|
HC FINE NEEDLE ASPIRATION
|
Facility
OP
|
$211.14
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
63001267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$210.91 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Medicare |
$69.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$210.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.64
|
| Rate for Payer: Cash Price |
$130.91
|
| Rate for Payer: Cash Price |
$130.91
|
| Rate for Payer: Centivo All Commercial |
$107.68
|
| Rate for Payer: Cigna All Commercial |
$182.21
|
| Rate for Payer: CORVEL All Commercial |
$196.36
|
| Rate for Payer: Coventry All Commercial |
$185.80
|
| Rate for Payer: Encore All Commercial |
$194.35
|
| Rate for Payer: Frontpath All Commercial |
$194.25
|
| Rate for Payer: Humana ChoiceCare |
$182.36
|
| Rate for Payer: Humana Medicare |
$107.68
|
| Rate for Payer: Lucent All Commercial |
$107.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.03
|
| Rate for Payer: Managed Health Services Medicaid |
$210.91
|
| Rate for Payer: MDWise Medicaid |
$210.91
|
| Rate for Payer: PHCS All Commercial |
$158.36
|
| Rate for Payer: PHP All Commercial |
$160.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.34
|
| Rate for Payer: Sagamore Health Network All Products |
$163.00
|
| Rate for Payer: Signature Care EPO |
$175.25
|
| Rate for Payer: Signature Care PPO |
$185.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.47
|
| Rate for Payer: United Healthcare Commercial |
$166.38
|
| Rate for Payer: United Healthcare Medicare |
$69.68
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
IP
|
$211.14
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
63001267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$158.36 |
| Max. Negotiated Rate |
$196.36 |
| Rate for Payer: Aetna Commercial |
$182.42
|
| Rate for Payer: Cash Price |
$130.91
|
| Rate for Payer: Cigna All Commercial |
$182.21
|
| Rate for Payer: CORVEL All Commercial |
$196.36
|
| Rate for Payer: Coventry All Commercial |
$185.80
|
| Rate for Payer: Encore All Commercial |
$194.35
|
| Rate for Payer: Frontpath All Commercial |
$194.25
|
| Rate for Payer: Humana ChoiceCare |
$182.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.03
|
| Rate for Payer: PHCS All Commercial |
$158.36
|
| Rate for Payer: PHP All Commercial |
$160.13
|
| Rate for Payer: Sagamore Health Network All Products |
$163.00
|
| Rate for Payer: Signature Care EPO |
$175.25
|
| Rate for Payer: Signature Care PPO |
$185.80
|
| Rate for Payer: United Healthcare Commercial |
$166.38
|
|
|
HC FIRST STEP SELECT MATTRESS /DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01330110
|
|
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 |
$189.97
|
| 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 |
$264.64
|
| 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 FIRST STEP SELECT MATTRESS /DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01330110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.23
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Centivo All Commercial |
$156.27
|
| 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 |
$264.64
|
| Rate for Payer: Humana Medicare |
$156.27
|
| Rate for Payer: Lucent All Commercial |
$156.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| 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 |
$101.11
|
|
|
HC FISH CHROMO HYBRID
|
Facility
OP
|
$77.08
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
63002085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$71.69 |
| Rate for Payer: Aetna Commercial |
$65.06
|
| Rate for Payer: Aetna Medicare |
$25.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$36.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.98
|
| Rate for Payer: Cash Price |
$47.79
|
| Rate for Payer: Cash Price |
$47.79
|
| Rate for Payer: Centivo All Commercial |
$39.31
|
| Rate for Payer: Cigna All Commercial |
$66.52
|
| Rate for Payer: CORVEL All Commercial |
$71.69
|
| Rate for Payer: Coventry All Commercial |
$67.83
|
| Rate for Payer: Encore All Commercial |
$70.95
|
| Rate for Payer: Frontpath All Commercial |
$70.91
|
| Rate for Payer: Humana ChoiceCare |
$66.58
|
| Rate for Payer: Humana Medicare |
$39.31
|
| Rate for Payer: Lucent All Commercial |
$39.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.37
|
| Rate for Payer: Managed Health Services Medicaid |
$36.44
|
| Rate for Payer: MDWise Medicaid |
$36.44
|
| Rate for Payer: PHCS All Commercial |
$57.81
|
| Rate for Payer: PHP All Commercial |
$58.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.06
|
| Rate for Payer: Sagamore Health Network All Products |
$59.51
|
| Rate for Payer: Signature Care EPO |
$63.98
|
| Rate for Payer: Signature Care PPO |
$67.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.52
|
| Rate for Payer: United Healthcare Commercial |
$60.74
|
| Rate for Payer: United Healthcare Medicare |
$25.44
|
|
|
HC FISH CHROMO HYBRID
|
Facility
IP
|
$77.08
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
63002085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$71.69 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Cash Price |
$47.79
|
| Rate for Payer: Cigna All Commercial |
$66.52
|
| Rate for Payer: CORVEL All Commercial |
$71.69
|
| Rate for Payer: Coventry All Commercial |
$67.83
|
| Rate for Payer: Encore All Commercial |
$70.95
|
| Rate for Payer: Frontpath All Commercial |
$70.91
|
| Rate for Payer: Humana ChoiceCare |
$66.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.37
|
| Rate for Payer: PHCS All Commercial |
$57.81
|
| Rate for Payer: PHP All Commercial |
$58.46
|
| Rate for Payer: Sagamore Health Network All Products |
$59.51
|
| Rate for Payer: Signature Care EPO |
$63.98
|
| Rate for Payer: Signature Care PPO |
$67.83
|
| Rate for Payer: United Healthcare Commercial |
$60.74
|
|
|
HC FISH INTERPHASE IN SITU
|
Facility
OP
|
$966.77
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$899.09 |
| Rate for Payer: Aetna Commercial |
$815.95
|
| Rate for Payer: Aetna Medicare |
$319.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$319.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$555.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$604.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$51.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.94
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Centivo All Commercial |
$493.05
|
| Rate for Payer: Cigna All Commercial |
$834.32
|
| Rate for Payer: CORVEL All Commercial |
$899.09
|
| Rate for Payer: Coventry All Commercial |
$850.75
|
| Rate for Payer: Encore All Commercial |
$889.91
|
| Rate for Payer: Frontpath All Commercial |
$889.42
|
| Rate for Payer: Humana ChoiceCare |
$835.00
|
| Rate for Payer: Humana Medicare |
$493.05
|
| Rate for Payer: Lucent All Commercial |
$493.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$870.09
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: MDWise Medicaid |
$51.19
|
| Rate for Payer: PHCS All Commercial |
$725.07
|
| Rate for Payer: PHP All Commercial |
$733.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$377.04
|
| Rate for Payer: Sagamore Health Network All Products |
$746.34
|
| Rate for Payer: Signature Care EPO |
$802.42
|
| Rate for Payer: Signature Care PPO |
$850.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$821.75
|
| Rate for Payer: United Healthcare Commercial |
$761.81
|
| Rate for Payer: United Healthcare Medicare |
$319.03
|
|
|
HC FISH INTERPHASE IN SITU
|
Facility
IP
|
$966.77
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$725.07 |
| Max. Negotiated Rate |
$899.09 |
| Rate for Payer: Aetna Commercial |
$835.29
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna All Commercial |
$834.32
|
| Rate for Payer: CORVEL All Commercial |
$899.09
|
| Rate for Payer: Coventry All Commercial |
$850.75
|
| Rate for Payer: Encore All Commercial |
$889.91
|
| Rate for Payer: Frontpath All Commercial |
$889.42
|
| Rate for Payer: Humana ChoiceCare |
$835.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$870.09
|
| Rate for Payer: PHCS All Commercial |
$725.07
|
| Rate for Payer: PHP All Commercial |
$733.20
|
| Rate for Payer: Sagamore Health Network All Products |
$746.34
|
| Rate for Payer: Signature Care EPO |
$802.42
|
| Rate for Payer: Signature Care PPO |
$850.75
|
| Rate for Payer: United Healthcare Commercial |
$761.81
|
|
|
HC FISH MOLEC DNA EA
|
Facility
OP
|
$366.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$340.70 |
| Rate for Payer: Aetna Commercial |
$309.19
|
| Rate for Payer: Aetna Medicare |
$120.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$210.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$132.98
|
| Rate for Payer: Cash Price |
$227.13
|
| Rate for Payer: Cash Price |
$227.13
|
| Rate for Payer: Centivo All Commercial |
$186.84
|
| Rate for Payer: Cigna All Commercial |
$316.15
|
| Rate for Payer: CORVEL All Commercial |
$340.70
|
| Rate for Payer: Coventry All Commercial |
$322.38
|
| Rate for Payer: Encore All Commercial |
$337.22
|
| Rate for Payer: Frontpath All Commercial |
$337.04
|
| Rate for Payer: Humana ChoiceCare |
$316.41
|
| Rate for Payer: Humana Medicare |
$186.84
|
| Rate for Payer: Lucent All Commercial |
$186.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$329.71
|
| Rate for Payer: Managed Health Services Medicaid |
$19.70
|
| Rate for Payer: MDWise Medicaid |
$19.70
|
| Rate for Payer: PHCS All Commercial |
$274.76
|
| Rate for Payer: PHP All Commercial |
$277.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.87
|
| Rate for Payer: Sagamore Health Network All Products |
$282.82
|
| Rate for Payer: Signature Care EPO |
$304.06
|
| Rate for Payer: Signature Care PPO |
$322.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$311.39
|
| Rate for Payer: United Healthcare Commercial |
$288.68
|
| Rate for Payer: United Healthcare Medicare |
$120.89
|
|
|
HC FISH MOLEC DNA EA
|
Facility
IP
|
$366.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$274.76 |
| Max. Negotiated Rate |
$340.70 |
| Rate for Payer: Aetna Commercial |
$316.52
|
| Rate for Payer: Cash Price |
$227.13
|
| Rate for Payer: Cigna All Commercial |
$316.15
|
| Rate for Payer: CORVEL All Commercial |
$340.70
|
| Rate for Payer: Coventry All Commercial |
$322.38
|
| Rate for Payer: Encore All Commercial |
$337.22
|
| Rate for Payer: Frontpath All Commercial |
$337.04
|
| Rate for Payer: Humana ChoiceCare |
$316.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$329.71
|
| Rate for Payer: PHCS All Commercial |
$274.76
|
| Rate for Payer: PHP All Commercial |
$277.83
|
| Rate for Payer: Sagamore Health Network All Products |
$282.82
|
| Rate for Payer: Signature Care EPO |
$304.06
|
| Rate for Payer: Signature Care PPO |
$322.38
|
| Rate for Payer: United Healthcare Commercial |
$288.68
|
|
|
HC FISH VISCERA RETAINER
|
Facility
IP
|
$297.16
|
|
| Hospital Charge Code |
41601917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.87 |
| Max. Negotiated Rate |
$276.36 |
| Rate for Payer: Aetna Commercial |
$256.75
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cigna All Commercial |
$256.45
|
| Rate for Payer: CORVEL All Commercial |
$276.36
|
| Rate for Payer: Coventry All Commercial |
$261.50
|
| Rate for Payer: Encore All Commercial |
$273.54
|
| Rate for Payer: Frontpath All Commercial |
$273.39
|
| Rate for Payer: Humana ChoiceCare |
$256.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.44
|
| Rate for Payer: PHCS All Commercial |
$222.87
|
| Rate for Payer: PHP All Commercial |
$225.37
|
| Rate for Payer: Sagamore Health Network All Products |
$229.41
|
| Rate for Payer: Signature Care EPO |
$246.64
|
| Rate for Payer: Signature Care PPO |
$261.50
|
| Rate for Payer: United Healthcare Commercial |
$234.16
|
|
|
HC FISH VISCERA RETAINER
|
Facility
OP
|
$297.16
|
|
| Hospital Charge Code |
41601917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.06 |
| Max. Negotiated Rate |
$276.36 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Medicare |
$98.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$170.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.87
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Centivo All Commercial |
$151.55
|
| Rate for Payer: Cigna All Commercial |
$256.45
|
| Rate for Payer: CORVEL All Commercial |
$276.36
|
| Rate for Payer: Coventry All Commercial |
$261.50
|
| Rate for Payer: Encore All Commercial |
$273.54
|
| Rate for Payer: Frontpath All Commercial |
$273.39
|
| Rate for Payer: Humana ChoiceCare |
$256.66
|
| Rate for Payer: Humana Medicare |
$151.55
|
| Rate for Payer: Lucent All Commercial |
$151.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$222.87
|
| Rate for Payer: PHP All Commercial |
$225.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.89
|
| Rate for Payer: Sagamore Health Network All Products |
$229.41
|
| Rate for Payer: Signature Care EPO |
$246.64
|
| Rate for Payer: Signature Care PPO |
$261.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$252.59
|
| Rate for Payer: United Healthcare Commercial |
$234.16
|
| Rate for Payer: United Healthcare Medicare |
$98.06
|
|
|
HC FIXATION TOOL
|
Facility
OP
|
$112.50
|
|
| Hospital Charge Code |
41607298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.84
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Centivo All Commercial |
$57.38
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Humana Medicare |
$57.38
|
| Rate for Payer: Lucent All Commercial |
$57.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.88
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.62
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
|
|
HC FIXATION TOOL
|
Facility
IP
|
$112.50
|
|
| Hospital Charge Code |
41607298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
|
|
HC FLANGE 1 INCH
|
Facility
IP
|
$32.80
|
|
| Hospital Charge Code |
41602245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Cigna All Commercial |
$28.31
|
| Rate for Payer: CORVEL All Commercial |
$30.50
|
| Rate for Payer: Coventry All Commercial |
$28.86
|
| Rate for Payer: Encore All Commercial |
$30.19
|
| Rate for Payer: Frontpath All Commercial |
$30.18
|
| Rate for Payer: Humana ChoiceCare |
$28.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.52
|
| Rate for Payer: PHCS All Commercial |
$24.60
|
| Rate for Payer: PHP All Commercial |
$24.88
|
| Rate for Payer: Sagamore Health Network All Products |
$25.32
|
| Rate for Payer: Signature Care EPO |
$27.22
|
| Rate for Payer: Signature Care PPO |
$28.86
|
| Rate for Payer: United Healthcare Commercial |
$25.85
|
|
|
HC FLANGE 1 INCH
|
Facility
OP
|
$32.80
|
|
| Hospital Charge Code |
41602245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.91
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Centivo All Commercial |
$16.73
|
| Rate for Payer: Cigna All Commercial |
$28.31
|
| Rate for Payer: CORVEL All Commercial |
$30.50
|
| Rate for Payer: Coventry All Commercial |
$28.86
|
| Rate for Payer: Encore All Commercial |
$30.19
|
| Rate for Payer: Frontpath All Commercial |
$30.18
|
| Rate for Payer: Humana ChoiceCare |
$28.33
|
| Rate for Payer: Humana Medicare |
$16.73
|
| Rate for Payer: Lucent All Commercial |
$16.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$24.60
|
| Rate for Payer: PHP All Commercial |
$24.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.79
|
| Rate for Payer: Sagamore Health Network All Products |
$25.32
|
| Rate for Payer: Signature Care EPO |
$27.22
|
| Rate for Payer: Signature Care PPO |
$28.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.88
|
| Rate for Payer: United Healthcare Commercial |
$25.85
|
| Rate for Payer: United Healthcare Medicare |
$10.82
|
|
|
HC FLEXOR ACCESS SHEATH 35 MM
|
Facility
IP
|
$932.26
|
|
| Hospital Charge Code |
41601357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.20 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Aetna Commercial |
$805.47
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cigna All Commercial |
$804.54
|
| Rate for Payer: CORVEL All Commercial |
$867.00
|
| Rate for Payer: Coventry All Commercial |
$820.39
|
| Rate for Payer: Encore All Commercial |
$858.15
|
| Rate for Payer: Frontpath All Commercial |
$857.68
|
| Rate for Payer: Humana ChoiceCare |
$805.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$839.03
|
| Rate for Payer: PHCS All Commercial |
$699.20
|
| Rate for Payer: PHP All Commercial |
$707.03
|
| Rate for Payer: Sagamore Health Network All Products |
$719.70
|
| Rate for Payer: Signature Care EPO |
$773.78
|
| Rate for Payer: Signature Care PPO |
$820.39
|
| Rate for Payer: United Healthcare Commercial |
$734.62
|
|
|
HC FLEXOR ACCESS SHEATH 35 MM
|
Facility
OP
|
$932.26
|
|
| Hospital Charge Code |
41601357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Aetna Commercial |
$786.83
|
| Rate for Payer: Aetna Medicare |
$307.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.41
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Centivo All Commercial |
$475.45
|
| Rate for Payer: Cigna All Commercial |
$804.54
|
| Rate for Payer: CORVEL All Commercial |
$867.00
|
| Rate for Payer: Coventry All Commercial |
$820.39
|
| Rate for Payer: Encore All Commercial |
$858.15
|
| Rate for Payer: Frontpath All Commercial |
$857.68
|
| Rate for Payer: Humana ChoiceCare |
$805.19
|
| Rate for Payer: Humana Medicare |
$475.45
|
| Rate for Payer: Lucent All Commercial |
$475.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$839.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$699.20
|
| Rate for Payer: PHP All Commercial |
$707.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.58
|
| Rate for Payer: Sagamore Health Network All Products |
$719.70
|
| Rate for Payer: Signature Care EPO |
$773.78
|
| Rate for Payer: Signature Care PPO |
$820.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$792.42
|
| Rate for Payer: United Healthcare Commercial |
$734.62
|
| Rate for Payer: United Healthcare Medicare |
$307.65
|
|
|
HC FLEXOR ACCESS SHEATH 45 MM
|
Facility
OP
|
$931.00
|
|
| Hospital Charge Code |
41601358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC FLEXOR ACCESS SHEATH 45 MM
|
Facility
IP
|
$931.00
|
|
| Hospital Charge Code |
41601358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC FLOURESCENT AB EA
|
Facility
OP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$116.90
|
| Rate for Payer: Aetna Medicare |
$45.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.28
|
| Rate for Payer: Cash Price |
$85.87
|
| Rate for Payer: Cash Price |
$85.87
|
| Rate for Payer: Centivo All Commercial |
$70.64
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.49
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Humana Medicare |
$70.64
|
| Rate for Payer: Lucent All Commercial |
$70.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.02
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$109.14
|
| Rate for Payer: United Healthcare Medicare |
$45.71
|
|
|
HC FLOURESCENT AB EA
|
Facility
IP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Cash Price |
$85.87
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.49
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.04
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: United Healthcare Commercial |
$109.14
|
|
|
HC FLOW CYTO MARKER 1ST
|
Facility
OP
|
$87.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$134.43 |
| Rate for Payer: Aetna Commercial |
$74.16
|
| Rate for Payer: Aetna Medicare |
$28.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$134.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.89
|
| Rate for Payer: Cash Price |
$54.48
|
| Rate for Payer: Cash Price |
$54.48
|
| Rate for Payer: Centivo All Commercial |
$44.81
|
| Rate for Payer: Cigna All Commercial |
$75.83
|
| Rate for Payer: CORVEL All Commercial |
$81.71
|
| Rate for Payer: Coventry All Commercial |
$77.32
|
| Rate for Payer: Encore All Commercial |
$80.88
|
| Rate for Payer: Frontpath All Commercial |
$80.83
|
| Rate for Payer: Humana ChoiceCare |
$75.89
|
| Rate for Payer: Humana Medicare |
$44.81
|
| Rate for Payer: Lucent All Commercial |
$44.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.43
|
| Rate for Payer: MDWise Medicaid |
$134.43
|
| Rate for Payer: PHCS All Commercial |
$65.90
|
| Rate for Payer: PHP All Commercial |
$66.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.27
|
| Rate for Payer: Sagamore Health Network All Products |
$67.83
|
| Rate for Payer: Signature Care EPO |
$72.93
|
| Rate for Payer: Signature Care PPO |
$77.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.68
|
| Rate for Payer: United Healthcare Commercial |
$69.24
|
| Rate for Payer: United Healthcare Medicare |
$28.99
|
|
|
HC FLOW CYTO MARKER 1ST
|
Facility
IP
|
$87.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.90 |
| Max. Negotiated Rate |
$81.71 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Cash Price |
$54.48
|
| Rate for Payer: Cigna All Commercial |
$75.83
|
| Rate for Payer: CORVEL All Commercial |
$81.71
|
| Rate for Payer: Coventry All Commercial |
$77.32
|
| Rate for Payer: Encore All Commercial |
$80.88
|
| Rate for Payer: Frontpath All Commercial |
$80.83
|
| Rate for Payer: Humana ChoiceCare |
$75.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.08
|
| Rate for Payer: PHCS All Commercial |
$65.90
|
| Rate for Payer: PHP All Commercial |
$66.64
|
| Rate for Payer: Sagamore Health Network All Products |
$67.83
|
| Rate for Payer: Signature Care EPO |
$72.93
|
| Rate for Payer: Signature Care PPO |
$77.32
|
| Rate for Payer: United Healthcare Commercial |
$69.24
|
|
|
HC FLOW CYTO MKR EA ADD X1
|
Facility
IP
|
$163.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
63001058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Aetna Commercial |
$141.08
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Cigna All Commercial |
$140.91
|
| Rate for Payer: CORVEL All Commercial |
$151.85
|
| Rate for Payer: Coventry All Commercial |
$143.69
|
| Rate for Payer: Encore All Commercial |
$150.30
|
| Rate for Payer: Frontpath All Commercial |
$150.22
|
| Rate for Payer: Humana ChoiceCare |
$141.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.95
|
| Rate for Payer: PHCS All Commercial |
$122.46
|
| Rate for Payer: PHP All Commercial |
$123.83
|
| Rate for Payer: Sagamore Health Network All Products |
$126.05
|
| Rate for Payer: Signature Care EPO |
$135.52
|
| Rate for Payer: Signature Care PPO |
$143.69
|
| Rate for Payer: United Healthcare Commercial |
$128.67
|
|
