|
HC INFLUENZA A/B
|
Facility
IP
|
$384.85
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
63087502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$288.63 |
| Max. Negotiated Rate |
$357.91 |
| Rate for Payer: Aetna Commercial |
$332.51
|
| Rate for Payer: Cash Price |
$238.61
|
| Rate for Payer: Cigna All Commercial |
$332.12
|
| Rate for Payer: CORVEL All Commercial |
$357.91
|
| Rate for Payer: Coventry All Commercial |
$338.66
|
| Rate for Payer: Encore All Commercial |
$354.25
|
| Rate for Payer: Frontpath All Commercial |
$354.06
|
| Rate for Payer: Humana ChoiceCare |
$332.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.36
|
| Rate for Payer: PHCS All Commercial |
$288.63
|
| Rate for Payer: PHP All Commercial |
$291.87
|
| Rate for Payer: Sagamore Health Network All Products |
$297.10
|
| Rate for Payer: Signature Care EPO |
$319.42
|
| Rate for Payer: Signature Care PPO |
$338.66
|
| Rate for Payer: United Healthcare Commercial |
$303.26
|
|
|
HC INFLUENZA B
|
Facility
OP
|
$64.85
|
|
|
Service Code
|
CPT 87400 59
|
| Hospital Charge Code |
63002153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$54.73
|
| Rate for Payer: Aetna Medicare |
$21.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.54
|
| Rate for Payer: Cash Price |
$40.21
|
| Rate for Payer: Centivo All Commercial |
$33.07
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.70
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Humana Medicare |
$33.07
|
| Rate for Payer: Lucent All Commercial |
$33.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.29
|
| Rate for Payer: Sagamore Health Network All Products |
$50.07
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.12
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
| Rate for Payer: United Healthcare Medicare |
$21.40
|
|
|
HC INFLUENZA B
|
Facility
IP
|
$64.85
|
|
|
Service Code
|
CPT 87400 59
|
| Hospital Charge Code |
63002153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$56.03
|
| Rate for Payer: Cash Price |
$40.21
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.70
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Sagamore Health Network All Products |
$50.07
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
|
|
HC INFLUENZA MULTIPLEX PROBE-EACH ADD'L
|
Facility
IP
|
$39.44
|
|
|
Service Code
|
CPT 87503
|
| Hospital Charge Code |
63001170
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$34.08
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cigna All Commercial |
$34.04
|
| Rate for Payer: CORVEL All Commercial |
$36.68
|
| Rate for Payer: Coventry All Commercial |
$34.71
|
| Rate for Payer: Encore All Commercial |
$36.31
|
| Rate for Payer: Frontpath All Commercial |
$36.29
|
| Rate for Payer: Humana ChoiceCare |
$34.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.50
|
| Rate for Payer: PHCS All Commercial |
$29.58
|
| Rate for Payer: PHP All Commercial |
$29.91
|
| Rate for Payer: Sagamore Health Network All Products |
$30.45
|
| Rate for Payer: Signature Care EPO |
$32.74
|
| Rate for Payer: Signature Care PPO |
$34.71
|
| Rate for Payer: United Healthcare Commercial |
$31.08
|
|
|
HC INFLUENZA MULTIPLEX PROBE-EACH ADD'L
|
Facility
OP
|
$39.44
|
|
|
Service Code
|
CPT 87503
|
| Hospital Charge Code |
63001170
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$28.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.32
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Centivo All Commercial |
$20.12
|
| Rate for Payer: Cigna All Commercial |
$34.04
|
| Rate for Payer: CORVEL All Commercial |
$36.68
|
| Rate for Payer: Coventry All Commercial |
$34.71
|
| Rate for Payer: Encore All Commercial |
$36.31
|
| Rate for Payer: Frontpath All Commercial |
$36.29
|
| Rate for Payer: Humana ChoiceCare |
$34.07
|
| Rate for Payer: Humana Medicare |
$20.12
|
| Rate for Payer: Lucent All Commercial |
$20.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.50
|
| Rate for Payer: Managed Health Services Medicaid |
$28.26
|
| Rate for Payer: MDWise Medicaid |
$28.26
|
| Rate for Payer: PHCS All Commercial |
$29.58
|
| Rate for Payer: PHP All Commercial |
$29.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.38
|
| Rate for Payer: Sagamore Health Network All Products |
$30.45
|
| Rate for Payer: Signature Care EPO |
$32.74
|
| Rate for Payer: Signature Care PPO |
$34.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.53
|
| Rate for Payer: United Healthcare Commercial |
$31.08
|
| Rate for Payer: United Healthcare Medicare |
$13.02
|
|
|
HC INFLUENZA MULTIPLEX PROBE-FIRST 2 TYPES
|
Facility
IP
|
$161.60
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
63001169
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$150.29 |
| Rate for Payer: Aetna Commercial |
$139.62
|
| Rate for Payer: Cash Price |
$100.19
|
| Rate for Payer: Cigna All Commercial |
$139.46
|
| Rate for Payer: CORVEL All Commercial |
$150.29
|
| Rate for Payer: Coventry All Commercial |
$142.21
|
| Rate for Payer: Encore All Commercial |
$148.75
|
| Rate for Payer: Frontpath All Commercial |
$148.67
|
| Rate for Payer: Humana ChoiceCare |
$139.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.44
|
| Rate for Payer: PHCS All Commercial |
$121.20
|
| Rate for Payer: PHP All Commercial |
$122.56
|
| Rate for Payer: Sagamore Health Network All Products |
$124.75
|
| Rate for Payer: Signature Care EPO |
$134.13
|
| Rate for Payer: Signature Care PPO |
$142.21
|
| Rate for Payer: United Healthcare Commercial |
$127.34
|
|
|
HC INFLUENZA MULTIPLEX PROBE-FIRST 2 TYPES
|
Facility
OP
|
$161.60
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
63001169
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$150.29 |
| Rate for Payer: Aetna Commercial |
$136.39
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$95.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.66
|
| Rate for Payer: Cash Price |
$100.19
|
| Rate for Payer: Cash Price |
$100.19
|
| Rate for Payer: Centivo All Commercial |
$82.42
|
| Rate for Payer: Cigna All Commercial |
$139.46
|
| Rate for Payer: CORVEL All Commercial |
$150.29
|
| Rate for Payer: Coventry All Commercial |
$142.21
|
| Rate for Payer: Encore All Commercial |
$148.75
|
| Rate for Payer: Frontpath All Commercial |
$148.67
|
| Rate for Payer: Humana ChoiceCare |
$139.57
|
| Rate for Payer: Humana Medicare |
$82.42
|
| Rate for Payer: Lucent All Commercial |
$82.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.44
|
| Rate for Payer: Managed Health Services Medicaid |
$95.80
|
| Rate for Payer: MDWise Medicaid |
$95.80
|
| Rate for Payer: PHCS All Commercial |
$121.20
|
| Rate for Payer: PHP All Commercial |
$122.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.02
|
| Rate for Payer: Sagamore Health Network All Products |
$124.75
|
| Rate for Payer: Signature Care EPO |
$134.13
|
| Rate for Payer: Signature Care PPO |
$142.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.36
|
| Rate for Payer: United Healthcare Commercial |
$127.34
|
| Rate for Payer: United Healthcare Medicare |
$53.33
|
|
|
HC INFUSAPORT DRAW
|
Facility
IP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
01266591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC INFUSAPORT DRAW
|
Facility
OP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
01266591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.76
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$81.15
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$52.51
|
|
|
HC INFUSAPORT DRAW
|
Facility
OP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
00520001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.76
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$81.15
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$52.51
|
|
|
HC INFUSAPORT DRAW
|
Facility
IP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
00520001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC INFUSAPORT POWER PAC II
|
Facility
OP
|
$1,450.00
|
|
|
Service Code
|
CPT A4301
|
| Hospital Charge Code |
41601922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,223.80
|
| Rate for Payer: Aetna Medicare |
$478.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$478.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$832.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$550.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$526.35
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Centivo All Commercial |
$739.50
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.36
|
| Rate for Payer: Humana Medicare |
$739.50
|
| Rate for Payer: Lucent All Commercial |
$739.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
| Rate for Payer: United Healthcare Medicare |
$478.50
|
|
|
HC INFUSAPORT POWER PAC II
|
Facility
IP
|
$1,450.00
|
|
|
Service Code
|
CPT A4301
|
| Hospital Charge Code |
41601922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,252.80
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
|
|
HC INFUSOR PRESSURE DISP 1000ML
|
Facility
OP
|
$59.83
|
|
| Hospital Charge Code |
41601228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$50.50
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.72
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: Centivo All Commercial |
$30.51
|
| Rate for Payer: Cigna All Commercial |
$51.63
|
| Rate for Payer: CORVEL All Commercial |
$55.64
|
| Rate for Payer: Coventry All Commercial |
$52.65
|
| Rate for Payer: Encore All Commercial |
$55.07
|
| Rate for Payer: Frontpath All Commercial |
$55.04
|
| Rate for Payer: Humana ChoiceCare |
$51.68
|
| Rate for Payer: Humana Medicare |
$30.51
|
| Rate for Payer: Lucent All Commercial |
$30.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.85
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$44.87
|
| Rate for Payer: PHP All Commercial |
$45.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.33
|
| Rate for Payer: Sagamore Health Network All Products |
$46.19
|
| Rate for Payer: Signature Care EPO |
$49.66
|
| Rate for Payer: Signature Care PPO |
$52.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.86
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
| Rate for Payer: United Healthcare Medicare |
$19.74
|
|
|
HC INFUSOR PRESSURE DISP 1000ML
|
Facility
IP
|
$59.83
|
|
| Hospital Charge Code |
41601228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.87 |
| Max. Negotiated Rate |
$55.64 |
| Rate for Payer: Aetna Commercial |
$51.69
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: Cigna All Commercial |
$51.63
|
| Rate for Payer: CORVEL All Commercial |
$55.64
|
| Rate for Payer: Coventry All Commercial |
$52.65
|
| Rate for Payer: Encore All Commercial |
$55.07
|
| Rate for Payer: Frontpath All Commercial |
$55.04
|
| Rate for Payer: Humana ChoiceCare |
$51.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.85
|
| Rate for Payer: PHCS All Commercial |
$44.87
|
| Rate for Payer: PHP All Commercial |
$45.38
|
| Rate for Payer: Sagamore Health Network All Products |
$46.19
|
| Rate for Payer: Signature Care EPO |
$49.66
|
| Rate for Payer: Signature Care PPO |
$52.65
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
|
|
HC INHALER - SUBSEQUENT
|
Facility
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
01706004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.88 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.47
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centivo All Commercial |
$86.36
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Humana Medicare |
$86.36
|
| Rate for Payer: Lucent All Commercial |
$86.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.04
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
| Rate for Payer: United Healthcare Medicare |
$55.88
|
|
|
HC INHALER - SUBSEQUENT
|
Facility
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
01706004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
|
|
HC INHIBIN A
|
Facility
OP
|
$139.59
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
63001906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$129.82 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Aetna Medicare |
$46.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.67
|
| Rate for Payer: Cash Price |
$86.54
|
| Rate for Payer: Cash Price |
$86.54
|
| Rate for Payer: Centivo All Commercial |
$71.19
|
| Rate for Payer: Cigna All Commercial |
$120.46
|
| Rate for Payer: CORVEL All Commercial |
$129.82
|
| Rate for Payer: Coventry All Commercial |
$122.84
|
| Rate for Payer: Encore All Commercial |
$128.49
|
| Rate for Payer: Frontpath All Commercial |
$128.42
|
| Rate for Payer: Humana ChoiceCare |
$120.56
|
| Rate for Payer: Humana Medicare |
$71.19
|
| Rate for Payer: Lucent All Commercial |
$71.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.63
|
| Rate for Payer: Managed Health Services Medicaid |
$15.59
|
| Rate for Payer: MDWise Medicaid |
$15.59
|
| Rate for Payer: PHCS All Commercial |
$104.69
|
| Rate for Payer: PHP All Commercial |
$105.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.44
|
| Rate for Payer: Sagamore Health Network All Products |
$107.76
|
| Rate for Payer: Signature Care EPO |
$115.86
|
| Rate for Payer: Signature Care PPO |
$122.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.65
|
| Rate for Payer: United Healthcare Commercial |
$109.99
|
| Rate for Payer: United Healthcare Medicare |
$46.06
|
|
|
HC INHIBIN A
|
Facility
IP
|
$139.59
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
63001906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$129.82 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$86.54
|
| Rate for Payer: Cigna All Commercial |
$120.46
|
| Rate for Payer: CORVEL All Commercial |
$129.82
|
| Rate for Payer: Coventry All Commercial |
$122.84
|
| Rate for Payer: Encore All Commercial |
$128.49
|
| Rate for Payer: Frontpath All Commercial |
$128.42
|
| Rate for Payer: Humana ChoiceCare |
$120.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.63
|
| Rate for Payer: PHCS All Commercial |
$104.69
|
| Rate for Payer: PHP All Commercial |
$105.86
|
| Rate for Payer: Sagamore Health Network All Products |
$107.76
|
| Rate for Payer: Signature Care EPO |
$115.86
|
| Rate for Payer: Signature Care PPO |
$122.84
|
| Rate for Payer: United Healthcare Commercial |
$109.99
|
|
|
HC INJ ANKLE ARTHROGRAM LT
|
Facility
OP
|
$1,122.00
|
|
| Hospital Charge Code |
01617648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.26 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$946.97
|
| Rate for Payer: Aetna Medicare |
$370.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$370.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$644.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$701.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$425.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$407.29
|
| Rate for Payer: Cash Price |
$695.64
|
| Rate for Payer: Centivo All Commercial |
$572.22
|
| Rate for Payer: Cigna All Commercial |
$968.29
|
| Rate for Payer: CORVEL All Commercial |
$1,043.46
|
| Rate for Payer: Coventry All Commercial |
$987.36
|
| Rate for Payer: Encore All Commercial |
$1,032.80
|
| Rate for Payer: Frontpath All Commercial |
$1,032.24
|
| Rate for Payer: Humana ChoiceCare |
$969.07
|
| Rate for Payer: Humana Medicare |
$572.22
|
| Rate for Payer: Lucent All Commercial |
$572.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.80
|
| Rate for Payer: PHCS All Commercial |
$841.50
|
| Rate for Payer: PHP All Commercial |
$850.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$437.58
|
| Rate for Payer: Sagamore Health Network All Products |
$866.18
|
| Rate for Payer: Signature Care EPO |
$931.26
|
| Rate for Payer: Signature Care PPO |
$987.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$953.70
|
| Rate for Payer: United Healthcare Commercial |
$884.14
|
| Rate for Payer: United Healthcare Medicare |
$370.26
|
|
|
HC INJ ANKLE ARTHROGRAM LT
|
Facility
IP
|
$1,122.00
|
|
| Hospital Charge Code |
01617648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$969.41
|
| Rate for Payer: Cash Price |
$695.64
|
| Rate for Payer: Cigna All Commercial |
$968.29
|
| Rate for Payer: CORVEL All Commercial |
$1,043.46
|
| Rate for Payer: Coventry All Commercial |
$987.36
|
| Rate for Payer: Encore All Commercial |
$1,032.80
|
| Rate for Payer: Frontpath All Commercial |
$1,032.24
|
| Rate for Payer: Humana ChoiceCare |
$969.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.80
|
| Rate for Payer: PHCS All Commercial |
$841.50
|
| Rate for Payer: PHP All Commercial |
$850.92
|
| Rate for Payer: Sagamore Health Network All Products |
$866.18
|
| Rate for Payer: Signature Care EPO |
$931.26
|
| Rate for Payer: Signature Care PPO |
$987.36
|
| Rate for Payer: United Healthcare Commercial |
$884.14
|
|
|
HC INJ ANKLE ARTHROGRAM RT
|
Facility
IP
|
$1,122.00
|
|
| Hospital Charge Code |
11617648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$969.41
|
| Rate for Payer: Cash Price |
$695.64
|
| Rate for Payer: Cigna All Commercial |
$968.29
|
| Rate for Payer: CORVEL All Commercial |
$1,043.46
|
| Rate for Payer: Coventry All Commercial |
$987.36
|
| Rate for Payer: Encore All Commercial |
$1,032.80
|
| Rate for Payer: Frontpath All Commercial |
$1,032.24
|
| Rate for Payer: Humana ChoiceCare |
$969.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.80
|
| Rate for Payer: PHCS All Commercial |
$841.50
|
| Rate for Payer: PHP All Commercial |
$850.92
|
| Rate for Payer: Sagamore Health Network All Products |
$866.18
|
| Rate for Payer: Signature Care EPO |
$931.26
|
| Rate for Payer: Signature Care PPO |
$987.36
|
| Rate for Payer: United Healthcare Commercial |
$884.14
|
|
|
HC INJ ANKLE ARTHROGRAM RT
|
Facility
OP
|
$1,122.00
|
|
| Hospital Charge Code |
11617648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.26 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$946.97
|
| Rate for Payer: Aetna Medicare |
$370.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$370.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$644.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$701.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$425.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$407.29
|
| Rate for Payer: Cash Price |
$695.64
|
| Rate for Payer: Centivo All Commercial |
$572.22
|
| Rate for Payer: Cigna All Commercial |
$968.29
|
| Rate for Payer: CORVEL All Commercial |
$1,043.46
|
| Rate for Payer: Coventry All Commercial |
$987.36
|
| Rate for Payer: Encore All Commercial |
$1,032.80
|
| Rate for Payer: Frontpath All Commercial |
$1,032.24
|
| Rate for Payer: Humana ChoiceCare |
$969.07
|
| Rate for Payer: Humana Medicare |
$572.22
|
| Rate for Payer: Lucent All Commercial |
$572.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.80
|
| Rate for Payer: PHCS All Commercial |
$841.50
|
| Rate for Payer: PHP All Commercial |
$850.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$437.58
|
| Rate for Payer: Sagamore Health Network All Products |
$866.18
|
| Rate for Payer: Signature Care EPO |
$931.26
|
| Rate for Payer: Signature Care PPO |
$987.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$953.70
|
| Rate for Payer: United Healthcare Commercial |
$884.14
|
| Rate for Payer: United Healthcare Medicare |
$370.26
|
|
|
HC INJ CYSTOGRAPHY/VOID URETHCYST
|
Facility
IP
|
$1,091.50
|
|
| Hospital Charge Code |
01611600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.63 |
| Max. Negotiated Rate |
$1,015.10 |
| Rate for Payer: Aetna Commercial |
$943.06
|
| Rate for Payer: Cash Price |
$676.73
|
| Rate for Payer: Cigna All Commercial |
$941.97
|
| Rate for Payer: CORVEL All Commercial |
$1,015.10
|
| Rate for Payer: Coventry All Commercial |
$960.52
|
| Rate for Payer: Encore All Commercial |
$1,004.73
|
| Rate for Payer: Frontpath All Commercial |
$1,004.18
|
| Rate for Payer: Humana ChoiceCare |
$942.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$982.35
|
| Rate for Payer: PHCS All Commercial |
$818.63
|
| Rate for Payer: PHP All Commercial |
$827.80
|
| Rate for Payer: Sagamore Health Network All Products |
$842.64
|
| Rate for Payer: Signature Care EPO |
$905.95
|
| Rate for Payer: Signature Care PPO |
$960.52
|
| Rate for Payer: United Healthcare Commercial |
$860.10
|
|
|
HC INJ CYSTOGRAPHY/VOID URETHCYST
|
Facility
OP
|
$1,091.50
|
|
| Hospital Charge Code |
01611600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$360.20 |
| Max. Negotiated Rate |
$1,015.10 |
| Rate for Payer: Aetna Commercial |
$921.23
|
| Rate for Payer: Aetna Medicare |
$360.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$360.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$626.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$682.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$414.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$396.22
|
| Rate for Payer: Cash Price |
$676.73
|
| Rate for Payer: Centivo All Commercial |
$556.67
|
| Rate for Payer: Cigna All Commercial |
$941.97
|
| Rate for Payer: CORVEL All Commercial |
$1,015.10
|
| Rate for Payer: Coventry All Commercial |
$960.52
|
| Rate for Payer: Encore All Commercial |
$1,004.73
|
| Rate for Payer: Frontpath All Commercial |
$1,004.18
|
| Rate for Payer: Humana ChoiceCare |
$942.73
|
| Rate for Payer: Humana Medicare |
$556.67
|
| Rate for Payer: Lucent All Commercial |
$556.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$982.35
|
| Rate for Payer: PHCS All Commercial |
$818.63
|
| Rate for Payer: PHP All Commercial |
$827.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.69
|
| Rate for Payer: Sagamore Health Network All Products |
$842.64
|
| Rate for Payer: Signature Care EPO |
$905.95
|
| Rate for Payer: Signature Care PPO |
$960.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$927.78
|
| Rate for Payer: United Healthcare Commercial |
$860.10
|
| Rate for Payer: United Healthcare Medicare |
$360.20
|
|
