|
HC INSULIN 120 MINUTES
|
Facility
OP
|
$129.55
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$120.48 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.03
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Centivo All Commercial |
$66.07
|
| Rate for Payer: Cigna All Commercial |
$111.80
|
| Rate for Payer: CORVEL All Commercial |
$120.48
|
| Rate for Payer: Coventry All Commercial |
$114.00
|
| Rate for Payer: Encore All Commercial |
$119.25
|
| Rate for Payer: Frontpath All Commercial |
$119.19
|
| Rate for Payer: Humana ChoiceCare |
$111.89
|
| Rate for Payer: Humana Medicare |
$66.07
|
| Rate for Payer: Lucent All Commercial |
$66.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.60
|
| Rate for Payer: PHCS All Commercial |
$97.16
|
| Rate for Payer: PHP All Commercial |
$98.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.52
|
| Rate for Payer: Sagamore Health Network All Products |
$100.01
|
| Rate for Payer: Signature Care EPO |
$107.53
|
| Rate for Payer: Signature Care PPO |
$114.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.12
|
| Rate for Payer: United Healthcare Commercial |
$102.09
|
| Rate for Payer: United Healthcare Medicare |
$42.75
|
|
|
HC INSULIN 120 MINUTES
|
Facility
IP
|
$129.55
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.16 |
| Max. Negotiated Rate |
$120.48 |
| Rate for Payer: Aetna Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Cigna All Commercial |
$111.80
|
| Rate for Payer: CORVEL All Commercial |
$120.48
|
| Rate for Payer: Coventry All Commercial |
$114.00
|
| Rate for Payer: Encore All Commercial |
$119.25
|
| Rate for Payer: Frontpath All Commercial |
$119.19
|
| Rate for Payer: Humana ChoiceCare |
$111.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.60
|
| Rate for Payer: PHCS All Commercial |
$97.16
|
| Rate for Payer: PHP All Commercial |
$98.25
|
| Rate for Payer: Sagamore Health Network All Products |
$100.01
|
| Rate for Payer: Signature Care EPO |
$107.53
|
| Rate for Payer: Signature Care PPO |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$102.09
|
|
|
HC INSULIN 30 MINUTE
|
Facility
OP
|
$129.55
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$120.48 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.03
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Centivo All Commercial |
$66.07
|
| Rate for Payer: Cigna All Commercial |
$111.80
|
| Rate for Payer: CORVEL All Commercial |
$120.48
|
| Rate for Payer: Coventry All Commercial |
$114.00
|
| Rate for Payer: Encore All Commercial |
$119.25
|
| Rate for Payer: Frontpath All Commercial |
$119.19
|
| Rate for Payer: Humana ChoiceCare |
$111.89
|
| Rate for Payer: Humana Medicare |
$66.07
|
| Rate for Payer: Lucent All Commercial |
$66.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.60
|
| Rate for Payer: PHCS All Commercial |
$97.16
|
| Rate for Payer: PHP All Commercial |
$98.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.52
|
| Rate for Payer: Sagamore Health Network All Products |
$100.01
|
| Rate for Payer: Signature Care EPO |
$107.53
|
| Rate for Payer: Signature Care PPO |
$114.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.12
|
| Rate for Payer: United Healthcare Commercial |
$102.09
|
| Rate for Payer: United Healthcare Medicare |
$42.75
|
|
|
HC INSULIN 30 MINUTE
|
Facility
IP
|
$129.55
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.16 |
| Max. Negotiated Rate |
$120.48 |
| Rate for Payer: Aetna Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Cigna All Commercial |
$111.80
|
| Rate for Payer: CORVEL All Commercial |
$120.48
|
| Rate for Payer: Coventry All Commercial |
$114.00
|
| Rate for Payer: Encore All Commercial |
$119.25
|
| Rate for Payer: Frontpath All Commercial |
$119.19
|
| Rate for Payer: Humana ChoiceCare |
$111.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.60
|
| Rate for Payer: PHCS All Commercial |
$97.16
|
| Rate for Payer: PHP All Commercial |
$98.25
|
| Rate for Payer: Sagamore Health Network All Products |
$100.01
|
| Rate for Payer: Signature Care EPO |
$107.53
|
| Rate for Payer: Signature Care PPO |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$102.09
|
|
|
HC INSULIN 60 MINUTES
|
Facility
OP
|
$118.26
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$99.81
|
| Rate for Payer: Aetna Medicare |
$39.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.93
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Centivo All Commercial |
$60.31
|
| Rate for Payer: Cigna All Commercial |
$102.06
|
| Rate for Payer: CORVEL All Commercial |
$109.98
|
| Rate for Payer: Coventry All Commercial |
$104.07
|
| Rate for Payer: Encore All Commercial |
$108.86
|
| Rate for Payer: Frontpath All Commercial |
$108.80
|
| Rate for Payer: Humana ChoiceCare |
$102.14
|
| Rate for Payer: Humana Medicare |
$60.31
|
| Rate for Payer: Lucent All Commercial |
$60.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.43
|
| Rate for Payer: PHCS All Commercial |
$88.69
|
| Rate for Payer: PHP All Commercial |
$89.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.12
|
| Rate for Payer: Sagamore Health Network All Products |
$91.30
|
| Rate for Payer: Signature Care EPO |
$98.15
|
| Rate for Payer: Signature Care PPO |
$104.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.52
|
| Rate for Payer: United Healthcare Commercial |
$93.19
|
| Rate for Payer: United Healthcare Medicare |
$39.03
|
|
|
HC INSULIN 60 MINUTES
|
Facility
IP
|
$118.26
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$102.18
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cigna All Commercial |
$102.06
|
| Rate for Payer: CORVEL All Commercial |
$109.98
|
| Rate for Payer: Coventry All Commercial |
$104.07
|
| Rate for Payer: Encore All Commercial |
$108.86
|
| Rate for Payer: Frontpath All Commercial |
$108.80
|
| Rate for Payer: Humana ChoiceCare |
$102.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.43
|
| Rate for Payer: PHCS All Commercial |
$88.69
|
| Rate for Payer: PHP All Commercial |
$89.69
|
| Rate for Payer: Sagamore Health Network All Products |
$91.30
|
| Rate for Payer: Signature Care EPO |
$98.15
|
| Rate for Payer: Signature Care PPO |
$104.07
|
| Rate for Payer: United Healthcare Commercial |
$93.19
|
|
|
HC INSULIN 90 MINUTES
|
Facility
OP
|
$129.55
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$120.48 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.03
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Centivo All Commercial |
$66.07
|
| Rate for Payer: Cigna All Commercial |
$111.80
|
| Rate for Payer: CORVEL All Commercial |
$120.48
|
| Rate for Payer: Coventry All Commercial |
$114.00
|
| Rate for Payer: Encore All Commercial |
$119.25
|
| Rate for Payer: Frontpath All Commercial |
$119.19
|
| Rate for Payer: Humana ChoiceCare |
$111.89
|
| Rate for Payer: Humana Medicare |
$66.07
|
| Rate for Payer: Lucent All Commercial |
$66.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.60
|
| Rate for Payer: PHCS All Commercial |
$97.16
|
| Rate for Payer: PHP All Commercial |
$98.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.52
|
| Rate for Payer: Sagamore Health Network All Products |
$100.01
|
| Rate for Payer: Signature Care EPO |
$107.53
|
| Rate for Payer: Signature Care PPO |
$114.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.12
|
| Rate for Payer: United Healthcare Commercial |
$102.09
|
| Rate for Payer: United Healthcare Medicare |
$42.75
|
|
|
HC INSULIN 90 MINUTES
|
Facility
IP
|
$129.55
|
|
|
Service Code
|
CPT 83525 91
|
| Hospital Charge Code |
63002151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.16 |
| Max. Negotiated Rate |
$120.48 |
| Rate for Payer: Aetna Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Cigna All Commercial |
$111.80
|
| Rate for Payer: CORVEL All Commercial |
$120.48
|
| Rate for Payer: Coventry All Commercial |
$114.00
|
| Rate for Payer: Encore All Commercial |
$119.25
|
| Rate for Payer: Frontpath All Commercial |
$119.19
|
| Rate for Payer: Humana ChoiceCare |
$111.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.60
|
| Rate for Payer: PHCS All Commercial |
$97.16
|
| Rate for Payer: PHP All Commercial |
$98.25
|
| Rate for Payer: Sagamore Health Network All Products |
$100.01
|
| Rate for Payer: Signature Care EPO |
$107.53
|
| Rate for Payer: Signature Care PPO |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$102.09
|
|
|
HC INSULIN AUTOANTIBODY
|
Facility
OP
|
$461.75
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
63001015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$429.43 |
| Rate for Payer: Aetna Commercial |
$389.72
|
| Rate for Payer: Aetna Medicare |
$152.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$265.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.62
|
| Rate for Payer: Cash Price |
$286.29
|
| Rate for Payer: Cash Price |
$286.29
|
| Rate for Payer: Centivo All Commercial |
$235.49
|
| Rate for Payer: Cigna All Commercial |
$398.49
|
| Rate for Payer: CORVEL All Commercial |
$429.43
|
| Rate for Payer: Coventry All Commercial |
$406.34
|
| Rate for Payer: Encore All Commercial |
$425.04
|
| Rate for Payer: Frontpath All Commercial |
$424.81
|
| Rate for Payer: Humana ChoiceCare |
$398.82
|
| Rate for Payer: Humana Medicare |
$235.49
|
| Rate for Payer: Lucent All Commercial |
$235.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.58
|
| Rate for Payer: Managed Health Services Medicaid |
$21.41
|
| Rate for Payer: MDWise Medicaid |
$21.41
|
| Rate for Payer: PHCS All Commercial |
$346.32
|
| Rate for Payer: PHP All Commercial |
$350.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.08
|
| Rate for Payer: Sagamore Health Network All Products |
$356.47
|
| Rate for Payer: Signature Care EPO |
$383.26
|
| Rate for Payer: Signature Care PPO |
$406.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.49
|
| Rate for Payer: United Healthcare Commercial |
$363.86
|
| Rate for Payer: United Healthcare Medicare |
$152.38
|
|
|
HC INSULIN AUTOANTIBODY
|
Facility
IP
|
$461.75
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
63001015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$346.32 |
| Max. Negotiated Rate |
$429.43 |
| Rate for Payer: Aetna Commercial |
$398.96
|
| Rate for Payer: Cash Price |
$286.29
|
| Rate for Payer: Cigna All Commercial |
$398.49
|
| Rate for Payer: CORVEL All Commercial |
$429.43
|
| Rate for Payer: Coventry All Commercial |
$406.34
|
| Rate for Payer: Encore All Commercial |
$425.04
|
| Rate for Payer: Frontpath All Commercial |
$424.81
|
| Rate for Payer: Humana ChoiceCare |
$398.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.58
|
| Rate for Payer: PHCS All Commercial |
$346.32
|
| Rate for Payer: PHP All Commercial |
$350.19
|
| Rate for Payer: Sagamore Health Network All Products |
$356.47
|
| Rate for Payer: Signature Care EPO |
$383.26
|
| Rate for Payer: Signature Care PPO |
$406.34
|
| Rate for Payer: United Healthcare Commercial |
$363.86
|
|
|
HC INSULIN BASELINE
|
Facility
OP
|
$125.46
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
63001612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna Commercial |
$105.89
|
| Rate for Payer: Aetna Medicare |
$41.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.54
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Centivo All Commercial |
$63.98
|
| Rate for Payer: Cigna All Commercial |
$108.27
|
| Rate for Payer: CORVEL All Commercial |
$116.68
|
| Rate for Payer: Coventry All Commercial |
$110.40
|
| Rate for Payer: Encore All Commercial |
$115.49
|
| Rate for Payer: Frontpath All Commercial |
$115.42
|
| Rate for Payer: Humana ChoiceCare |
$108.36
|
| Rate for Payer: Humana Medicare |
$63.98
|
| Rate for Payer: Lucent All Commercial |
$63.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.91
|
| Rate for Payer: Managed Health Services Medicaid |
$11.43
|
| Rate for Payer: MDWise Medicaid |
$11.43
|
| Rate for Payer: PHCS All Commercial |
$94.10
|
| Rate for Payer: PHP All Commercial |
$95.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.93
|
| Rate for Payer: Sagamore Health Network All Products |
$96.86
|
| Rate for Payer: Signature Care EPO |
$104.13
|
| Rate for Payer: Signature Care PPO |
$110.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.64
|
| Rate for Payer: United Healthcare Commercial |
$98.86
|
| Rate for Payer: United Healthcare Medicare |
$41.40
|
|
|
HC INSULIN BASELINE
|
Facility
IP
|
$125.46
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
63001612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.10 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna Commercial |
$108.40
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cigna All Commercial |
$108.27
|
| Rate for Payer: CORVEL All Commercial |
$116.68
|
| Rate for Payer: Coventry All Commercial |
$110.40
|
| Rate for Payer: Encore All Commercial |
$115.49
|
| Rate for Payer: Frontpath All Commercial |
$115.42
|
| Rate for Payer: Humana ChoiceCare |
$108.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.91
|
| Rate for Payer: PHCS All Commercial |
$94.10
|
| Rate for Payer: PHP All Commercial |
$95.15
|
| Rate for Payer: Sagamore Health Network All Products |
$96.86
|
| Rate for Payer: Signature Care EPO |
$104.13
|
| Rate for Payer: Signature Care PPO |
$110.40
|
| Rate for Payer: United Healthcare Commercial |
$98.86
|
|
|
HC INSULIN FREE
|
Facility
OP
|
$34.78
|
|
|
Service Code
|
CPT 83527
|
| Hospital Charge Code |
63001613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Aetna Commercial |
$29.36
|
| Rate for Payer: Aetna Medicare |
$11.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.63
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Centivo All Commercial |
$17.74
|
| Rate for Payer: Cigna All Commercial |
$30.02
|
| Rate for Payer: CORVEL All Commercial |
$32.35
|
| Rate for Payer: Coventry All Commercial |
$30.61
|
| Rate for Payer: Encore All Commercial |
$32.02
|
| Rate for Payer: Frontpath All Commercial |
$32.00
|
| Rate for Payer: Humana ChoiceCare |
$30.04
|
| Rate for Payer: Humana Medicare |
$17.74
|
| Rate for Payer: Lucent All Commercial |
$17.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.30
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: MDWise Medicaid |
$12.95
|
| Rate for Payer: PHCS All Commercial |
$26.09
|
| Rate for Payer: PHP All Commercial |
$26.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.56
|
| Rate for Payer: Sagamore Health Network All Products |
$26.85
|
| Rate for Payer: Signature Care EPO |
$28.87
|
| Rate for Payer: Signature Care PPO |
$30.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.56
|
| Rate for Payer: United Healthcare Commercial |
$27.41
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
|
|
HC INSULIN FREE
|
Facility
IP
|
$34.78
|
|
|
Service Code
|
CPT 83527
|
| Hospital Charge Code |
63001613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Aetna Commercial |
$30.05
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cigna All Commercial |
$30.02
|
| Rate for Payer: CORVEL All Commercial |
$32.35
|
| Rate for Payer: Coventry All Commercial |
$30.61
|
| Rate for Payer: Encore All Commercial |
$32.02
|
| Rate for Payer: Frontpath All Commercial |
$32.00
|
| Rate for Payer: Humana ChoiceCare |
$30.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.30
|
| Rate for Payer: PHCS All Commercial |
$26.09
|
| Rate for Payer: PHP All Commercial |
$26.38
|
| Rate for Payer: Sagamore Health Network All Products |
$26.85
|
| Rate for Payer: Signature Care EPO |
$28.87
|
| Rate for Payer: Signature Care PPO |
$30.61
|
| Rate for Payer: United Healthcare Commercial |
$27.41
|
|
|
HC INSULIN-LIKE GROWTH FACTOR
|
Facility
IP
|
$234.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
63001680
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.87 |
| Max. Negotiated Rate |
$218.08 |
| Rate for Payer: Aetna Commercial |
$202.61
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.08
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: PHCS All Commercial |
$175.87
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.63
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: United Healthcare Commercial |
$184.78
|
|
|
HC INSULIN-LIKE GROWTH FACTOR
|
Facility
OP
|
$234.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
63001680
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$218.08 |
| Rate for Payer: Aetna Commercial |
$197.92
|
| Rate for Payer: Aetna Medicare |
$77.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.12
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Centivo All Commercial |
$119.59
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.08
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Humana Medicare |
$119.59
|
| Rate for Payer: Lucent All Commercial |
$119.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: Managed Health Services Medicaid |
$21.26
|
| Rate for Payer: MDWise Medicaid |
$21.26
|
| Rate for Payer: PHCS All Commercial |
$175.87
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.45
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.63
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.32
|
| Rate for Payer: United Healthcare Commercial |
$184.78
|
| Rate for Payer: United Healthcare Medicare |
$77.38
|
|
|
HC INTENSIVE CARE LEVEL 1
|
Facility
IP
|
$3,182.40
|
|
| Hospital Charge Code |
10010052
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,386.80 |
| Max. Negotiated Rate |
$5,584.50 |
| Rate for Payer: Aetna Commercial |
$2,749.59
|
| Rate for Payer: Aetna Medicare |
$3,285.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,285.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,777.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,613.50
|
| Rate for Payer: Cash Price |
$1,973.09
|
| Rate for Payer: Cash Price |
$1,973.09
|
| Rate for Payer: Centivo All Commercial |
$3,613.50
|
| Rate for Payer: Cigna All Commercial |
$2,746.41
|
| Rate for Payer: CORVEL All Commercial |
$2,959.63
|
| Rate for Payer: Coventry All Commercial |
$2,800.51
|
| Rate for Payer: Encore All Commercial |
$2,929.40
|
| Rate for Payer: Frontpath All Commercial |
$2,927.81
|
| Rate for Payer: Humana ChoiceCare |
$2,748.64
|
| Rate for Payer: Humana Medicare |
$3,285.00
|
| Rate for Payer: Lucent All Commercial |
$5,584.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,864.16
|
| Rate for Payer: PHCS All Commercial |
$2,386.80
|
| Rate for Payer: PHP All Commercial |
$2,413.53
|
| Rate for Payer: Sagamore Health Network All Products |
$2,456.81
|
| Rate for Payer: Signature Care EPO |
$2,641.39
|
| Rate for Payer: Signature Care PPO |
$2,800.51
|
| Rate for Payer: United Healthcare Commercial |
$2,507.73
|
| Rate for Payer: United Healthcare Medicare |
$3,285.00
|
|
|
HC INTERCEED ADHESION BARRIER 5X6
|
Facility
OP
|
$1,772.68
|
|
| Hospital Charge Code |
41602494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,648.59 |
| Rate for Payer: Aetna Commercial |
$1,496.14
|
| Rate for Payer: Aetna Medicare |
$584.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$584.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,018.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,108.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$672.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$643.48
|
| Rate for Payer: Cash Price |
$1,099.06
|
| Rate for Payer: Cash Price |
$1,099.06
|
| Rate for Payer: Centivo All Commercial |
$904.07
|
| Rate for Payer: Cigna All Commercial |
$1,529.82
|
| Rate for Payer: CORVEL All Commercial |
$1,648.59
|
| Rate for Payer: Coventry All Commercial |
$1,559.96
|
| Rate for Payer: Encore All Commercial |
$1,631.75
|
| Rate for Payer: Frontpath All Commercial |
$1,630.87
|
| Rate for Payer: Humana ChoiceCare |
$1,531.06
|
| Rate for Payer: Humana Medicare |
$904.07
|
| Rate for Payer: Lucent All Commercial |
$904.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,595.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,329.51
|
| Rate for Payer: PHP All Commercial |
$1,344.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$691.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,368.51
|
| Rate for Payer: Signature Care EPO |
$1,471.32
|
| Rate for Payer: Signature Care PPO |
$1,559.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,506.78
|
| Rate for Payer: United Healthcare Commercial |
$1,396.87
|
| Rate for Payer: United Healthcare Medicare |
$584.98
|
|
|
HC INTERCEED ADHESION BARRIER 5X6
|
Facility
IP
|
$1,772.68
|
|
| Hospital Charge Code |
41602494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,329.51 |
| Max. Negotiated Rate |
$1,648.59 |
| Rate for Payer: Aetna Commercial |
$1,531.60
|
| Rate for Payer: Cash Price |
$1,099.06
|
| Rate for Payer: Cigna All Commercial |
$1,529.82
|
| Rate for Payer: CORVEL All Commercial |
$1,648.59
|
| Rate for Payer: Coventry All Commercial |
$1,559.96
|
| Rate for Payer: Encore All Commercial |
$1,631.75
|
| Rate for Payer: Frontpath All Commercial |
$1,630.87
|
| Rate for Payer: Humana ChoiceCare |
$1,531.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,595.41
|
| Rate for Payer: PHCS All Commercial |
$1,329.51
|
| Rate for Payer: PHP All Commercial |
$1,344.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,368.51
|
| Rate for Payer: Signature Care EPO |
$1,471.32
|
| Rate for Payer: Signature Care PPO |
$1,559.96
|
| Rate for Payer: United Healthcare Commercial |
$1,396.87
|
|
|
HC INTERJECT NEEDLE
|
Facility
OP
|
$217.77
|
|
| Hospital Charge Code |
41608207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$202.53 |
| Rate for Payer: Aetna Commercial |
$183.80
|
| Rate for Payer: Aetna Medicare |
$71.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.05
|
| Rate for Payer: Cash Price |
$135.02
|
| Rate for Payer: Cash Price |
$135.02
|
| Rate for Payer: Centivo All Commercial |
$111.06
|
| Rate for Payer: Cigna All Commercial |
$187.94
|
| Rate for Payer: CORVEL All Commercial |
$202.53
|
| Rate for Payer: Coventry All Commercial |
$191.64
|
| Rate for Payer: Encore All Commercial |
$200.46
|
| Rate for Payer: Frontpath All Commercial |
$200.35
|
| Rate for Payer: Humana ChoiceCare |
$188.09
|
| Rate for Payer: Humana Medicare |
$111.06
|
| Rate for Payer: Lucent All Commercial |
$111.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.99
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$163.33
|
| Rate for Payer: PHP All Commercial |
$165.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.93
|
| Rate for Payer: Sagamore Health Network All Products |
$168.12
|
| Rate for Payer: Signature Care EPO |
$180.75
|
| Rate for Payer: Signature Care PPO |
$191.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.10
|
| Rate for Payer: United Healthcare Commercial |
$171.60
|
| Rate for Payer: United Healthcare Medicare |
$71.86
|
|
|
HC INTERJECT NEEDLE
|
Facility
IP
|
$217.77
|
|
| Hospital Charge Code |
41608207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.33 |
| Max. Negotiated Rate |
$202.53 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Cash Price |
$135.02
|
| Rate for Payer: Cigna All Commercial |
$187.94
|
| Rate for Payer: CORVEL All Commercial |
$202.53
|
| Rate for Payer: Coventry All Commercial |
$191.64
|
| Rate for Payer: Encore All Commercial |
$200.46
|
| Rate for Payer: Frontpath All Commercial |
$200.35
|
| Rate for Payer: Humana ChoiceCare |
$188.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.99
|
| Rate for Payer: PHCS All Commercial |
$163.33
|
| Rate for Payer: PHP All Commercial |
$165.16
|
| Rate for Payer: Sagamore Health Network All Products |
$168.12
|
| Rate for Payer: Signature Care EPO |
$180.75
|
| Rate for Payer: Signature Care PPO |
$191.64
|
| Rate for Payer: United Healthcare Commercial |
$171.60
|
|
|
HC INTERLEUKIN 6 BY MAFD
|
Facility
IP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.61 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$188.48
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
HC INTERLEUKIN 6 BY MAFD
|
Facility
OP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$184.12
|
| Rate for Payer: Aetna Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.19
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Centivo All Commercial |
$111.26
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Humana Medicare |
$111.26
|
| Rate for Payer: Lucent All Commercial |
$111.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.08
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.43
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$71.99
|
|
|
HC INTERPHASE IN SITU >100C
|
Facility
OP
|
$910.06
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002090
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$846.36 |
| Rate for Payer: Aetna Commercial |
$768.09
|
| Rate for Payer: Aetna Medicare |
$300.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$522.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$51.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$345.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$330.35
|
| Rate for Payer: Cash Price |
$564.24
|
| Rate for Payer: Cash Price |
$564.24
|
| Rate for Payer: Centivo All Commercial |
$464.13
|
| Rate for Payer: Cigna All Commercial |
$785.39
|
| Rate for Payer: CORVEL All Commercial |
$846.36
|
| Rate for Payer: Coventry All Commercial |
$800.86
|
| Rate for Payer: Encore All Commercial |
$837.71
|
| Rate for Payer: Frontpath All Commercial |
$837.26
|
| Rate for Payer: Humana ChoiceCare |
$786.02
|
| Rate for Payer: Humana Medicare |
$464.13
|
| Rate for Payer: Lucent All Commercial |
$464.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$819.06
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: MDWise Medicaid |
$51.19
|
| Rate for Payer: PHCS All Commercial |
$682.55
|
| Rate for Payer: PHP All Commercial |
$690.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$354.93
|
| Rate for Payer: Sagamore Health Network All Products |
$702.57
|
| Rate for Payer: Signature Care EPO |
$755.35
|
| Rate for Payer: Signature Care PPO |
$800.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$773.55
|
| Rate for Payer: United Healthcare Commercial |
$717.13
|
| Rate for Payer: United Healthcare Medicare |
$300.32
|
|
|
HC INTERPHASE IN SITU >100C
|
Facility
IP
|
$910.06
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002090
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$682.55 |
| Max. Negotiated Rate |
$846.36 |
| Rate for Payer: Aetna Commercial |
$786.30
|
| Rate for Payer: Cash Price |
$564.24
|
| Rate for Payer: Cigna All Commercial |
$785.39
|
| Rate for Payer: CORVEL All Commercial |
$846.36
|
| Rate for Payer: Coventry All Commercial |
$800.86
|
| Rate for Payer: Encore All Commercial |
$837.71
|
| Rate for Payer: Frontpath All Commercial |
$837.26
|
| Rate for Payer: Humana ChoiceCare |
$786.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$819.06
|
| Rate for Payer: PHCS All Commercial |
$682.55
|
| Rate for Payer: PHP All Commercial |
$690.19
|
| Rate for Payer: Sagamore Health Network All Products |
$702.57
|
| Rate for Payer: Signature Care EPO |
$755.35
|
| Rate for Payer: Signature Care PPO |
$800.86
|
| Rate for Payer: United Healthcare Commercial |
$717.13
|
|
