|
HC GCATH 9F ACU PRO 54CM CSST
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
|
HC GCATH 9F ACU PRO 54CM CSST
|
Facility
OP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,566.68
|
| Rate for Payer: Aetna Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.82
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Centivo All Commercial |
$946.69
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Humana Medicare |
$946.69
|
| Rate for Payer: Lucent All Commercial |
$946.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$723.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.81
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
| Rate for Payer: United Healthcare Medicare |
$612.56
|
|
|
HC GCATH 9F ACU PRO 54CM CSW
|
Facility
OP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,566.68
|
| Rate for Payer: Aetna Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.82
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Centivo All Commercial |
$946.69
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Humana Medicare |
$946.69
|
| Rate for Payer: Lucent All Commercial |
$946.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$723.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.81
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
| Rate for Payer: United Healthcare Medicare |
$612.56
|
|
|
HC GCATH 9F ACU PRO 54CM CSW
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
|
HC GC CULTURE
|
Facility
OP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$116.48
|
| Rate for Payer: Aetna Medicare |
$45.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.10
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Centivo All Commercial |
$70.38
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.03
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Humana Medicare |
$70.38
|
| Rate for Payer: Lucent All Commercial |
$70.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: Managed Health Services Medicaid |
$6.63
|
| Rate for Payer: MDWise Medicaid |
$6.63
|
| Rate for Payer: PHCS All Commercial |
$103.50
|
| Rate for Payer: PHP All Commercial |
$104.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.82
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.54
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.31
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$45.54
|
|
|
HC GC CULTURE
|
Facility
IP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$119.24
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.03
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: PHCS All Commercial |
$103.50
|
| Rate for Payer: PHP All Commercial |
$104.66
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.54
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
|
|
HC GC DNA-URINE
|
Facility
IP
|
$168.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC GC DNA-URINE
|
Facility
OP
|
$168.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.09
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$85.83
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$85.83
|
| Rate for Payer: Lucent All Commercial |
$85.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$55.54
|
|
|
HC GEL DIFFUSION-EA
|
Facility
IP
|
$77.81
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
63001900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.35 |
| Max. Negotiated Rate |
$72.36 |
| Rate for Payer: Aetna Commercial |
$67.22
|
| Rate for Payer: Cash Price |
$48.24
|
| Rate for Payer: Cigna All Commercial |
$67.15
|
| Rate for Payer: CORVEL All Commercial |
$72.36
|
| Rate for Payer: Coventry All Commercial |
$68.47
|
| Rate for Payer: Encore All Commercial |
$71.62
|
| Rate for Payer: Frontpath All Commercial |
$71.58
|
| Rate for Payer: Humana ChoiceCare |
$67.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.03
|
| Rate for Payer: PHCS All Commercial |
$58.35
|
| Rate for Payer: PHP All Commercial |
$59.01
|
| Rate for Payer: Sagamore Health Network All Products |
$60.07
|
| Rate for Payer: Signature Care EPO |
$64.58
|
| Rate for Payer: Signature Care PPO |
$68.47
|
| Rate for Payer: United Healthcare Commercial |
$61.31
|
|
|
HC GEL DIFFUSION-EA
|
Facility
OP
|
$77.81
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
63001900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$72.36 |
| Rate for Payer: Aetna Commercial |
$65.67
|
| Rate for Payer: Aetna Medicare |
$25.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.24
|
| Rate for Payer: Cash Price |
$48.24
|
| Rate for Payer: Cash Price |
$48.24
|
| Rate for Payer: Centivo All Commercial |
$39.68
|
| Rate for Payer: Cigna All Commercial |
$67.15
|
| Rate for Payer: CORVEL All Commercial |
$72.36
|
| Rate for Payer: Coventry All Commercial |
$68.47
|
| Rate for Payer: Encore All Commercial |
$71.62
|
| Rate for Payer: Frontpath All Commercial |
$71.58
|
| Rate for Payer: Humana ChoiceCare |
$67.20
|
| Rate for Payer: Humana Medicare |
$39.68
|
| Rate for Payer: Lucent All Commercial |
$39.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.03
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$58.35
|
| Rate for Payer: PHP All Commercial |
$59.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.34
|
| Rate for Payer: Sagamore Health Network All Products |
$60.07
|
| Rate for Payer: Signature Care EPO |
$64.58
|
| Rate for Payer: Signature Care PPO |
$68.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.13
|
| Rate for Payer: United Healthcare Commercial |
$61.31
|
| Rate for Payer: United Healthcare Medicare |
$25.68
|
|
|
HC GEN CULTURE
|
Facility
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC GEN CULTURE
|
Facility
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
|
HC GENERAL ANESTH EA ADD MIN
|
Facility
OP
|
$23.57
|
|
| Hospital Charge Code |
01246651
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.56
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Centivo All Commercial |
$12.02
|
| Rate for Payer: Cigna All Commercial |
$20.34
|
| Rate for Payer: CORVEL All Commercial |
$21.92
|
| Rate for Payer: Coventry All Commercial |
$20.74
|
| Rate for Payer: Encore All Commercial |
$21.70
|
| Rate for Payer: Frontpath All Commercial |
$21.69
|
| Rate for Payer: Humana ChoiceCare |
$20.36
|
| Rate for Payer: Humana Medicare |
$12.02
|
| Rate for Payer: Lucent All Commercial |
$12.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.21
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$17.68
|
| Rate for Payer: PHP All Commercial |
$17.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.19
|
| Rate for Payer: Sagamore Health Network All Products |
$18.20
|
| Rate for Payer: Signature Care EPO |
$19.56
|
| Rate for Payer: Signature Care PPO |
$20.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.04
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
| Rate for Payer: United Healthcare Medicare |
$7.78
|
|
|
HC GENERAL ANESTH EA ADD MIN
|
Facility
IP
|
$23.57
|
|
| Hospital Charge Code |
01246651
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$21.92 |
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna All Commercial |
$20.34
|
| Rate for Payer: CORVEL All Commercial |
$21.92
|
| Rate for Payer: Coventry All Commercial |
$20.74
|
| Rate for Payer: Encore All Commercial |
$21.70
|
| Rate for Payer: Frontpath All Commercial |
$21.69
|
| Rate for Payer: Humana ChoiceCare |
$20.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.21
|
| Rate for Payer: PHCS All Commercial |
$17.68
|
| Rate for Payer: PHP All Commercial |
$17.88
|
| Rate for Payer: Sagamore Health Network All Products |
$18.20
|
| Rate for Payer: Signature Care EPO |
$19.56
|
| Rate for Payer: Signature Care PPO |
$20.74
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
|
|
HC GENERAL ANESTH INITIAL 15 MIN
|
Facility
IP
|
$350.17
|
|
| Hospital Charge Code |
01246650
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$262.62 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Commercial |
$302.54
|
| Rate for Payer: Cash Price |
$217.10
|
| Rate for Payer: Cigna All Commercial |
$302.19
|
| Rate for Payer: CORVEL All Commercial |
$325.65
|
| Rate for Payer: Coventry All Commercial |
$308.15
|
| Rate for Payer: Encore All Commercial |
$322.33
|
| Rate for Payer: Frontpath All Commercial |
$322.15
|
| Rate for Payer: Humana ChoiceCare |
$302.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.15
|
| Rate for Payer: PHCS All Commercial |
$262.62
|
| Rate for Payer: PHP All Commercial |
$265.57
|
| Rate for Payer: Sagamore Health Network All Products |
$270.33
|
| Rate for Payer: Signature Care EPO |
$290.64
|
| Rate for Payer: Signature Care PPO |
$308.15
|
| Rate for Payer: United Healthcare Commercial |
$275.93
|
|
|
HC GENERAL ANESTH INITIAL 15 MIN
|
Facility
OP
|
$350.17
|
|
| Hospital Charge Code |
01246650
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$115.55 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Commercial |
$295.54
|
| Rate for Payer: Aetna Medicare |
$115.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.11
|
| Rate for Payer: Cash Price |
$217.10
|
| Rate for Payer: Cash Price |
$217.10
|
| Rate for Payer: Centivo All Commercial |
$178.58
|
| Rate for Payer: Cigna All Commercial |
$302.19
|
| Rate for Payer: CORVEL All Commercial |
$325.65
|
| Rate for Payer: Coventry All Commercial |
$308.15
|
| Rate for Payer: Encore All Commercial |
$322.33
|
| Rate for Payer: Frontpath All Commercial |
$322.15
|
| Rate for Payer: Humana ChoiceCare |
$302.44
|
| Rate for Payer: Humana Medicare |
$178.58
|
| Rate for Payer: Lucent All Commercial |
$178.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.15
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$262.62
|
| Rate for Payer: PHP All Commercial |
$265.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.56
|
| Rate for Payer: Sagamore Health Network All Products |
$270.33
|
| Rate for Payer: Signature Care EPO |
$290.64
|
| Rate for Payer: Signature Care PPO |
$308.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.64
|
| Rate for Payer: United Healthcare Commercial |
$275.93
|
| Rate for Payer: United Healthcare Medicare |
$115.55
|
|
|
HC GENETIC SCREEN
|
Facility
OP
|
$654.15
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
63001460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$608.36 |
| Rate for Payer: Aetna Commercial |
$552.10
|
| Rate for Payer: Aetna Medicare |
$215.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$215.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$375.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$408.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.46
|
| Rate for Payer: Cash Price |
$405.57
|
| Rate for Payer: Cash Price |
$405.57
|
| Rate for Payer: Centivo All Commercial |
$333.61
|
| Rate for Payer: Cigna All Commercial |
$564.53
|
| Rate for Payer: CORVEL All Commercial |
$608.36
|
| Rate for Payer: Coventry All Commercial |
$575.65
|
| Rate for Payer: Encore All Commercial |
$602.14
|
| Rate for Payer: Frontpath All Commercial |
$601.81
|
| Rate for Payer: Humana ChoiceCare |
$564.99
|
| Rate for Payer: Humana Medicare |
$333.61
|
| Rate for Payer: Lucent All Commercial |
$333.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.73
|
| Rate for Payer: Managed Health Services Medicaid |
$16.87
|
| Rate for Payer: MDWise Medicaid |
$16.87
|
| Rate for Payer: PHCS All Commercial |
$490.61
|
| Rate for Payer: PHP All Commercial |
$496.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.12
|
| Rate for Payer: Sagamore Health Network All Products |
$505.00
|
| Rate for Payer: Signature Care EPO |
$542.94
|
| Rate for Payer: Signature Care PPO |
$575.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.02
|
| Rate for Payer: United Healthcare Commercial |
$515.47
|
| Rate for Payer: United Healthcare Medicare |
$215.87
|
|
|
HC GENETIC SCREEN
|
Facility
IP
|
$654.15
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
63001460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$490.61 |
| Max. Negotiated Rate |
$608.36 |
| Rate for Payer: Aetna Commercial |
$565.18
|
| Rate for Payer: Cash Price |
$405.57
|
| Rate for Payer: Cigna All Commercial |
$564.53
|
| Rate for Payer: CORVEL All Commercial |
$608.36
|
| Rate for Payer: Coventry All Commercial |
$575.65
|
| Rate for Payer: Encore All Commercial |
$602.14
|
| Rate for Payer: Frontpath All Commercial |
$601.81
|
| Rate for Payer: Humana ChoiceCare |
$564.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.73
|
| Rate for Payer: PHCS All Commercial |
$490.61
|
| Rate for Payer: PHP All Commercial |
$496.10
|
| Rate for Payer: Sagamore Health Network All Products |
$505.00
|
| Rate for Payer: Signature Care EPO |
$542.94
|
| Rate for Payer: Signature Care PPO |
$575.65
|
| Rate for Payer: United Healthcare Commercial |
$515.47
|
|
|
HC GENTAMYCIN - PEAK
|
Facility
IP
|
$601.81
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$559.68 |
| Rate for Payer: Aetna Commercial |
$519.96
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cigna All Commercial |
$519.36
|
| Rate for Payer: CORVEL All Commercial |
$559.68
|
| Rate for Payer: Coventry All Commercial |
$529.59
|
| Rate for Payer: Encore All Commercial |
$553.97
|
| Rate for Payer: Frontpath All Commercial |
$553.67
|
| Rate for Payer: Humana ChoiceCare |
$519.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.63
|
| Rate for Payer: PHCS All Commercial |
$451.36
|
| Rate for Payer: PHP All Commercial |
$456.41
|
| Rate for Payer: Sagamore Health Network All Products |
$464.60
|
| Rate for Payer: Signature Care EPO |
$499.50
|
| Rate for Payer: Signature Care PPO |
$529.59
|
| Rate for Payer: United Healthcare Commercial |
$474.23
|
|
|
HC GENTAMYCIN - PEAK
|
Facility
OP
|
$601.81
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$559.68 |
| Rate for Payer: Aetna Commercial |
$507.93
|
| Rate for Payer: Aetna Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$345.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$376.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.46
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Centivo All Commercial |
$306.92
|
| Rate for Payer: Cigna All Commercial |
$519.36
|
| Rate for Payer: CORVEL All Commercial |
$559.68
|
| Rate for Payer: Coventry All Commercial |
$529.59
|
| Rate for Payer: Encore All Commercial |
$553.97
|
| Rate for Payer: Frontpath All Commercial |
$553.67
|
| Rate for Payer: Humana ChoiceCare |
$519.78
|
| Rate for Payer: Humana Medicare |
$306.92
|
| Rate for Payer: Lucent All Commercial |
$306.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.63
|
| Rate for Payer: Managed Health Services Medicaid |
$16.38
|
| Rate for Payer: MDWise Medicaid |
$16.38
|
| Rate for Payer: PHCS All Commercial |
$451.36
|
| Rate for Payer: PHP All Commercial |
$456.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.71
|
| Rate for Payer: Sagamore Health Network All Products |
$464.60
|
| Rate for Payer: Signature Care EPO |
$499.50
|
| Rate for Payer: Signature Care PPO |
$529.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$511.54
|
| Rate for Payer: United Healthcare Commercial |
$474.23
|
| Rate for Payer: United Healthcare Medicare |
$198.60
|
|
|
HC GENTAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$213.90 |
| Rate for Payer: Aetna Commercial |
$198.72
|
| Rate for Payer: Cash Price |
$142.60
|
| Rate for Payer: Cigna All Commercial |
$198.49
|
| Rate for Payer: CORVEL All Commercial |
$213.90
|
| Rate for Payer: Coventry All Commercial |
$202.40
|
| Rate for Payer: Encore All Commercial |
$211.71
|
| Rate for Payer: Frontpath All Commercial |
$211.60
|
| Rate for Payer: Humana ChoiceCare |
$198.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.00
|
| Rate for Payer: PHCS All Commercial |
$172.50
|
| Rate for Payer: PHP All Commercial |
$174.43
|
| Rate for Payer: Sagamore Health Network All Products |
$177.56
|
| Rate for Payer: Signature Care EPO |
$190.90
|
| Rate for Payer: Signature Care PPO |
$202.40
|
| Rate for Payer: United Healthcare Commercial |
$181.24
|
|
|
HC GENTAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$213.90 |
| Rate for Payer: Aetna Commercial |
$194.12
|
| Rate for Payer: Aetna Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.49
|
| Rate for Payer: Cash Price |
$142.60
|
| Rate for Payer: Cash Price |
$142.60
|
| Rate for Payer: Centivo All Commercial |
$117.30
|
| Rate for Payer: Cigna All Commercial |
$198.49
|
| Rate for Payer: CORVEL All Commercial |
$213.90
|
| Rate for Payer: Coventry All Commercial |
$202.40
|
| Rate for Payer: Encore All Commercial |
$211.71
|
| Rate for Payer: Frontpath All Commercial |
$211.60
|
| Rate for Payer: Humana ChoiceCare |
$198.65
|
| Rate for Payer: Humana Medicare |
$117.30
|
| Rate for Payer: Lucent All Commercial |
$117.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.00
|
| Rate for Payer: Managed Health Services Medicaid |
$16.38
|
| Rate for Payer: MDWise Medicaid |
$16.38
|
| Rate for Payer: PHCS All Commercial |
$172.50
|
| Rate for Payer: PHP All Commercial |
$174.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.70
|
| Rate for Payer: Sagamore Health Network All Products |
$177.56
|
| Rate for Payer: Signature Care EPO |
$190.90
|
| Rate for Payer: Signature Care PPO |
$202.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.50
|
| Rate for Payer: United Healthcare Commercial |
$181.24
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
|
|
HC GENTAMYCIN - TROUGH
|
Facility
OP
|
$601.81
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$559.68 |
| Rate for Payer: Aetna Commercial |
$507.93
|
| Rate for Payer: Aetna Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$345.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$376.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.46
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Centivo All Commercial |
$306.92
|
| Rate for Payer: Cigna All Commercial |
$519.36
|
| Rate for Payer: CORVEL All Commercial |
$559.68
|
| Rate for Payer: Coventry All Commercial |
$529.59
|
| Rate for Payer: Encore All Commercial |
$553.97
|
| Rate for Payer: Frontpath All Commercial |
$553.67
|
| Rate for Payer: Humana ChoiceCare |
$519.78
|
| Rate for Payer: Humana Medicare |
$306.92
|
| Rate for Payer: Lucent All Commercial |
$306.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.63
|
| Rate for Payer: Managed Health Services Medicaid |
$16.38
|
| Rate for Payer: MDWise Medicaid |
$16.38
|
| Rate for Payer: PHCS All Commercial |
$451.36
|
| Rate for Payer: PHP All Commercial |
$456.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.71
|
| Rate for Payer: Sagamore Health Network All Products |
$464.60
|
| Rate for Payer: Signature Care EPO |
$499.50
|
| Rate for Payer: Signature Care PPO |
$529.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$511.54
|
| Rate for Payer: United Healthcare Commercial |
$474.23
|
| Rate for Payer: United Healthcare Medicare |
$198.60
|
|
|
HC GENTAMYCIN - TROUGH
|
Facility
IP
|
$601.81
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$559.68 |
| Rate for Payer: Aetna Commercial |
$519.96
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cigna All Commercial |
$519.36
|
| Rate for Payer: CORVEL All Commercial |
$559.68
|
| Rate for Payer: Coventry All Commercial |
$529.59
|
| Rate for Payer: Encore All Commercial |
$553.97
|
| Rate for Payer: Frontpath All Commercial |
$553.67
|
| Rate for Payer: Humana ChoiceCare |
$519.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.63
|
| Rate for Payer: PHCS All Commercial |
$451.36
|
| Rate for Payer: PHP All Commercial |
$456.41
|
| Rate for Payer: Sagamore Health Network All Products |
$464.60
|
| Rate for Payer: Signature Care EPO |
$499.50
|
| Rate for Payer: Signature Care PPO |
$529.59
|
| Rate for Payer: United Healthcare Commercial |
$474.23
|
|
|
HC GGTP
|
Facility
OP
|
$97.03
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
63001150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$32.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.22
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Centivo All Commercial |
$49.49
|
| Rate for Payer: Cigna All Commercial |
$83.74
|
| Rate for Payer: CORVEL All Commercial |
$90.24
|
| Rate for Payer: Coventry All Commercial |
$85.39
|
| Rate for Payer: Encore All Commercial |
$89.32
|
| Rate for Payer: Frontpath All Commercial |
$89.27
|
| Rate for Payer: Humana ChoiceCare |
$83.81
|
| Rate for Payer: Humana Medicare |
$49.49
|
| Rate for Payer: Lucent All Commercial |
$49.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.33
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: MDWise Medicaid |
$7.20
|
| Rate for Payer: PHCS All Commercial |
$72.77
|
| Rate for Payer: PHP All Commercial |
$73.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.84
|
| Rate for Payer: Sagamore Health Network All Products |
$74.91
|
| Rate for Payer: Signature Care EPO |
$80.54
|
| Rate for Payer: Signature Care PPO |
$85.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.48
|
| Rate for Payer: United Healthcare Commercial |
$76.46
|
| Rate for Payer: United Healthcare Medicare |
$32.02
|
|
