|
HC INJ KNEE ARTHROGRAM RT
|
Facility
OP
|
$704.82
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
11617370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.59 |
| Max. Negotiated Rate |
$655.48 |
| Rate for Payer: Aetna Commercial |
$594.87
|
| Rate for Payer: Aetna Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$404.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.85
|
| Rate for Payer: Cash Price |
$436.99
|
| Rate for Payer: Centivo All Commercial |
$359.46
|
| Rate for Payer: Cigna All Commercial |
$608.26
|
| Rate for Payer: CORVEL All Commercial |
$655.48
|
| Rate for Payer: Coventry All Commercial |
$620.24
|
| Rate for Payer: Encore All Commercial |
$648.79
|
| Rate for Payer: Frontpath All Commercial |
$648.43
|
| Rate for Payer: Humana ChoiceCare |
$608.75
|
| Rate for Payer: Humana Medicare |
$359.46
|
| Rate for Payer: Lucent All Commercial |
$359.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$634.34
|
| Rate for Payer: PHCS All Commercial |
$528.62
|
| Rate for Payer: PHP All Commercial |
$534.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.88
|
| Rate for Payer: Sagamore Health Network All Products |
$544.12
|
| Rate for Payer: Signature Care EPO |
$585.00
|
| Rate for Payer: Signature Care PPO |
$620.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$599.10
|
| Rate for Payer: United Healthcare Commercial |
$555.40
|
| Rate for Payer: United Healthcare Medicare |
$232.59
|
|
|
HC INJ PLATELET PLASMA
|
Facility
IP
|
$875.16
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
01206666
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$656.37 |
| Max. Negotiated Rate |
$813.90 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Cash Price |
$542.60
|
| Rate for Payer: Cigna All Commercial |
$755.26
|
| Rate for Payer: CORVEL All Commercial |
$813.90
|
| Rate for Payer: Coventry All Commercial |
$770.14
|
| Rate for Payer: Encore All Commercial |
$805.58
|
| Rate for Payer: Frontpath All Commercial |
$805.15
|
| Rate for Payer: Humana ChoiceCare |
$755.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.64
|
| Rate for Payer: PHCS All Commercial |
$656.37
|
| Rate for Payer: PHP All Commercial |
$663.72
|
| Rate for Payer: Sagamore Health Network All Products |
$675.62
|
| Rate for Payer: Signature Care EPO |
$726.38
|
| Rate for Payer: Signature Care PPO |
$770.14
|
| Rate for Payer: United Healthcare Commercial |
$689.63
|
|
|
HC INJ PLATELET PLASMA
|
Facility
OP
|
$875.16
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
01206666
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$288.80 |
| Max. Negotiated Rate |
$813.90 |
| Rate for Payer: Aetna Commercial |
$738.64
|
| Rate for Payer: Aetna Medicare |
$288.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$502.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$547.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$332.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$317.68
|
| Rate for Payer: Cash Price |
$542.60
|
| Rate for Payer: Centivo All Commercial |
$446.33
|
| Rate for Payer: Cigna All Commercial |
$755.26
|
| Rate for Payer: CORVEL All Commercial |
$813.90
|
| Rate for Payer: Coventry All Commercial |
$770.14
|
| Rate for Payer: Encore All Commercial |
$805.58
|
| Rate for Payer: Frontpath All Commercial |
$805.15
|
| Rate for Payer: Humana ChoiceCare |
$755.88
|
| Rate for Payer: Humana Medicare |
$446.33
|
| Rate for Payer: Lucent All Commercial |
$446.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.64
|
| Rate for Payer: PHCS All Commercial |
$656.37
|
| Rate for Payer: PHP All Commercial |
$663.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.31
|
| Rate for Payer: Sagamore Health Network All Products |
$675.62
|
| Rate for Payer: Signature Care EPO |
$726.38
|
| Rate for Payer: Signature Care PPO |
$770.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$743.89
|
| Rate for Payer: United Healthcare Commercial |
$689.63
|
| Rate for Payer: United Healthcare Medicare |
$288.80
|
|
|
HC INJ SHOULDER ARTHROGRAM BI
|
Facility
OP
|
$822.29
|
|
|
Service Code
|
CPT 23350 50
|
| Hospital Charge Code |
21613350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$764.73 |
| Rate for Payer: Aetna Commercial |
$694.02
|
| Rate for Payer: Aetna Medicare |
$271.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$271.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$472.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$514.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.49
|
| Rate for Payer: Cash Price |
$509.82
|
| Rate for Payer: Centivo All Commercial |
$419.37
|
| Rate for Payer: Cigna All Commercial |
$709.64
|
| Rate for Payer: CORVEL All Commercial |
$764.73
|
| Rate for Payer: Coventry All Commercial |
$723.62
|
| Rate for Payer: Encore All Commercial |
$756.92
|
| Rate for Payer: Frontpath All Commercial |
$756.51
|
| Rate for Payer: Humana ChoiceCare |
$710.21
|
| Rate for Payer: Humana Medicare |
$419.37
|
| Rate for Payer: Lucent All Commercial |
$419.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$740.06
|
| Rate for Payer: PHCS All Commercial |
$616.72
|
| Rate for Payer: PHP All Commercial |
$623.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$320.69
|
| Rate for Payer: Sagamore Health Network All Products |
$634.81
|
| Rate for Payer: Signature Care EPO |
$682.50
|
| Rate for Payer: Signature Care PPO |
$723.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$698.95
|
| Rate for Payer: United Healthcare Commercial |
$647.97
|
| Rate for Payer: United Healthcare Medicare |
$271.36
|
|
|
HC INJ SHOULDER ARTHROGRAM BI
|
Facility
IP
|
$822.29
|
|
|
Service Code
|
CPT 23350 50
|
| Hospital Charge Code |
21613350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$616.72 |
| Max. Negotiated Rate |
$764.73 |
| Rate for Payer: Aetna Commercial |
$710.46
|
| Rate for Payer: Cash Price |
$509.82
|
| Rate for Payer: Cigna All Commercial |
$709.64
|
| Rate for Payer: CORVEL All Commercial |
$764.73
|
| Rate for Payer: Coventry All Commercial |
$723.62
|
| Rate for Payer: Encore All Commercial |
$756.92
|
| Rate for Payer: Frontpath All Commercial |
$756.51
|
| Rate for Payer: Humana ChoiceCare |
$710.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$740.06
|
| Rate for Payer: PHCS All Commercial |
$616.72
|
| Rate for Payer: PHP All Commercial |
$623.63
|
| Rate for Payer: Sagamore Health Network All Products |
$634.81
|
| Rate for Payer: Signature Care EPO |
$682.50
|
| Rate for Payer: Signature Care PPO |
$723.62
|
| Rate for Payer: United Healthcare Commercial |
$647.97
|
|
|
HC INJ SHOULDER ARTHROGRAM LT
|
Facility
IP
|
$649.74
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
01613350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$487.30 |
| Max. Negotiated Rate |
$604.26 |
| Rate for Payer: Aetna Commercial |
$561.38
|
| Rate for Payer: Cash Price |
$402.84
|
| Rate for Payer: Cigna All Commercial |
$560.73
|
| Rate for Payer: CORVEL All Commercial |
$604.26
|
| Rate for Payer: Coventry All Commercial |
$571.77
|
| Rate for Payer: Encore All Commercial |
$598.09
|
| Rate for Payer: Frontpath All Commercial |
$597.76
|
| Rate for Payer: Humana ChoiceCare |
$561.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.77
|
| Rate for Payer: PHCS All Commercial |
$487.30
|
| Rate for Payer: PHP All Commercial |
$492.76
|
| Rate for Payer: Sagamore Health Network All Products |
$501.60
|
| Rate for Payer: Signature Care EPO |
$539.28
|
| Rate for Payer: Signature Care PPO |
$571.77
|
| Rate for Payer: United Healthcare Commercial |
$512.00
|
|
|
HC INJ SHOULDER ARTHROGRAM LT
|
Facility
OP
|
$649.74
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
01613350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.41 |
| Max. Negotiated Rate |
$604.26 |
| Rate for Payer: Aetna Commercial |
$548.38
|
| Rate for Payer: Aetna Medicare |
$214.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.86
|
| Rate for Payer: Cash Price |
$402.84
|
| Rate for Payer: Cash Price |
$402.84
|
| Rate for Payer: Centivo All Commercial |
$331.37
|
| Rate for Payer: Cigna All Commercial |
$560.73
|
| Rate for Payer: CORVEL All Commercial |
$604.26
|
| Rate for Payer: Coventry All Commercial |
$571.77
|
| Rate for Payer: Encore All Commercial |
$598.09
|
| Rate for Payer: Frontpath All Commercial |
$597.76
|
| Rate for Payer: Humana ChoiceCare |
$561.18
|
| Rate for Payer: Humana Medicare |
$331.37
|
| Rate for Payer: Lucent All Commercial |
$331.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.77
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$487.30
|
| Rate for Payer: PHP All Commercial |
$492.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.40
|
| Rate for Payer: Sagamore Health Network All Products |
$501.60
|
| Rate for Payer: Signature Care EPO |
$539.28
|
| Rate for Payer: Signature Care PPO |
$571.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.28
|
| Rate for Payer: United Healthcare Commercial |
$512.00
|
| Rate for Payer: United Healthcare Medicare |
$214.41
|
|
|
HC INJ SHOULDER ARTHROGRAM RT
|
Facility
OP
|
$649.74
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
11613350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.41 |
| Max. Negotiated Rate |
$604.26 |
| Rate for Payer: Aetna Commercial |
$548.38
|
| Rate for Payer: Aetna Medicare |
$214.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.86
|
| Rate for Payer: Cash Price |
$402.84
|
| Rate for Payer: Cash Price |
$402.84
|
| Rate for Payer: Centivo All Commercial |
$331.37
|
| Rate for Payer: Cigna All Commercial |
$560.73
|
| Rate for Payer: CORVEL All Commercial |
$604.26
|
| Rate for Payer: Coventry All Commercial |
$571.77
|
| Rate for Payer: Encore All Commercial |
$598.09
|
| Rate for Payer: Frontpath All Commercial |
$597.76
|
| Rate for Payer: Humana ChoiceCare |
$561.18
|
| Rate for Payer: Humana Medicare |
$331.37
|
| Rate for Payer: Lucent All Commercial |
$331.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.77
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$487.30
|
| Rate for Payer: PHP All Commercial |
$492.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.40
|
| Rate for Payer: Sagamore Health Network All Products |
$501.60
|
| Rate for Payer: Signature Care EPO |
$539.28
|
| Rate for Payer: Signature Care PPO |
$571.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.28
|
| Rate for Payer: United Healthcare Commercial |
$512.00
|
| Rate for Payer: United Healthcare Medicare |
$214.41
|
|
|
HC INJ SHOULDER ARTHROGRAM RT
|
Facility
IP
|
$649.74
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
11613350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$487.30 |
| Max. Negotiated Rate |
$604.26 |
| Rate for Payer: Aetna Commercial |
$561.38
|
| Rate for Payer: Cash Price |
$402.84
|
| Rate for Payer: Cigna All Commercial |
$560.73
|
| Rate for Payer: CORVEL All Commercial |
$604.26
|
| Rate for Payer: Coventry All Commercial |
$571.77
|
| Rate for Payer: Encore All Commercial |
$598.09
|
| Rate for Payer: Frontpath All Commercial |
$597.76
|
| Rate for Payer: Humana ChoiceCare |
$561.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.77
|
| Rate for Payer: PHCS All Commercial |
$487.30
|
| Rate for Payer: PHP All Commercial |
$492.76
|
| Rate for Payer: Sagamore Health Network All Products |
$501.60
|
| Rate for Payer: Signature Care EPO |
$539.28
|
| Rate for Payer: Signature Care PPO |
$571.77
|
| Rate for Payer: United Healthcare Commercial |
$512.00
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
IP
|
$280.50
|
|
|
Service Code
|
CPT M0220
|
| Hospital Charge Code |
00520220
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cigna All Commercial |
$242.07
|
| Rate for Payer: CORVEL All Commercial |
$260.86
|
| Rate for Payer: Coventry All Commercial |
$246.84
|
| Rate for Payer: Encore All Commercial |
$258.20
|
| Rate for Payer: Frontpath All Commercial |
$258.06
|
| Rate for Payer: Humana ChoiceCare |
$242.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.45
|
| Rate for Payer: PHCS All Commercial |
$210.38
|
| Rate for Payer: PHP All Commercial |
$212.73
|
| Rate for Payer: Sagamore Health Network All Products |
$216.55
|
| Rate for Payer: Signature Care EPO |
$232.82
|
| Rate for Payer: Signature Care PPO |
$246.84
|
| Rate for Payer: United Healthcare Commercial |
$221.03
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
OP
|
$280.50
|
|
|
Service Code
|
CPT M0220
|
| Hospital Charge Code |
00520220
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna Commercial |
$236.74
|
| Rate for Payer: Aetna Medicare |
$92.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.82
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Centivo All Commercial |
$143.06
|
| Rate for Payer: Cigna All Commercial |
$242.07
|
| Rate for Payer: CORVEL All Commercial |
$260.86
|
| Rate for Payer: Coventry All Commercial |
$246.84
|
| Rate for Payer: Encore All Commercial |
$258.20
|
| Rate for Payer: Frontpath All Commercial |
$258.06
|
| Rate for Payer: Humana ChoiceCare |
$242.27
|
| Rate for Payer: Humana Medicare |
$143.06
|
| Rate for Payer: Lucent All Commercial |
$143.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.45
|
| Rate for Payer: PHCS All Commercial |
$210.38
|
| Rate for Payer: PHP All Commercial |
$212.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.40
|
| Rate for Payer: Sagamore Health Network All Products |
$216.55
|
| Rate for Payer: Signature Care EPO |
$232.82
|
| Rate for Payer: Signature Care PPO |
$246.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$238.42
|
| Rate for Payer: United Healthcare Commercial |
$221.03
|
| Rate for Payer: United Healthcare Medicare |
$92.56
|
|
|
HC INJ WRIST ARTHROGRAM BI
|
Facility
IP
|
$657.96
|
|
|
Service Code
|
CPT 25246 50
|
| Hospital Charge Code |
21615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.47 |
| Max. Negotiated Rate |
$611.90 |
| Rate for Payer: Aetna Commercial |
$568.48
|
| Rate for Payer: Cash Price |
$407.94
|
| Rate for Payer: Cigna All Commercial |
$567.82
|
| Rate for Payer: CORVEL All Commercial |
$611.90
|
| Rate for Payer: Coventry All Commercial |
$579.01
|
| Rate for Payer: Encore All Commercial |
$605.65
|
| Rate for Payer: Frontpath All Commercial |
$605.32
|
| Rate for Payer: Humana ChoiceCare |
$568.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$592.17
|
| Rate for Payer: PHCS All Commercial |
$493.47
|
| Rate for Payer: PHP All Commercial |
$499.00
|
| Rate for Payer: Sagamore Health Network All Products |
$507.95
|
| Rate for Payer: Signature Care EPO |
$546.11
|
| Rate for Payer: Signature Care PPO |
$579.01
|
| Rate for Payer: United Healthcare Commercial |
$518.47
|
|
|
HC INJ WRIST ARTHROGRAM BI
|
Facility
OP
|
$657.96
|
|
|
Service Code
|
CPT 25246 50
|
| Hospital Charge Code |
21615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.13 |
| Max. Negotiated Rate |
$611.90 |
| Rate for Payer: Aetna Commercial |
$555.32
|
| Rate for Payer: Aetna Medicare |
$217.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$217.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.84
|
| Rate for Payer: Cash Price |
$407.94
|
| Rate for Payer: Centivo All Commercial |
$335.56
|
| Rate for Payer: Cigna All Commercial |
$567.82
|
| Rate for Payer: CORVEL All Commercial |
$611.90
|
| Rate for Payer: Coventry All Commercial |
$579.01
|
| Rate for Payer: Encore All Commercial |
$605.65
|
| Rate for Payer: Frontpath All Commercial |
$605.32
|
| Rate for Payer: Humana ChoiceCare |
$568.28
|
| Rate for Payer: Humana Medicare |
$335.56
|
| Rate for Payer: Lucent All Commercial |
$335.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$592.17
|
| Rate for Payer: PHCS All Commercial |
$493.47
|
| Rate for Payer: PHP All Commercial |
$499.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.60
|
| Rate for Payer: Sagamore Health Network All Products |
$507.95
|
| Rate for Payer: Signature Care EPO |
$546.11
|
| Rate for Payer: Signature Care PPO |
$579.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$559.27
|
| Rate for Payer: United Healthcare Commercial |
$518.47
|
| Rate for Payer: United Healthcare Medicare |
$217.13
|
|
|
HC INJ WRIST ARTHROGRAM LT
|
Facility
IP
|
$726.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
01615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.68 |
| Max. Negotiated Rate |
$675.40 |
| Rate for Payer: Aetna Commercial |
$627.47
|
| Rate for Payer: Cash Price |
$450.27
|
| Rate for Payer: Cigna All Commercial |
$626.75
|
| Rate for Payer: CORVEL All Commercial |
$675.40
|
| Rate for Payer: Coventry All Commercial |
$639.09
|
| Rate for Payer: Encore All Commercial |
$668.50
|
| Rate for Payer: Frontpath All Commercial |
$668.14
|
| Rate for Payer: Humana ChoiceCare |
$627.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.62
|
| Rate for Payer: PHCS All Commercial |
$544.68
|
| Rate for Payer: PHP All Commercial |
$550.78
|
| Rate for Payer: Sagamore Health Network All Products |
$560.66
|
| Rate for Payer: Signature Care EPO |
$602.78
|
| Rate for Payer: Signature Care PPO |
$639.09
|
| Rate for Payer: United Healthcare Commercial |
$572.28
|
|
|
HC INJ WRIST ARTHROGRAM LT
|
Facility
OP
|
$726.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
01615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.66 |
| Max. Negotiated Rate |
$675.40 |
| Rate for Payer: Aetna Commercial |
$612.95
|
| Rate for Payer: Aetna Medicare |
$239.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$417.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$453.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$275.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$263.63
|
| Rate for Payer: Cash Price |
$450.27
|
| Rate for Payer: Cash Price |
$450.27
|
| Rate for Payer: Centivo All Commercial |
$370.38
|
| Rate for Payer: Cigna All Commercial |
$626.75
|
| Rate for Payer: CORVEL All Commercial |
$675.40
|
| Rate for Payer: Coventry All Commercial |
$639.09
|
| Rate for Payer: Encore All Commercial |
$668.50
|
| Rate for Payer: Frontpath All Commercial |
$668.14
|
| Rate for Payer: Humana ChoiceCare |
$627.25
|
| Rate for Payer: Humana Medicare |
$370.38
|
| Rate for Payer: Lucent All Commercial |
$370.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.62
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$544.68
|
| Rate for Payer: PHP All Commercial |
$550.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.23
|
| Rate for Payer: Sagamore Health Network All Products |
$560.66
|
| Rate for Payer: Signature Care EPO |
$602.78
|
| Rate for Payer: Signature Care PPO |
$639.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$617.30
|
| Rate for Payer: United Healthcare Commercial |
$572.28
|
| Rate for Payer: United Healthcare Medicare |
$239.66
|
|
|
HC INJ WRIST ARTHROGRAM RT
|
Facility
OP
|
$726.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
11615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.66 |
| Max. Negotiated Rate |
$675.40 |
| Rate for Payer: Aetna Commercial |
$612.95
|
| Rate for Payer: Aetna Medicare |
$239.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$417.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$453.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$275.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$263.63
|
| Rate for Payer: Cash Price |
$450.27
|
| Rate for Payer: Cash Price |
$450.27
|
| Rate for Payer: Centivo All Commercial |
$370.38
|
| Rate for Payer: Cigna All Commercial |
$626.75
|
| Rate for Payer: CORVEL All Commercial |
$675.40
|
| Rate for Payer: Coventry All Commercial |
$639.09
|
| Rate for Payer: Encore All Commercial |
$668.50
|
| Rate for Payer: Frontpath All Commercial |
$668.14
|
| Rate for Payer: Humana ChoiceCare |
$627.25
|
| Rate for Payer: Humana Medicare |
$370.38
|
| Rate for Payer: Lucent All Commercial |
$370.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.62
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$544.68
|
| Rate for Payer: PHP All Commercial |
$550.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.23
|
| Rate for Payer: Sagamore Health Network All Products |
$560.66
|
| Rate for Payer: Signature Care EPO |
$602.78
|
| Rate for Payer: Signature Care PPO |
$639.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$617.30
|
| Rate for Payer: United Healthcare Commercial |
$572.28
|
| Rate for Payer: United Healthcare Medicare |
$239.66
|
|
|
HC INJ WRIST ARTHROGRAM RT
|
Facility
IP
|
$726.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
11615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.68 |
| Max. Negotiated Rate |
$675.40 |
| Rate for Payer: Aetna Commercial |
$627.47
|
| Rate for Payer: Cash Price |
$450.27
|
| Rate for Payer: Cigna All Commercial |
$626.75
|
| Rate for Payer: CORVEL All Commercial |
$675.40
|
| Rate for Payer: Coventry All Commercial |
$639.09
|
| Rate for Payer: Encore All Commercial |
$668.50
|
| Rate for Payer: Frontpath All Commercial |
$668.14
|
| Rate for Payer: Humana ChoiceCare |
$627.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.62
|
| Rate for Payer: PHCS All Commercial |
$544.68
|
| Rate for Payer: PHP All Commercial |
$550.78
|
| Rate for Payer: Sagamore Health Network All Products |
$560.66
|
| Rate for Payer: Signature Care EPO |
$602.78
|
| Rate for Payer: Signature Care PPO |
$639.09
|
| Rate for Payer: United Healthcare Commercial |
$572.28
|
|
|
HC INPATIENT CARDIAC REHAB
|
Facility
IP
|
$222.43
|
|
| Hospital Charge Code |
01608003
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$166.82 |
| Max. Negotiated Rate |
$206.86 |
| Rate for Payer: Aetna Commercial |
$192.18
|
| Rate for Payer: Cash Price |
$137.91
|
| Rate for Payer: Cigna All Commercial |
$191.96
|
| Rate for Payer: CORVEL All Commercial |
$206.86
|
| Rate for Payer: Coventry All Commercial |
$195.74
|
| Rate for Payer: Encore All Commercial |
$204.75
|
| Rate for Payer: Frontpath All Commercial |
$204.64
|
| Rate for Payer: Humana ChoiceCare |
$192.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.19
|
| Rate for Payer: PHCS All Commercial |
$166.82
|
| Rate for Payer: PHP All Commercial |
$168.69
|
| Rate for Payer: Sagamore Health Network All Products |
$171.72
|
| Rate for Payer: Signature Care EPO |
$184.62
|
| Rate for Payer: Signature Care PPO |
$195.74
|
| Rate for Payer: United Healthcare Commercial |
$175.28
|
|
|
HC INPATIENT CARDIAC REHAB
|
Facility
OP
|
$222.43
|
|
| Hospital Charge Code |
01608003
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$240.28 |
| Rate for Payer: Aetna Commercial |
$187.73
|
| Rate for Payer: Aetna Medicare |
$73.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$127.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$240.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.74
|
| Rate for Payer: Cash Price |
$137.91
|
| Rate for Payer: Cash Price |
$137.91
|
| Rate for Payer: Centivo All Commercial |
$113.44
|
| Rate for Payer: Cigna All Commercial |
$191.96
|
| Rate for Payer: CORVEL All Commercial |
$206.86
|
| Rate for Payer: Coventry All Commercial |
$195.74
|
| Rate for Payer: Encore All Commercial |
$204.75
|
| Rate for Payer: Frontpath All Commercial |
$204.64
|
| Rate for Payer: Humana ChoiceCare |
$192.11
|
| Rate for Payer: Humana Medicare |
$113.44
|
| Rate for Payer: Lucent All Commercial |
$113.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.19
|
| Rate for Payer: Managed Health Services Medicaid |
$240.28
|
| Rate for Payer: MDWise Medicaid |
$240.28
|
| Rate for Payer: PHCS All Commercial |
$166.82
|
| Rate for Payer: PHP All Commercial |
$168.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.75
|
| Rate for Payer: Sagamore Health Network All Products |
$171.72
|
| Rate for Payer: Signature Care EPO |
$184.62
|
| Rate for Payer: Signature Care PPO |
$195.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$189.07
|
| Rate for Payer: United Healthcare Commercial |
$175.28
|
| Rate for Payer: United Healthcare Medicare |
$73.40
|
|
|
HC INST BIOP MONOP 18G X 16CM
|
Facility
OP
|
$1,102.87
|
|
| Hospital Charge Code |
41608071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,025.67 |
| Rate for Payer: Aetna Commercial |
$930.82
|
| Rate for Payer: Aetna Medicare |
$363.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$363.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$633.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$689.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$418.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$400.34
|
| Rate for Payer: Cash Price |
$683.78
|
| Rate for Payer: Cash Price |
$683.78
|
| Rate for Payer: Centivo All Commercial |
$562.46
|
| Rate for Payer: Cigna All Commercial |
$951.78
|
| Rate for Payer: CORVEL All Commercial |
$1,025.67
|
| Rate for Payer: Coventry All Commercial |
$970.53
|
| Rate for Payer: Encore All Commercial |
$1,015.19
|
| Rate for Payer: Frontpath All Commercial |
$1,014.64
|
| Rate for Payer: Humana ChoiceCare |
$952.55
|
| Rate for Payer: Humana Medicare |
$562.46
|
| Rate for Payer: Lucent All Commercial |
$562.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$992.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$827.15
|
| Rate for Payer: PHP All Commercial |
$836.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.12
|
| Rate for Payer: Sagamore Health Network All Products |
$851.42
|
| Rate for Payer: Signature Care EPO |
$915.38
|
| Rate for Payer: Signature Care PPO |
$970.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$937.44
|
| Rate for Payer: United Healthcare Commercial |
$869.06
|
| Rate for Payer: United Healthcare Medicare |
$363.95
|
|
|
HC INST BIOP MONOP 18G X 16CM
|
Facility
IP
|
$1,102.87
|
|
| Hospital Charge Code |
41608071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.15 |
| Max. Negotiated Rate |
$1,025.67 |
| Rate for Payer: Aetna Commercial |
$952.88
|
| Rate for Payer: Cash Price |
$683.78
|
| Rate for Payer: Cigna All Commercial |
$951.78
|
| Rate for Payer: CORVEL All Commercial |
$1,025.67
|
| Rate for Payer: Coventry All Commercial |
$970.53
|
| Rate for Payer: Encore All Commercial |
$1,015.19
|
| Rate for Payer: Frontpath All Commercial |
$1,014.64
|
| Rate for Payer: Humana ChoiceCare |
$952.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$992.58
|
| Rate for Payer: PHCS All Commercial |
$827.15
|
| Rate for Payer: PHP All Commercial |
$836.42
|
| Rate for Payer: Sagamore Health Network All Products |
$851.42
|
| Rate for Payer: Signature Care EPO |
$915.38
|
| Rate for Payer: Signature Care PPO |
$970.53
|
| Rate for Payer: United Healthcare Commercial |
$869.06
|
|
|
HC INST BIOP MONOP 18G X 20CM
|
Facility
OP
|
$204.40
|
|
| Hospital Charge Code |
41608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$172.51
|
| Rate for Payer: Aetna Medicare |
$67.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.20
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Centivo All Commercial |
$104.24
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Humana Medicare |
$104.24
|
| Rate for Payer: Lucent All Commercial |
$104.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.72
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.74
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
| Rate for Payer: United Healthcare Medicare |
$67.45
|
|
|
HC INST BIOP MONOP 18G X 20CM
|
Facility
IP
|
$204.40
|
|
| Hospital Charge Code |
41608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
|
|
HC INSULIN
|
Facility
OP
|
$151.47
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
63001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna Medicare |
$49.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.98
|
| Rate for Payer: Cash Price |
$93.91
|
| Rate for Payer: Cash Price |
$93.91
|
| Rate for Payer: Centivo All Commercial |
$77.25
|
| Rate for Payer: Cigna All Commercial |
$130.72
|
| Rate for Payer: CORVEL All Commercial |
$140.87
|
| Rate for Payer: Coventry All Commercial |
$133.29
|
| Rate for Payer: Encore All Commercial |
$139.43
|
| Rate for Payer: Frontpath All Commercial |
$139.35
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Humana Medicare |
$77.25
|
| Rate for Payer: Lucent All Commercial |
$77.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.43
|
| Rate for Payer: MDWise Medicaid |
$11.43
|
| Rate for Payer: PHCS All Commercial |
$113.60
|
| Rate for Payer: PHP All Commercial |
$114.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.07
|
| Rate for Payer: Sagamore Health Network All Products |
$116.93
|
| Rate for Payer: Signature Care EPO |
$125.72
|
| Rate for Payer: Signature Care PPO |
$133.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.75
|
| Rate for Payer: United Healthcare Commercial |
$119.36
|
| Rate for Payer: United Healthcare Medicare |
$49.99
|
|
|
HC INSULIN
|
Facility
IP
|
$151.47
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
63001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$130.87
|
| Rate for Payer: Cash Price |
$93.91
|
| Rate for Payer: Cigna All Commercial |
$130.72
|
| Rate for Payer: CORVEL All Commercial |
$140.87
|
| Rate for Payer: Coventry All Commercial |
$133.29
|
| Rate for Payer: Encore All Commercial |
$139.43
|
| Rate for Payer: Frontpath All Commercial |
$139.35
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.32
|
| Rate for Payer: PHCS All Commercial |
$113.60
|
| Rate for Payer: PHP All Commercial |
$114.87
|
| Rate for Payer: Sagamore Health Network All Products |
$116.93
|
| Rate for Payer: Signature Care EPO |
$125.72
|
| Rate for Payer: Signature Care PPO |
$133.29
|
| Rate for Payer: United Healthcare Commercial |
$119.36
|
|
