|
HC I2B SCREW LP 2.4X13 CORT
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.50 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Aetna Commercial |
$1,373.76
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna All Commercial |
$1,372.17
|
| Rate for Payer: CORVEL All Commercial |
$1,478.70
|
| Rate for Payer: Coventry All Commercial |
$1,399.20
|
| Rate for Payer: Encore All Commercial |
$1,463.60
|
| Rate for Payer: Frontpath All Commercial |
$1,462.80
|
| Rate for Payer: Humana ChoiceCare |
$1,373.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,431.00
|
| Rate for Payer: PHCS All Commercial |
$1,192.50
|
| Rate for Payer: PHP All Commercial |
$1,205.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,227.48
|
| Rate for Payer: Signature Care EPO |
$1,319.70
|
| Rate for Payer: Signature Care PPO |
$1,399.20
|
| Rate for Payer: United Healthcare Commercial |
$1,252.92
|
|
|
HC I2B SCREW LP 2.4X16 CORT
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
|
|
HC I2B SCREW LP 2.4X16 CORT
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,055.00
|
| Rate for Payer: Aetna Medicare |
$400.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$387.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$717.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$781.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$460.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$440.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Centivo All Commercial |
$680.00
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Humana Medicare |
$400.00
|
| Rate for Payer: Lucent All Commercial |
$680.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$487.50
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
| Rate for Payer: United Healthcare Medicare |
$400.00
|
|
|
HC I2B T-PLATE 5-H MINI
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,951.50 |
| Rate for Payer: Aetna Commercial |
$7,216.20
|
| Rate for Payer: Aetna Medicare |
$2,736.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,650.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,910.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,344.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,146.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,009.60
|
| Rate for Payer: Cash Price |
$5,130.00
|
| Rate for Payer: Cash Price |
$5,130.00
|
| Rate for Payer: Centivo All Commercial |
$4,651.20
|
| Rate for Payer: Cigna All Commercial |
$7,378.65
|
| Rate for Payer: CORVEL All Commercial |
$7,951.50
|
| Rate for Payer: Coventry All Commercial |
$7,524.00
|
| Rate for Payer: Encore All Commercial |
$7,870.27
|
| Rate for Payer: Frontpath All Commercial |
$7,866.00
|
| Rate for Payer: Humana ChoiceCare |
$7,384.64
|
| Rate for Payer: Humana Medicare |
$2,736.00
|
| Rate for Payer: Lucent All Commercial |
$4,651.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,695.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,412.50
|
| Rate for Payer: PHP All Commercial |
$6,484.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,334.50
|
| Rate for Payer: Sagamore Health Network All Products |
$6,600.60
|
| Rate for Payer: Signature Care EPO |
$7,096.50
|
| Rate for Payer: Signature Care PPO |
$7,524.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,267.50
|
| Rate for Payer: United Healthcare Commercial |
$6,737.40
|
| Rate for Payer: United Healthcare Medicare |
$2,736.00
|
|
|
HC I2B T-PLATE 5-H MINI
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,412.50 |
| Max. Negotiated Rate |
$7,951.50 |
| Rate for Payer: Aetna Commercial |
$7,387.20
|
| Rate for Payer: Cash Price |
$5,130.00
|
| Rate for Payer: Cigna All Commercial |
$7,378.65
|
| Rate for Payer: CORVEL All Commercial |
$7,951.50
|
| Rate for Payer: Coventry All Commercial |
$7,524.00
|
| Rate for Payer: Encore All Commercial |
$7,870.27
|
| Rate for Payer: Frontpath All Commercial |
$7,866.00
|
| Rate for Payer: Humana ChoiceCare |
$7,384.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,695.00
|
| Rate for Payer: PHCS All Commercial |
$6,412.50
|
| Rate for Payer: PHP All Commercial |
$6,484.32
|
| Rate for Payer: Sagamore Health Network All Products |
$6,600.60
|
| Rate for Payer: Signature Care EPO |
$7,096.50
|
| Rate for Payer: Signature Care PPO |
$7,524.00
|
| Rate for Payer: United Healthcare Commercial |
$6,737.40
|
|
|
HC IBD CHEMILUMISCENT ASSAY
|
Facility
|
IP
|
$161.16
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63001488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.87 |
| Max. Negotiated Rate |
$149.88 |
| Rate for Payer: Aetna Commercial |
$139.24
|
| Rate for Payer: Cash Price |
$96.70
|
| Rate for Payer: Cigna All Commercial |
$139.08
|
| Rate for Payer: CORVEL All Commercial |
$149.88
|
| Rate for Payer: Coventry All Commercial |
$141.82
|
| Rate for Payer: Encore All Commercial |
$148.35
|
| Rate for Payer: Frontpath All Commercial |
$148.27
|
| Rate for Payer: Humana ChoiceCare |
$139.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.04
|
| Rate for Payer: PHCS All Commercial |
$120.87
|
| Rate for Payer: PHP All Commercial |
$122.22
|
| Rate for Payer: Sagamore Health Network All Products |
$124.42
|
| Rate for Payer: Signature Care EPO |
$133.76
|
| Rate for Payer: Signature Care PPO |
$141.82
|
| Rate for Payer: United Healthcare Commercial |
$126.99
|
|
|
HC IBD CHEMILUMISCENT ASSAY
|
Facility
|
OP
|
$161.16
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63001488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$149.88 |
| Rate for Payer: Aetna Commercial |
$136.02
|
| Rate for Payer: Aetna Medicare |
$51.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.73
|
| Rate for Payer: Cash Price |
$96.70
|
| Rate for Payer: Cash Price |
$96.70
|
| Rate for Payer: Centivo All Commercial |
$87.67
|
| Rate for Payer: Cigna All Commercial |
$139.08
|
| Rate for Payer: CORVEL All Commercial |
$149.88
|
| Rate for Payer: Coventry All Commercial |
$141.82
|
| Rate for Payer: Encore All Commercial |
$148.35
|
| Rate for Payer: Frontpath All Commercial |
$148.27
|
| Rate for Payer: Humana ChoiceCare |
$139.19
|
| Rate for Payer: Humana Medicare |
$51.57
|
| Rate for Payer: Lucent All Commercial |
$87.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.04
|
| Rate for Payer: Managed Health Services Medicaid |
$14.12
|
| Rate for Payer: MDWise Medicaid |
$14.12
|
| Rate for Payer: PHCS All Commercial |
$120.87
|
| Rate for Payer: PHP All Commercial |
$122.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.85
|
| Rate for Payer: Sagamore Health Network All Products |
$124.42
|
| Rate for Payer: Signature Care EPO |
$133.76
|
| Rate for Payer: Signature Care PPO |
$141.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.99
|
| Rate for Payer: United Healthcare Commercial |
$126.99
|
| Rate for Payer: United Healthcare Medicare |
$51.57
|
|
|
HC IGA
|
Facility
|
IP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.03 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$100.26
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
|
|
HC IGA
|
Facility
|
OP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$97.94
|
| Rate for Payer: Aetna Medicare |
$37.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.85
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Centivo All Commercial |
$63.13
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Humana Medicare |
$37.13
|
| Rate for Payer: Lucent All Commercial |
$63.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: MDWise Medicaid |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
|
|
HC IGE
|
Facility
|
IP
|
$179.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$166.95 |
| Rate for Payer: Aetna Commercial |
$155.11
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cigna All Commercial |
$154.93
|
| Rate for Payer: CORVEL All Commercial |
$166.95
|
| Rate for Payer: Coventry All Commercial |
$157.98
|
| Rate for Payer: Encore All Commercial |
$165.25
|
| Rate for Payer: Frontpath All Commercial |
$165.16
|
| Rate for Payer: Humana ChoiceCare |
$155.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.57
|
| Rate for Payer: PHCS All Commercial |
$134.64
|
| Rate for Payer: PHP All Commercial |
$136.15
|
| Rate for Payer: Sagamore Health Network All Products |
$138.59
|
| Rate for Payer: Signature Care EPO |
$149.00
|
| Rate for Payer: Signature Care PPO |
$157.98
|
| Rate for Payer: United Healthcare Commercial |
$141.46
|
|
|
HC IGE
|
Facility
|
OP
|
$179.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$166.95 |
| Rate for Payer: Aetna Commercial |
$151.51
|
| Rate for Payer: Aetna Medicare |
$57.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.19
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Centivo All Commercial |
$97.66
|
| Rate for Payer: Cigna All Commercial |
$154.93
|
| Rate for Payer: CORVEL All Commercial |
$166.95
|
| Rate for Payer: Coventry All Commercial |
$157.98
|
| Rate for Payer: Encore All Commercial |
$165.25
|
| Rate for Payer: Frontpath All Commercial |
$165.16
|
| Rate for Payer: Humana ChoiceCare |
$155.05
|
| Rate for Payer: Humana Medicare |
$57.45
|
| Rate for Payer: Lucent All Commercial |
$97.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.57
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: MDWise Medicaid |
$16.46
|
| Rate for Payer: PHCS All Commercial |
$134.64
|
| Rate for Payer: PHP All Commercial |
$136.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.01
|
| Rate for Payer: Sagamore Health Network All Products |
$138.59
|
| Rate for Payer: Signature Care EPO |
$149.00
|
| Rate for Payer: Signature Care PPO |
$157.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.59
|
| Rate for Payer: United Healthcare Commercial |
$141.46
|
| Rate for Payer: United Healthcare Medicare |
$57.45
|
|
|
HC IGE - PANEL
|
Facility
|
OP
|
$145.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$135.33 |
| Rate for Payer: Aetna Commercial |
$122.82
|
| Rate for Payer: Aetna Medicare |
$46.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.22
|
| Rate for Payer: Cash Price |
$87.31
|
| Rate for Payer: Cash Price |
$87.31
|
| Rate for Payer: Centivo All Commercial |
$79.16
|
| Rate for Payer: Cigna All Commercial |
$125.58
|
| Rate for Payer: CORVEL All Commercial |
$135.33
|
| Rate for Payer: Coventry All Commercial |
$128.06
|
| Rate for Payer: Encore All Commercial |
$133.95
|
| Rate for Payer: Frontpath All Commercial |
$133.88
|
| Rate for Payer: Humana ChoiceCare |
$125.69
|
| Rate for Payer: Humana Medicare |
$46.57
|
| Rate for Payer: Lucent All Commercial |
$79.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.97
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: MDWise Medicaid |
$16.46
|
| Rate for Payer: PHCS All Commercial |
$109.14
|
| Rate for Payer: PHP All Commercial |
$110.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.75
|
| Rate for Payer: Sagamore Health Network All Products |
$112.34
|
| Rate for Payer: Signature Care EPO |
$120.78
|
| Rate for Payer: Signature Care PPO |
$128.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.69
|
| Rate for Payer: United Healthcare Commercial |
$114.67
|
| Rate for Payer: United Healthcare Medicare |
$46.57
|
|
|
HC IGE - PANEL
|
Facility
|
IP
|
$145.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$135.33 |
| Rate for Payer: Aetna Commercial |
$125.73
|
| Rate for Payer: Cash Price |
$87.31
|
| Rate for Payer: Cigna All Commercial |
$125.58
|
| Rate for Payer: CORVEL All Commercial |
$135.33
|
| Rate for Payer: Coventry All Commercial |
$128.06
|
| Rate for Payer: Encore All Commercial |
$133.95
|
| Rate for Payer: Frontpath All Commercial |
$133.88
|
| Rate for Payer: Humana ChoiceCare |
$125.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.97
|
| Rate for Payer: PHCS All Commercial |
$109.14
|
| Rate for Payer: PHP All Commercial |
$110.36
|
| Rate for Payer: Sagamore Health Network All Products |
$112.34
|
| Rate for Payer: Signature Care EPO |
$120.78
|
| Rate for Payer: Signature Care PPO |
$128.06
|
| Rate for Payer: United Healthcare Commercial |
$114.67
|
|
|
HC IGF BINDING PROTEIN3
|
Facility
|
IP
|
$145.61
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63001489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.21 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$125.81
|
| Rate for Payer: Cash Price |
$87.37
|
| Rate for Payer: Cigna All Commercial |
$125.66
|
| Rate for Payer: CORVEL All Commercial |
$135.42
|
| Rate for Payer: Coventry All Commercial |
$128.14
|
| Rate for Payer: Encore All Commercial |
$134.03
|
| Rate for Payer: Frontpath All Commercial |
$133.96
|
| Rate for Payer: Humana ChoiceCare |
$125.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.05
|
| Rate for Payer: PHCS All Commercial |
$109.21
|
| Rate for Payer: PHP All Commercial |
$110.43
|
| Rate for Payer: Sagamore Health Network All Products |
$112.41
|
| Rate for Payer: Signature Care EPO |
$120.86
|
| Rate for Payer: Signature Care PPO |
$128.14
|
| Rate for Payer: United Healthcare Commercial |
$114.74
|
|
|
HC IGF BINDING PROTEIN3
|
Facility
|
OP
|
$145.61
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63001489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$122.89
|
| Rate for Payer: Aetna Medicare |
$46.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.25
|
| Rate for Payer: Cash Price |
$87.37
|
| Rate for Payer: Cash Price |
$87.37
|
| Rate for Payer: Centivo All Commercial |
$79.21
|
| Rate for Payer: Cigna All Commercial |
$125.66
|
| Rate for Payer: CORVEL All Commercial |
$135.42
|
| Rate for Payer: Coventry All Commercial |
$128.14
|
| Rate for Payer: Encore All Commercial |
$134.03
|
| Rate for Payer: Frontpath All Commercial |
$133.96
|
| Rate for Payer: Humana ChoiceCare |
$125.76
|
| Rate for Payer: Humana Medicare |
$46.60
|
| Rate for Payer: Lucent All Commercial |
$79.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.05
|
| Rate for Payer: Managed Health Services Medicaid |
$14.12
|
| Rate for Payer: MDWise Medicaid |
$14.12
|
| Rate for Payer: PHCS All Commercial |
$109.21
|
| Rate for Payer: PHP All Commercial |
$110.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.79
|
| Rate for Payer: Sagamore Health Network All Products |
$112.41
|
| Rate for Payer: Signature Care EPO |
$120.86
|
| Rate for Payer: Signature Care PPO |
$128.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.77
|
| Rate for Payer: United Healthcare Commercial |
$114.74
|
| Rate for Payer: United Healthcare Medicare |
$46.60
|
|
|
HC IGG
|
Facility
|
OP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$97.94
|
| Rate for Payer: Aetna Medicare |
$37.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.85
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Centivo All Commercial |
$63.13
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Humana Medicare |
$37.13
|
| Rate for Payer: Lucent All Commercial |
$63.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: MDWise Medicaid |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
|
|
HC IGG
|
Facility
|
IP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.03 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$100.26
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
|
|
HC IGG SUBCLASSES
|
Facility
|
IP
|
$71.06
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
63001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cigna All Commercial |
$61.32
|
| Rate for Payer: CORVEL All Commercial |
$66.09
|
| Rate for Payer: Coventry All Commercial |
$62.53
|
| Rate for Payer: Encore All Commercial |
$65.41
|
| Rate for Payer: Frontpath All Commercial |
$65.38
|
| Rate for Payer: Humana ChoiceCare |
$61.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.95
|
| Rate for Payer: PHCS All Commercial |
$53.30
|
| Rate for Payer: PHP All Commercial |
$53.89
|
| Rate for Payer: Sagamore Health Network All Products |
$54.86
|
| Rate for Payer: Signature Care EPO |
$58.98
|
| Rate for Payer: Signature Care PPO |
$62.53
|
| Rate for Payer: United Healthcare Commercial |
$56.00
|
|
|
HC IGG SUBCLASSES
|
Facility
|
OP
|
$71.06
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
63001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$59.97
|
| Rate for Payer: Aetna Medicare |
$22.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$32.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.01
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Centivo All Commercial |
$38.66
|
| Rate for Payer: Cigna All Commercial |
$61.32
|
| Rate for Payer: CORVEL All Commercial |
$66.09
|
| Rate for Payer: Coventry All Commercial |
$62.53
|
| Rate for Payer: Encore All Commercial |
$65.41
|
| Rate for Payer: Frontpath All Commercial |
$65.38
|
| Rate for Payer: Humana ChoiceCare |
$61.37
|
| Rate for Payer: Humana Medicare |
$22.74
|
| Rate for Payer: Lucent All Commercial |
$38.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.95
|
| Rate for Payer: Managed Health Services Medicaid |
$8.02
|
| Rate for Payer: MDWise Medicaid |
$8.02
|
| Rate for Payer: PHCS All Commercial |
$53.30
|
| Rate for Payer: PHP All Commercial |
$53.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.71
|
| Rate for Payer: Sagamore Health Network All Products |
$54.86
|
| Rate for Payer: Signature Care EPO |
$58.98
|
| Rate for Payer: Signature Care PPO |
$62.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.40
|
| Rate for Payer: United Healthcare Commercial |
$56.00
|
| Rate for Payer: United Healthcare Medicare |
$22.74
|
|
|
HC IGM
|
Facility
|
OP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001322
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$97.94
|
| Rate for Payer: Aetna Medicare |
$37.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.85
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Centivo All Commercial |
$63.13
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Humana Medicare |
$37.13
|
| Rate for Payer: Lucent All Commercial |
$63.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: MDWise Medicaid |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
|
|
HC IGM
|
Facility
|
IP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001322
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.03 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$100.26
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
|
OP
|
$4,909.26
|
|
| Hospital Charge Code |
1669407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,521.87 |
| Max. Negotiated Rate |
$4,565.61 |
| Rate for Payer: Aetna Commercial |
$4,143.42
|
| Rate for Payer: Aetna Medicare |
$1,570.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,521.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,819.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,068.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,806.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,728.06
|
| Rate for Payer: Cash Price |
$2,945.56
|
| Rate for Payer: Centivo All Commercial |
$2,670.64
|
| Rate for Payer: Cigna All Commercial |
$4,236.69
|
| Rate for Payer: CORVEL All Commercial |
$4,565.61
|
| Rate for Payer: Coventry All Commercial |
$4,320.15
|
| Rate for Payer: Encore All Commercial |
$4,518.97
|
| Rate for Payer: Frontpath All Commercial |
$4,516.52
|
| Rate for Payer: Humana ChoiceCare |
$4,240.13
|
| Rate for Payer: Humana Medicare |
$1,570.96
|
| Rate for Payer: Lucent All Commercial |
$2,670.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,418.33
|
| Rate for Payer: PHCS All Commercial |
$3,681.95
|
| Rate for Payer: PHP All Commercial |
$3,723.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,914.61
|
| Rate for Payer: Sagamore Health Network All Products |
$3,789.95
|
| Rate for Payer: Signature Care EPO |
$4,074.69
|
| Rate for Payer: Signature Care PPO |
$4,320.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,172.87
|
| Rate for Payer: United Healthcare Commercial |
$3,868.50
|
| Rate for Payer: United Healthcare Medicare |
$1,570.96
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
|
IP
|
$4,909.26
|
|
| Hospital Charge Code |
1669407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,681.95 |
| Max. Negotiated Rate |
$4,565.61 |
| Rate for Payer: Aetna Commercial |
$4,241.60
|
| Rate for Payer: Cash Price |
$2,945.56
|
| Rate for Payer: Cigna All Commercial |
$4,236.69
|
| Rate for Payer: CORVEL All Commercial |
$4,565.61
|
| Rate for Payer: Coventry All Commercial |
$4,320.15
|
| Rate for Payer: Encore All Commercial |
$4,518.97
|
| Rate for Payer: Frontpath All Commercial |
$4,516.52
|
| Rate for Payer: Humana ChoiceCare |
$4,240.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,418.33
|
| Rate for Payer: PHCS All Commercial |
$3,681.95
|
| Rate for Payer: PHP All Commercial |
$3,723.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,789.95
|
| Rate for Payer: Signature Care EPO |
$4,074.69
|
| Rate for Payer: Signature Care PPO |
$4,320.15
|
| Rate for Payer: United Healthcare Commercial |
$3,868.50
|
|
|
HC IMAGER 2 IOC CATHETER
|
Facility
|
OP
|
$761.25
|
|
| Hospital Charge Code |
41608431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$707.96 |
| Rate for Payer: Aetna Commercial |
$642.50
|
| Rate for Payer: Aetna Medicare |
$243.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$235.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$437.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$475.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$280.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$267.96
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Centivo All Commercial |
$414.12
|
| Rate for Payer: Cigna All Commercial |
$656.96
|
| Rate for Payer: CORVEL All Commercial |
$707.96
|
| Rate for Payer: Coventry All Commercial |
$669.90
|
| Rate for Payer: Encore All Commercial |
$700.73
|
| Rate for Payer: Frontpath All Commercial |
$700.35
|
| Rate for Payer: Humana ChoiceCare |
$657.49
|
| Rate for Payer: Humana Medicare |
$243.60
|
| Rate for Payer: Lucent All Commercial |
$414.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.12
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$570.94
|
| Rate for Payer: PHP All Commercial |
$577.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$296.89
|
| Rate for Payer: Sagamore Health Network All Products |
$587.68
|
| Rate for Payer: Signature Care EPO |
$631.84
|
| Rate for Payer: Signature Care PPO |
$669.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$647.06
|
| Rate for Payer: United Healthcare Commercial |
$599.87
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
|
|
HC IMAGER 2 IOC CATHETER
|
Facility
|
IP
|
$761.25
|
|
| Hospital Charge Code |
41608431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.94 |
| Max. Negotiated Rate |
$707.96 |
| Rate for Payer: Aetna Commercial |
$657.72
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna All Commercial |
$656.96
|
| Rate for Payer: CORVEL All Commercial |
$707.96
|
| Rate for Payer: Coventry All Commercial |
$669.90
|
| Rate for Payer: Encore All Commercial |
$700.73
|
| Rate for Payer: Frontpath All Commercial |
$700.35
|
| Rate for Payer: Humana ChoiceCare |
$657.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.12
|
| Rate for Payer: PHCS All Commercial |
$570.94
|
| Rate for Payer: PHP All Commercial |
$577.33
|
| Rate for Payer: Sagamore Health Network All Products |
$587.68
|
| Rate for Payer: Signature Care EPO |
$631.84
|
| Rate for Payer: Signature Care PPO |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$599.87
|
|
