|
HC IMMUNO MULTIPLE STEP
|
Facility
|
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna Commercial |
$112.03
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.59
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.70
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC IMMUNO MULTIPLE STEP - EA
|
Facility
|
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna Commercial |
$112.03
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.59
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.70
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC IMMUNO MULTIPLE STEP - EA
|
Facility
|
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$41.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.64
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Centivo All Commercial |
$70.54
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.59
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$41.49
|
| Rate for Payer: Lucent All Commercial |
$70.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.70
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$41.49
|
|
|
HC IMMUNO NONANTBY GI DISTRESS CH
|
Facility
|
OP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Medicare |
$33.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.16
|
| Rate for Payer: Cash Price |
$63.34
|
| Rate for Payer: Cash Price |
$63.34
|
| Rate for Payer: Centivo All Commercial |
$57.43
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Humana Medicare |
$33.78
|
| Rate for Payer: Lucent All Commercial |
$57.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.17
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.73
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
| Rate for Payer: United Healthcare Medicare |
$33.78
|
|
|
HC IMMUNO NONANTBY GI DISTRESS CH
|
Facility
|
IP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.18 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$91.21
|
| Rate for Payer: Cash Price |
$63.34
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
|
|
HC IMMUNOPEROXIDASE EA AB
|
Facility
|
IP
|
$483.99
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
63001271
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$362.99 |
| Max. Negotiated Rate |
$450.11 |
| Rate for Payer: Aetna Commercial |
$418.17
|
| Rate for Payer: Cash Price |
$290.39
|
| Rate for Payer: Cigna All Commercial |
$417.68
|
| Rate for Payer: CORVEL All Commercial |
$450.11
|
| Rate for Payer: Coventry All Commercial |
$425.91
|
| Rate for Payer: Encore All Commercial |
$445.51
|
| Rate for Payer: Frontpath All Commercial |
$445.27
|
| Rate for Payer: Humana ChoiceCare |
$418.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.59
|
| Rate for Payer: PHCS All Commercial |
$362.99
|
| Rate for Payer: PHP All Commercial |
$367.06
|
| Rate for Payer: Sagamore Health Network All Products |
$373.64
|
| Rate for Payer: Signature Care EPO |
$401.71
|
| Rate for Payer: Signature Care PPO |
$425.91
|
| Rate for Payer: United Healthcare Commercial |
$381.38
|
|
|
HC IMMUNOPEROXIDASE EA AB
|
Facility
|
OP
|
$483.99
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
63001271
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$450.11 |
| Rate for Payer: Aetna Commercial |
$408.49
|
| Rate for Payer: Aetna Medicare |
$154.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$222.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.36
|
| Rate for Payer: Cash Price |
$290.39
|
| Rate for Payer: Cash Price |
$290.39
|
| Rate for Payer: Centivo All Commercial |
$263.29
|
| Rate for Payer: Cigna All Commercial |
$417.68
|
| Rate for Payer: CORVEL All Commercial |
$450.11
|
| Rate for Payer: Coventry All Commercial |
$425.91
|
| Rate for Payer: Encore All Commercial |
$445.51
|
| Rate for Payer: Frontpath All Commercial |
$445.27
|
| Rate for Payer: Humana ChoiceCare |
$418.02
|
| Rate for Payer: Humana Medicare |
$154.88
|
| Rate for Payer: Lucent All Commercial |
$263.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.59
|
| Rate for Payer: Managed Health Services Medicaid |
$41.27
|
| Rate for Payer: MDWise Medicaid |
$41.27
|
| Rate for Payer: PHCS All Commercial |
$362.99
|
| Rate for Payer: PHP All Commercial |
$367.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.76
|
| Rate for Payer: Sagamore Health Network All Products |
$373.64
|
| Rate for Payer: Signature Care EPO |
$401.71
|
| Rate for Payer: Signature Care PPO |
$425.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$411.39
|
| Rate for Payer: United Healthcare Commercial |
$381.38
|
| Rate for Payer: United Healthcare Medicare |
$154.88
|
|
|
HC IMMUNOPEROXIDASE EA STAIN CH
|
Facility
|
OP
|
$245.87
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
63001270
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.22 |
| Max. Negotiated Rate |
$228.66 |
| Rate for Payer: Aetna Commercial |
$207.51
|
| Rate for Payer: Aetna Medicare |
$78.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$113.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.55
|
| Rate for Payer: Cash Price |
$147.52
|
| Rate for Payer: Centivo All Commercial |
$133.75
|
| Rate for Payer: Cigna All Commercial |
$212.19
|
| Rate for Payer: CORVEL All Commercial |
$228.66
|
| Rate for Payer: Coventry All Commercial |
$216.37
|
| Rate for Payer: Encore All Commercial |
$226.32
|
| Rate for Payer: Frontpath All Commercial |
$226.20
|
| Rate for Payer: Humana ChoiceCare |
$212.36
|
| Rate for Payer: Humana Medicare |
$78.68
|
| Rate for Payer: Lucent All Commercial |
$133.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.28
|
| Rate for Payer: PHCS All Commercial |
$184.40
|
| Rate for Payer: PHP All Commercial |
$186.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.89
|
| Rate for Payer: Sagamore Health Network All Products |
$189.81
|
| Rate for Payer: Signature Care EPO |
$204.07
|
| Rate for Payer: Signature Care PPO |
$216.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.99
|
| Rate for Payer: United Healthcare Commercial |
$193.75
|
| Rate for Payer: United Healthcare Medicare |
$78.68
|
|
|
HC IMMUNOPEROXIDASE EA STAIN CH
|
Facility
|
IP
|
$245.87
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
63001270
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$228.66 |
| Rate for Payer: Aetna Commercial |
$212.43
|
| Rate for Payer: Cash Price |
$147.52
|
| Rate for Payer: Cigna All Commercial |
$212.19
|
| Rate for Payer: CORVEL All Commercial |
$228.66
|
| Rate for Payer: Coventry All Commercial |
$216.37
|
| Rate for Payer: Encore All Commercial |
$226.32
|
| Rate for Payer: Frontpath All Commercial |
$226.20
|
| Rate for Payer: Humana ChoiceCare |
$212.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.28
|
| Rate for Payer: PHCS All Commercial |
$184.40
|
| Rate for Payer: PHP All Commercial |
$186.47
|
| Rate for Payer: Sagamore Health Network All Products |
$189.81
|
| Rate for Payer: Signature Care EPO |
$204.07
|
| Rate for Payer: Signature Care PPO |
$216.37
|
| Rate for Payer: United Healthcare Commercial |
$193.75
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR COMPELX
|
Facility
|
IP
|
$6,364.80
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
1547386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,773.60 |
| Max. Negotiated Rate |
$5,919.26 |
| Rate for Payer: Aetna Commercial |
$5,499.19
|
| Rate for Payer: Cash Price |
$3,818.88
|
| Rate for Payer: Cigna All Commercial |
$5,492.82
|
| Rate for Payer: CORVEL All Commercial |
$5,919.26
|
| Rate for Payer: Coventry All Commercial |
$5,601.02
|
| Rate for Payer: Encore All Commercial |
$5,858.80
|
| Rate for Payer: Frontpath All Commercial |
$5,855.62
|
| Rate for Payer: Humana ChoiceCare |
$5,497.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,728.32
|
| Rate for Payer: PHCS All Commercial |
$4,773.60
|
| Rate for Payer: PHP All Commercial |
$4,827.06
|
| Rate for Payer: Sagamore Health Network All Products |
$4,913.63
|
| Rate for Payer: Signature Care EPO |
$5,282.78
|
| Rate for Payer: Signature Care PPO |
$5,601.02
|
| Rate for Payer: United Healthcare Commercial |
$5,015.46
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR COMPELX
|
Facility
|
OP
|
$6,364.80
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
1547386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$507.55 |
| Max. Negotiated Rate |
$5,919.26 |
| Rate for Payer: Aetna Commercial |
$5,371.89
|
| Rate for Payer: Aetna Medicare |
$2,036.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$507.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,973.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,655.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,978.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$507.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,342.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,240.41
|
| Rate for Payer: Cash Price |
$3,818.88
|
| Rate for Payer: Cash Price |
$3,818.88
|
| Rate for Payer: Centivo All Commercial |
$3,462.45
|
| Rate for Payer: Cigna All Commercial |
$5,492.82
|
| Rate for Payer: CORVEL All Commercial |
$5,919.26
|
| Rate for Payer: Coventry All Commercial |
$5,601.02
|
| Rate for Payer: Encore All Commercial |
$5,858.80
|
| Rate for Payer: Frontpath All Commercial |
$5,855.62
|
| Rate for Payer: Humana ChoiceCare |
$5,497.28
|
| Rate for Payer: Humana Medicare |
$2,036.74
|
| Rate for Payer: Lucent All Commercial |
$3,462.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,728.32
|
| Rate for Payer: Managed Health Services Medicaid |
$507.55
|
| Rate for Payer: MDWise Medicaid |
$507.55
|
| Rate for Payer: PHCS All Commercial |
$4,773.60
|
| Rate for Payer: PHP All Commercial |
$4,827.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,482.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4,913.63
|
| Rate for Payer: Signature Care EPO |
$5,282.78
|
| Rate for Payer: Signature Care PPO |
$5,601.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,410.08
|
| Rate for Payer: United Healthcare Commercial |
$5,015.46
|
| Rate for Payer: United Healthcare Medicare |
$2,036.74
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR SIMPLE
|
Facility
|
IP
|
$5,304.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
1547385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,978.00 |
| Max. Negotiated Rate |
$4,932.72 |
| Rate for Payer: Aetna Commercial |
$4,582.66
|
| Rate for Payer: Cash Price |
$3,182.40
|
| Rate for Payer: Cigna All Commercial |
$4,577.35
|
| Rate for Payer: CORVEL All Commercial |
$4,932.72
|
| Rate for Payer: Coventry All Commercial |
$4,667.52
|
| Rate for Payer: Encore All Commercial |
$4,882.33
|
| Rate for Payer: Frontpath All Commercial |
$4,879.68
|
| Rate for Payer: Humana ChoiceCare |
$4,581.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,773.60
|
| Rate for Payer: PHCS All Commercial |
$3,978.00
|
| Rate for Payer: PHP All Commercial |
$4,022.55
|
| Rate for Payer: Sagamore Health Network All Products |
$4,094.69
|
| Rate for Payer: Signature Care EPO |
$4,402.32
|
| Rate for Payer: Signature Care PPO |
$4,667.52
|
| Rate for Payer: United Healthcare Commercial |
$4,179.55
|
|
|
HC IMRT NTSTY MODUL RAD TX DLVR SIMPLE
|
Facility
|
OP
|
$5,304.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
1547385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$507.55 |
| Max. Negotiated Rate |
$4,932.72 |
| Rate for Payer: Aetna Commercial |
$4,476.58
|
| Rate for Payer: Aetna Medicare |
$1,697.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$507.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,644.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,046.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,315.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$507.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,951.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,867.01
|
| Rate for Payer: Cash Price |
$3,182.40
|
| Rate for Payer: Cash Price |
$3,182.40
|
| Rate for Payer: Centivo All Commercial |
$2,885.38
|
| Rate for Payer: Cigna All Commercial |
$4,577.35
|
| Rate for Payer: CORVEL All Commercial |
$4,932.72
|
| Rate for Payer: Coventry All Commercial |
$4,667.52
|
| Rate for Payer: Encore All Commercial |
$4,882.33
|
| Rate for Payer: Frontpath All Commercial |
$4,879.68
|
| Rate for Payer: Humana ChoiceCare |
$4,581.06
|
| Rate for Payer: Humana Medicare |
$1,697.28
|
| Rate for Payer: Lucent All Commercial |
$2,885.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,773.60
|
| Rate for Payer: Managed Health Services Medicaid |
$507.55
|
| Rate for Payer: MDWise Medicaid |
$507.55
|
| Rate for Payer: PHCS All Commercial |
$3,978.00
|
| Rate for Payer: PHP All Commercial |
$4,022.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,068.56
|
| Rate for Payer: Sagamore Health Network All Products |
$4,094.69
|
| Rate for Payer: Signature Care EPO |
$4,402.32
|
| Rate for Payer: Signature Care PPO |
$4,667.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,508.40
|
| Rate for Payer: United Healthcare Commercial |
$4,179.55
|
| Rate for Payer: United Healthcare Medicare |
$1,697.28
|
|
|
HC IMRT PLANNING
|
Facility
|
OP
|
$11,668.80
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
1547301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,066.66 |
| Max. Negotiated Rate |
$10,851.98 |
| Rate for Payer: Aetna Commercial |
$9,848.47
|
| Rate for Payer: Aetna Medicare |
$3,734.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,066.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,617.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,701.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,294.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,066.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,294.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,107.42
|
| Rate for Payer: Cash Price |
$7,001.28
|
| Rate for Payer: Cash Price |
$7,001.28
|
| Rate for Payer: Centivo All Commercial |
$6,347.83
|
| Rate for Payer: Cigna All Commercial |
$10,070.17
|
| Rate for Payer: CORVEL All Commercial |
$10,851.98
|
| Rate for Payer: Coventry All Commercial |
$10,268.54
|
| Rate for Payer: Encore All Commercial |
$10,741.13
|
| Rate for Payer: Frontpath All Commercial |
$10,735.30
|
| Rate for Payer: Humana ChoiceCare |
$10,078.34
|
| Rate for Payer: Humana Medicare |
$3,734.02
|
| Rate for Payer: Lucent All Commercial |
$6,347.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,501.92
|
| Rate for Payer: Managed Health Services Medicaid |
$1,066.66
|
| Rate for Payer: MDWise Medicaid |
$1,066.66
|
| Rate for Payer: PHCS All Commercial |
$8,751.60
|
| Rate for Payer: PHP All Commercial |
$8,849.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,550.83
|
| Rate for Payer: Sagamore Health Network All Products |
$9,008.31
|
| Rate for Payer: Signature Care EPO |
$9,685.10
|
| Rate for Payer: Signature Care PPO |
$10,268.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,918.48
|
| Rate for Payer: United Healthcare Commercial |
$9,195.01
|
| Rate for Payer: United Healthcare Medicare |
$3,734.02
|
|
|
HC IMRT PLANNING
|
Facility
|
IP
|
$11,668.80
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
1547301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$8,751.60 |
| Max. Negotiated Rate |
$10,851.98 |
| Rate for Payer: Aetna Commercial |
$10,081.84
|
| Rate for Payer: Cash Price |
$7,001.28
|
| Rate for Payer: Cigna All Commercial |
$10,070.17
|
| Rate for Payer: CORVEL All Commercial |
$10,851.98
|
| Rate for Payer: Coventry All Commercial |
$10,268.54
|
| Rate for Payer: Encore All Commercial |
$10,741.13
|
| Rate for Payer: Frontpath All Commercial |
$10,735.30
|
| Rate for Payer: Humana ChoiceCare |
$10,078.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,501.92
|
| Rate for Payer: PHCS All Commercial |
$8,751.60
|
| Rate for Payer: PHP All Commercial |
$8,849.62
|
| Rate for Payer: Sagamore Health Network All Products |
$9,008.31
|
| Rate for Payer: Signature Care EPO |
$9,685.10
|
| Rate for Payer: Signature Care PPO |
$10,268.54
|
| Rate for Payer: United Healthcare Commercial |
$9,195.01
|
|
|
HC INCISION & DRAINAGE KIT
|
Facility
|
OP
|
$89.88
|
|
| Hospital Charge Code |
41601214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$83.59 |
| Rate for Payer: Aetna Commercial |
$75.86
|
| Rate for Payer: Aetna Medicare |
$28.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.64
|
| Rate for Payer: Cash Price |
$53.93
|
| Rate for Payer: Cash Price |
$53.93
|
| Rate for Payer: Centivo All Commercial |
$48.89
|
| Rate for Payer: Cigna All Commercial |
$77.57
|
| Rate for Payer: CORVEL All Commercial |
$83.59
|
| Rate for Payer: Coventry All Commercial |
$79.09
|
| Rate for Payer: Encore All Commercial |
$82.73
|
| Rate for Payer: Frontpath All Commercial |
$82.69
|
| Rate for Payer: Humana ChoiceCare |
$77.63
|
| Rate for Payer: Humana Medicare |
$28.76
|
| Rate for Payer: Lucent All Commercial |
$48.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.89
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$67.41
|
| Rate for Payer: PHP All Commercial |
$68.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.05
|
| Rate for Payer: Sagamore Health Network All Products |
$69.39
|
| Rate for Payer: Signature Care EPO |
$74.60
|
| Rate for Payer: Signature Care PPO |
$79.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.40
|
| Rate for Payer: United Healthcare Commercial |
$70.83
|
| Rate for Payer: United Healthcare Medicare |
$28.76
|
|
|
HC INCISION & DRAINAGE KIT
|
Facility
|
IP
|
$89.88
|
|
| Hospital Charge Code |
41601214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.41 |
| Max. Negotiated Rate |
$83.59 |
| Rate for Payer: Aetna Commercial |
$77.66
|
| Rate for Payer: Cash Price |
$53.93
|
| Rate for Payer: Cigna All Commercial |
$77.57
|
| Rate for Payer: CORVEL All Commercial |
$83.59
|
| Rate for Payer: Coventry All Commercial |
$79.09
|
| Rate for Payer: Encore All Commercial |
$82.73
|
| Rate for Payer: Frontpath All Commercial |
$82.69
|
| Rate for Payer: Humana ChoiceCare |
$77.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.89
|
| Rate for Payer: PHCS All Commercial |
$67.41
|
| Rate for Payer: PHP All Commercial |
$68.16
|
| Rate for Payer: Sagamore Health Network All Products |
$69.39
|
| Rate for Payer: Signature Care EPO |
$74.60
|
| Rate for Payer: Signature Care PPO |
$79.09
|
| Rate for Payer: United Healthcare Commercial |
$70.83
|
|
|
HC INDIV THERAPY-15 MIN-SP
|
Facility
|
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748054
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$101.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.41
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Centivo All Commercial |
$172.18
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$101.28
|
| Rate for Payer: Lucent All Commercial |
$172.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$101.28
|
|
|
HC INDIV THERAPY-15 MIN-SP
|
Facility
|
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748054
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-30 MIN-SP
|
Facility
|
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748055
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$101.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.41
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Centivo All Commercial |
$172.18
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$101.28
|
| Rate for Payer: Lucent All Commercial |
$172.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$101.28
|
|
|
HC INDIV THERAPY-30 MIN-SP
|
Facility
|
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748055
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-45 MIN-SP
|
Facility
|
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748056
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$101.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.41
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Centivo All Commercial |
$172.18
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$101.28
|
| Rate for Payer: Lucent All Commercial |
$172.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$101.28
|
|
|
HC INDIV THERAPY-45 MIN-SP
|
Facility
|
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748056
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-60 MIN-SP
|
Facility
|
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748057
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
|
|
HC INDIV THERAPY-60 MIN-SP
|
Facility
|
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1748057
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$294.35 |
| Rate for Payer: Aetna Commercial |
$267.13
|
| Rate for Payer: Aetna Medicare |
$101.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.41
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Centivo All Commercial |
$172.18
|
| Rate for Payer: Cigna All Commercial |
$273.15
|
| Rate for Payer: CORVEL All Commercial |
$294.35
|
| Rate for Payer: Coventry All Commercial |
$278.53
|
| Rate for Payer: Encore All Commercial |
$291.35
|
| Rate for Payer: Frontpath All Commercial |
$291.19
|
| Rate for Payer: Humana ChoiceCare |
$273.37
|
| Rate for Payer: Humana Medicare |
$101.28
|
| Rate for Payer: Lucent All Commercial |
$172.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.86
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$240.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$244.35
|
| Rate for Payer: Signature Care EPO |
$262.70
|
| Rate for Payer: Signature Care PPO |
$278.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$269.03
|
| Rate for Payer: United Healthcare Commercial |
$249.41
|
| Rate for Payer: United Healthcare Medicare |
$101.28
|
|
