|
HC ELECTRODE LOOP 20X15
|
Facility
IP
|
$76.57
|
|
| Hospital Charge Code |
41608235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$71.21 |
| Rate for Payer: Aetna Commercial |
$66.16
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cigna All Commercial |
$66.08
|
| Rate for Payer: CORVEL All Commercial |
$71.21
|
| Rate for Payer: Coventry All Commercial |
$67.38
|
| Rate for Payer: Encore All Commercial |
$70.48
|
| Rate for Payer: Frontpath All Commercial |
$70.44
|
| Rate for Payer: Humana ChoiceCare |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.91
|
| Rate for Payer: PHCS All Commercial |
$57.43
|
| Rate for Payer: PHP All Commercial |
$58.07
|
| Rate for Payer: Sagamore Health Network All Products |
$59.11
|
| Rate for Payer: Signature Care EPO |
$63.55
|
| Rate for Payer: Signature Care PPO |
$67.38
|
| Rate for Payer: United Healthcare Commercial |
$60.34
|
|
|
HC ELECTRODE LOOP 26 FR
|
Facility
IP
|
$547.82
|
|
| Hospital Charge Code |
41601912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.86 |
| Max. Negotiated Rate |
$509.47 |
| Rate for Payer: Aetna Commercial |
$473.32
|
| Rate for Payer: Cash Price |
$339.65
|
| Rate for Payer: Cigna All Commercial |
$472.77
|
| Rate for Payer: CORVEL All Commercial |
$509.47
|
| Rate for Payer: Coventry All Commercial |
$482.08
|
| Rate for Payer: Encore All Commercial |
$504.27
|
| Rate for Payer: Frontpath All Commercial |
$503.99
|
| Rate for Payer: Humana ChoiceCare |
$473.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$493.04
|
| Rate for Payer: PHCS All Commercial |
$410.86
|
| Rate for Payer: PHP All Commercial |
$415.47
|
| Rate for Payer: Sagamore Health Network All Products |
$422.92
|
| Rate for Payer: Signature Care EPO |
$454.69
|
| Rate for Payer: Signature Care PPO |
$482.08
|
| Rate for Payer: United Healthcare Commercial |
$431.68
|
|
|
HC ELECTRODE LOOP 26 FR
|
Facility
OP
|
$547.82
|
|
| Hospital Charge Code |
41601912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$509.47 |
| Rate for Payer: Aetna Commercial |
$462.36
|
| Rate for Payer: Aetna Medicare |
$180.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$180.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$314.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$342.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.86
|
| Rate for Payer: Cash Price |
$339.65
|
| Rate for Payer: Cash Price |
$339.65
|
| Rate for Payer: Centivo All Commercial |
$279.39
|
| Rate for Payer: Cigna All Commercial |
$472.77
|
| Rate for Payer: CORVEL All Commercial |
$509.47
|
| Rate for Payer: Coventry All Commercial |
$482.08
|
| Rate for Payer: Encore All Commercial |
$504.27
|
| Rate for Payer: Frontpath All Commercial |
$503.99
|
| Rate for Payer: Humana ChoiceCare |
$473.15
|
| Rate for Payer: Humana Medicare |
$279.39
|
| Rate for Payer: Lucent All Commercial |
$279.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$493.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$410.86
|
| Rate for Payer: PHP All Commercial |
$415.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$213.65
|
| Rate for Payer: Sagamore Health Network All Products |
$422.92
|
| Rate for Payer: Signature Care EPO |
$454.69
|
| Rate for Payer: Signature Care PPO |
$482.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$465.65
|
| Rate for Payer: United Healthcare Commercial |
$431.68
|
| Rate for Payer: United Healthcare Medicare |
$180.78
|
|
|
HC ELECTRODE LOOP HF MED 12 D BIP
|
Facility
IP
|
$2,479.17
|
|
| Hospital Charge Code |
41602498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,859.38 |
| Max. Negotiated Rate |
$2,305.63 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Cash Price |
$1,537.09
|
| Rate for Payer: Cigna All Commercial |
$2,139.52
|
| Rate for Payer: CORVEL All Commercial |
$2,305.63
|
| Rate for Payer: Coventry All Commercial |
$2,181.67
|
| Rate for Payer: Encore All Commercial |
$2,282.08
|
| Rate for Payer: Frontpath All Commercial |
$2,280.84
|
| Rate for Payer: Humana ChoiceCare |
$2,141.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,231.25
|
| Rate for Payer: PHCS All Commercial |
$1,859.38
|
| Rate for Payer: PHP All Commercial |
$1,880.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,913.92
|
| Rate for Payer: Signature Care EPO |
$2,057.71
|
| Rate for Payer: Signature Care PPO |
$2,181.67
|
| Rate for Payer: United Healthcare Commercial |
$1,953.59
|
|
|
HC ELECTRODE LOOP HF MED 12 D BIP
|
Facility
OP
|
$2,479.17
|
|
| Hospital Charge Code |
41602498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,305.63 |
| Rate for Payer: Aetna Commercial |
$2,092.42
|
| Rate for Payer: Aetna Medicare |
$818.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$818.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,423.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,549.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$940.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$899.94
|
| Rate for Payer: Cash Price |
$1,537.09
|
| Rate for Payer: Cash Price |
$1,537.09
|
| Rate for Payer: Centivo All Commercial |
$1,264.38
|
| Rate for Payer: Cigna All Commercial |
$2,139.52
|
| Rate for Payer: CORVEL All Commercial |
$2,305.63
|
| Rate for Payer: Coventry All Commercial |
$2,181.67
|
| Rate for Payer: Encore All Commercial |
$2,282.08
|
| Rate for Payer: Frontpath All Commercial |
$2,280.84
|
| Rate for Payer: Humana ChoiceCare |
$2,141.26
|
| Rate for Payer: Humana Medicare |
$1,264.38
|
| Rate for Payer: Lucent All Commercial |
$1,264.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,231.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,859.38
|
| Rate for Payer: PHP All Commercial |
$1,880.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$966.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,913.92
|
| Rate for Payer: Signature Care EPO |
$2,057.71
|
| Rate for Payer: Signature Care PPO |
$2,181.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,107.29
|
| Rate for Payer: United Healthcare Commercial |
$1,953.59
|
| Rate for Payer: United Healthcare Medicare |
$818.13
|
|
|
HC ELECTRODE LOOP SAFE T 10X10
|
Facility
OP
|
$140.81
|
|
| Hospital Charge Code |
41602552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.47 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Aetna Commercial |
$118.84
|
| Rate for Payer: Aetna Medicare |
$46.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.11
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Centivo All Commercial |
$71.81
|
| Rate for Payer: Cigna All Commercial |
$121.52
|
| Rate for Payer: CORVEL All Commercial |
$130.95
|
| Rate for Payer: Coventry All Commercial |
$123.91
|
| Rate for Payer: Encore All Commercial |
$129.62
|
| Rate for Payer: Frontpath All Commercial |
$129.55
|
| Rate for Payer: Humana ChoiceCare |
$121.62
|
| Rate for Payer: Humana Medicare |
$71.81
|
| Rate for Payer: Lucent All Commercial |
$71.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$105.61
|
| Rate for Payer: PHP All Commercial |
$106.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.92
|
| Rate for Payer: Sagamore Health Network All Products |
$108.71
|
| Rate for Payer: Signature Care EPO |
$116.87
|
| Rate for Payer: Signature Care PPO |
$123.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.69
|
| Rate for Payer: United Healthcare Commercial |
$110.96
|
| Rate for Payer: United Healthcare Medicare |
$46.47
|
|
|
HC ELECTRODE LOOP SAFE T 10X10
|
Facility
IP
|
$140.81
|
|
| Hospital Charge Code |
41602552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.61 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna All Commercial |
$121.52
|
| Rate for Payer: CORVEL All Commercial |
$130.95
|
| Rate for Payer: Coventry All Commercial |
$123.91
|
| Rate for Payer: Encore All Commercial |
$129.62
|
| Rate for Payer: Frontpath All Commercial |
$129.55
|
| Rate for Payer: Humana ChoiceCare |
$121.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.73
|
| Rate for Payer: PHCS All Commercial |
$105.61
|
| Rate for Payer: PHP All Commercial |
$106.79
|
| Rate for Payer: Sagamore Health Network All Products |
$108.71
|
| Rate for Payer: Signature Care EPO |
$116.87
|
| Rate for Payer: Signature Care PPO |
$123.91
|
| Rate for Payer: United Healthcare Commercial |
$110.96
|
|
|
HC ELECTRODE LOOP SAFE T 15X12
|
Facility
OP
|
$150.81
|
|
| Hospital Charge Code |
41602551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Aetna Commercial |
$127.28
|
| Rate for Payer: Aetna Medicare |
$49.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.74
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Centivo All Commercial |
$76.91
|
| Rate for Payer: Cigna All Commercial |
$130.15
|
| Rate for Payer: CORVEL All Commercial |
$140.25
|
| Rate for Payer: Coventry All Commercial |
$132.71
|
| Rate for Payer: Encore All Commercial |
$138.82
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Humana ChoiceCare |
$130.25
|
| Rate for Payer: Humana Medicare |
$76.91
|
| Rate for Payer: Lucent All Commercial |
$76.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$113.11
|
| Rate for Payer: PHP All Commercial |
$114.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.82
|
| Rate for Payer: Sagamore Health Network All Products |
$116.43
|
| Rate for Payer: Signature Care EPO |
$125.17
|
| Rate for Payer: Signature Care PPO |
$132.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.19
|
| Rate for Payer: United Healthcare Commercial |
$118.84
|
| Rate for Payer: United Healthcare Medicare |
$49.77
|
|
|
HC ELECTRODE LOOP SAFE T 15X12
|
Facility
IP
|
$150.81
|
|
| Hospital Charge Code |
41602551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Aetna Commercial |
$130.30
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna All Commercial |
$130.15
|
| Rate for Payer: CORVEL All Commercial |
$140.25
|
| Rate for Payer: Coventry All Commercial |
$132.71
|
| Rate for Payer: Encore All Commercial |
$138.82
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Humana ChoiceCare |
$130.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.73
|
| Rate for Payer: PHCS All Commercial |
$113.11
|
| Rate for Payer: PHP All Commercial |
$114.37
|
| Rate for Payer: Sagamore Health Network All Products |
$116.43
|
| Rate for Payer: Signature Care EPO |
$125.17
|
| Rate for Payer: Signature Care PPO |
$132.71
|
| Rate for Payer: United Healthcare Commercial |
$118.84
|
|
|
HC ELECTRODE LOOP SAFE T 20X15
|
Facility
IP
|
$137.59
|
|
| Hospital Charge Code |
41602550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$127.96 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna All Commercial |
$118.74
|
| Rate for Payer: CORVEL All Commercial |
$127.96
|
| Rate for Payer: Coventry All Commercial |
$121.08
|
| Rate for Payer: Encore All Commercial |
$126.65
|
| Rate for Payer: Frontpath All Commercial |
$126.58
|
| Rate for Payer: Humana ChoiceCare |
$118.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.83
|
| Rate for Payer: PHCS All Commercial |
$103.19
|
| Rate for Payer: PHP All Commercial |
$104.35
|
| Rate for Payer: Sagamore Health Network All Products |
$106.22
|
| Rate for Payer: Signature Care EPO |
$114.20
|
| Rate for Payer: Signature Care PPO |
$121.08
|
| Rate for Payer: United Healthcare Commercial |
$108.42
|
|
|
HC ELECTRODE LOOP SAFE T 20X15
|
Facility
OP
|
$137.59
|
|
| Hospital Charge Code |
41602550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$127.96 |
| Rate for Payer: Aetna Commercial |
$116.13
|
| Rate for Payer: Aetna Medicare |
$45.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.95
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Centivo All Commercial |
$70.17
|
| Rate for Payer: Cigna All Commercial |
$118.74
|
| Rate for Payer: CORVEL All Commercial |
$127.96
|
| Rate for Payer: Coventry All Commercial |
$121.08
|
| Rate for Payer: Encore All Commercial |
$126.65
|
| Rate for Payer: Frontpath All Commercial |
$126.58
|
| Rate for Payer: Humana ChoiceCare |
$118.84
|
| Rate for Payer: Humana Medicare |
$70.17
|
| Rate for Payer: Lucent All Commercial |
$70.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.83
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$103.19
|
| Rate for Payer: PHP All Commercial |
$104.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.66
|
| Rate for Payer: Sagamore Health Network All Products |
$106.22
|
| Rate for Payer: Signature Care EPO |
$114.20
|
| Rate for Payer: Signature Care PPO |
$121.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.95
|
| Rate for Payer: United Healthcare Commercial |
$108.42
|
| Rate for Payer: United Healthcare Medicare |
$45.40
|
|
|
HC ELECTROLYTES PANEL
|
Facility
OP
|
$89.57
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
63001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Aetna Commercial |
$75.59
|
| Rate for Payer: Aetna Medicare |
$29.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.51
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Centivo All Commercial |
$45.68
|
| Rate for Payer: Cigna All Commercial |
$77.30
|
| Rate for Payer: CORVEL All Commercial |
$83.30
|
| Rate for Payer: Coventry All Commercial |
$78.82
|
| Rate for Payer: Encore All Commercial |
$82.45
|
| Rate for Payer: Frontpath All Commercial |
$82.40
|
| Rate for Payer: Humana ChoiceCare |
$77.36
|
| Rate for Payer: Humana Medicare |
$45.68
|
| Rate for Payer: Lucent All Commercial |
$45.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.61
|
| Rate for Payer: Managed Health Services Medicaid |
$7.01
|
| Rate for Payer: MDWise Medicaid |
$7.01
|
| Rate for Payer: PHCS All Commercial |
$67.17
|
| Rate for Payer: PHP All Commercial |
$67.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.93
|
| Rate for Payer: Sagamore Health Network All Products |
$69.15
|
| Rate for Payer: Signature Care EPO |
$74.34
|
| Rate for Payer: Signature Care PPO |
$78.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.13
|
| Rate for Payer: United Healthcare Commercial |
$70.58
|
| Rate for Payer: United Healthcare Medicare |
$29.56
|
|
|
HC ELECTROLYTES PANEL
|
Facility
IP
|
$89.57
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
63001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Aetna Commercial |
$77.39
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Cigna All Commercial |
$77.30
|
| Rate for Payer: CORVEL All Commercial |
$83.30
|
| Rate for Payer: Coventry All Commercial |
$78.82
|
| Rate for Payer: Encore All Commercial |
$82.45
|
| Rate for Payer: Frontpath All Commercial |
$82.40
|
| Rate for Payer: Humana ChoiceCare |
$77.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.61
|
| Rate for Payer: PHCS All Commercial |
$67.17
|
| Rate for Payer: PHP All Commercial |
$67.93
|
| Rate for Payer: Sagamore Health Network All Products |
$69.15
|
| Rate for Payer: Signature Care EPO |
$74.34
|
| Rate for Payer: Signature Care PPO |
$78.82
|
| Rate for Payer: United Healthcare Commercial |
$70.58
|
|
|
HC ELECTRON MICROSCOPY DX
|
Facility
IP
|
$1,884.09
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
63001264
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,413.07 |
| Max. Negotiated Rate |
$1,752.21 |
| Rate for Payer: Aetna Commercial |
$1,627.86
|
| Rate for Payer: Cash Price |
$1,168.14
|
| Rate for Payer: Cigna All Commercial |
$1,625.97
|
| Rate for Payer: CORVEL All Commercial |
$1,752.21
|
| Rate for Payer: Coventry All Commercial |
$1,658.00
|
| Rate for Payer: Encore All Commercial |
$1,734.31
|
| Rate for Payer: Frontpath All Commercial |
$1,733.37
|
| Rate for Payer: Humana ChoiceCare |
$1,627.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,695.68
|
| Rate for Payer: PHCS All Commercial |
$1,413.07
|
| Rate for Payer: PHP All Commercial |
$1,428.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,454.52
|
| Rate for Payer: Signature Care EPO |
$1,563.80
|
| Rate for Payer: Signature Care PPO |
$1,658.00
|
| Rate for Payer: United Healthcare Commercial |
$1,484.67
|
|
|
HC ELECTRON MICROSCOPY DX
|
Facility
OP
|
$1,884.09
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
63001264
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$408.76 |
| Max. Negotiated Rate |
$1,752.21 |
| Rate for Payer: Aetna Commercial |
$1,590.17
|
| Rate for Payer: Aetna Medicare |
$621.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$621.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,082.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$408.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$715.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$683.93
|
| Rate for Payer: Cash Price |
$1,168.14
|
| Rate for Payer: Cash Price |
$1,168.14
|
| Rate for Payer: Centivo All Commercial |
$960.89
|
| Rate for Payer: Cigna All Commercial |
$1,625.97
|
| Rate for Payer: CORVEL All Commercial |
$1,752.21
|
| Rate for Payer: Coventry All Commercial |
$1,658.00
|
| Rate for Payer: Encore All Commercial |
$1,734.31
|
| Rate for Payer: Frontpath All Commercial |
$1,733.37
|
| Rate for Payer: Humana ChoiceCare |
$1,627.29
|
| Rate for Payer: Humana Medicare |
$960.89
|
| Rate for Payer: Lucent All Commercial |
$960.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,695.68
|
| Rate for Payer: Managed Health Services Medicaid |
$408.76
|
| Rate for Payer: MDWise Medicaid |
$408.76
|
| Rate for Payer: PHCS All Commercial |
$1,413.07
|
| Rate for Payer: PHP All Commercial |
$1,428.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$734.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,454.52
|
| Rate for Payer: Signature Care EPO |
$1,563.80
|
| Rate for Payer: Signature Care PPO |
$1,658.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,601.48
|
| Rate for Payer: United Healthcare Commercial |
$1,484.67
|
| Rate for Payer: United Healthcare Medicare |
$621.75
|
|
|
HC ELECTROPHORESIS, PROTEIN, RANDOM URINE
|
Facility
OP
|
$93.80
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
63001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$87.23 |
| Rate for Payer: Aetna Commercial |
$79.17
|
| Rate for Payer: Aetna Medicare |
$30.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$39.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.05
|
| Rate for Payer: Cash Price |
$58.16
|
| Rate for Payer: Cash Price |
$58.16
|
| Rate for Payer: Centivo All Commercial |
$47.84
|
| Rate for Payer: Cigna All Commercial |
$80.95
|
| Rate for Payer: CORVEL All Commercial |
$87.23
|
| Rate for Payer: Coventry All Commercial |
$82.54
|
| Rate for Payer: Encore All Commercial |
$86.34
|
| Rate for Payer: Frontpath All Commercial |
$86.30
|
| Rate for Payer: Humana ChoiceCare |
$81.01
|
| Rate for Payer: Humana Medicare |
$47.84
|
| Rate for Payer: Lucent All Commercial |
$47.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.42
|
| Rate for Payer: Managed Health Services Medicaid |
$39.51
|
| Rate for Payer: MDWise Medicaid |
$39.51
|
| Rate for Payer: PHCS All Commercial |
$70.35
|
| Rate for Payer: PHP All Commercial |
$71.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.58
|
| Rate for Payer: Sagamore Health Network All Products |
$72.41
|
| Rate for Payer: Signature Care EPO |
$77.85
|
| Rate for Payer: Signature Care PPO |
$82.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.73
|
| Rate for Payer: United Healthcare Commercial |
$73.91
|
| Rate for Payer: United Healthcare Medicare |
$30.95
|
|
|
HC ELECTROPHORESIS, PROTEIN, RANDOM URINE
|
Facility
IP
|
$93.80
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
63001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$87.23 |
| Rate for Payer: Aetna Commercial |
$81.04
|
| Rate for Payer: Cash Price |
$58.16
|
| Rate for Payer: Cigna All Commercial |
$80.95
|
| Rate for Payer: CORVEL All Commercial |
$87.23
|
| Rate for Payer: Coventry All Commercial |
$82.54
|
| Rate for Payer: Encore All Commercial |
$86.34
|
| Rate for Payer: Frontpath All Commercial |
$86.30
|
| Rate for Payer: Humana ChoiceCare |
$81.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.42
|
| Rate for Payer: PHCS All Commercial |
$70.35
|
| Rate for Payer: PHP All Commercial |
$71.14
|
| Rate for Payer: Sagamore Health Network All Products |
$72.41
|
| Rate for Payer: Signature Care EPO |
$77.85
|
| Rate for Payer: Signature Care PPO |
$82.54
|
| Rate for Payer: United Healthcare Commercial |
$73.91
|
|
|
HC ELECTROPHORESIS, PROTEIN, SERUM
|
Facility
OP
|
$173.91
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
63001298
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$146.78
|
| Rate for Payer: Aetna Medicare |
$57.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.13
|
| Rate for Payer: Cash Price |
$107.82
|
| Rate for Payer: Cash Price |
$107.82
|
| Rate for Payer: Centivo All Commercial |
$88.69
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Humana Medicare |
$88.69
|
| Rate for Payer: Lucent All Commercial |
$88.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: Managed Health Services Medicaid |
$5.12
|
| Rate for Payer: MDWise Medicaid |
$5.12
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.82
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.82
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
| Rate for Payer: United Healthcare Medicare |
$57.39
|
|
|
HC ELECTROPHORESIS, PROTEIN, SERUM
|
Facility
IP
|
$173.91
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
63001298
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$150.26
|
| Rate for Payer: Cash Price |
$107.82
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
|
|
HC ELECT STIMULATION WOUND - OT
|
Facility
OP
|
$164.95
|
|
|
Service Code
|
CPT G0281 GO
|
| Hospital Charge Code |
01732005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$153.41 |
| Rate for Payer: Aetna Commercial |
$139.22
|
| Rate for Payer: Aetna Medicare |
$54.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.88
|
| Rate for Payer: Cash Price |
$102.27
|
| Rate for Payer: Centivo All Commercial |
$84.13
|
| Rate for Payer: Cigna All Commercial |
$142.36
|
| Rate for Payer: CORVEL All Commercial |
$153.41
|
| Rate for Payer: Coventry All Commercial |
$145.16
|
| Rate for Payer: Encore All Commercial |
$151.84
|
| Rate for Payer: Frontpath All Commercial |
$151.76
|
| Rate for Payer: Humana ChoiceCare |
$142.47
|
| Rate for Payer: Humana Medicare |
$84.13
|
| Rate for Payer: Lucent All Commercial |
$84.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.46
|
| Rate for Payer: PHCS All Commercial |
$123.72
|
| Rate for Payer: PHP All Commercial |
$125.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.33
|
| Rate for Payer: Sagamore Health Network All Products |
$127.34
|
| Rate for Payer: Signature Care EPO |
$136.91
|
| Rate for Payer: Signature Care PPO |
$145.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.21
|
| Rate for Payer: United Healthcare Commercial |
$129.98
|
| Rate for Payer: United Healthcare Medicare |
$54.43
|
|
|
HC ELECT STIMULATION WOUND - OT
|
Facility
IP
|
$164.95
|
|
|
Service Code
|
CPT G0281 GO
|
| Hospital Charge Code |
01732005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$123.72 |
| Max. Negotiated Rate |
$153.41 |
| Rate for Payer: Aetna Commercial |
$142.52
|
| Rate for Payer: Cash Price |
$102.27
|
| Rate for Payer: Cigna All Commercial |
$142.36
|
| Rate for Payer: CORVEL All Commercial |
$153.41
|
| Rate for Payer: Coventry All Commercial |
$145.16
|
| Rate for Payer: Encore All Commercial |
$151.84
|
| Rate for Payer: Frontpath All Commercial |
$151.76
|
| Rate for Payer: Humana ChoiceCare |
$142.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.46
|
| Rate for Payer: PHCS All Commercial |
$123.72
|
| Rate for Payer: PHP All Commercial |
$125.10
|
| Rate for Payer: Sagamore Health Network All Products |
$127.34
|
| Rate for Payer: Signature Care EPO |
$136.91
|
| Rate for Payer: Signature Care PPO |
$145.16
|
| Rate for Payer: United Healthcare Commercial |
$129.98
|
|
|
HC ELECT STIMULATION WOUND - PT
|
Facility
IP
|
$158.61
|
|
|
Service Code
|
CPT G0281 GP
|
| Hospital Charge Code |
01722014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$118.96 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Aetna Commercial |
$137.04
|
| Rate for Payer: Cash Price |
$98.34
|
| Rate for Payer: Cigna All Commercial |
$136.88
|
| Rate for Payer: CORVEL All Commercial |
$147.51
|
| Rate for Payer: Coventry All Commercial |
$139.58
|
| Rate for Payer: Encore All Commercial |
$146.00
|
| Rate for Payer: Frontpath All Commercial |
$145.92
|
| Rate for Payer: Humana ChoiceCare |
$136.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.75
|
| Rate for Payer: PHCS All Commercial |
$118.96
|
| Rate for Payer: PHP All Commercial |
$120.29
|
| Rate for Payer: Sagamore Health Network All Products |
$122.45
|
| Rate for Payer: Signature Care EPO |
$131.65
|
| Rate for Payer: Signature Care PPO |
$139.58
|
| Rate for Payer: United Healthcare Commercial |
$124.98
|
|
|
HC ELECT STIMULATION WOUND - PT
|
Facility
OP
|
$158.61
|
|
|
Service Code
|
CPT G0281 GP
|
| Hospital Charge Code |
01722014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Aetna Commercial |
$133.87
|
| Rate for Payer: Aetna Medicare |
$52.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.58
|
| Rate for Payer: Cash Price |
$98.34
|
| Rate for Payer: Centivo All Commercial |
$80.89
|
| Rate for Payer: Cigna All Commercial |
$136.88
|
| Rate for Payer: CORVEL All Commercial |
$147.51
|
| Rate for Payer: Coventry All Commercial |
$139.58
|
| Rate for Payer: Encore All Commercial |
$146.00
|
| Rate for Payer: Frontpath All Commercial |
$145.92
|
| Rate for Payer: Humana ChoiceCare |
$136.99
|
| Rate for Payer: Humana Medicare |
$80.89
|
| Rate for Payer: Lucent All Commercial |
$80.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.75
|
| Rate for Payer: PHCS All Commercial |
$118.96
|
| Rate for Payer: PHP All Commercial |
$120.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.86
|
| Rate for Payer: Sagamore Health Network All Products |
$122.45
|
| Rate for Payer: Signature Care EPO |
$131.65
|
| Rate for Payer: Signature Care PPO |
$139.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134.82
|
| Rate for Payer: United Healthcare Commercial |
$124.98
|
| Rate for Payer: United Healthcare Medicare |
$52.34
|
|
|
HC ENDO AVITENE 5MM
|
Facility
IP
|
$1,353.44
|
|
| Hospital Charge Code |
41601913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.08 |
| Max. Negotiated Rate |
$1,258.70 |
| Rate for Payer: Aetna Commercial |
$1,169.37
|
| Rate for Payer: Cash Price |
$839.13
|
| Rate for Payer: Cigna All Commercial |
$1,168.02
|
| Rate for Payer: CORVEL All Commercial |
$1,258.70
|
| Rate for Payer: Coventry All Commercial |
$1,191.03
|
| Rate for Payer: Encore All Commercial |
$1,245.84
|
| Rate for Payer: Frontpath All Commercial |
$1,245.16
|
| Rate for Payer: Humana ChoiceCare |
$1,168.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,218.10
|
| Rate for Payer: PHCS All Commercial |
$1,015.08
|
| Rate for Payer: PHP All Commercial |
$1,026.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,044.86
|
| Rate for Payer: Signature Care EPO |
$1,123.36
|
| Rate for Payer: Signature Care PPO |
$1,191.03
|
| Rate for Payer: United Healthcare Commercial |
$1,066.51
|
|
|
HC ENDO AVITENE 5MM
|
Facility
OP
|
$1,353.44
|
|
| Hospital Charge Code |
41601913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.64 |
| Max. Negotiated Rate |
$1,258.70 |
| Rate for Payer: Aetna Commercial |
$1,142.30
|
| Rate for Payer: Aetna Medicare |
$446.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$446.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$777.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$846.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$513.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$491.30
|
| Rate for Payer: Cash Price |
$839.13
|
| Rate for Payer: Cash Price |
$839.13
|
| Rate for Payer: Centivo All Commercial |
$690.25
|
| Rate for Payer: Cigna All Commercial |
$1,168.02
|
| Rate for Payer: CORVEL All Commercial |
$1,258.70
|
| Rate for Payer: Coventry All Commercial |
$1,191.03
|
| Rate for Payer: Encore All Commercial |
$1,245.84
|
| Rate for Payer: Frontpath All Commercial |
$1,245.16
|
| Rate for Payer: Humana ChoiceCare |
$1,168.97
|
| Rate for Payer: Humana Medicare |
$690.25
|
| Rate for Payer: Lucent All Commercial |
$690.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,218.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,015.08
|
| Rate for Payer: PHP All Commercial |
$1,026.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$527.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,044.86
|
| Rate for Payer: Signature Care EPO |
$1,123.36
|
| Rate for Payer: Signature Care PPO |
$1,191.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,150.42
|
| Rate for Payer: United Healthcare Commercial |
$1,066.51
|
| Rate for Payer: United Healthcare Medicare |
$446.64
|
|
