|
HC CIRCUMCISION ROUTINE
|
Facility
|
OP
|
$1,060.80
|
|
| Hospital Charge Code |
1023230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.85 |
| Max. Negotiated Rate |
$986.54 |
| Rate for Payer: Aetna Commercial |
$895.32
|
| Rate for Payer: Aetna Medicare |
$339.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$609.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$663.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$390.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$373.40
|
| Rate for Payer: Cash Price |
$636.48
|
| Rate for Payer: Centivo All Commercial |
$577.08
|
| Rate for Payer: Cigna All Commercial |
$915.47
|
| Rate for Payer: CORVEL All Commercial |
$986.54
|
| Rate for Payer: Coventry All Commercial |
$933.50
|
| Rate for Payer: Encore All Commercial |
$976.47
|
| Rate for Payer: Frontpath All Commercial |
$975.94
|
| Rate for Payer: Humana ChoiceCare |
$916.21
|
| Rate for Payer: Humana Medicare |
$339.46
|
| Rate for Payer: Lucent All Commercial |
$577.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$954.72
|
| Rate for Payer: PHCS All Commercial |
$795.60
|
| Rate for Payer: PHP All Commercial |
$804.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$413.71
|
| Rate for Payer: Sagamore Health Network All Products |
$818.94
|
| Rate for Payer: Signature Care EPO |
$880.46
|
| Rate for Payer: Signature Care PPO |
$933.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$901.68
|
| Rate for Payer: United Healthcare Commercial |
$835.91
|
| Rate for Payer: United Healthcare Medicare |
$339.46
|
|
|
HC CITADEL (THERAPULSE II) BED /DAY
|
Facility
|
OP
|
$306.41
|
|
| Hospital Charge Code |
1890101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$98.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.86
|
| Rate for Payer: Cash Price |
$183.85
|
| Rate for Payer: Cash Price |
$183.85
|
| Rate for Payer: Centivo All Commercial |
$166.69
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.65
|
| Rate for Payer: Humana Medicare |
$98.05
|
| Rate for Payer: Lucent All Commercial |
$166.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$98.05
|
|
|
HC CITADEL (THERAPULSE II) BED /DAY
|
Facility
|
IP
|
$306.41
|
|
| Hospital Charge Code |
1890101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$183.85
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC CKMB ASSAY
|
Facility
|
OP
|
$228.33
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
63001306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$212.35 |
| Rate for Payer: Aetna Commercial |
$192.71
|
| Rate for Payer: Aetna Medicare |
$73.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$104.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.37
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Centivo All Commercial |
$124.21
|
| Rate for Payer: Cigna All Commercial |
$197.05
|
| Rate for Payer: CORVEL All Commercial |
$212.35
|
| Rate for Payer: Coventry All Commercial |
$200.93
|
| Rate for Payer: Encore All Commercial |
$210.18
|
| Rate for Payer: Frontpath All Commercial |
$210.06
|
| Rate for Payer: Humana ChoiceCare |
$197.21
|
| Rate for Payer: Humana Medicare |
$73.07
|
| Rate for Payer: Lucent All Commercial |
$124.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.50
|
| Rate for Payer: Managed Health Services Medicaid |
$11.55
|
| Rate for Payer: MDWise Medicaid |
$11.55
|
| Rate for Payer: PHCS All Commercial |
$171.25
|
| Rate for Payer: PHP All Commercial |
$173.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.05
|
| Rate for Payer: Sagamore Health Network All Products |
$176.27
|
| Rate for Payer: Signature Care EPO |
$189.51
|
| Rate for Payer: Signature Care PPO |
$200.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.08
|
| Rate for Payer: United Healthcare Commercial |
$179.92
|
| Rate for Payer: United Healthcare Medicare |
$73.07
|
|
|
HC CKMB ASSAY
|
Facility
|
IP
|
$228.33
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
63001306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$212.35 |
| Rate for Payer: Aetna Commercial |
$197.28
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna All Commercial |
$197.05
|
| Rate for Payer: CORVEL All Commercial |
$212.35
|
| Rate for Payer: Coventry All Commercial |
$200.93
|
| Rate for Payer: Encore All Commercial |
$210.18
|
| Rate for Payer: Frontpath All Commercial |
$210.06
|
| Rate for Payer: Humana ChoiceCare |
$197.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.50
|
| Rate for Payer: PHCS All Commercial |
$171.25
|
| Rate for Payer: PHP All Commercial |
$173.17
|
| Rate for Payer: Sagamore Health Network All Products |
$176.27
|
| Rate for Payer: Signature Care EPO |
$189.51
|
| Rate for Payer: Signature Care PPO |
$200.93
|
| Rate for Payer: United Healthcare Commercial |
$179.92
|
|
|
HC CLINICL SWALLOW EVAL - SP
|
Facility
|
IP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
1742610
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$387.51 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$446.41
|
| Rate for Payer: Cash Price |
$310.01
|
| Rate for Payer: Cigna All Commercial |
$445.89
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.84
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
|
|
HC CLINICL SWALLOW EVAL - SP
|
Facility
|
OP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
1742610
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$436.08
|
| Rate for Payer: Aetna Medicare |
$165.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$296.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.87
|
| Rate for Payer: Cash Price |
$310.01
|
| Rate for Payer: Cash Price |
$310.01
|
| Rate for Payer: Centivo All Commercial |
$281.07
|
| Rate for Payer: Cigna All Commercial |
$445.89
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Humana Medicare |
$165.34
|
| Rate for Payer: Lucent All Commercial |
$281.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.51
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.84
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.18
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
| Rate for Payer: United Healthcare Medicare |
$165.34
|
|
|
HC CLINIC VISIT
|
Facility
|
OP
|
$132.12
|
|
|
Service Code
|
CPT G0463 25
|
| Hospital Charge Code |
410104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$122.87 |
| Rate for Payer: Aetna Commercial |
$111.51
|
| Rate for Payer: Aetna Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.51
|
| Rate for Payer: Cash Price |
$79.27
|
| Rate for Payer: Cash Price |
$79.27
|
| Rate for Payer: Centivo All Commercial |
$71.87
|
| Rate for Payer: Cigna All Commercial |
$114.02
|
| Rate for Payer: CORVEL All Commercial |
$122.87
|
| Rate for Payer: Coventry All Commercial |
$116.27
|
| Rate for Payer: Encore All Commercial |
$121.62
|
| Rate for Payer: Frontpath All Commercial |
$121.55
|
| Rate for Payer: Humana ChoiceCare |
$114.11
|
| Rate for Payer: Humana Medicare |
$42.28
|
| Rate for Payer: Lucent All Commercial |
$71.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.91
|
| Rate for Payer: Managed Health Services Medicaid |
$40.80
|
| Rate for Payer: MDWise Medicaid |
$40.80
|
| Rate for Payer: PHCS All Commercial |
$99.09
|
| Rate for Payer: PHP All Commercial |
$100.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.53
|
| Rate for Payer: Sagamore Health Network All Products |
$102.00
|
| Rate for Payer: Signature Care EPO |
$109.66
|
| Rate for Payer: Signature Care PPO |
$116.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.30
|
| Rate for Payer: United Healthcare Commercial |
$104.11
|
| Rate for Payer: United Healthcare Medicare |
$42.28
|
|
|
HC CLINIC VISIT
|
Facility
|
IP
|
$132.12
|
|
|
Service Code
|
CPT 99211 25
|
| Hospital Charge Code |
410104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.09 |
| Max. Negotiated Rate |
$122.87 |
| Rate for Payer: Aetna Commercial |
$114.15
|
| Rate for Payer: Cash Price |
$79.27
|
| Rate for Payer: Cigna All Commercial |
$114.02
|
| Rate for Payer: CORVEL All Commercial |
$122.87
|
| Rate for Payer: Coventry All Commercial |
$116.27
|
| Rate for Payer: Encore All Commercial |
$121.62
|
| Rate for Payer: Frontpath All Commercial |
$121.55
|
| Rate for Payer: Humana ChoiceCare |
$114.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.91
|
| Rate for Payer: PHCS All Commercial |
$99.09
|
| Rate for Payer: PHP All Commercial |
$100.20
|
| Rate for Payer: Sagamore Health Network All Products |
$102.00
|
| Rate for Payer: Signature Care EPO |
$109.66
|
| Rate for Payer: Signature Care PPO |
$116.27
|
| Rate for Payer: United Healthcare Commercial |
$104.11
|
|
|
HC CLINIC VISIT
|
Facility
|
OP
|
$132.12
|
|
|
Service Code
|
CPT 99211 25
|
| Hospital Charge Code |
410104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$122.87 |
| Rate for Payer: Aetna Commercial |
$111.51
|
| Rate for Payer: Aetna Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.51
|
| Rate for Payer: Cash Price |
$79.27
|
| Rate for Payer: Cash Price |
$79.27
|
| Rate for Payer: Centivo All Commercial |
$71.87
|
| Rate for Payer: Cigna All Commercial |
$114.02
|
| Rate for Payer: CORVEL All Commercial |
$122.87
|
| Rate for Payer: Coventry All Commercial |
$116.27
|
| Rate for Payer: Encore All Commercial |
$121.62
|
| Rate for Payer: Frontpath All Commercial |
$121.55
|
| Rate for Payer: Humana ChoiceCare |
$114.11
|
| Rate for Payer: Humana Medicare |
$42.28
|
| Rate for Payer: Lucent All Commercial |
$71.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.91
|
| Rate for Payer: Managed Health Services Medicaid |
$40.80
|
| Rate for Payer: MDWise Medicaid |
$40.80
|
| Rate for Payer: PHCS All Commercial |
$99.09
|
| Rate for Payer: PHP All Commercial |
$100.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.53
|
| Rate for Payer: Sagamore Health Network All Products |
$102.00
|
| Rate for Payer: Signature Care EPO |
$109.66
|
| Rate for Payer: Signature Care PPO |
$116.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.30
|
| Rate for Payer: United Healthcare Commercial |
$104.11
|
| Rate for Payer: United Healthcare Medicare |
$42.28
|
|
|
HC CLIP REPLAY HEMOSTASIS
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
41604628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.75 |
| Max. Negotiated Rate |
$514.29 |
| Rate for Payer: Aetna Commercial |
$477.79
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna All Commercial |
$477.24
|
| Rate for Payer: CORVEL All Commercial |
$514.29
|
| Rate for Payer: Coventry All Commercial |
$486.64
|
| Rate for Payer: Encore All Commercial |
$509.04
|
| Rate for Payer: Frontpath All Commercial |
$508.76
|
| Rate for Payer: Humana ChoiceCare |
$477.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$497.70
|
| Rate for Payer: PHCS All Commercial |
$414.75
|
| Rate for Payer: PHP All Commercial |
$419.40
|
| Rate for Payer: Sagamore Health Network All Products |
$426.92
|
| Rate for Payer: Signature Care EPO |
$458.99
|
| Rate for Payer: Signature Care PPO |
$486.64
|
| Rate for Payer: United Healthcare Commercial |
$435.76
|
|
|
HC CLIP REPLAY HEMOSTASIS
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
41604628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$514.29 |
| Rate for Payer: Aetna Commercial |
$466.73
|
| Rate for Payer: Aetna Medicare |
$176.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$317.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$345.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$203.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$194.66
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Centivo All Commercial |
$300.83
|
| Rate for Payer: Cigna All Commercial |
$477.24
|
| Rate for Payer: CORVEL All Commercial |
$514.29
|
| Rate for Payer: Coventry All Commercial |
$486.64
|
| Rate for Payer: Encore All Commercial |
$509.04
|
| Rate for Payer: Frontpath All Commercial |
$508.76
|
| Rate for Payer: Humana ChoiceCare |
$477.63
|
| Rate for Payer: Humana Medicare |
$176.96
|
| Rate for Payer: Lucent All Commercial |
$300.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$497.70
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$414.75
|
| Rate for Payer: PHP All Commercial |
$419.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.67
|
| Rate for Payer: Sagamore Health Network All Products |
$426.92
|
| Rate for Payer: Signature Care EPO |
$458.99
|
| Rate for Payer: Signature Care PPO |
$486.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$470.05
|
| Rate for Payer: United Healthcare Commercial |
$435.76
|
| Rate for Payer: United Healthcare Medicare |
$176.96
|
|
|
HC CLOSURE SYSTEM
|
Facility
|
IP
|
$1,020.60
|
|
| Hospital Charge Code |
41602091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$765.45 |
| Max. Negotiated Rate |
$949.16 |
| Rate for Payer: Aetna Commercial |
$881.80
|
| Rate for Payer: Cash Price |
$612.36
|
| Rate for Payer: Cigna All Commercial |
$880.78
|
| Rate for Payer: CORVEL All Commercial |
$949.16
|
| Rate for Payer: Coventry All Commercial |
$898.13
|
| Rate for Payer: Encore All Commercial |
$939.46
|
| Rate for Payer: Frontpath All Commercial |
$938.95
|
| Rate for Payer: Humana ChoiceCare |
$881.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.54
|
| Rate for Payer: PHCS All Commercial |
$765.45
|
| Rate for Payer: PHP All Commercial |
$774.02
|
| Rate for Payer: Sagamore Health Network All Products |
$787.90
|
| Rate for Payer: Signature Care EPO |
$847.10
|
| Rate for Payer: Signature Care PPO |
$898.13
|
| Rate for Payer: United Healthcare Commercial |
$804.23
|
|
|
HC CLOSURE SYSTEM
|
Facility
|
OP
|
$1,020.60
|
|
| Hospital Charge Code |
41602091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$949.16 |
| Rate for Payer: Aetna Commercial |
$861.39
|
| Rate for Payer: Aetna Medicare |
$326.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$316.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$586.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.25
|
| Rate for Payer: Cash Price |
$612.36
|
| Rate for Payer: Cash Price |
$612.36
|
| Rate for Payer: Centivo All Commercial |
$555.21
|
| Rate for Payer: Cigna All Commercial |
$880.78
|
| Rate for Payer: CORVEL All Commercial |
$949.16
|
| Rate for Payer: Coventry All Commercial |
$898.13
|
| Rate for Payer: Encore All Commercial |
$939.46
|
| Rate for Payer: Frontpath All Commercial |
$938.95
|
| Rate for Payer: Humana ChoiceCare |
$881.49
|
| Rate for Payer: Humana Medicare |
$326.59
|
| Rate for Payer: Lucent All Commercial |
$555.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.54
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$765.45
|
| Rate for Payer: PHP All Commercial |
$774.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$398.03
|
| Rate for Payer: Sagamore Health Network All Products |
$787.90
|
| Rate for Payer: Signature Care EPO |
$847.10
|
| Rate for Payer: Signature Care PPO |
$898.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$867.51
|
| Rate for Payer: United Healthcare Commercial |
$804.23
|
| Rate for Payer: United Healthcare Medicare |
$326.59
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$129.57
|
|
| Hospital Charge Code |
41607817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Aetna Commercial |
$109.36
|
| Rate for Payer: Aetna Medicare |
$41.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.61
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Centivo All Commercial |
$70.49
|
| Rate for Payer: Cigna All Commercial |
$111.82
|
| Rate for Payer: CORVEL All Commercial |
$120.50
|
| Rate for Payer: Coventry All Commercial |
$114.02
|
| Rate for Payer: Encore All Commercial |
$119.27
|
| Rate for Payer: Frontpath All Commercial |
$119.20
|
| Rate for Payer: Humana ChoiceCare |
$111.91
|
| Rate for Payer: Humana Medicare |
$41.46
|
| Rate for Payer: Lucent All Commercial |
$70.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.61
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$97.18
|
| Rate for Payer: PHP All Commercial |
$98.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.53
|
| Rate for Payer: Sagamore Health Network All Products |
$100.03
|
| Rate for Payer: Signature Care EPO |
$107.54
|
| Rate for Payer: Signature Care PPO |
$114.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.13
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
| Rate for Payer: United Healthcare Medicare |
$41.46
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$735.00
|
|
| Hospital Charge Code |
41608539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$635.04
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$237.30
|
|
| Hospital Charge Code |
41607809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$205.03
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cigna All Commercial |
$204.79
|
| Rate for Payer: CORVEL All Commercial |
$220.69
|
| Rate for Payer: Coventry All Commercial |
$208.82
|
| Rate for Payer: Encore All Commercial |
$218.43
|
| Rate for Payer: Frontpath All Commercial |
$218.32
|
| Rate for Payer: Humana ChoiceCare |
$204.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: PHCS All Commercial |
$177.97
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Sagamore Health Network All Products |
$183.20
|
| Rate for Payer: Signature Care EPO |
$196.96
|
| Rate for Payer: Signature Care PPO |
$208.82
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$1,425.45
|
|
| Hospital Charge Code |
41607803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,069.09 |
| Max. Negotiated Rate |
$1,325.67 |
| Rate for Payer: Aetna Commercial |
$1,231.59
|
| Rate for Payer: Cash Price |
$855.27
|
| Rate for Payer: Cigna All Commercial |
$1,230.16
|
| Rate for Payer: CORVEL All Commercial |
$1,325.67
|
| Rate for Payer: Coventry All Commercial |
$1,254.40
|
| Rate for Payer: Encore All Commercial |
$1,312.13
|
| Rate for Payer: Frontpath All Commercial |
$1,311.41
|
| Rate for Payer: Humana ChoiceCare |
$1,231.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,282.90
|
| Rate for Payer: PHCS All Commercial |
$1,069.09
|
| Rate for Payer: PHP All Commercial |
$1,081.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,100.45
|
| Rate for Payer: Signature Care EPO |
$1,183.12
|
| Rate for Payer: Signature Care PPO |
$1,254.40
|
| Rate for Payer: United Healthcare Commercial |
$1,123.25
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$74.62
|
|
| Hospital Charge Code |
41608538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$69.40 |
| Rate for Payer: Aetna Commercial |
$64.47
|
| Rate for Payer: Cash Price |
$44.77
|
| Rate for Payer: Cigna All Commercial |
$64.40
|
| Rate for Payer: CORVEL All Commercial |
$69.40
|
| Rate for Payer: Coventry All Commercial |
$65.67
|
| Rate for Payer: Encore All Commercial |
$68.69
|
| Rate for Payer: Frontpath All Commercial |
$68.65
|
| Rate for Payer: Humana ChoiceCare |
$64.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.16
|
| Rate for Payer: PHCS All Commercial |
$55.97
|
| Rate for Payer: PHP All Commercial |
$56.59
|
| Rate for Payer: Sagamore Health Network All Products |
$57.61
|
| Rate for Payer: Signature Care EPO |
$61.93
|
| Rate for Payer: Signature Care PPO |
$65.67
|
| Rate for Payer: United Healthcare Commercial |
$58.80
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$6,624.00
|
|
| Hospital Charge Code |
41607397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,341.50
|
|
| Hospital Charge Code |
41607811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,247.60 |
| Rate for Payer: Aetna Commercial |
$1,132.23
|
| Rate for Payer: Aetna Medicare |
$429.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$415.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$770.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$838.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$493.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$472.21
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Centivo All Commercial |
$729.78
|
| Rate for Payer: Cigna All Commercial |
$1,157.71
|
| Rate for Payer: CORVEL All Commercial |
$1,247.60
|
| Rate for Payer: Coventry All Commercial |
$1,180.52
|
| Rate for Payer: Encore All Commercial |
$1,234.85
|
| Rate for Payer: Frontpath All Commercial |
$1,234.18
|
| Rate for Payer: Humana ChoiceCare |
$1,158.65
|
| Rate for Payer: Humana Medicare |
$429.28
|
| Rate for Payer: Lucent All Commercial |
$729.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,207.35
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,006.12
|
| Rate for Payer: PHP All Commercial |
$1,017.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$523.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,035.64
|
| Rate for Payer: Signature Care EPO |
$1,113.44
|
| Rate for Payer: Signature Care PPO |
$1,180.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,140.28
|
| Rate for Payer: United Healthcare Commercial |
$1,057.10
|
| Rate for Payer: United Healthcare Medicare |
$429.28
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
41608308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,147.50 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,321.92
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna All Commercial |
$1,320.39
|
| Rate for Payer: CORVEL All Commercial |
$1,422.90
|
| Rate for Payer: Coventry All Commercial |
$1,346.40
|
| Rate for Payer: Encore All Commercial |
$1,408.37
|
| Rate for Payer: Frontpath All Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$1,321.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,377.00
|
| Rate for Payer: PHCS All Commercial |
$1,147.50
|
| Rate for Payer: PHP All Commercial |
$1,160.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,181.16
|
| Rate for Payer: Signature Care EPO |
$1,269.90
|
| Rate for Payer: Signature Care PPO |
$1,346.40
|
| Rate for Payer: United Healthcare Commercial |
$1,205.64
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$129.57
|
|
| Hospital Charge Code |
41607817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Aetna Commercial |
$111.95
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Cigna All Commercial |
$111.82
|
| Rate for Payer: CORVEL All Commercial |
$120.50
|
| Rate for Payer: Coventry All Commercial |
$114.02
|
| Rate for Payer: Encore All Commercial |
$119.27
|
| Rate for Payer: Frontpath All Commercial |
$119.20
|
| Rate for Payer: Humana ChoiceCare |
$111.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.61
|
| Rate for Payer: PHCS All Commercial |
$97.18
|
| Rate for Payer: PHP All Commercial |
$98.27
|
| Rate for Payer: Sagamore Health Network All Products |
$100.03
|
| Rate for Payer: Signature Care EPO |
$107.54
|
| Rate for Payer: Signature Care PPO |
$114.02
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,545.50
|
|
| Hospital Charge Code |
41607810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,437.32 |
| Rate for Payer: Aetna Commercial |
$1,304.40
|
| Rate for Payer: Aetna Medicare |
$494.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$479.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$887.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$966.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$568.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$544.02
|
| Rate for Payer: Cash Price |
$927.30
|
| Rate for Payer: Cash Price |
$927.30
|
| Rate for Payer: Centivo All Commercial |
$840.75
|
| Rate for Payer: Cigna All Commercial |
$1,333.77
|
| Rate for Payer: CORVEL All Commercial |
$1,437.32
|
| Rate for Payer: Coventry All Commercial |
$1,360.04
|
| Rate for Payer: Encore All Commercial |
$1,422.63
|
| Rate for Payer: Frontpath All Commercial |
$1,421.86
|
| Rate for Payer: Humana ChoiceCare |
$1,334.85
|
| Rate for Payer: Humana Medicare |
$494.56
|
| Rate for Payer: Lucent All Commercial |
$840.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,390.95
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,159.12
|
| Rate for Payer: PHP All Commercial |
$1,172.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$602.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,193.13
|
| Rate for Payer: Signature Care EPO |
$1,282.77
|
| Rate for Payer: Signature Care PPO |
$1,360.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,313.67
|
| Rate for Payer: United Healthcare Commercial |
$1,217.85
|
| Rate for Payer: United Healthcare Medicare |
$494.56
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$1,327.50
|
|
| Hospital Charge Code |
41608309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.62 |
| Max. Negotiated Rate |
$1,234.58 |
| Rate for Payer: Aetna Commercial |
$1,146.96
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna All Commercial |
$1,145.63
|
| Rate for Payer: CORVEL All Commercial |
$1,234.58
|
| Rate for Payer: Coventry All Commercial |
$1,168.20
|
| Rate for Payer: Encore All Commercial |
$1,221.96
|
| Rate for Payer: Frontpath All Commercial |
$1,221.30
|
| Rate for Payer: Humana ChoiceCare |
$1,146.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,194.75
|
| Rate for Payer: PHCS All Commercial |
$995.62
|
| Rate for Payer: PHP All Commercial |
$1,006.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,024.83
|
| Rate for Payer: Signature Care EPO |
$1,101.83
|
| Rate for Payer: Signature Care PPO |
$1,168.20
|
| Rate for Payer: United Healthcare Commercial |
$1,046.07
|
|
