HC GLUCOSE TOLERANCE 5HR SPE
|
Facility
OP
|
$35.34
|
|
Service Code
|
CPT 82952
|
Hospital Charge Code |
63001139
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$3.92 |
Max. Negotiated Rate |
$32.87 |
Rate for Payer: Aetna Commercial |
$29.83
|
Rate for Payer: Aetna Medicare |
$11.66
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.66
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.24
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.24
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.92
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.41
|
Rate for Payer: CareSource Indiana of IN Medicare |
$12.83
|
Rate for Payer: Cash Price |
$21.91
|
Rate for Payer: Cash Price |
$21.91
|
Rate for Payer: Centivo All Commercial |
$18.02
|
Rate for Payer: Cigna All Commercial |
$30.50
|
Rate for Payer: CORVEL All Commercial |
$32.87
|
Rate for Payer: Coventry All Commercial |
$31.10
|
Rate for Payer: Encore All Commercial |
$32.53
|
Rate for Payer: Frontpath All Commercial |
$32.52
|
Rate for Payer: Humana ChoiceCare |
$30.53
|
Rate for Payer: Humana Medicare |
$18.02
|
Rate for Payer: Lucent All Commercial |
$18.02
|
Rate for Payer: Lutheran Preferred All Commercial |
$31.81
|
Rate for Payer: Managed Health Services Medicaid |
$3.92
|
Rate for Payer: MDWise Medicaid |
$3.92
|
Rate for Payer: PHCS All Commercial |
$26.51
|
Rate for Payer: PHP All Commercial |
$26.80
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$13.78
|
Rate for Payer: Sagamore Health Network All Products |
$27.28
|
Rate for Payer: Signature Care EPO |
$29.33
|
Rate for Payer: Signature Care PPO |
$31.10
|
Rate for Payer: Three Rivers Preferred All Commercial |
$30.04
|
Rate for Payer: United Healthcare Commercial |
$27.85
|
Rate for Payer: United Healthcare Medicare |
$11.66
|
|
HC GLUCOSE URINE
|
Facility
IP
|
$77.88
|
|
Service Code
|
CPT 82945
|
Hospital Charge Code |
63001551
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$58.41 |
Max. Negotiated Rate |
$72.43 |
Rate for Payer: Aetna Commercial |
$67.29
|
Rate for Payer: Cash Price |
$48.28
|
Rate for Payer: Cigna All Commercial |
$67.21
|
Rate for Payer: CORVEL All Commercial |
$72.43
|
Rate for Payer: Coventry All Commercial |
$68.53
|
Rate for Payer: Encore All Commercial |
$71.69
|
Rate for Payer: Frontpath All Commercial |
$71.65
|
Rate for Payer: Humana ChoiceCare |
$67.26
|
Rate for Payer: Lutheran Preferred All Commercial |
$70.09
|
Rate for Payer: PHCS All Commercial |
$58.41
|
Rate for Payer: PHP All Commercial |
$59.06
|
Rate for Payer: Sagamore Health Network All Products |
$60.12
|
Rate for Payer: Signature Care EPO |
$64.64
|
Rate for Payer: Signature Care PPO |
$68.53
|
Rate for Payer: United Healthcare Commercial |
$61.37
|
|
HC GLUCOSE URINE
|
Facility
OP
|
$77.88
|
|
Service Code
|
CPT 82945
|
Hospital Charge Code |
63001551
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$3.93 |
Max. Negotiated Rate |
$72.43 |
Rate for Payer: Aetna Commercial |
$65.73
|
Rate for Payer: Aetna Medicare |
$25.70
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.70
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.72
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.68
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.93
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.55
|
Rate for Payer: CareSource Indiana of IN Medicare |
$28.27
|
Rate for Payer: Cash Price |
$48.28
|
Rate for Payer: Cash Price |
$48.28
|
Rate for Payer: Centivo All Commercial |
$39.72
|
Rate for Payer: Cigna All Commercial |
$67.21
|
Rate for Payer: CORVEL All Commercial |
$72.43
|
Rate for Payer: Coventry All Commercial |
$68.53
|
Rate for Payer: Encore All Commercial |
$71.69
|
Rate for Payer: Frontpath All Commercial |
$71.65
|
Rate for Payer: Humana ChoiceCare |
$67.26
|
Rate for Payer: Humana Medicare |
$39.72
|
Rate for Payer: Lucent All Commercial |
$39.72
|
Rate for Payer: Lutheran Preferred All Commercial |
$70.09
|
Rate for Payer: Managed Health Services Medicaid |
$3.93
|
Rate for Payer: MDWise Medicaid |
$3.93
|
Rate for Payer: PHCS All Commercial |
$58.41
|
Rate for Payer: PHP All Commercial |
$59.06
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$30.37
|
Rate for Payer: Sagamore Health Network All Products |
$60.12
|
Rate for Payer: Signature Care EPO |
$64.64
|
Rate for Payer: Signature Care PPO |
$68.53
|
Rate for Payer: Three Rivers Preferred All Commercial |
$66.20
|
Rate for Payer: United Healthcare Commercial |
$61.37
|
Rate for Payer: United Healthcare Medicare |
$25.70
|
|
HC GLUTAMIC ACID DECARBOXLA
|
Facility
IP
|
$211.67
|
|
Service Code
|
CPT 83520
|
Hospital Charge Code |
63001600
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$158.75 |
Max. Negotiated Rate |
$196.85 |
Rate for Payer: Aetna Commercial |
$182.88
|
Rate for Payer: Cash Price |
$131.24
|
Rate for Payer: Cigna All Commercial |
$182.67
|
Rate for Payer: CORVEL All Commercial |
$196.85
|
Rate for Payer: Coventry All Commercial |
$186.27
|
Rate for Payer: Encore All Commercial |
$194.84
|
Rate for Payer: Frontpath All Commercial |
$194.74
|
Rate for Payer: Humana ChoiceCare |
$182.82
|
Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
Rate for Payer: PHCS All Commercial |
$158.75
|
Rate for Payer: PHP All Commercial |
$160.53
|
Rate for Payer: Sagamore Health Network All Products |
$163.41
|
Rate for Payer: Signature Care EPO |
$175.69
|
Rate for Payer: Signature Care PPO |
$186.27
|
Rate for Payer: United Healthcare Commercial |
$166.80
|
|
HC GLUTAMIC ACID DECARBOXLA
|
Facility
OP
|
$211.67
|
|
Service Code
|
CPT 83520
|
Hospital Charge Code |
63001600
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$17.27 |
Max. Negotiated Rate |
$196.85 |
Rate for Payer: Aetna Commercial |
$178.65
|
Rate for Payer: Aetna Medicare |
$69.85
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.85
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.56
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.32
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.33
|
Rate for Payer: CareSource Indiana of IN Medicare |
$76.84
|
Rate for Payer: Cash Price |
$131.24
|
Rate for Payer: Cash Price |
$131.24
|
Rate for Payer: Centivo All Commercial |
$107.95
|
Rate for Payer: Cigna All Commercial |
$182.67
|
Rate for Payer: CORVEL All Commercial |
$196.85
|
Rate for Payer: Coventry All Commercial |
$186.27
|
Rate for Payer: Encore All Commercial |
$194.84
|
Rate for Payer: Frontpath All Commercial |
$194.74
|
Rate for Payer: Humana ChoiceCare |
$182.82
|
Rate for Payer: Humana Medicare |
$107.95
|
Rate for Payer: Lucent All Commercial |
$107.95
|
Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
Rate for Payer: Managed Health Services Medicaid |
$17.27
|
Rate for Payer: MDWise Medicaid |
$17.27
|
Rate for Payer: PHCS All Commercial |
$158.75
|
Rate for Payer: PHP All Commercial |
$160.53
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$82.55
|
Rate for Payer: Sagamore Health Network All Products |
$163.41
|
Rate for Payer: Signature Care EPO |
$175.69
|
Rate for Payer: Signature Care PPO |
$186.27
|
Rate for Payer: Three Rivers Preferred All Commercial |
$179.92
|
Rate for Payer: United Healthcare Commercial |
$166.80
|
Rate for Payer: United Healthcare Medicare |
$69.85
|
|
HC GLYCOSYLATED HEMOGLOBIN A1C
|
Facility
OP
|
$97.79
|
|
Service Code
|
CPT 83036
|
Hospital Charge Code |
63001186
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$9.71 |
Max. Negotiated Rate |
$90.94 |
Rate for Payer: Aetna Commercial |
$82.53
|
Rate for Payer: Aetna Medicare |
$32.27
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.27
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.94
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.94
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.71
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.11
|
Rate for Payer: CareSource Indiana of IN Medicare |
$35.50
|
Rate for Payer: Cash Price |
$60.63
|
Rate for Payer: Cash Price |
$60.63
|
Rate for Payer: Centivo All Commercial |
$49.87
|
Rate for Payer: Cigna All Commercial |
$84.39
|
Rate for Payer: CORVEL All Commercial |
$90.94
|
Rate for Payer: Coventry All Commercial |
$86.05
|
Rate for Payer: Encore All Commercial |
$90.01
|
Rate for Payer: Frontpath All Commercial |
$89.96
|
Rate for Payer: Humana ChoiceCare |
$84.46
|
Rate for Payer: Humana Medicare |
$49.87
|
Rate for Payer: Lucent All Commercial |
$49.87
|
Rate for Payer: Lutheran Preferred All Commercial |
$88.01
|
Rate for Payer: Managed Health Services Medicaid |
$9.71
|
Rate for Payer: MDWise Medicaid |
$9.71
|
Rate for Payer: PHCS All Commercial |
$73.34
|
Rate for Payer: PHP All Commercial |
$74.16
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$38.14
|
Rate for Payer: Sagamore Health Network All Products |
$75.49
|
Rate for Payer: Signature Care EPO |
$81.16
|
Rate for Payer: Signature Care PPO |
$86.05
|
Rate for Payer: Three Rivers Preferred All Commercial |
$83.12
|
Rate for Payer: United Healthcare Commercial |
$77.06
|
Rate for Payer: United Healthcare Medicare |
$32.27
|
|
HC GLYCOSYLATED HEMOGLOBIN A1C
|
Facility
IP
|
$97.79
|
|
Service Code
|
CPT 83036
|
Hospital Charge Code |
63001186
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$73.34 |
Max. Negotiated Rate |
$90.94 |
Rate for Payer: Aetna Commercial |
$84.49
|
Rate for Payer: Cash Price |
$60.63
|
Rate for Payer: Cigna All Commercial |
$84.39
|
Rate for Payer: CORVEL All Commercial |
$90.94
|
Rate for Payer: Coventry All Commercial |
$86.05
|
Rate for Payer: Encore All Commercial |
$90.01
|
Rate for Payer: Frontpath All Commercial |
$89.96
|
Rate for Payer: Humana ChoiceCare |
$84.46
|
Rate for Payer: Lutheran Preferred All Commercial |
$88.01
|
Rate for Payer: PHCS All Commercial |
$73.34
|
Rate for Payer: PHP All Commercial |
$74.16
|
Rate for Payer: Sagamore Health Network All Products |
$75.49
|
Rate for Payer: Signature Care EPO |
$81.16
|
Rate for Payer: Signature Care PPO |
$86.05
|
Rate for Payer: United Healthcare Commercial |
$77.06
|
|
HC GM1 ANTIBODY, IGG & IGM
|
Facility
OP
|
$65.03
|
|
Service Code
|
CPT 83516
|
Hospital Charge Code |
63044045
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$11.53 |
Max. Negotiated Rate |
$60.47 |
Rate for Payer: Aetna Commercial |
$54.88
|
Rate for Payer: Aetna Medicare |
$21.46
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.46
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.89
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.89
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.68
|
Rate for Payer: CareSource Indiana of IN Medicare |
$23.60
|
Rate for Payer: Cash Price |
$40.32
|
Rate for Payer: Cash Price |
$40.32
|
Rate for Payer: Centivo All Commercial |
$33.16
|
Rate for Payer: Cigna All Commercial |
$56.12
|
Rate for Payer: CORVEL All Commercial |
$60.47
|
Rate for Payer: Coventry All Commercial |
$57.22
|
Rate for Payer: Encore All Commercial |
$59.86
|
Rate for Payer: Frontpath All Commercial |
$59.82
|
Rate for Payer: Humana ChoiceCare |
$56.16
|
Rate for Payer: Humana Medicare |
$33.16
|
Rate for Payer: Lucent All Commercial |
$33.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$58.52
|
Rate for Payer: Managed Health Services Medicaid |
$11.53
|
Rate for Payer: MDWise Medicaid |
$11.53
|
Rate for Payer: PHCS All Commercial |
$48.77
|
Rate for Payer: PHP All Commercial |
$49.31
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$25.36
|
Rate for Payer: Sagamore Health Network All Products |
$50.20
|
Rate for Payer: Signature Care EPO |
$53.97
|
Rate for Payer: Signature Care PPO |
$57.22
|
Rate for Payer: Three Rivers Preferred All Commercial |
$55.27
|
Rate for Payer: United Healthcare Commercial |
$51.24
|
Rate for Payer: United Healthcare Medicare |
$21.46
|
|
HC GM1 ANTIBODY, IGG & IGM
|
Facility
IP
|
$65.03
|
|
Service Code
|
CPT 83516
|
Hospital Charge Code |
63044045
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$48.77 |
Max. Negotiated Rate |
$60.47 |
Rate for Payer: Aetna Commercial |
$56.18
|
Rate for Payer: Cash Price |
$40.32
|
Rate for Payer: Cigna All Commercial |
$56.12
|
Rate for Payer: CORVEL All Commercial |
$60.47
|
Rate for Payer: Coventry All Commercial |
$57.22
|
Rate for Payer: Encore All Commercial |
$59.86
|
Rate for Payer: Frontpath All Commercial |
$59.82
|
Rate for Payer: Humana ChoiceCare |
$56.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$58.52
|
Rate for Payer: PHCS All Commercial |
$48.77
|
Rate for Payer: PHP All Commercial |
$49.31
|
Rate for Payer: Sagamore Health Network All Products |
$50.20
|
Rate for Payer: Signature Care EPO |
$53.97
|
Rate for Payer: Signature Care PPO |
$57.22
|
Rate for Payer: United Healthcare Commercial |
$51.24
|
|
HC GM1 ANTIBODY, IGG & IGM-B
|
Facility
OP
|
$65.03
|
|
Service Code
|
CPT 83516
|
Hospital Charge Code |
63044046
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$11.53 |
Max. Negotiated Rate |
$60.47 |
Rate for Payer: Aetna Commercial |
$54.88
|
Rate for Payer: Aetna Medicare |
$21.46
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.46
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.89
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.89
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.68
|
Rate for Payer: CareSource Indiana of IN Medicare |
$23.60
|
Rate for Payer: Cash Price |
$40.32
|
Rate for Payer: Cash Price |
$40.32
|
Rate for Payer: Centivo All Commercial |
$33.16
|
Rate for Payer: Cigna All Commercial |
$56.12
|
Rate for Payer: CORVEL All Commercial |
$60.47
|
Rate for Payer: Coventry All Commercial |
$57.22
|
Rate for Payer: Encore All Commercial |
$59.86
|
Rate for Payer: Frontpath All Commercial |
$59.82
|
Rate for Payer: Humana ChoiceCare |
$56.16
|
Rate for Payer: Humana Medicare |
$33.16
|
Rate for Payer: Lucent All Commercial |
$33.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$58.52
|
Rate for Payer: Managed Health Services Medicaid |
$11.53
|
Rate for Payer: MDWise Medicaid |
$11.53
|
Rate for Payer: PHCS All Commercial |
$48.77
|
Rate for Payer: PHP All Commercial |
$49.31
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$25.36
|
Rate for Payer: Sagamore Health Network All Products |
$50.20
|
Rate for Payer: Signature Care EPO |
$53.97
|
Rate for Payer: Signature Care PPO |
$57.22
|
Rate for Payer: Three Rivers Preferred All Commercial |
$55.27
|
Rate for Payer: United Healthcare Commercial |
$51.24
|
Rate for Payer: United Healthcare Medicare |
$21.46
|
|
HC GM1 ANTIBODY, IGG & IGM-B
|
Facility
IP
|
$65.03
|
|
Service Code
|
CPT 83516
|
Hospital Charge Code |
63044046
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$48.77 |
Max. Negotiated Rate |
$60.47 |
Rate for Payer: Aetna Commercial |
$56.18
|
Rate for Payer: Cash Price |
$40.32
|
Rate for Payer: Cigna All Commercial |
$56.12
|
Rate for Payer: CORVEL All Commercial |
$60.47
|
Rate for Payer: Coventry All Commercial |
$57.22
|
Rate for Payer: Encore All Commercial |
$59.86
|
Rate for Payer: Frontpath All Commercial |
$59.82
|
Rate for Payer: Humana ChoiceCare |
$56.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$58.52
|
Rate for Payer: PHCS All Commercial |
$48.77
|
Rate for Payer: PHP All Commercial |
$49.31
|
Rate for Payer: Sagamore Health Network All Products |
$50.20
|
Rate for Payer: Signature Care EPO |
$53.97
|
Rate for Payer: Signature Care PPO |
$57.22
|
Rate for Payer: United Healthcare Commercial |
$51.24
|
|
HC GOWN BAIR PAWS FLEX
|
Facility
OP
|
$94.81
|
|
Hospital Charge Code |
41601061
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$31.29 |
Max. Negotiated Rate |
$96.84 |
Rate for Payer: Aetna Commercial |
$80.02
|
Rate for Payer: Aetna Medicare |
$31.29
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.29
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.45
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.27
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.98
|
Rate for Payer: CareSource Indiana of IN Medicare |
$34.42
|
Rate for Payer: Cash Price |
$58.78
|
Rate for Payer: Cash Price |
$58.78
|
Rate for Payer: Centivo All Commercial |
$48.35
|
Rate for Payer: Cigna All Commercial |
$81.82
|
Rate for Payer: CORVEL All Commercial |
$88.17
|
Rate for Payer: Coventry All Commercial |
$83.43
|
Rate for Payer: Encore All Commercial |
$87.27
|
Rate for Payer: Frontpath All Commercial |
$87.23
|
Rate for Payer: Humana ChoiceCare |
$81.89
|
Rate for Payer: Humana Medicare |
$48.35
|
Rate for Payer: Lucent All Commercial |
$48.35
|
Rate for Payer: Lutheran Preferred All Commercial |
$85.33
|
Rate for Payer: Managed Health Services Medicaid |
$96.84
|
Rate for Payer: MDWise Medicaid |
$96.84
|
Rate for Payer: PHCS All Commercial |
$71.11
|
Rate for Payer: PHP All Commercial |
$71.90
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$36.98
|
Rate for Payer: Sagamore Health Network All Products |
$73.19
|
Rate for Payer: Signature Care EPO |
$78.69
|
Rate for Payer: Signature Care PPO |
$83.43
|
Rate for Payer: Three Rivers Preferred All Commercial |
$80.59
|
Rate for Payer: United Healthcare Commercial |
$74.71
|
Rate for Payer: United Healthcare Medicare |
$31.29
|
|
HC GOWN BAIR PAWS FLEX
|
Facility
IP
|
$94.81
|
|
Hospital Charge Code |
41601061
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$71.11 |
Max. Negotiated Rate |
$88.17 |
Rate for Payer: Aetna Commercial |
$81.92
|
Rate for Payer: Cash Price |
$58.78
|
Rate for Payer: Cigna All Commercial |
$81.82
|
Rate for Payer: CORVEL All Commercial |
$88.17
|
Rate for Payer: Coventry All Commercial |
$83.43
|
Rate for Payer: Encore All Commercial |
$87.27
|
Rate for Payer: Frontpath All Commercial |
$87.23
|
Rate for Payer: Humana ChoiceCare |
$81.89
|
Rate for Payer: Lutheran Preferred All Commercial |
$85.33
|
Rate for Payer: PHCS All Commercial |
$71.11
|
Rate for Payer: PHP All Commercial |
$71.90
|
Rate for Payer: Sagamore Health Network All Products |
$73.19
|
Rate for Payer: Signature Care EPO |
$78.69
|
Rate for Payer: Signature Care PPO |
$83.43
|
Rate for Payer: United Healthcare Commercial |
$74.71
|
|
HC GOWN BAIR PAWS PED WARMING
|
Facility
IP
|
$70.47
|
|
Hospital Charge Code |
41601063
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$52.85 |
Max. Negotiated Rate |
$65.54 |
Rate for Payer: Aetna Commercial |
$60.89
|
Rate for Payer: Cash Price |
$43.69
|
Rate for Payer: Cigna All Commercial |
$60.82
|
Rate for Payer: CORVEL All Commercial |
$65.54
|
Rate for Payer: Coventry All Commercial |
$62.01
|
Rate for Payer: Encore All Commercial |
$64.87
|
Rate for Payer: Frontpath All Commercial |
$64.83
|
Rate for Payer: Humana ChoiceCare |
$60.86
|
Rate for Payer: Lutheran Preferred All Commercial |
$63.42
|
Rate for Payer: PHCS All Commercial |
$52.85
|
Rate for Payer: PHP All Commercial |
$53.44
|
Rate for Payer: Sagamore Health Network All Products |
$54.40
|
Rate for Payer: Signature Care EPO |
$58.49
|
Rate for Payer: Signature Care PPO |
$62.01
|
Rate for Payer: United Healthcare Commercial |
$55.53
|
|
HC GOWN BAIR PAWS PED WARMING
|
Facility
OP
|
$70.47
|
|
Hospital Charge Code |
41601063
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$23.26 |
Max. Negotiated Rate |
$96.84 |
Rate for Payer: Aetna Commercial |
$59.48
|
Rate for Payer: Aetna Medicare |
$23.26
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.26
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.47
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.05
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.74
|
Rate for Payer: CareSource Indiana of IN Medicare |
$25.58
|
Rate for Payer: Cash Price |
$43.69
|
Rate for Payer: Cash Price |
$43.69
|
Rate for Payer: Centivo All Commercial |
$35.94
|
Rate for Payer: Cigna All Commercial |
$60.82
|
Rate for Payer: CORVEL All Commercial |
$65.54
|
Rate for Payer: Coventry All Commercial |
$62.01
|
Rate for Payer: Encore All Commercial |
$64.87
|
Rate for Payer: Frontpath All Commercial |
$64.83
|
Rate for Payer: Humana ChoiceCare |
$60.86
|
Rate for Payer: Humana Medicare |
$35.94
|
Rate for Payer: Lucent All Commercial |
$35.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$63.42
|
Rate for Payer: Managed Health Services Medicaid |
$96.84
|
Rate for Payer: MDWise Medicaid |
$96.84
|
Rate for Payer: PHCS All Commercial |
$52.85
|
Rate for Payer: PHP All Commercial |
$53.44
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$27.48
|
Rate for Payer: Sagamore Health Network All Products |
$54.40
|
Rate for Payer: Signature Care EPO |
$58.49
|
Rate for Payer: Signature Care PPO |
$62.01
|
Rate for Payer: Three Rivers Preferred All Commercial |
$59.90
|
Rate for Payer: United Healthcare Commercial |
$55.53
|
Rate for Payer: United Healthcare Medicare |
$23.26
|
|
HC GRAFT SEMI TEND 0.65X22
|
Facility
IP
|
$5,400.00
|
|
Service Code
|
CPT C1762
|
Hospital Charge Code |
41608115
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,050.00 |
Max. Negotiated Rate |
$5,022.00 |
Rate for Payer: Aetna Commercial |
$4,665.60
|
Rate for Payer: Cash Price |
$3,348.00
|
Rate for Payer: Cigna All Commercial |
$4,660.20
|
Rate for Payer: CORVEL All Commercial |
$5,022.00
|
Rate for Payer: Coventry All Commercial |
$4,752.00
|
Rate for Payer: Encore All Commercial |
$4,970.70
|
Rate for Payer: Frontpath All Commercial |
$4,968.00
|
Rate for Payer: Humana ChoiceCare |
$4,663.98
|
Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
Rate for Payer: PHCS All Commercial |
$4,050.00
|
Rate for Payer: PHP All Commercial |
$4,095.36
|
Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
Rate for Payer: Signature Care EPO |
$4,482.00
|
Rate for Payer: Signature Care PPO |
$4,752.00
|
Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
HC GRAFT SEMI TEND 0.65X22
|
Facility
OP
|
$5,400.00
|
|
Service Code
|
CPT C1762
|
Hospital Charge Code |
41608115
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$5,022.00 |
Rate for Payer: Aetna Commercial |
$4,557.60
|
Rate for Payer: Aetna Medicare |
$1,782.00
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,782.00
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,101.22
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.54
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,049.30
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,960.20
|
Rate for Payer: Cash Price |
$3,348.00
|
Rate for Payer: Cash Price |
$3,348.00
|
Rate for Payer: Centivo All Commercial |
$2,754.00
|
Rate for Payer: Cigna All Commercial |
$4,660.20
|
Rate for Payer: CORVEL All Commercial |
$5,022.00
|
Rate for Payer: Coventry All Commercial |
$4,752.00
|
Rate for Payer: Encore All Commercial |
$4,970.70
|
Rate for Payer: Frontpath All Commercial |
$4,968.00
|
Rate for Payer: Humana ChoiceCare |
$4,663.98
|
Rate for Payer: Humana Medicare |
$2,754.00
|
Rate for Payer: Lucent All Commercial |
$2,754.00
|
Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$4,050.00
|
Rate for Payer: PHP All Commercial |
$4,095.36
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$2,106.00
|
Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
Rate for Payer: Signature Care EPO |
$4,482.00
|
Rate for Payer: Signature Care PPO |
$4,752.00
|
Rate for Payer: Three Rivers Preferred All Commercial |
$4,590.00
|
Rate for Payer: United Healthcare Commercial |
$4,255.20
|
Rate for Payer: United Healthcare Medicare |
$1,782.00
|
|
HC GRAMSTAIN
|
Facility
IP
|
$100.74
|
|
Service Code
|
CPT 87205
|
Hospital Charge Code |
63001077
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$75.55 |
Max. Negotiated Rate |
$93.68 |
Rate for Payer: Aetna Commercial |
$87.04
|
Rate for Payer: Cash Price |
$62.46
|
Rate for Payer: Cigna All Commercial |
$86.93
|
Rate for Payer: CORVEL All Commercial |
$93.68
|
Rate for Payer: Coventry All Commercial |
$88.65
|
Rate for Payer: Encore All Commercial |
$92.73
|
Rate for Payer: Frontpath All Commercial |
$92.68
|
Rate for Payer: Humana ChoiceCare |
$87.00
|
Rate for Payer: Lutheran Preferred All Commercial |
$90.66
|
Rate for Payer: PHCS All Commercial |
$75.55
|
Rate for Payer: PHP All Commercial |
$76.40
|
Rate for Payer: Sagamore Health Network All Products |
$77.77
|
Rate for Payer: Signature Care EPO |
$83.61
|
Rate for Payer: Signature Care PPO |
$88.65
|
Rate for Payer: United Healthcare Commercial |
$79.38
|
|
HC GRAMSTAIN
|
Facility
OP
|
$100.74
|
|
Service Code
|
CPT 87205
|
Hospital Charge Code |
63001077
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$4.27 |
Max. Negotiated Rate |
$93.68 |
Rate for Payer: Aetna Commercial |
$85.02
|
Rate for Payer: Aetna Medicare |
$33.24
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.24
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.30
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.30
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.27
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.23
|
Rate for Payer: CareSource Indiana of IN Medicare |
$36.57
|
Rate for Payer: Cash Price |
$62.46
|
Rate for Payer: Cash Price |
$62.46
|
Rate for Payer: Centivo All Commercial |
$51.37
|
Rate for Payer: Cigna All Commercial |
$86.93
|
Rate for Payer: CORVEL All Commercial |
$93.68
|
Rate for Payer: Coventry All Commercial |
$88.65
|
Rate for Payer: Encore All Commercial |
$92.73
|
Rate for Payer: Frontpath All Commercial |
$92.68
|
Rate for Payer: Humana ChoiceCare |
$87.00
|
Rate for Payer: Humana Medicare |
$51.37
|
Rate for Payer: Lucent All Commercial |
$51.37
|
Rate for Payer: Lutheran Preferred All Commercial |
$90.66
|
Rate for Payer: Managed Health Services Medicaid |
$4.27
|
Rate for Payer: MDWise Medicaid |
$4.27
|
Rate for Payer: PHCS All Commercial |
$75.55
|
Rate for Payer: PHP All Commercial |
$76.40
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$39.29
|
Rate for Payer: Sagamore Health Network All Products |
$77.77
|
Rate for Payer: Signature Care EPO |
$83.61
|
Rate for Payer: Signature Care PPO |
$88.65
|
Rate for Payer: Three Rivers Preferred All Commercial |
$85.62
|
Rate for Payer: United Healthcare Commercial |
$79.38
|
Rate for Payer: United Healthcare Medicare |
$33.24
|
|
HC GRANULOCYTE PHERESIS EACH
|
Facility
OP
|
$3,524.18
|
|
Service Code
|
CPT P9050
|
Hospital Charge Code |
01375320
|
Hospital Revenue Code
|
390
|
Min. Negotiated Rate |
$278.73 |
Max. Negotiated Rate |
$3,277.49 |
Rate for Payer: Aetna Commercial |
$2,974.41
|
Rate for Payer: Aetna Medicare |
$1,162.98
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,162.98
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,023.94
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,202.97
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,337.43
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,279.28
|
Rate for Payer: Cash Price |
$2,184.99
|
Rate for Payer: Cash Price |
$2,184.99
|
Rate for Payer: Centivo All Commercial |
$1,797.33
|
Rate for Payer: Cigna All Commercial |
$3,041.37
|
Rate for Payer: CORVEL All Commercial |
$3,277.49
|
Rate for Payer: Coventry All Commercial |
$3,101.28
|
Rate for Payer: Encore All Commercial |
$3,244.01
|
Rate for Payer: Frontpath All Commercial |
$3,242.25
|
Rate for Payer: Humana ChoiceCare |
$3,043.84
|
Rate for Payer: Humana Medicare |
$1,797.33
|
Rate for Payer: Lucent All Commercial |
$1,797.33
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,171.76
|
Rate for Payer: Managed Health Services Medicaid |
$278.73
|
Rate for Payer: MDWise Medicaid |
$278.73
|
Rate for Payer: PHCS All Commercial |
$2,643.14
|
Rate for Payer: PHP All Commercial |
$2,672.74
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,374.43
|
Rate for Payer: Sagamore Health Network All Products |
$2,720.67
|
Rate for Payer: Signature Care EPO |
$2,925.07
|
Rate for Payer: Signature Care PPO |
$3,101.28
|
Rate for Payer: Three Rivers Preferred All Commercial |
$2,995.55
|
Rate for Payer: United Healthcare Commercial |
$2,777.06
|
Rate for Payer: United Healthcare Medicare |
$1,162.98
|
|
HC GRANULOCYTE PHERESIS EACH
|
Facility
IP
|
$3,524.18
|
|
Service Code
|
CPT P9050
|
Hospital Charge Code |
01375320
|
Hospital Revenue Code
|
390
|
Min. Negotiated Rate |
$2,643.14 |
Max. Negotiated Rate |
$3,277.49 |
Rate for Payer: Aetna Commercial |
$3,044.89
|
Rate for Payer: Cash Price |
$2,184.99
|
Rate for Payer: Cigna All Commercial |
$3,041.37
|
Rate for Payer: CORVEL All Commercial |
$3,277.49
|
Rate for Payer: Coventry All Commercial |
$3,101.28
|
Rate for Payer: Encore All Commercial |
$3,244.01
|
Rate for Payer: Frontpath All Commercial |
$3,242.25
|
Rate for Payer: Humana ChoiceCare |
$3,043.84
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,171.76
|
Rate for Payer: PHCS All Commercial |
$2,643.14
|
Rate for Payer: PHP All Commercial |
$2,672.74
|
Rate for Payer: Sagamore Health Network All Products |
$2,720.67
|
Rate for Payer: Signature Care EPO |
$2,925.07
|
Rate for Payer: Signature Care PPO |
$3,101.28
|
Rate for Payer: United Healthcare Commercial |
$2,777.06
|
|
HC GRASPER CAPTURA 3 PRONG 3.2 FR
|
Facility
OP
|
$1,078.85
|
|
Hospital Charge Code |
41602274
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$1,003.33 |
Rate for Payer: Aetna Commercial |
$910.55
|
Rate for Payer: Aetna Medicare |
$356.02
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$356.02
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$619.58
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$674.39
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$409.42
|
Rate for Payer: CareSource Indiana of IN Medicare |
$391.62
|
Rate for Payer: Cash Price |
$668.89
|
Rate for Payer: Cash Price |
$668.89
|
Rate for Payer: Centivo All Commercial |
$550.21
|
Rate for Payer: Cigna All Commercial |
$931.05
|
Rate for Payer: CORVEL All Commercial |
$1,003.33
|
Rate for Payer: Coventry All Commercial |
$949.39
|
Rate for Payer: Encore All Commercial |
$993.08
|
Rate for Payer: Frontpath All Commercial |
$992.54
|
Rate for Payer: Humana ChoiceCare |
$931.80
|
Rate for Payer: Humana Medicare |
$550.21
|
Rate for Payer: Lucent All Commercial |
$550.21
|
Rate for Payer: Lutheran Preferred All Commercial |
$970.96
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$809.14
|
Rate for Payer: PHP All Commercial |
$818.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$420.75
|
Rate for Payer: Sagamore Health Network All Products |
$832.87
|
Rate for Payer: Signature Care EPO |
$895.45
|
Rate for Payer: Signature Care PPO |
$949.39
|
Rate for Payer: Three Rivers Preferred All Commercial |
$917.02
|
Rate for Payer: United Healthcare Commercial |
$850.13
|
Rate for Payer: United Healthcare Medicare |
$356.02
|
|
HC GRASPER CAPTURA 3 PRONG 3.2 FR
|
Facility
IP
|
$1,078.85
|
|
Hospital Charge Code |
41602274
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$809.14 |
Max. Negotiated Rate |
$1,003.33 |
Rate for Payer: Aetna Commercial |
$932.13
|
Rate for Payer: Cash Price |
$668.89
|
Rate for Payer: Cigna All Commercial |
$931.05
|
Rate for Payer: CORVEL All Commercial |
$1,003.33
|
Rate for Payer: Coventry All Commercial |
$949.39
|
Rate for Payer: Encore All Commercial |
$993.08
|
Rate for Payer: Frontpath All Commercial |
$992.54
|
Rate for Payer: Humana ChoiceCare |
$931.80
|
Rate for Payer: Lutheran Preferred All Commercial |
$970.96
|
Rate for Payer: PHCS All Commercial |
$809.14
|
Rate for Payer: PHP All Commercial |
$818.20
|
Rate for Payer: Sagamore Health Network All Products |
$832.87
|
Rate for Payer: Signature Care EPO |
$895.45
|
Rate for Payer: Signature Care PPO |
$949.39
|
Rate for Payer: United Healthcare Commercial |
$850.13
|
|
HC GRASPER SUTURE 60 DEG IDEAL
|
Facility
IP
|
$2,175.00
|
|
Hospital Charge Code |
41606950
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,631.25 |
Max. Negotiated Rate |
$2,022.75 |
Rate for Payer: Aetna Commercial |
$1,879.20
|
Rate for Payer: Cash Price |
$1,348.50
|
Rate for Payer: Cigna All Commercial |
$1,877.02
|
Rate for Payer: CORVEL All Commercial |
$2,022.75
|
Rate for Payer: Coventry All Commercial |
$1,914.00
|
Rate for Payer: Encore All Commercial |
$2,002.09
|
Rate for Payer: Frontpath All Commercial |
$2,001.00
|
Rate for Payer: Humana ChoiceCare |
$1,878.55
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,957.50
|
Rate for Payer: PHCS All Commercial |
$1,631.25
|
Rate for Payer: PHP All Commercial |
$1,649.52
|
Rate for Payer: Sagamore Health Network All Products |
$1,679.10
|
Rate for Payer: Signature Care EPO |
$1,805.25
|
Rate for Payer: Signature Care PPO |
$1,914.00
|
Rate for Payer: United Healthcare Commercial |
$1,713.90
|
|
HC GRASPER SUTURE 60 DEG IDEAL
|
Facility
OP
|
$2,175.00
|
|
Hospital Charge Code |
41606950
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$2,022.75 |
Rate for Payer: Aetna Commercial |
$1,835.70
|
Rate for Payer: Aetna Medicare |
$717.75
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$717.75
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,249.10
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,359.59
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$825.41
|
Rate for Payer: CareSource Indiana of IN Medicare |
$789.52
|
Rate for Payer: Cash Price |
$1,348.50
|
Rate for Payer: Cash Price |
$1,348.50
|
Rate for Payer: Centivo All Commercial |
$1,109.25
|
Rate for Payer: Cigna All Commercial |
$1,877.02
|
Rate for Payer: CORVEL All Commercial |
$2,022.75
|
Rate for Payer: Coventry All Commercial |
$1,914.00
|
Rate for Payer: Encore All Commercial |
$2,002.09
|
Rate for Payer: Frontpath All Commercial |
$2,001.00
|
Rate for Payer: Humana ChoiceCare |
$1,878.55
|
Rate for Payer: Humana Medicare |
$1,109.25
|
Rate for Payer: Lucent All Commercial |
$1,109.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,957.50
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$1,631.25
|
Rate for Payer: PHP All Commercial |
$1,649.52
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$848.25
|
Rate for Payer: Sagamore Health Network All Products |
$1,679.10
|
Rate for Payer: Signature Care EPO |
$1,805.25
|
Rate for Payer: Signature Care PPO |
$1,914.00
|
Rate for Payer: Three Rivers Preferred All Commercial |
$1,848.75
|
Rate for Payer: United Healthcare Commercial |
$1,713.90
|
Rate for Payer: United Healthcare Medicare |
$717.75
|
|