|
HC IMMUNOPEROXIDASE EA AB
|
Facility
OP
|
$483.99
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
63001271
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$159.72 |
| Max. Negotiated Rate |
$450.11 |
| Rate for Payer: Aetna Commercial |
$408.49
|
| Rate for Payer: Aetna Medicare |
$159.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$160.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.69
|
| Rate for Payer: Cash Price |
$300.07
|
| Rate for Payer: Cash Price |
$300.07
|
| Rate for Payer: Centivo All Commercial |
$246.83
|
| Rate for Payer: Cigna All Commercial |
$417.68
|
| Rate for Payer: CORVEL All Commercial |
$450.11
|
| Rate for Payer: Coventry All Commercial |
$425.91
|
| Rate for Payer: Encore All Commercial |
$445.51
|
| Rate for Payer: Frontpath All Commercial |
$445.27
|
| Rate for Payer: Humana ChoiceCare |
$418.02
|
| Rate for Payer: Humana Medicare |
$246.83
|
| Rate for Payer: Lucent All Commercial |
$246.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.59
|
| Rate for Payer: Managed Health Services Medicaid |
$160.95
|
| Rate for Payer: MDWise Medicaid |
$160.95
|
| Rate for Payer: PHCS All Commercial |
$362.99
|
| Rate for Payer: PHP All Commercial |
$367.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.76
|
| Rate for Payer: Sagamore Health Network All Products |
$373.64
|
| Rate for Payer: Signature Care EPO |
$401.71
|
| Rate for Payer: Signature Care PPO |
$425.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$411.39
|
| Rate for Payer: United Healthcare Commercial |
$381.38
|
| Rate for Payer: United Healthcare Medicare |
$159.72
|
|
|
HC IMMUNOPEROXIDASE EA STAIN CH
|
Facility
IP
|
$245.87
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
63001270
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$228.66 |
| Rate for Payer: Aetna Commercial |
$212.43
|
| Rate for Payer: Cash Price |
$152.44
|
| Rate for Payer: Cigna All Commercial |
$212.19
|
| Rate for Payer: CORVEL All Commercial |
$228.66
|
| Rate for Payer: Coventry All Commercial |
$216.37
|
| Rate for Payer: Encore All Commercial |
$226.32
|
| Rate for Payer: Frontpath All Commercial |
$226.20
|
| Rate for Payer: Humana ChoiceCare |
$212.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.28
|
| Rate for Payer: PHCS All Commercial |
$184.40
|
| Rate for Payer: PHP All Commercial |
$186.47
|
| Rate for Payer: Sagamore Health Network All Products |
$189.81
|
| Rate for Payer: Signature Care EPO |
$204.07
|
| Rate for Payer: Signature Care PPO |
$216.37
|
| Rate for Payer: United Healthcare Commercial |
$193.75
|
|
|
HC IMMUNOPEROXIDASE EA STAIN CH
|
Facility
OP
|
$245.87
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
63001270
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.14 |
| Max. Negotiated Rate |
$228.66 |
| Rate for Payer: Aetna Commercial |
$207.52
|
| Rate for Payer: Aetna Medicare |
$81.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.25
|
| Rate for Payer: Cash Price |
$152.44
|
| Rate for Payer: Centivo All Commercial |
$125.39
|
| Rate for Payer: Cigna All Commercial |
$212.19
|
| Rate for Payer: CORVEL All Commercial |
$228.66
|
| Rate for Payer: Coventry All Commercial |
$216.37
|
| Rate for Payer: Encore All Commercial |
$226.32
|
| Rate for Payer: Frontpath All Commercial |
$226.20
|
| Rate for Payer: Humana ChoiceCare |
$212.36
|
| Rate for Payer: Humana Medicare |
$125.39
|
| Rate for Payer: Lucent All Commercial |
$125.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.28
|
| Rate for Payer: PHCS All Commercial |
$184.40
|
| Rate for Payer: PHP All Commercial |
$186.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.89
|
| Rate for Payer: Sagamore Health Network All Products |
$189.81
|
| Rate for Payer: Signature Care EPO |
$204.07
|
| Rate for Payer: Signature Care PPO |
$216.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.99
|
| Rate for Payer: United Healthcare Commercial |
$193.75
|
| Rate for Payer: United Healthcare Medicare |
$81.14
|
|
|
HC IMPLANT MINI MAG(MULTIPLE OF 6)
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
|
HC IMPLANT MINI MAG(MULTIPLE OF 6)
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC IMPLANT SYSTEM INTERNAL BRACE LIGAMENT
|
Facility
IP
|
$3,870.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,902.50 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna Commercial |
$3,343.68
|
| Rate for Payer: Cash Price |
$2,399.40
|
| Rate for Payer: Cigna All Commercial |
$3,339.81
|
| Rate for Payer: CORVEL All Commercial |
$3,599.10
|
| Rate for Payer: Coventry All Commercial |
$3,405.60
|
| Rate for Payer: Encore All Commercial |
$3,562.34
|
| Rate for Payer: Frontpath All Commercial |
$3,560.40
|
| Rate for Payer: Humana ChoiceCare |
$3,342.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,483.00
|
| Rate for Payer: PHCS All Commercial |
$2,902.50
|
| Rate for Payer: PHP All Commercial |
$2,935.01
|
| Rate for Payer: Sagamore Health Network All Products |
$2,987.64
|
| Rate for Payer: Signature Care EPO |
$3,212.10
|
| Rate for Payer: Signature Care PPO |
$3,405.60
|
| Rate for Payer: United Healthcare Commercial |
$3,049.56
|
|
|
HC IMPLANT SYSTEM INTERNAL BRACE LIGAMENT
|
Facility
OP
|
$3,870.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna Commercial |
$3,266.28
|
| Rate for Payer: Aetna Medicare |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,222.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,419.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,468.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,404.81
|
| Rate for Payer: Cash Price |
$2,399.40
|
| Rate for Payer: Cash Price |
$2,399.40
|
| Rate for Payer: Centivo All Commercial |
$1,973.70
|
| Rate for Payer: Cigna All Commercial |
$3,339.81
|
| Rate for Payer: CORVEL All Commercial |
$3,599.10
|
| Rate for Payer: Coventry All Commercial |
$3,405.60
|
| Rate for Payer: Encore All Commercial |
$3,562.34
|
| Rate for Payer: Frontpath All Commercial |
$3,560.40
|
| Rate for Payer: Humana ChoiceCare |
$3,342.52
|
| Rate for Payer: Humana Medicare |
$1,973.70
|
| Rate for Payer: Lucent All Commercial |
$1,973.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,483.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,902.50
|
| Rate for Payer: PHP All Commercial |
$2,935.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,509.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,987.64
|
| Rate for Payer: Signature Care EPO |
$3,212.10
|
| Rate for Payer: Signature Care PPO |
$3,405.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,289.50
|
| Rate for Payer: United Healthcare Commercial |
$3,049.56
|
| Rate for Payer: United Healthcare Medicare |
$1,277.10
|
|
|
HC IMPLANT SYSTEM, TRIM-IT DRILL PIN 2X100
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC IMPLANT SYSTEM, TRIM-IT DRILL PIN 2X100
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR COMPELX
|
Facility
IP
|
$6,364.80
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
01547386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,773.60 |
| Max. Negotiated Rate |
$5,919.26 |
| Rate for Payer: Aetna Commercial |
$5,499.19
|
| Rate for Payer: Cash Price |
$3,946.18
|
| Rate for Payer: Cigna All Commercial |
$5,492.82
|
| Rate for Payer: CORVEL All Commercial |
$5,919.26
|
| Rate for Payer: Coventry All Commercial |
$5,601.02
|
| Rate for Payer: Encore All Commercial |
$5,858.80
|
| Rate for Payer: Frontpath All Commercial |
$5,855.62
|
| Rate for Payer: Humana ChoiceCare |
$5,497.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,728.32
|
| Rate for Payer: PHCS All Commercial |
$4,773.60
|
| Rate for Payer: PHP All Commercial |
$4,827.06
|
| Rate for Payer: Sagamore Health Network All Products |
$4,913.63
|
| Rate for Payer: Signature Care EPO |
$5,282.78
|
| Rate for Payer: Signature Care PPO |
$5,601.02
|
| Rate for Payer: United Healthcare Commercial |
$5,015.46
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR COMPELX
|
Facility
OP
|
$6,364.80
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
01547386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,979.45 |
| Max. Negotiated Rate |
$5,919.26 |
| Rate for Payer: Aetna Commercial |
$5,371.89
|
| Rate for Payer: Aetna Medicare |
$2,100.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,100.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,655.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,978.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,979.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,415.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,310.42
|
| Rate for Payer: Cash Price |
$3,946.18
|
| Rate for Payer: Cash Price |
$3,946.18
|
| Rate for Payer: Centivo All Commercial |
$3,246.05
|
| Rate for Payer: Cigna All Commercial |
$5,492.82
|
| Rate for Payer: CORVEL All Commercial |
$5,919.26
|
| Rate for Payer: Coventry All Commercial |
$5,601.02
|
| Rate for Payer: Encore All Commercial |
$5,858.80
|
| Rate for Payer: Frontpath All Commercial |
$5,855.62
|
| Rate for Payer: Humana ChoiceCare |
$5,497.28
|
| Rate for Payer: Humana Medicare |
$3,246.05
|
| Rate for Payer: Lucent All Commercial |
$3,246.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,728.32
|
| Rate for Payer: Managed Health Services Medicaid |
$1,979.45
|
| Rate for Payer: MDWise Medicaid |
$1,979.45
|
| Rate for Payer: PHCS All Commercial |
$4,773.60
|
| Rate for Payer: PHP All Commercial |
$4,827.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,482.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4,913.63
|
| Rate for Payer: Signature Care EPO |
$5,282.78
|
| Rate for Payer: Signature Care PPO |
$5,601.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,410.08
|
| Rate for Payer: United Healthcare Commercial |
$5,015.46
|
| Rate for Payer: United Healthcare Medicare |
$2,100.38
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR SIMPLE
|
Facility
OP
|
$5,304.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
01547385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,750.32 |
| Max. Negotiated Rate |
$4,932.72 |
| Rate for Payer: Aetna Commercial |
$4,476.58
|
| Rate for Payer: Aetna Medicare |
$1,750.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,750.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,046.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,315.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,979.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,012.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,925.35
|
| Rate for Payer: Cash Price |
$3,288.48
|
| Rate for Payer: Cash Price |
$3,288.48
|
| Rate for Payer: Centivo All Commercial |
$2,705.04
|
| Rate for Payer: Cigna All Commercial |
$4,577.35
|
| Rate for Payer: CORVEL All Commercial |
$4,932.72
|
| Rate for Payer: Coventry All Commercial |
$4,667.52
|
| Rate for Payer: Encore All Commercial |
$4,882.33
|
| Rate for Payer: Frontpath All Commercial |
$4,879.68
|
| Rate for Payer: Humana ChoiceCare |
$4,581.06
|
| Rate for Payer: Humana Medicare |
$2,705.04
|
| Rate for Payer: Lucent All Commercial |
$2,705.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,773.60
|
| Rate for Payer: Managed Health Services Medicaid |
$1,979.45
|
| Rate for Payer: MDWise Medicaid |
$1,979.45
|
| Rate for Payer: PHCS All Commercial |
$3,978.00
|
| Rate for Payer: PHP All Commercial |
$4,022.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,068.56
|
| Rate for Payer: Sagamore Health Network All Products |
$4,094.69
|
| Rate for Payer: Signature Care EPO |
$4,402.32
|
| Rate for Payer: Signature Care PPO |
$4,667.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,508.40
|
| Rate for Payer: United Healthcare Commercial |
$4,179.55
|
| Rate for Payer: United Healthcare Medicare |
$1,750.32
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR SIMPLE
|
Facility
IP
|
$5,304.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
01547385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,978.00 |
| Max. Negotiated Rate |
$4,932.72 |
| Rate for Payer: Aetna Commercial |
$4,582.66
|
| Rate for Payer: Cash Price |
$3,288.48
|
| Rate for Payer: Cigna All Commercial |
$4,577.35
|
| Rate for Payer: CORVEL All Commercial |
$4,932.72
|
| Rate for Payer: Coventry All Commercial |
$4,667.52
|
| Rate for Payer: Encore All Commercial |
$4,882.33
|
| Rate for Payer: Frontpath All Commercial |
$4,879.68
|
| Rate for Payer: Humana ChoiceCare |
$4,581.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,773.60
|
| Rate for Payer: PHCS All Commercial |
$3,978.00
|
| Rate for Payer: PHP All Commercial |
$4,022.55
|
| Rate for Payer: Sagamore Health Network All Products |
$4,094.69
|
| Rate for Payer: Signature Care EPO |
$4,402.32
|
| Rate for Payer: Signature Care PPO |
$4,667.52
|
| Rate for Payer: United Healthcare Commercial |
$4,179.55
|
|
|
HC IMRT PLANNING
|
Facility
OP
|
$11,668.80
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
01547301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,850.70 |
| Max. Negotiated Rate |
$10,851.98 |
| Rate for Payer: Aetna Commercial |
$9,848.47
|
| Rate for Payer: Aetna Medicare |
$3,850.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,850.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,701.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,294.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4,159.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,428.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,235.77
|
| Rate for Payer: Cash Price |
$7,234.66
|
| Rate for Payer: Cash Price |
$7,234.66
|
| Rate for Payer: Centivo All Commercial |
$5,951.09
|
| Rate for Payer: Cigna All Commercial |
$10,070.17
|
| Rate for Payer: CORVEL All Commercial |
$10,851.98
|
| Rate for Payer: Coventry All Commercial |
$10,268.54
|
| Rate for Payer: Encore All Commercial |
$10,741.13
|
| Rate for Payer: Frontpath All Commercial |
$10,735.30
|
| Rate for Payer: Humana ChoiceCare |
$10,078.34
|
| Rate for Payer: Humana Medicare |
$5,951.09
|
| Rate for Payer: Lucent All Commercial |
$5,951.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,501.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4,159.97
|
| Rate for Payer: MDWise Medicaid |
$4,159.97
|
| Rate for Payer: PHCS All Commercial |
$8,751.60
|
| Rate for Payer: PHP All Commercial |
$8,849.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,550.83
|
| Rate for Payer: Sagamore Health Network All Products |
$9,008.31
|
| Rate for Payer: Signature Care EPO |
$9,685.10
|
| Rate for Payer: Signature Care PPO |
$10,268.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,918.48
|
| Rate for Payer: United Healthcare Commercial |
$9,195.01
|
| Rate for Payer: United Healthcare Medicare |
$3,850.70
|
|
|
HC IMRT PLANNING
|
Facility
IP
|
$11,668.80
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
01547301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$8,751.60 |
| Max. Negotiated Rate |
$10,851.98 |
| Rate for Payer: Aetna Commercial |
$10,081.84
|
| Rate for Payer: Cash Price |
$7,234.66
|
| Rate for Payer: Cigna All Commercial |
$10,070.17
|
| Rate for Payer: CORVEL All Commercial |
$10,851.98
|
| Rate for Payer: Coventry All Commercial |
$10,268.54
|
| Rate for Payer: Encore All Commercial |
$10,741.13
|
| Rate for Payer: Frontpath All Commercial |
$10,735.30
|
| Rate for Payer: Humana ChoiceCare |
$10,078.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,501.92
|
| Rate for Payer: PHCS All Commercial |
$8,751.60
|
| Rate for Payer: PHP All Commercial |
$8,849.62
|
| Rate for Payer: Sagamore Health Network All Products |
$9,008.31
|
| Rate for Payer: Signature Care EPO |
$9,685.10
|
| Rate for Payer: Signature Care PPO |
$10,268.54
|
| Rate for Payer: United Healthcare Commercial |
$9,195.01
|
|
|
HC INCISION & DRAINAGE KIT
|
Facility
OP
|
$62.65
|
|
| Hospital Charge Code |
41601214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$52.88
|
| Rate for Payer: Aetna Medicare |
$20.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.74
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Centivo All Commercial |
$31.95
|
| Rate for Payer: Cigna All Commercial |
$54.07
|
| Rate for Payer: CORVEL All Commercial |
$58.26
|
| Rate for Payer: Coventry All Commercial |
$55.13
|
| Rate for Payer: Encore All Commercial |
$57.67
|
| Rate for Payer: Frontpath All Commercial |
$57.64
|
| Rate for Payer: Humana ChoiceCare |
$54.11
|
| Rate for Payer: Humana Medicare |
$31.95
|
| Rate for Payer: Lucent All Commercial |
$31.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$46.99
|
| Rate for Payer: PHP All Commercial |
$47.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.43
|
| Rate for Payer: Sagamore Health Network All Products |
$48.37
|
| Rate for Payer: Signature Care EPO |
$52.00
|
| Rate for Payer: Signature Care PPO |
$55.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$49.37
|
| Rate for Payer: United Healthcare Medicare |
$20.67
|
|
|
HC INCISION & DRAINAGE KIT
|
Facility
IP
|
$62.65
|
|
| Hospital Charge Code |
41601214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$54.13
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna All Commercial |
$54.07
|
| Rate for Payer: CORVEL All Commercial |
$58.26
|
| Rate for Payer: Coventry All Commercial |
$55.13
|
| Rate for Payer: Encore All Commercial |
$57.67
|
| Rate for Payer: Frontpath All Commercial |
$57.64
|
| Rate for Payer: Humana ChoiceCare |
$54.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.38
|
| Rate for Payer: PHCS All Commercial |
$46.99
|
| Rate for Payer: PHP All Commercial |
$47.51
|
| Rate for Payer: Sagamore Health Network All Products |
$48.37
|
| Rate for Payer: Signature Care EPO |
$52.00
|
| Rate for Payer: Signature Care PPO |
$55.13
|
| Rate for Payer: United Healthcare Commercial |
$49.37
|
|
|
HC INDIV THERAPY-105 MIN-SP
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01749058
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC INDIV THERAPY-105 MIN-SP
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01749058
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC INDIV THERAPY-120 MIN-SP
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01749059
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC INDIV THERAPY-120 MIN-SP
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01749059
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC INDIV THERAPY-15 MIN-SP
|
Facility
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748054
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.89
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Centivo All Commercial |
$161.42
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$161.42
|
| Rate for Payer: Lucent All Commercial |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$104.45
|
|
|
HC INDIV THERAPY-15 MIN-SP
|
Facility
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748054
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-30 MIN-SP
|
Facility
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748055
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-30 MIN-SP
|
Facility
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
01748055
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.89
|
| Rate for Payer: Cash Price |
$196.23
|
| Rate for Payer: Centivo All Commercial |
$161.42
|
| Rate for Payer: Cigna All Commercial |
$273.14
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.34
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$161.42
|
| Rate for Payer: Lucent All Commercial |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.34
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$104.45
|
|
