|
HC FASTLOAD DUAL SYRINGE SP PACK
|
Facility
IP
|
$99.54
|
|
| Hospital Charge Code |
41601351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$92.57 |
| Rate for Payer: Aetna Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$61.72
|
| Rate for Payer: Cigna All Commercial |
$85.90
|
| Rate for Payer: CORVEL All Commercial |
$92.57
|
| Rate for Payer: Coventry All Commercial |
$87.60
|
| Rate for Payer: Encore All Commercial |
$91.63
|
| Rate for Payer: Frontpath All Commercial |
$91.58
|
| Rate for Payer: Humana ChoiceCare |
$85.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.59
|
| Rate for Payer: PHCS All Commercial |
$74.66
|
| Rate for Payer: PHP All Commercial |
$75.49
|
| Rate for Payer: Sagamore Health Network All Products |
$76.84
|
| Rate for Payer: Signature Care EPO |
$82.62
|
| Rate for Payer: Signature Care PPO |
$87.60
|
| Rate for Payer: United Healthcare Commercial |
$78.44
|
|
|
HC FASTLOAD DUAL SYRINGE SP PACK
|
Facility
OP
|
$99.54
|
|
| Hospital Charge Code |
41601351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$32.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.13
|
| Rate for Payer: Cash Price |
$61.72
|
| Rate for Payer: Cash Price |
$61.72
|
| Rate for Payer: Centivo All Commercial |
$50.77
|
| Rate for Payer: Cigna All Commercial |
$85.90
|
| Rate for Payer: CORVEL All Commercial |
$92.57
|
| Rate for Payer: Coventry All Commercial |
$87.60
|
| Rate for Payer: Encore All Commercial |
$91.63
|
| Rate for Payer: Frontpath All Commercial |
$91.58
|
| Rate for Payer: Humana ChoiceCare |
$85.97
|
| Rate for Payer: Humana Medicare |
$50.77
|
| Rate for Payer: Lucent All Commercial |
$50.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$74.66
|
| Rate for Payer: PHP All Commercial |
$75.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.82
|
| Rate for Payer: Sagamore Health Network All Products |
$76.84
|
| Rate for Payer: Signature Care EPO |
$82.62
|
| Rate for Payer: Signature Care PPO |
$87.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.61
|
| Rate for Payer: United Healthcare Commercial |
$78.44
|
| Rate for Payer: United Healthcare Medicare |
$32.85
|
|
|
HC FASTLOAD MR SYRINGE PACK
|
Facility
IP
|
$92.12
|
|
| Hospital Charge Code |
41601876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Cash Price |
$57.11
|
| Rate for Payer: Cigna All Commercial |
$79.50
|
| Rate for Payer: CORVEL All Commercial |
$85.67
|
| Rate for Payer: Coventry All Commercial |
$81.07
|
| Rate for Payer: Encore All Commercial |
$84.80
|
| Rate for Payer: Frontpath All Commercial |
$84.75
|
| Rate for Payer: Humana ChoiceCare |
$79.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.91
|
| Rate for Payer: PHCS All Commercial |
$69.09
|
| Rate for Payer: PHP All Commercial |
$69.86
|
| Rate for Payer: Sagamore Health Network All Products |
$71.12
|
| Rate for Payer: Signature Care EPO |
$76.46
|
| Rate for Payer: Signature Care PPO |
$81.07
|
| Rate for Payer: United Healthcare Commercial |
$72.59
|
|
|
HC FASTLOAD MR SYRINGE PACK
|
Facility
OP
|
$92.12
|
|
| Hospital Charge Code |
41601876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$77.75
|
| Rate for Payer: Aetna Medicare |
$30.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.44
|
| Rate for Payer: Cash Price |
$57.11
|
| Rate for Payer: Cash Price |
$57.11
|
| Rate for Payer: Centivo All Commercial |
$46.98
|
| Rate for Payer: Cigna All Commercial |
$79.50
|
| Rate for Payer: CORVEL All Commercial |
$85.67
|
| Rate for Payer: Coventry All Commercial |
$81.07
|
| Rate for Payer: Encore All Commercial |
$84.80
|
| Rate for Payer: Frontpath All Commercial |
$84.75
|
| Rate for Payer: Humana ChoiceCare |
$79.56
|
| Rate for Payer: Humana Medicare |
$46.98
|
| Rate for Payer: Lucent All Commercial |
$46.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$69.09
|
| Rate for Payer: PHP All Commercial |
$69.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.93
|
| Rate for Payer: Sagamore Health Network All Products |
$71.12
|
| Rate for Payer: Signature Care EPO |
$76.46
|
| Rate for Payer: Signature Care PPO |
$81.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$72.59
|
| Rate for Payer: United Healthcare Medicare |
$30.40
|
|
|
HC FC AMYLASE
|
Facility
OP
|
$13.34
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.26
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.84
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Centivo All Commercial |
$6.80
|
| Rate for Payer: Cigna All Commercial |
$11.51
|
| Rate for Payer: CORVEL All Commercial |
$12.41
|
| Rate for Payer: Coventry All Commercial |
$11.74
|
| Rate for Payer: Encore All Commercial |
$12.28
|
| Rate for Payer: Frontpath All Commercial |
$12.27
|
| Rate for Payer: Humana ChoiceCare |
$11.52
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: Lucent All Commercial |
$6.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.01
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: MDWise Medicaid |
$6.48
|
| Rate for Payer: PHCS All Commercial |
$10.01
|
| Rate for Payer: PHP All Commercial |
$10.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.20
|
| Rate for Payer: Sagamore Health Network All Products |
$10.30
|
| Rate for Payer: Signature Care EPO |
$11.07
|
| Rate for Payer: Signature Care PPO |
$11.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.34
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$4.40
|
|
|
HC FC AMYLASE
|
Facility
IP
|
$13.34
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.53
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna All Commercial |
$11.51
|
| Rate for Payer: CORVEL All Commercial |
$12.41
|
| Rate for Payer: Coventry All Commercial |
$11.74
|
| Rate for Payer: Encore All Commercial |
$12.28
|
| Rate for Payer: Frontpath All Commercial |
$12.27
|
| Rate for Payer: Humana ChoiceCare |
$11.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.01
|
| Rate for Payer: PHCS All Commercial |
$10.01
|
| Rate for Payer: PHP All Commercial |
$10.12
|
| Rate for Payer: Sagamore Health Network All Products |
$10.30
|
| Rate for Payer: Signature Care EPO |
$11.07
|
| Rate for Payer: Signature Care PPO |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
|
|
HC FC BASIC METABOLIC
|
Facility
OP
|
$9.69
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
63001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: Aetna Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.52
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Centivo All Commercial |
$4.94
|
| Rate for Payer: Cigna All Commercial |
$8.36
|
| Rate for Payer: CORVEL All Commercial |
$9.01
|
| Rate for Payer: Coventry All Commercial |
$8.53
|
| Rate for Payer: Encore All Commercial |
$8.92
|
| Rate for Payer: Frontpath All Commercial |
$8.91
|
| Rate for Payer: Humana ChoiceCare |
$8.37
|
| Rate for Payer: Humana Medicare |
$4.94
|
| Rate for Payer: Lucent All Commercial |
$4.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.72
|
| Rate for Payer: Managed Health Services Medicaid |
$8.46
|
| Rate for Payer: MDWise Medicaid |
$8.46
|
| Rate for Payer: PHCS All Commercial |
$7.27
|
| Rate for Payer: PHP All Commercial |
$7.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7.48
|
| Rate for Payer: Signature Care EPO |
$8.04
|
| Rate for Payer: Signature Care PPO |
$8.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
|
|
HC FC BASIC METABOLIC
|
Facility
IP
|
$9.69
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
63001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cigna All Commercial |
$8.36
|
| Rate for Payer: CORVEL All Commercial |
$9.01
|
| Rate for Payer: Coventry All Commercial |
$8.53
|
| Rate for Payer: Encore All Commercial |
$8.92
|
| Rate for Payer: Frontpath All Commercial |
$8.91
|
| Rate for Payer: Humana ChoiceCare |
$8.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.72
|
| Rate for Payer: PHCS All Commercial |
$7.27
|
| Rate for Payer: PHP All Commercial |
$7.35
|
| Rate for Payer: Sagamore Health Network All Products |
$7.48
|
| Rate for Payer: Signature Care EPO |
$8.04
|
| Rate for Payer: Signature Care PPO |
$8.53
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
|
|
HC FC CBC/AUTO
|
Facility
OP
|
$7.12
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001727
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$6.01
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.58
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Centivo All Commercial |
$3.63
|
| Rate for Payer: Cigna All Commercial |
$6.14
|
| Rate for Payer: CORVEL All Commercial |
$6.62
|
| Rate for Payer: Coventry All Commercial |
$6.27
|
| Rate for Payer: Encore All Commercial |
$6.55
|
| Rate for Payer: Frontpath All Commercial |
$6.55
|
| Rate for Payer: Humana ChoiceCare |
$6.15
|
| Rate for Payer: Humana Medicare |
$3.63
|
| Rate for Payer: Lucent All Commercial |
$3.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.41
|
| Rate for Payer: Managed Health Services Medicaid |
$7.77
|
| Rate for Payer: MDWise Medicaid |
$7.77
|
| Rate for Payer: PHCS All Commercial |
$5.34
|
| Rate for Payer: PHP All Commercial |
$5.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5.50
|
| Rate for Payer: Signature Care EPO |
$5.91
|
| Rate for Payer: Signature Care PPO |
$6.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.05
|
| Rate for Payer: United Healthcare Commercial |
$5.61
|
| Rate for Payer: United Healthcare Medicare |
$2.35
|
|
|
HC FC CBC/AUTO
|
Facility
IP
|
$7.12
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001727
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$6.15
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna All Commercial |
$6.14
|
| Rate for Payer: CORVEL All Commercial |
$6.62
|
| Rate for Payer: Coventry All Commercial |
$6.27
|
| Rate for Payer: Encore All Commercial |
$6.55
|
| Rate for Payer: Frontpath All Commercial |
$6.55
|
| Rate for Payer: Humana ChoiceCare |
$6.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.41
|
| Rate for Payer: PHCS All Commercial |
$5.34
|
| Rate for Payer: PHP All Commercial |
$5.40
|
| Rate for Payer: Sagamore Health Network All Products |
$5.50
|
| Rate for Payer: Signature Care EPO |
$5.91
|
| Rate for Payer: Signature Care PPO |
$6.27
|
| Rate for Payer: United Healthcare Commercial |
$5.61
|
|
|
HC FC CBC/AUTO DIFFERENTIAL
|
Facility
OP
|
$6.38
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$5.38
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.31
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Centivo All Commercial |
$3.25
|
| Rate for Payer: Cigna All Commercial |
$5.50
|
| Rate for Payer: CORVEL All Commercial |
$5.93
|
| Rate for Payer: Coventry All Commercial |
$5.61
|
| Rate for Payer: Encore All Commercial |
$5.87
|
| Rate for Payer: Frontpath All Commercial |
$5.86
|
| Rate for Payer: Humana ChoiceCare |
$5.51
|
| Rate for Payer: Humana Medicare |
$3.25
|
| Rate for Payer: Lucent All Commercial |
$3.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.74
|
| Rate for Payer: Managed Health Services Medicaid |
$7.77
|
| Rate for Payer: MDWise Medicaid |
$7.77
|
| Rate for Payer: PHCS All Commercial |
$4.78
|
| Rate for Payer: PHP All Commercial |
$4.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.49
|
| Rate for Payer: Sagamore Health Network All Products |
$4.92
|
| Rate for Payer: Signature Care EPO |
$5.29
|
| Rate for Payer: Signature Care PPO |
$5.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.42
|
| Rate for Payer: United Healthcare Commercial |
$5.02
|
| Rate for Payer: United Healthcare Medicare |
$2.10
|
|
|
HC FC CBC/AUTO DIFFERENTIAL
|
Facility
IP
|
$6.38
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$5.93 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cigna All Commercial |
$5.50
|
| Rate for Payer: CORVEL All Commercial |
$5.93
|
| Rate for Payer: Coventry All Commercial |
$5.61
|
| Rate for Payer: Encore All Commercial |
$5.87
|
| Rate for Payer: Frontpath All Commercial |
$5.86
|
| Rate for Payer: Humana ChoiceCare |
$5.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.74
|
| Rate for Payer: PHCS All Commercial |
$4.78
|
| Rate for Payer: PHP All Commercial |
$4.83
|
| Rate for Payer: Sagamore Health Network All Products |
$4.92
|
| Rate for Payer: Signature Care EPO |
$5.29
|
| Rate for Payer: Signature Care PPO |
$5.61
|
| Rate for Payer: United Healthcare Commercial |
$5.02
|
|
|
HC FC CBC W/O DIFF
|
Facility
OP
|
$6.12
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001729
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.22
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Centivo All Commercial |
$3.12
|
| Rate for Payer: Cigna All Commercial |
$5.28
|
| Rate for Payer: CORVEL All Commercial |
$5.69
|
| Rate for Payer: Coventry All Commercial |
$5.39
|
| Rate for Payer: Encore All Commercial |
$5.63
|
| Rate for Payer: Frontpath All Commercial |
$5.63
|
| Rate for Payer: Humana ChoiceCare |
$5.29
|
| Rate for Payer: Humana Medicare |
$3.12
|
| Rate for Payer: Lucent All Commercial |
$3.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.51
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$4.59
|
| Rate for Payer: PHP All Commercial |
$4.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.39
|
| Rate for Payer: Sagamore Health Network All Products |
$4.72
|
| Rate for Payer: Signature Care EPO |
$5.08
|
| Rate for Payer: Signature Care PPO |
$5.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.20
|
| Rate for Payer: United Healthcare Commercial |
$4.82
|
| Rate for Payer: United Healthcare Medicare |
$2.02
|
|
|
HC FC CBC W/O DIFF
|
Facility
IP
|
$6.12
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001729
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cigna All Commercial |
$5.28
|
| Rate for Payer: CORVEL All Commercial |
$5.69
|
| Rate for Payer: Coventry All Commercial |
$5.39
|
| Rate for Payer: Encore All Commercial |
$5.63
|
| Rate for Payer: Frontpath All Commercial |
$5.63
|
| Rate for Payer: Humana ChoiceCare |
$5.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.51
|
| Rate for Payer: PHCS All Commercial |
$4.59
|
| Rate for Payer: PHP All Commercial |
$4.64
|
| Rate for Payer: Sagamore Health Network All Products |
$4.72
|
| Rate for Payer: Signature Care EPO |
$5.08
|
| Rate for Payer: Signature Care PPO |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$4.82
|
|
|
HC FC CBC W/OUT DIFFERENTIAL
|
Facility
OP
|
$6.12
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.22
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Centivo All Commercial |
$3.12
|
| Rate for Payer: Cigna All Commercial |
$5.28
|
| Rate for Payer: CORVEL All Commercial |
$5.69
|
| Rate for Payer: Coventry All Commercial |
$5.39
|
| Rate for Payer: Encore All Commercial |
$5.63
|
| Rate for Payer: Frontpath All Commercial |
$5.63
|
| Rate for Payer: Humana ChoiceCare |
$5.29
|
| Rate for Payer: Humana Medicare |
$3.12
|
| Rate for Payer: Lucent All Commercial |
$3.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.51
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$4.59
|
| Rate for Payer: PHP All Commercial |
$4.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.39
|
| Rate for Payer: Sagamore Health Network All Products |
$4.72
|
| Rate for Payer: Signature Care EPO |
$5.08
|
| Rate for Payer: Signature Care PPO |
$5.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.20
|
| Rate for Payer: United Healthcare Commercial |
$4.82
|
| Rate for Payer: United Healthcare Medicare |
$2.02
|
|
|
HC FC CBC W/OUT DIFFERENTIAL
|
Facility
IP
|
$6.12
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cigna All Commercial |
$5.28
|
| Rate for Payer: CORVEL All Commercial |
$5.69
|
| Rate for Payer: Coventry All Commercial |
$5.39
|
| Rate for Payer: Encore All Commercial |
$5.63
|
| Rate for Payer: Frontpath All Commercial |
$5.63
|
| Rate for Payer: Humana ChoiceCare |
$5.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.51
|
| Rate for Payer: PHCS All Commercial |
$4.59
|
| Rate for Payer: PHP All Commercial |
$4.64
|
| Rate for Payer: Sagamore Health Network All Products |
$4.72
|
| Rate for Payer: Signature Care EPO |
$5.08
|
| Rate for Payer: Signature Care PPO |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$4.82
|
|
|
HC FC C DIFFICILE/DNA
|
Facility
OP
|
$21.69
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
63002036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$37.27 |
| Rate for Payer: Aetna Commercial |
$18.30
|
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.87
|
| Rate for Payer: Cash Price |
$13.45
|
| Rate for Payer: Cash Price |
$13.45
|
| Rate for Payer: Centivo All Commercial |
$11.06
|
| Rate for Payer: Cigna All Commercial |
$18.71
|
| Rate for Payer: CORVEL All Commercial |
$20.17
|
| Rate for Payer: Coventry All Commercial |
$19.08
|
| Rate for Payer: Encore All Commercial |
$19.96
|
| Rate for Payer: Frontpath All Commercial |
$19.95
|
| Rate for Payer: Humana ChoiceCare |
$18.73
|
| Rate for Payer: Humana Medicare |
$11.06
|
| Rate for Payer: Lucent All Commercial |
$11.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.52
|
| Rate for Payer: Managed Health Services Medicaid |
$37.27
|
| Rate for Payer: MDWise Medicaid |
$37.27
|
| Rate for Payer: PHCS All Commercial |
$16.26
|
| Rate for Payer: PHP All Commercial |
$16.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.46
|
| Rate for Payer: Sagamore Health Network All Products |
$16.74
|
| Rate for Payer: Signature Care EPO |
$18.00
|
| Rate for Payer: Signature Care PPO |
$19.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.43
|
| Rate for Payer: United Healthcare Commercial |
$17.09
|
| Rate for Payer: United Healthcare Medicare |
$7.16
|
|
|
HC FC C DIFFICILE/DNA
|
Facility
IP
|
$21.69
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
63002036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$20.17 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Cash Price |
$13.45
|
| Rate for Payer: Cigna All Commercial |
$18.71
|
| Rate for Payer: CORVEL All Commercial |
$20.17
|
| Rate for Payer: Coventry All Commercial |
$19.08
|
| Rate for Payer: Encore All Commercial |
$19.96
|
| Rate for Payer: Frontpath All Commercial |
$19.95
|
| Rate for Payer: Humana ChoiceCare |
$18.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.52
|
| Rate for Payer: PHCS All Commercial |
$16.26
|
| Rate for Payer: PHP All Commercial |
$16.45
|
| Rate for Payer: Sagamore Health Network All Products |
$16.74
|
| Rate for Payer: Signature Care EPO |
$18.00
|
| Rate for Payer: Signature Care PPO |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$17.09
|
|
|
HC FC CREATININE
|
Facility
OP
|
$9.69
|
|
|
Service Code
|
CPT 82540
|
| Hospital Charge Code |
63001508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: Aetna Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.52
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Centivo All Commercial |
$4.94
|
| Rate for Payer: Cigna All Commercial |
$8.36
|
| Rate for Payer: CORVEL All Commercial |
$9.01
|
| Rate for Payer: Coventry All Commercial |
$8.53
|
| Rate for Payer: Encore All Commercial |
$8.92
|
| Rate for Payer: Frontpath All Commercial |
$8.91
|
| Rate for Payer: Humana ChoiceCare |
$8.37
|
| Rate for Payer: Humana Medicare |
$4.94
|
| Rate for Payer: Lucent All Commercial |
$4.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.72
|
| Rate for Payer: Managed Health Services Medicaid |
$4.64
|
| Rate for Payer: MDWise Medicaid |
$4.64
|
| Rate for Payer: PHCS All Commercial |
$7.27
|
| Rate for Payer: PHP All Commercial |
$7.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7.48
|
| Rate for Payer: Signature Care EPO |
$8.04
|
| Rate for Payer: Signature Care PPO |
$8.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
|
|
HC FC CREATININE
|
Facility
IP
|
$9.69
|
|
|
Service Code
|
CPT 82540
|
| Hospital Charge Code |
63001508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cigna All Commercial |
$8.36
|
| Rate for Payer: CORVEL All Commercial |
$9.01
|
| Rate for Payer: Coventry All Commercial |
$8.53
|
| Rate for Payer: Encore All Commercial |
$8.92
|
| Rate for Payer: Frontpath All Commercial |
$8.91
|
| Rate for Payer: Humana ChoiceCare |
$8.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.72
|
| Rate for Payer: PHCS All Commercial |
$7.27
|
| Rate for Payer: PHP All Commercial |
$7.35
|
| Rate for Payer: Sagamore Health Network All Products |
$7.48
|
| Rate for Payer: Signature Care EPO |
$8.04
|
| Rate for Payer: Signature Care PPO |
$8.53
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
|
|
HC FC DIGOXIN
|
Facility
OP
|
$24.74
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
63001371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.98
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Centivo All Commercial |
$12.61
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Humana Medicare |
$12.61
|
| Rate for Payer: Lucent All Commercial |
$12.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: Managed Health Services Medicaid |
$13.28
|
| Rate for Payer: MDWise Medicaid |
$13.28
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.65
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.02
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
| Rate for Payer: United Healthcare Medicare |
$8.16
|
|
|
HC FC DIGOXIN
|
Facility
IP
|
$24.74
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
63001371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$21.37
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
|
|
HC FC DILANTIN
|
Facility
OP
|
$24.74
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.98
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Centivo All Commercial |
$12.61
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Humana Medicare |
$12.61
|
| Rate for Payer: Lucent All Commercial |
$12.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.65
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.02
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
| Rate for Payer: United Healthcare Medicare |
$8.16
|
|
|
HC FC DILANTIN
|
Facility
IP
|
$24.74
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$21.37
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
|
|
HC FC DRAWING FEE
|
Facility
IP
|
$5.56
|
|
| Hospital Charge Code |
63002256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cigna All Commercial |
$4.80
|
| Rate for Payer: CORVEL All Commercial |
$5.17
|
| Rate for Payer: Coventry All Commercial |
$4.89
|
| Rate for Payer: Encore All Commercial |
$5.12
|
| Rate for Payer: Frontpath All Commercial |
$5.11
|
| Rate for Payer: Humana ChoiceCare |
$4.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.00
|
| Rate for Payer: PHCS All Commercial |
$4.17
|
| Rate for Payer: PHP All Commercial |
$4.22
|
| Rate for Payer: Sagamore Health Network All Products |
$4.29
|
| Rate for Payer: Signature Care EPO |
$4.61
|
| Rate for Payer: Signature Care PPO |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$4.38
|
|
