|
HC INDIV THERAPY - SP
|
Facility
|
IP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1742507
|
|
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 - SP
|
Facility
|
OP
|
$316.51
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
1742507
|
|
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 INFLUENZA A
|
Facility
|
OP
|
$64.85
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
63002032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$54.73
|
| Rate for Payer: Aetna Medicare |
$20.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.83
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Centivo All Commercial |
$35.28
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.69
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Humana Medicare |
$20.75
|
| Rate for Payer: Lucent All Commercial |
$35.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: Managed Health Services Medicaid |
$14.13
|
| Rate for Payer: MDWise Medicaid |
$14.13
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.29
|
| Rate for Payer: Sagamore Health Network All Products |
$50.06
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.12
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
| Rate for Payer: United Healthcare Medicare |
$20.75
|
|
|
HC INFLUENZA A
|
Facility
|
IP
|
$64.85
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
63002032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$56.03
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.69
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Sagamore Health Network All Products |
$50.06
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
|
|
HC INFLUENZA B
|
Facility
|
IP
|
$64.85
|
|
|
Service Code
|
CPT 87400 59
|
| Hospital Charge Code |
63002153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$56.03
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.69
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Sagamore Health Network All Products |
$50.06
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
|
|
HC INFLUENZA B
|
Facility
|
OP
|
$64.85
|
|
|
Service Code
|
CPT 87400 59
|
| Hospital Charge Code |
63002153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$60.31 |
| Rate for Payer: Aetna Commercial |
$54.73
|
| Rate for Payer: Aetna Medicare |
$20.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.83
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Centivo All Commercial |
$35.28
|
| Rate for Payer: Cigna All Commercial |
$55.97
|
| Rate for Payer: CORVEL All Commercial |
$60.31
|
| Rate for Payer: Coventry All Commercial |
$57.07
|
| Rate for Payer: Encore All Commercial |
$59.69
|
| Rate for Payer: Frontpath All Commercial |
$59.66
|
| Rate for Payer: Humana ChoiceCare |
$56.01
|
| Rate for Payer: Humana Medicare |
$20.75
|
| Rate for Payer: Lucent All Commercial |
$35.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.37
|
| Rate for Payer: Managed Health Services Medicaid |
$14.13
|
| Rate for Payer: MDWise Medicaid |
$14.13
|
| Rate for Payer: PHCS All Commercial |
$48.64
|
| Rate for Payer: PHP All Commercial |
$49.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.29
|
| Rate for Payer: Sagamore Health Network All Products |
$50.06
|
| Rate for Payer: Signature Care EPO |
$53.83
|
| Rate for Payer: Signature Care PPO |
$57.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.12
|
| Rate for Payer: United Healthcare Commercial |
$51.10
|
| Rate for Payer: United Healthcare Medicare |
$20.75
|
|
|
HC INFUSAPORT DRAW
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
520001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC INFUSAPORT DRAW
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
1266591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC INFUSAPORT DRAW
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
1266591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.33 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.01
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Centivo All Commercial |
$86.56
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$50.92
|
| Rate for Payer: Lucent All Commercial |
$86.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$50.92
|
|
|
HC INFUSAPORT DRAW
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
520001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.33 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.01
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Centivo All Commercial |
$86.56
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$50.92
|
| Rate for Payer: Lucent All Commercial |
$86.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$50.92
|
|
|
HC INFUSAPORT POWER PAC II
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT A4301
|
| Hospital Charge Code |
41601922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,223.80
|
| Rate for Payer: Aetna Medicare |
$464.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$449.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$832.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$533.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$510.40
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Centivo All Commercial |
$788.80
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.37
|
| Rate for Payer: Humana Medicare |
$464.00
|
| Rate for Payer: Lucent All Commercial |
$788.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
| Rate for Payer: United Healthcare Medicare |
$464.00
|
|
|
HC INFUSAPORT POWER PAC II
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT A4301
|
| Hospital Charge Code |
41601922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,252.80
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
|
|
HC INFUSOR PRESSURE DISP 1000ML
|
Facility
|
OP
|
$59.83
|
|
| Hospital Charge Code |
41601228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$55.64 |
| Rate for Payer: Aetna Commercial |
$50.50
|
| Rate for Payer: Aetna Medicare |
$19.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.06
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Centivo All Commercial |
$32.55
|
| Rate for Payer: Cigna All Commercial |
$51.63
|
| Rate for Payer: CORVEL All Commercial |
$55.64
|
| Rate for Payer: Coventry All Commercial |
$52.65
|
| Rate for Payer: Encore All Commercial |
$55.07
|
| Rate for Payer: Frontpath All Commercial |
$55.04
|
| Rate for Payer: Humana ChoiceCare |
$51.68
|
| Rate for Payer: Humana Medicare |
$19.15
|
| Rate for Payer: Lucent All Commercial |
$32.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.85
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$44.87
|
| Rate for Payer: PHP All Commercial |
$45.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.33
|
| Rate for Payer: Sagamore Health Network All Products |
$46.19
|
| Rate for Payer: Signature Care EPO |
$49.66
|
| Rate for Payer: Signature Care PPO |
$52.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.86
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
| Rate for Payer: United Healthcare Medicare |
$19.15
|
|
|
HC INFUSOR PRESSURE DISP 1000ML
|
Facility
|
IP
|
$59.83
|
|
| Hospital Charge Code |
41601228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.87 |
| Max. Negotiated Rate |
$55.64 |
| Rate for Payer: Aetna Commercial |
$51.69
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cigna All Commercial |
$51.63
|
| Rate for Payer: CORVEL All Commercial |
$55.64
|
| Rate for Payer: Coventry All Commercial |
$52.65
|
| Rate for Payer: Encore All Commercial |
$55.07
|
| Rate for Payer: Frontpath All Commercial |
$55.04
|
| Rate for Payer: Humana ChoiceCare |
$51.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.85
|
| Rate for Payer: PHCS All Commercial |
$44.87
|
| Rate for Payer: PHP All Commercial |
$45.38
|
| Rate for Payer: Sagamore Health Network All Products |
$46.19
|
| Rate for Payer: Signature Care EPO |
$49.66
|
| Rate for Payer: Signature Care PPO |
$52.65
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
|
|
HC INHALER - SUBSEQUENT
|
Facility
|
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
1706004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
|
|
HC INHALER - SUBSEQUENT
|
Facility
|
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
1706004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$54.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Centivo All Commercial |
$92.12
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Humana Medicare |
$54.19
|
| Rate for Payer: Lucent All Commercial |
$92.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.04
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
| Rate for Payer: United Healthcare Medicare |
$54.19
|
|
|
HC INJ ANKLE ARTHROGRAM LT
|
Facility
|
IP
|
$1,122.00
|
|
| Hospital Charge Code |
1617648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$969.41
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna All Commercial |
$968.29
|
| Rate for Payer: CORVEL All Commercial |
$1,043.46
|
| Rate for Payer: Coventry All Commercial |
$987.36
|
| Rate for Payer: Encore All Commercial |
$1,032.80
|
| Rate for Payer: Frontpath All Commercial |
$1,032.24
|
| Rate for Payer: Humana ChoiceCare |
$969.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.80
|
| Rate for Payer: PHCS All Commercial |
$841.50
|
| Rate for Payer: PHP All Commercial |
$850.92
|
| Rate for Payer: Sagamore Health Network All Products |
$866.18
|
| Rate for Payer: Signature Care EPO |
$931.26
|
| Rate for Payer: Signature Care PPO |
$987.36
|
| Rate for Payer: United Healthcare Commercial |
$884.14
|
|
|
HC INJ ANKLE ARTHROGRAM LT
|
Facility
|
OP
|
$1,122.00
|
|
| Hospital Charge Code |
1617648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.82 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$946.97
|
| Rate for Payer: Aetna Medicare |
$359.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$347.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$644.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$701.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$412.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$394.94
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Centivo All Commercial |
$610.37
|
| Rate for Payer: Cigna All Commercial |
$968.29
|
| Rate for Payer: CORVEL All Commercial |
$1,043.46
|
| Rate for Payer: Coventry All Commercial |
$987.36
|
| Rate for Payer: Encore All Commercial |
$1,032.80
|
| Rate for Payer: Frontpath All Commercial |
$1,032.24
|
| Rate for Payer: Humana ChoiceCare |
$969.07
|
| Rate for Payer: Humana Medicare |
$359.04
|
| Rate for Payer: Lucent All Commercial |
$610.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.80
|
| Rate for Payer: PHCS All Commercial |
$841.50
|
| Rate for Payer: PHP All Commercial |
$850.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$437.58
|
| Rate for Payer: Sagamore Health Network All Products |
$866.18
|
| Rate for Payer: Signature Care EPO |
$931.26
|
| Rate for Payer: Signature Care PPO |
$987.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$953.70
|
| Rate for Payer: United Healthcare Commercial |
$884.14
|
| Rate for Payer: United Healthcare Medicare |
$359.04
|
|
|
HC INJ CYSTOGRAPHY/VOID URETHCYST
|
Facility
|
OP
|
$1,091.50
|
|
| Hospital Charge Code |
1611600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$1,015.10 |
| Rate for Payer: Aetna Commercial |
$921.23
|
| Rate for Payer: Aetna Medicare |
$349.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$626.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$682.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$401.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$384.21
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Centivo All Commercial |
$593.78
|
| Rate for Payer: Cigna All Commercial |
$941.96
|
| Rate for Payer: CORVEL All Commercial |
$1,015.10
|
| Rate for Payer: Coventry All Commercial |
$960.52
|
| Rate for Payer: Encore All Commercial |
$1,004.73
|
| Rate for Payer: Frontpath All Commercial |
$1,004.18
|
| Rate for Payer: Humana ChoiceCare |
$942.73
|
| Rate for Payer: Humana Medicare |
$349.28
|
| Rate for Payer: Lucent All Commercial |
$593.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$982.35
|
| Rate for Payer: PHCS All Commercial |
$818.62
|
| Rate for Payer: PHP All Commercial |
$827.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.69
|
| Rate for Payer: Sagamore Health Network All Products |
$842.64
|
| Rate for Payer: Signature Care EPO |
$905.95
|
| Rate for Payer: Signature Care PPO |
$960.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$927.77
|
| Rate for Payer: United Healthcare Commercial |
$860.10
|
| Rate for Payer: United Healthcare Medicare |
$349.28
|
|
|
HC INJ CYSTOGRAPHY/VOID URETHCYST
|
Facility
|
IP
|
$1,091.50
|
|
| Hospital Charge Code |
1611600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.62 |
| Max. Negotiated Rate |
$1,015.10 |
| Rate for Payer: Aetna Commercial |
$943.06
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna All Commercial |
$941.96
|
| Rate for Payer: CORVEL All Commercial |
$1,015.10
|
| Rate for Payer: Coventry All Commercial |
$960.52
|
| Rate for Payer: Encore All Commercial |
$1,004.73
|
| Rate for Payer: Frontpath All Commercial |
$1,004.18
|
| Rate for Payer: Humana ChoiceCare |
$942.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$982.35
|
| Rate for Payer: PHCS All Commercial |
$818.62
|
| Rate for Payer: PHP All Commercial |
$827.79
|
| Rate for Payer: Sagamore Health Network All Products |
$842.64
|
| Rate for Payer: Signature Care EPO |
$905.95
|
| Rate for Payer: Signature Care PPO |
$960.52
|
| Rate for Payer: United Healthcare Commercial |
$860.10
|
|
|
HC INJECTION FOR CHOLANGIOGRAM EXIST ACCESS
|
Facility
|
IP
|
$736.03
|
|
| Hospital Charge Code |
1597531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.02 |
| Max. Negotiated Rate |
$684.51 |
| Rate for Payer: Aetna Commercial |
$635.93
|
| Rate for Payer: Cash Price |
$441.62
|
| Rate for Payer: Cigna All Commercial |
$635.19
|
| Rate for Payer: CORVEL All Commercial |
$684.51
|
| Rate for Payer: Coventry All Commercial |
$647.71
|
| Rate for Payer: Encore All Commercial |
$677.52
|
| Rate for Payer: Frontpath All Commercial |
$677.15
|
| Rate for Payer: Humana ChoiceCare |
$635.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.43
|
| Rate for Payer: PHCS All Commercial |
$552.02
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.90
|
| Rate for Payer: Signature Care PPO |
$647.71
|
| Rate for Payer: United Healthcare Commercial |
$579.99
|
|
|
HC INJECTION FOR CHOLANGIOGRAM EXIST ACCESS
|
Facility
|
OP
|
$736.03
|
|
| Hospital Charge Code |
1597531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.17 |
| Max. Negotiated Rate |
$684.51 |
| Rate for Payer: Aetna Commercial |
$621.21
|
| Rate for Payer: Aetna Medicare |
$235.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$228.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$422.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$460.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$259.08
|
| Rate for Payer: Cash Price |
$441.62
|
| Rate for Payer: Centivo All Commercial |
$400.40
|
| Rate for Payer: Cigna All Commercial |
$635.19
|
| Rate for Payer: CORVEL All Commercial |
$684.51
|
| Rate for Payer: Coventry All Commercial |
$647.71
|
| Rate for Payer: Encore All Commercial |
$677.52
|
| Rate for Payer: Frontpath All Commercial |
$677.15
|
| Rate for Payer: Humana ChoiceCare |
$635.71
|
| Rate for Payer: Humana Medicare |
$235.53
|
| Rate for Payer: Lucent All Commercial |
$400.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.43
|
| Rate for Payer: PHCS All Commercial |
$552.02
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$287.05
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.90
|
| Rate for Payer: Signature Care PPO |
$647.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$625.63
|
| Rate for Payer: United Healthcare Commercial |
$579.99
|
| Rate for Payer: United Healthcare Medicare |
$235.53
|
|
|
HC INJ ELBOW ARTHROGRAM LT
|
Facility
|
IP
|
$589.82
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
1614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$442.37 |
| Max. Negotiated Rate |
$548.53 |
| Rate for Payer: Aetna Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$353.89
|
| Rate for Payer: Cigna All Commercial |
$509.01
|
| Rate for Payer: CORVEL All Commercial |
$548.53
|
| Rate for Payer: Coventry All Commercial |
$519.04
|
| Rate for Payer: Encore All Commercial |
$542.93
|
| Rate for Payer: Frontpath All Commercial |
$542.63
|
| Rate for Payer: Humana ChoiceCare |
$509.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.84
|
| Rate for Payer: PHCS All Commercial |
$442.37
|
| Rate for Payer: PHP All Commercial |
$447.32
|
| Rate for Payer: Sagamore Health Network All Products |
$455.34
|
| Rate for Payer: Signature Care EPO |
$489.55
|
| Rate for Payer: Signature Care PPO |
$519.04
|
| Rate for Payer: United Healthcare Commercial |
$464.78
|
|
|
HC INJ ELBOW ARTHROGRAM LT
|
Facility
|
OP
|
$589.82
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
1614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$548.53 |
| Rate for Payer: Aetna Commercial |
$497.81
|
| Rate for Payer: Aetna Medicare |
$188.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$368.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$217.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$207.62
|
| Rate for Payer: Cash Price |
$353.89
|
| Rate for Payer: Cash Price |
$353.89
|
| Rate for Payer: Centivo All Commercial |
$320.86
|
| Rate for Payer: Cigna All Commercial |
$509.01
|
| Rate for Payer: CORVEL All Commercial |
$548.53
|
| Rate for Payer: Coventry All Commercial |
$519.04
|
| Rate for Payer: Encore All Commercial |
$542.93
|
| Rate for Payer: Frontpath All Commercial |
$542.63
|
| Rate for Payer: Humana ChoiceCare |
$509.43
|
| Rate for Payer: Humana Medicare |
$188.74
|
| Rate for Payer: Lucent All Commercial |
$320.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.84
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$442.37
|
| Rate for Payer: PHP All Commercial |
$447.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.03
|
| Rate for Payer: Sagamore Health Network All Products |
$455.34
|
| Rate for Payer: Signature Care EPO |
$489.55
|
| Rate for Payer: Signature Care PPO |
$519.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$501.35
|
| Rate for Payer: United Healthcare Commercial |
$464.78
|
| Rate for Payer: United Healthcare Medicare |
$188.74
|
|
|
HC INJ ELBOW ARTHROGRAM RT
|
Facility
|
OP
|
$589.82
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
11614229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$548.53 |
| Rate for Payer: Aetna Commercial |
$497.81
|
| Rate for Payer: Aetna Medicare |
$188.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$368.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$217.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$207.62
|
| Rate for Payer: Cash Price |
$353.89
|
| Rate for Payer: Cash Price |
$353.89
|
| Rate for Payer: Centivo All Commercial |
$320.86
|
| Rate for Payer: Cigna All Commercial |
$509.01
|
| Rate for Payer: CORVEL All Commercial |
$548.53
|
| Rate for Payer: Coventry All Commercial |
$519.04
|
| Rate for Payer: Encore All Commercial |
$542.93
|
| Rate for Payer: Frontpath All Commercial |
$542.63
|
| Rate for Payer: Humana ChoiceCare |
$509.43
|
| Rate for Payer: Humana Medicare |
$188.74
|
| Rate for Payer: Lucent All Commercial |
$320.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.84
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$442.37
|
| Rate for Payer: PHP All Commercial |
$447.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.03
|
| Rate for Payer: Sagamore Health Network All Products |
$455.34
|
| Rate for Payer: Signature Care EPO |
$489.55
|
| Rate for Payer: Signature Care PPO |
$519.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$501.35
|
| Rate for Payer: United Healthcare Commercial |
$464.78
|
| Rate for Payer: United Healthcare Medicare |
$188.74
|
|
