Commercial |
$245.64
|
| Rate for Payer: Humana ChoiceCare |
$230.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.30
|
| Rate for Payer: PHCS All Commercial |
$200.25
|
| Rate for Payer: PHP All Commercial |
$202.49
|
| Rate for Payer: Sagamore Health Network All Products |
$206.12
|
| Rate for Payer: Signature Care EPO |
$221.61
|
| Rate for Payer: Signature Care PPO |
$234.96
|
| Rate for Payer: United Healthcare Commercial |
$210.40
|
|
|
HC CEA
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
63001337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$248.31 |
| Rate for Payer: Aetna Commercial |
$225.35
|
| Rate for Payer: Aetna Medicare |
$85.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.98
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Centivo All Commercial |
$145.25
|
| Rate for Payer: Cigna All Commercial |
$230.42
|
| Rate for Payer: CORVEL All Commercial |
$248.31
|
| Rate for Payer: Coventry All Commercial |
$234.96
|
| Rate for Payer: Encore All Commercial |
$245.77
|
| Rate for Payer: Frontpath All Commercial |
$245.64
|
| Rate for Payer: Humana ChoiceCare |
$230.61
|
| Rate for Payer: Humana Medicare |
$85.44
|
| Rate for Payer: Lucent All Commercial |
$145.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.30
|
| Rate for Payer: Managed Health Services Medicaid |
$18.96
|
| Rate for Payer: MDWise Medicaid |
$18.96
|
| Rate for Payer: PHCS All Commercial |
$200.25
|
| Rate for Payer: PHP All Commercial |
$202.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.13
|
| Rate for Payer: Sagamore Health Network All Products |
$206.12
|
| Rate for Payer: Signature Care EPO |
$221.61
|
| Rate for Payer: Signature Care PPO |
$234.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.95
|
| Rate for Payer: United Healthcare Commercial |
$210.40
|
| Rate for Payer: United Healthcare Medicare |
$85.44
|
|
|
HC CELL COUNT BODY FLUID
|
Facility
|
OP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$134.39 |
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Aetna Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.87
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$78.61
|
| Rate for Payer: Cigna All Commercial |
$124.71
|
| Rate for Payer: CORVEL All Commercial |
$134.39
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.81
|
| Rate for Payer: Humana Medicare |
$46.24
|
| Rate for Payer: Lucent All Commercial |
$78.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: Managed Health Services Medicaid |
$4.72
|
| Rate for Payer: MDWise Medicaid |
$4.72
|
| Rate for Payer: PHCS All Commercial |
$108.38
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.36
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.94
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.83
|
| Rate for Payer: United Healthcare Commercial |
$113.87
|
| Rate for Payer: United Healthcare Medicare |
$46.24
|
|
|
HC CELL COUNT BODY FLUID
|
Facility
|
IP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$134.39 |
| Rate for Payer: Aetna Commercial |
$124.86
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$124.71
|
| Rate for Payer: CORVEL All Commercial |
$134.39
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: PHCS All Commercial |
$108.38
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.94
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: United Healthcare Commercial |
$113.87
|
|
|
HC CENTRAL LINE INSERTION
|
Facility
|
IP
|
$1,266.25
|
|
| Hospital Charge Code |
1682005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$949.69 |
| Max. Negotiated Rate |
$1,177.61 |
| Rate for Payer: Aetna Commercial |
$1,094.04
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Cigna All Commercial |
$1,092.77
|
| Rate for Payer: CORVEL All Commercial |
$1,177.61
|
| Rate for Payer: Coventry All Commercial |
$1,114.30
|
| Rate for Payer: Encore All Commercial |
$1,165.58
|
| Rate for Payer: Frontpath All Commercial |
$1,164.95
|
| Rate for Payer: Humana ChoiceCare |
$1,093.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,139.62
|
| Rate for Payer: PHCS All Commercial |
$949.69
|
| Rate for Payer: PHP All Commercial |
$960.32
|
| Rate for Payer: Sagamore Health Network All Products |
$977.54
|
| Rate for Payer: Signature Care EPO |
$1,050.99
|
| Rate for Payer: Signature Care PPO |
$1,114.30
|
| Rate for Payer: United Healthcare Commercial |
$997.80
|
|
|
HC CENTRAL LINE INSERTION
|
Facility
|
OP
|
$1,266.25
|
|
| Hospital Charge Code |
1682005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$392.54 |
| Max. Negotiated Rate |
$1,177.61 |
| Rate for Payer: Aetna Commercial |
$1,068.71
|
| Rate for Payer: Aetna Medicare |
$405.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$392.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$727.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$791.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$465.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$445.72
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Centivo All Commercial |
$688.84
|
| Rate for Payer: Cigna All Commercial |
$1,092.77
|
| Rate for Payer: CORVEL All Commercial |
$1,177.61
|
| Rate for Payer: Coventry All Commercial |
$1,114.30
|
| Rate for Payer: Encore All Commercial |
$1,165.58
|
| Rate for Payer: Frontpath All Commercial |
$1,164.95
|
| Rate for Payer: Humana ChoiceCare |
$1,093.66
|
| Rate for Payer: Humana Medicare |
$405.20
|
| Rate for Payer: Lucent All Commercial |
$688.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,139.62
|
| Rate for Payer: PHCS All Commercial |
$949.69
|
| Rate for Payer: PHP All Commercial |
$960.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$493.84
|
| Rate for Payer: Sagamore Health Network All Products |
$977.54
|
| Rate for Payer: Signature Care EPO |
$1,050.99
|
| Rate for Payer: Signature Care PPO |
$1,114.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,076.31
|
| Rate for Payer: United Healthcare Commercial |
$997.80
|
| Rate for Payer: United Healthcare Medicare |
$405.20
|
|
|
HC CENTRAL/PICC LINE D
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
526592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC CENTRAL/PICC LINE D
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
526592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.33 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.01
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Centivo All Commercial |
$86.56
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$50.92
|
| Rate for Payer: Lucent All Commercial |
$86.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$50.92
|
|
|
HC CENTRAL/PICC LINE DRAW
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
1266592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC CENTRAL/PICC LINE DRAW
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
1266592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.33 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.01
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Centivo All Commercial |
$86.56
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$50.92
|
| Rate for Payer: Lucent All Commercial |
$86.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$50.92
|
|
|
HC CERENE CRYOTHERAPY DEVICE
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
41607039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Aetna Commercial |
$3,646.08
|
| Rate for Payer: Aetna Medicare |
$1,382.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,339.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,480.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,700.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,589.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,520.64
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Centivo All Commercial |
$2,350.08
|
| Rate for Payer: Cigna All Commercial |
$3,728.16
|
| Rate for Payer: CORVEL All Commercial |
$4,017.60
|
| Rate for Payer: Coventry All Commercial |
$3,801.60
|
| Rate for Payer: Encore All Commercial |
$3,976.56
|
| Rate for Payer: Frontpath All Commercial |
$3,974.40
|
| Rate for Payer: Humana ChoiceCare |
$3,731.18
|
| Rate for Payer: Humana Medicare |
$1,382.40
|
| Rate for Payer: Lucent All Commercial |
$2,350.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,888.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,240.00
|
| Rate for Payer: PHP All Commercial |
$3,276.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,684.80
|
| Rate for Payer: Sagamore Health Network All Products |
$3,335.04
|
| Rate for Payer: Signature Care EPO |
$3,585.60
|
| Rate for Payer: Signature Care PPO |
$3,801.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,672.00
|
| Rate for Payer: United Healthcare Commercial |
$3,404.16
|
| Rate for Payer: United Healthcare Medicare |
$1,382.40
|
|
|
HC CERENE CRYOTHERAPY DEVICE
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
41607039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Aetna Commercial |
$3,732.48
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna All Commercial |
$3,728.16
|
| Rate for Payer: CORVEL All Commercial |
$4,017.60
|
| Rate for Payer: Coventry All Commercial |
$3,801.60
|
| Rate for Payer: Encore All Commercial |
$3,976.56
|
| Rate for Payer: Frontpath All Commercial |
$3,974.40
|
| Rate for Payer: Humana ChoiceCare |
$3,731.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,888.00
|
| Rate for Payer: PHCS All Commercial |
$3,240.00
|
| Rate for Payer: PHP All Commercial |
$3,276.29
|
| Rate for Payer: Sagamore Health Network All Products |
$3,335.04
|
| Rate for Payer: Signature Care EPO |
$3,585.60
|
| Rate for Payer: Signature Care PPO |
$3,801.60
|
| Rate for Payer: United Healthcare Commercial |
$3,404.16
|
|
|
HC CERULOPLASMIN
|
Facility
|
IP
|
$165.93
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
63001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.45 |
| Max. Negotiated Rate |
$154.31 |
| Rate for Payer: Aetna Commercial |
$143.36
|
| Rate for Payer: Cash Price |
$99.56
|
| Rate for Payer: Cigna All Commercial |
$143.20
|
| Rate for Payer: CORVEL All Commercial |
$154.31
|
| Rate for Payer: Coventry All Commercial |
$146.02
|
| Rate for Payer: Encore All Commercial |
$152.74
|
| Rate for Payer: Frontpath All Commercial |
$152.66
|
| Rate for Payer: Humana ChoiceCare |
$143.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.34
|
| Rate for Payer: PHCS All Commercial |
$124.45
|
| Rate for Payer: PHP All Commercial |
$125.84
|
| Rate for Payer: Sagamore Health Network All Products |
$128.10
|
| Rate for Payer: Signature Care EPO |
$137.72
|
| Rate for Payer: Signature Care PPO |
$146.02
|
| Rate for Payer: United Healthcare Commercial |
$130.75
|
|
|
HC CERULOPLASMIN
|
Facility
|
OP
|
$165.93
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
63001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$154.31 |
| Rate for Payer: Aetna Commercial |
$140.04
|
| Rate for Payer: Aetna Medicare |
$53.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.41
|
| Rate for Payer: Cash Price |
$99.56
|
| Rate for Payer: Cash Price |
$99.56
|
| Rate for Payer: Centivo All Commercial |
$90.27
|
| Rate for Payer: Cigna All Commercial |
$143.20
|
| Rate for Payer: CORVEL All Commercial |
$154.31
|
| Rate for Payer: Coventry All Commercial |
$146.02
|
| Rate for Payer: Encore All Commercial |
$152.74
|
| Rate for Payer: Frontpath All Commercial |
$152.66
|
| Rate for Payer: Humana ChoiceCare |
$143.31
|
| Rate for Payer: Humana Medicare |
$53.10
|
| Rate for Payer: Lucent All Commercial |
$90.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.34
|
| Rate for Payer: Managed Health Services Medicaid |
$10.74
|
| Rate for Payer: MDWise Medicaid |
$10.74
|
| Rate for Payer: PHCS All Commercial |
$124.45
|
| Rate for Payer: PHP All Commercial |
$125.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.71
|
| Rate for Payer: Sagamore Health Network All Products |
$128.10
|
| Rate for Payer: Signature Care EPO |
$137.72
|
| Rate for Payer: Signature Care PPO |
$146.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.04
|
| Rate for Payer: United Healthcare Commercial |
$130.75
|
| Rate for Payer: United Healthcare Medicare |
$53.10
|
|
|
HC CHANGE OF CYST TUBE SIMPLE
|
Facility
|
OP
|
$395.28
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
1611705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$367.61 |
| Rate for Payer: Aetna Commercial |
$333.62
|
| Rate for Payer: Aetna Medicare |
$126.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$227.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$247.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.14
|
| Rate for Payer: Cash Price |
$237.17
|
| Rate for Payer: Cash Price |
$237.17
|
| Rate for Payer: Centivo All Commercial |
$215.03
|
| Rate for Payer: Cigna All Commercial |
$341.13
|
| Rate for Payer: CORVEL All Commercial |
$367.61
|
| Rate for Payer: Coventry All Commercial |
$347.85
|
| Rate for Payer: Encore All Commercial |
$363.86
|
| Rate for Payer: Frontpath All Commercial |
$363.66
|
| Rate for Payer: Humana ChoiceCare |
$341.40
|
| Rate for Payer: Humana Medicare |
$126.49
|
| Rate for Payer: Lucent All Commercial |
$215.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.75
|
| Rate for Payer: Managed Health Services Medicaid |
$97.73
|
| Rate for Payer: MDWise Medicaid |
$97.73
|
| Rate for Payer: PHCS All Commercial |
$296.46
|
| Rate for Payer: PHP All Commercial |
$299.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.16
|
| Rate for Payer: Sagamore Health Network All Products |
$305.16
|
| Rate for Payer: Signature Care EPO |
$328.08
|
| Rate for Payer: Signature Care PPO |
$347.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.99
|
| Rate for Payer: United Healthcare Commercial |
$311.48
|
| Rate for Payer: United Healthcare Medicare |
$126.49
|
|
|
HC CHANGE OF CYST TUBE SIMPLE
|
Facility
|
IP
|
$395.28
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
1611705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$296.46 |
| Max. Negotiated Rate |
$367.61 |
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Cash Price |
$237.17
|
| Rate for Payer: Cigna All Commercial |
$341.13
|
| Rate for Payer: CORVEL All Commercial |
$367.61
|
| Rate for Payer: Coventry All Commercial |
$347.85
|
| Rate for Payer: Encore All Commercial |
$363.86
|
| Rate for Payer: Frontpath All Commercial |
$363.66
|
| Rate for Payer: Humana ChoiceCare |
$341.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.75
|
| Rate for Payer: PHCS All Commercial |
$296.46
|
| Rate for Payer: PHP All Commercial |
$299.78
|
| Rate for Payer: Sagamore Health Network All Products |
$305.16
|
| Rate for Payer: Signature Care EPO |
$328.08
|
| Rate for Payer: Signature Care PPO |
$347.85
|
| Rate for Payer: United Healthcare Commercial |
$311.48
|
|
|
HC CHEMO INF EA ADDL 31-60 MIN
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
526412
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$30.21 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$344.35
|
| Rate for Payer: Aetna Medicare |
$130.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$30.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$234.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.62
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Centivo All Commercial |
$221.95
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Humana Medicare |
$130.56
|
| Rate for Payer: Lucent All Commercial |
$221.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: Managed Health Services Medicaid |
$30.21
|
| Rate for Payer: MDWise Medicaid |
$30.21
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.12
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.80
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
| Rate for Payer: United Healthcare Medicare |
$130.56
|
|
|
HC CHEMO INF EA ADDL 31-60 MIN
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
526412
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$379.44 |
| Rate for Payer: Aetna Commercial |
$352.51
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna All Commercial |
$352.10
|
| Rate for Payer: CORVEL All Commercial |
$379.44
|
| Rate for Payer: Coventry All Commercial |
$359.04
|
| Rate for Payer: Encore All Commercial |
$375.56
|
| Rate for Payer: Frontpath All Commercial |
$375.36
|
| Rate for Payer: Humana ChoiceCare |
$352.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.20
|
| Rate for Payer: PHCS All Commercial |
$306.00
|
| Rate for Payer: PHP All Commercial |
$309.43
|
| Rate for Payer: Sagamore Health Network All Products |
$314.98
|
| Rate for Payer: Signature Care EPO |
$338.64
|
| Rate for Payer: Signature Care PPO |
$359.04
|
| Rate for Payer: United Healthcare Commercial |
$321.50
|
|
|
HC CHEMO INFUS INIT 16-60 MIN
|
Facility
|
IP
|
$848.64
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
526410
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$636.48 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$733.22
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
|
|
HC CHEMO INFUS INIT 16-60 MIN
|
Facility
|
OP
|
$848.64
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
526410
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$83.23 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$716.25
|
| Rate for Payer: Aetna Medicare |
$271.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$83.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$487.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$83.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.72
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Centivo All Commercial |
$461.66
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Humana Medicare |
$271.56
|
| Rate for Payer: Lucent All Commercial |
$461.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: Managed Health Services Medicaid |
$83.23
|
| Rate for Payer: MDWise Medicaid |
$83.23
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.97
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.34
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
| Rate for Payer: United Healthcare Medicare |
$271.56
|
|
|
HC CHEST DRAIN PLEUREVAC
|
Facility
|
IP
|
$390.83
|
|
| Hospital Charge Code |
41601037
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.12 |
| Max. Negotiated Rate |
$363.47 |
| Rate for Payer: Aetna Commercial |
$337.68
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna All Commercial |
$337.29
|
| Rate for Payer: CORVEL All Commercial |
$363.47
|
| Rate for Payer: Coventry All Commercial |
$343.93
|
| Rate for Payer: Encore All Commercial |
$359.76
|
| Rate for Payer: Frontpath All Commercial |
$359.56
|
| Rate for Payer: Humana ChoiceCare |
$337.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.75
|
| Rate for Payer: PHCS All Commercial |
$293.12
|
| Rate for Payer: PHP All Commercial |
$296.41
|
| Rate for Payer: Sagamore Health Network All Products |
$301.72
|
| Rate for Payer: Signature Care EPO |
$324.39
|
| Rate for Payer: Signature Care PPO |
$343.93
|
| Rate for Payer: United Healthcare Commercial |
$307.97
|
|
|
HC CHEST DRAIN PLEUREVAC
|
Facility
|
OP
|
$390.83
|
|
| Hospital Charge Code |
41601037
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$363.47 |
| Rate for Payer: Aetna Commercial |
$329.86
|
| Rate for Payer: Aetna Medicare |
$125.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$224.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.57
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Centivo All Commercial |
$212.61
|
| Rate for Payer: Cigna All Commercial |
$337.29
|
| Rate for Payer: CORVEL All Commercial |
$363.47
|
| Rate for Payer: Coventry All Commercial |
$343.93
|
| Rate for Payer: Encore All Commercial |
$359.76
|
| Rate for Payer: Frontpath All Commercial |
$359.56
|
| Rate for Payer: Humana ChoiceCare |
$337.56
|
| Rate for Payer: Humana Medicare |
$125.07
|
| Rate for Payer: Lucent All Commercial |
$212.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$293.12
|
| Rate for Payer: PHP All Commercial |
$296.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.42
|
| Rate for Payer: Sagamore Health Network All Products |
$301.72
|
| Rate for Payer: Signature Care EPO |
$324.39
|
| Rate for Payer: Signature Care PPO |
$343.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.21
|
| Rate for Payer: United Healthcare Commercial |
$307.97
|
| Rate for Payer: United Healthcare Medicare |
$125.07
|
|
|
HC CHEST TUBE INSERTION
|
Facility
|
IP
|
$420.86
|
|
| Hospital Charge Code |
1682006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.64 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$363.62
|
| Rate for Payer: Cash Price |
$252.52
|
| Rate for Payer: Cigna All Commercial |
$363.20
|
| Rate for Payer: CORVEL All Commercial |
$391.40
|
| Rate for Payer: Coventry All Commercial |
$370.36
|
| Rate for Payer: Encore All Commercial |
$387.40
|
| Rate for Payer: Frontpath All Commercial |
$387.19
|
| Rate for Payer: Humana ChoiceCare |
$363.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.77
|
| Rate for Payer: PHCS All Commercial |
$315.64
|
| Rate for Payer: PHP All Commercial |
$319.18
|
| Rate for Payer: Sagamore Health Network All Products |
$324.90
|
| Rate for Payer: Signature Care EPO |
$349.31
|
| Rate for Payer: Signature Care PPO |
$370.36
|
| Rate for Payer: United Healthcare Commercial |
$331.64
|
|
|
HC CHEST TUBE INSERTION
|
Facility
|
OP
|
$420.86
|
|
| Hospital Charge Code |
1682006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.47 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$355.21
|
| Rate for Payer: Aetna Medicare |
$134.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$241.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$154.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.14
|
| Rate for Payer: Cash Price |
$252.52
|
| Rate for Payer: Centivo All Commercial |
$228.95
|
| Rate for Payer: Cigna All Commercial |
$363.20
|
| Rate for Payer: CORVEL All Commercial |
$391.40
|
| Rate for Payer: Coventry All Commercial |
$370.36
|
| Rate for Payer: Encore All Commercial |
$387.40
|
| Rate for Payer: Frontpath All Commercial |
$387.19
|
| Rate for Payer: Humana ChoiceCare |
$363.50
|
| Rate for Payer: Humana Medicare |
$134.68
|
| Rate for Payer: Lucent All Commercial |
$228.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.77
|
| Rate for Payer: PHCS All Commercial |
$315.64
|
| Rate for Payer: PHP All Commercial |
$319.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.14
|
| Rate for Payer: Sagamore Health Network All Products |
$324.90
|
| Rate for Payer: Signature Care EPO |
$349.31
|
| Rate for Payer: Signature Care PPO |
$370.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.73
|
| Rate for Payer: United Healthcare Commercial |
$331.64
|
| Rate for Payer: United Healthcare Medicare |
$134.68
|
|
