|
HC INJ WRIST ARTHROGRAM RT
|
Facility
|
IP
|
$726.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
11615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.68 |
| Max. Negotiated Rate |
$675.40 |
| Rate for Payer: Aetna Commercial |
$627.47
|
| Rate for Payer: Cash Price |
$435.74
|
| Rate for Payer: Cigna All Commercial |
$626.75
|
| Rate for Payer: CORVEL All Commercial |
$675.40
|
| Rate for Payer: Coventry All Commercial |
$639.09
|
| Rate for Payer: Encore All Commercial |
$668.50
|
| Rate for Payer: Frontpath All Commercial |
$668.14
|
| Rate for Payer: Humana ChoiceCare |
$627.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.62
|
| Rate for Payer: PHCS All Commercial |
$544.68
|
| Rate for Payer: PHP All Commercial |
$550.78
|
| Rate for Payer: Sagamore Health Network All Products |
$560.66
|
| Rate for Payer: Signature Care EPO |
$602.78
|
| Rate for Payer: Signature Care PPO |
$639.09
|
| Rate for Payer: United Healthcare Commercial |
$572.28
|
|
|
HC INJ WRIST ARTHROGRAM RT
|
Facility
|
OP
|
$726.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
11615246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$675.40 |
| Rate for Payer: Aetna Commercial |
$612.95
|
| Rate for Payer: Aetna Medicare |
$232.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$225.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$417.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$453.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.64
|
| Rate for Payer: Cash Price |
$435.74
|
| Rate for Payer: Cash Price |
$435.74
|
| Rate for Payer: Centivo All Commercial |
$395.07
|
| Rate for Payer: Cigna All Commercial |
$626.75
|
| Rate for Payer: CORVEL All Commercial |
$675.40
|
| Rate for Payer: Coventry All Commercial |
$639.09
|
| Rate for Payer: Encore All Commercial |
$668.50
|
| Rate for Payer: Frontpath All Commercial |
$668.14
|
| Rate for Payer: Humana ChoiceCare |
$627.25
|
| Rate for Payer: Humana Medicare |
$232.40
|
| Rate for Payer: Lucent All Commercial |
$395.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.62
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$544.68
|
| Rate for Payer: PHP All Commercial |
$550.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.23
|
| Rate for Payer: Sagamore Health Network All Products |
$560.66
|
| Rate for Payer: Signature Care EPO |
$602.78
|
| Rate for Payer: Signature Care PPO |
$639.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$617.30
|
| Rate for Payer: United Healthcare Commercial |
$572.28
|
| Rate for Payer: United Healthcare Medicare |
$232.40
|
|
|
HC INS SUPRAPUBIC CATH FOR ASP
|
Facility
|
IP
|
$5,810.50
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
1610102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,357.88 |
| Max. Negotiated Rate |
$5,403.77 |
| Rate for Payer: Aetna Commercial |
$5,020.27
|
| Rate for Payer: Cash Price |
$3,486.30
|
| Rate for Payer: Cigna All Commercial |
$5,014.46
|
| Rate for Payer: CORVEL All Commercial |
$5,403.77
|
| Rate for Payer: Coventry All Commercial |
$5,113.24
|
| Rate for Payer: Encore All Commercial |
$5,348.57
|
| Rate for Payer: Frontpath All Commercial |
$5,345.66
|
| Rate for Payer: Humana ChoiceCare |
$5,018.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,229.45
|
| Rate for Payer: PHCS All Commercial |
$4,357.88
|
| Rate for Payer: PHP All Commercial |
$4,406.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,485.71
|
| Rate for Payer: Signature Care EPO |
$4,822.72
|
| Rate for Payer: Signature Care PPO |
$5,113.24
|
| Rate for Payer: United Healthcare Commercial |
$4,578.67
|
|
|
HC INS SUPRAPUBIC CATH FOR ASP
|
Facility
|
OP
|
$5,810.50
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
1610102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$5,403.77 |
| Rate for Payer: Aetna Commercial |
$4,904.06
|
| Rate for Payer: Aetna Medicare |
$1,859.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$166.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,801.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,336.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,632.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$166.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,138.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,045.30
|
| Rate for Payer: Cash Price |
$3,486.30
|
| Rate for Payer: Cash Price |
$3,486.30
|
| Rate for Payer: Centivo All Commercial |
$3,160.91
|
| Rate for Payer: Cigna All Commercial |
$5,014.46
|
| Rate for Payer: CORVEL All Commercial |
$5,403.77
|
| Rate for Payer: Coventry All Commercial |
$5,113.24
|
| Rate for Payer: Encore All Commercial |
$5,348.57
|
| Rate for Payer: Frontpath All Commercial |
$5,345.66
|
| Rate for Payer: Humana ChoiceCare |
$5,018.53
|
| Rate for Payer: Humana Medicare |
$1,859.36
|
| Rate for Payer: Lucent All Commercial |
$3,160.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,229.45
|
| Rate for Payer: Managed Health Services Medicaid |
$166.20
|
| Rate for Payer: MDWise Medicaid |
$166.20
|
| Rate for Payer: PHCS All Commercial |
$4,357.88
|
| Rate for Payer: PHP All Commercial |
$4,406.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,266.09
|
| Rate for Payer: Sagamore Health Network All Products |
$4,485.71
|
| Rate for Payer: Signature Care EPO |
$4,822.72
|
| Rate for Payer: Signature Care PPO |
$5,113.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,938.93
|
| Rate for Payer: United Healthcare Commercial |
$4,578.67
|
| Rate for Payer: United Healthcare Medicare |
$1,859.36
|
|
|
HC INST BIOP MONOP 18G X 10CM
|
Facility
|
OP
|
$204.40
|
|
| Hospital Charge Code |
41608069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$172.51
|
| Rate for Payer: Aetna Medicare |
$65.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.95
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Centivo All Commercial |
$111.19
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Humana Medicare |
$65.41
|
| Rate for Payer: Lucent All Commercial |
$111.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.72
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.74
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
| Rate for Payer: United Healthcare Medicare |
$65.41
|
|
|
HC INST BIOP MONOP 18G X 10CM
|
Facility
|
IP
|
$204.40
|
|
| Hospital Charge Code |
41608069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
|
|
HC INST BIOP MONOP 18G X 16CM
|
Facility
|
OP
|
$204.40
|
|
| Hospital Charge Code |
41608071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$172.51
|
| Rate for Payer: Aetna Medicare |
$65.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.95
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Centivo All Commercial |
$111.19
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Humana Medicare |
$65.41
|
| Rate for Payer: Lucent All Commercial |
$111.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.72
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.74
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
| Rate for Payer: United Healthcare Medicare |
$65.41
|
|
|
HC INST BIOP MONOP 18G X 16CM
|
Facility
|
IP
|
$204.40
|
|
| Hospital Charge Code |
41608071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
|
|
HC INST BIOP MONOP 18G X 20CM
|
Facility
|
OP
|
$204.40
|
|
| Hospital Charge Code |
41608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$172.51
|
| Rate for Payer: Aetna Medicare |
$65.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.95
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Centivo All Commercial |
$111.19
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Humana Medicare |
$65.41
|
| Rate for Payer: Lucent All Commercial |
$111.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.72
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.74
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
| Rate for Payer: United Healthcare Medicare |
$65.41
|
|
|
HC INST BIOP MONOP 18G X 20CM
|
Facility
|
IP
|
$204.40
|
|
| Hospital Charge Code |
41608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
|
|
HC INSULIN
|
Facility
|
IP
|
$151.47
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
63001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$130.87
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Cigna All Commercial |
$130.72
|
| Rate for Payer: CORVEL All Commercial |
$140.87
|
| Rate for Payer: Coventry All Commercial |
$133.29
|
| Rate for Payer: Encore All Commercial |
$139.43
|
| Rate for Payer: Frontpath All Commercial |
$139.35
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.32
|
| Rate for Payer: PHCS All Commercial |
$113.60
|
| Rate for Payer: PHP All Commercial |
$114.87
|
| Rate for Payer: Sagamore Health Network All Products |
$116.93
|
| Rate for Payer: Signature Care EPO |
$125.72
|
| Rate for Payer: Signature Care PPO |
$133.29
|
| Rate for Payer: United Healthcare Commercial |
$119.36
|
|
|
HC INSULIN
|
Facility
|
OP
|
$151.47
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
63001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna Medicare |
$48.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$69.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.32
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Centivo All Commercial |
$82.40
|
| Rate for Payer: Cigna All Commercial |
$130.72
|
| Rate for Payer: CORVEL All Commercial |
$140.87
|
| Rate for Payer: Coventry All Commercial |
$133.29
|
| Rate for Payer: Encore All Commercial |
$139.43
|
| Rate for Payer: Frontpath All Commercial |
$139.35
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Humana Medicare |
$48.47
|
| Rate for Payer: Lucent All Commercial |
$82.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.43
|
| Rate for Payer: MDWise Medicaid |
$11.43
|
| Rate for Payer: PHCS All Commercial |
$113.60
|
| Rate for Payer: PHP All Commercial |
$114.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.07
|
| Rate for Payer: Sagamore Health Network All Products |
$116.93
|
| Rate for Payer: Signature Care EPO |
$125.72
|
| Rate for Payer: Signature Care PPO |
$133.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.75
|
| Rate for Payer: United Healthcare Commercial |
$119.36
|
| Rate for Payer: United Healthcare Medicare |
$48.47
|
|
|
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 |
$147.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$212.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$212.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$169.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.54
|
| Rate for Payer: Cash Price |
$277.05
|
| Rate for Payer: Cash Price |
$277.05
|
| Rate for Payer: Centivo All Commercial |
$251.19
|
| 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 |
$398.81
|
| Rate for Payer: Humana Medicare |
$147.76
|
| Rate for Payer: Lucent All Commercial |
$251.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.57
|
| Rate for Payer: Managed Health Services Medicaid |
$21.41
|
| Rate for Payer: MDWise Medicaid |
$21.41
|
| Rate for Payer: PHCS All Commercial |
$346.31
|
| 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 |
$383.25
|
| 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 |
$147.76
|
|
|
HC INSULIN AUTOANTIBODY
|
Facility
|
IP
|
$461.75
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
63001015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$346.31 |
| Max. Negotiated Rate |
$429.43 |
| Rate for Payer: Aetna Commercial |
$398.95
|
| Rate for Payer: Cash Price |
$277.05
|
| 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 |
$398.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.57
|
| Rate for Payer: PHCS All Commercial |
$346.31
|
| Rate for Payer: PHP All Commercial |
$350.19
|
| Rate for Payer: Sagamore Health Network All Products |
$356.47
|
| Rate for Payer: Signature Care EPO |
$383.25
|
| Rate for Payer: Signature Care PPO |
$406.34
|
| Rate for Payer: United Healthcare Commercial |
$363.86
|
|
|
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 |
$20.87
|
| 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 |
$32.01
|
| 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 FREE
|
Facility
|
OP
|
$34.78
|
|
|
Service Code
|
CPT 83527
|
| Hospital Charge Code |
63001613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Aetna Commercial |
$29.35
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.24
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Centivo All Commercial |
$18.92
|
| 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 |
$32.01
|
| Rate for Payer: Frontpath All Commercial |
$32.00
|
| Rate for Payer: Humana ChoiceCare |
$30.04
|
| Rate for Payer: Humana Medicare |
$11.13
|
| Rate for Payer: Lucent All Commercial |
$18.92
|
| 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 |
$11.13
|
|
|
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 |
$218.09 |
| Rate for Payer: Aetna Commercial |
$197.92
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.54
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Centivo All Commercial |
$127.57
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.09
|
| 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 |
$75.04
|
| Rate for Payer: Lucent All Commercial |
$127.57
|
| 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 |
$175.88
|
| 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 |
$184.79
|
| Rate for Payer: United Healthcare Medicare |
$75.04
|
|
|
HC INSULIN-LIKE GROWTH FACTOR
|
Facility
|
IP
|
$234.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
63001680
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.88 |
| Max. Negotiated Rate |
$218.09 |
| Rate for Payer: Aetna Commercial |
$202.61
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.09
|
| 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 |
$175.88
|
| 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 |
$184.79
|
|
|
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 |
$6,636.80 |
| Rate for Payer: Aetna Commercial |
$2,749.59
|
| Rate for Payer: Aetna Medicare |
$3,904.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,864.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,489.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,294.40
|
| Rate for Payer: Cash Price |
$1,909.44
|
| Rate for Payer: Cash Price |
$1,909.44
|
| Rate for Payer: Centivo All Commercial |
$6,636.80
|
| 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 |
$3,904.00
|
| Rate for Payer: Lucent All Commercial |
$6,636.80
|
| 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 |
$3,904.00
|
|
|
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 |
$1,063.61
|
| 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 INTERCEED ADHESION BARRIER 5X6
|
Facility
|
OP
|
$1,772.68
|
|
| Hospital Charge Code |
41602494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,648.59 |
| Rate for Payer: Aetna Commercial |
$1,496.14
|
| Rate for Payer: Aetna Medicare |
$567.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$549.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,018.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,108.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$652.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$623.98
|
| Rate for Payer: Cash Price |
$1,063.61
|
| Rate for Payer: Cash Price |
$1,063.61
|
| Rate for Payer: Centivo All Commercial |
$964.34
|
| 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 |
$567.26
|
| Rate for Payer: Lucent All Commercial |
$964.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,595.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$567.26
|
|
|
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 |
$130.66
|
| 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 INTERJECT NEEDLE
|
Facility
|
OP
|
$217.77
|
|
| Hospital Charge Code |
41608207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$202.53 |
| Rate for Payer: Aetna Commercial |
$183.80
|
| Rate for Payer: Aetna Medicare |
$69.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$125.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.66
|
| Rate for Payer: Cash Price |
$130.66
|
| Rate for Payer: Cash Price |
$130.66
|
| Rate for Payer: Centivo All Commercial |
$118.47
|
| 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 |
$69.69
|
| Rate for Payer: Lucent All Commercial |
$118.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.99
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$69.69
|
|
|
HC INTERPHASE IN SITU >100C
|
Facility
|
IP
|
$910.06
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002090
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$682.54 |
| Max. Negotiated Rate |
$846.36 |
| Rate for Payer: Aetna Commercial |
$786.29
|
| Rate for Payer: Cash Price |
$546.04
|
| Rate for Payer: Cigna All Commercial |
$785.38
|
| Rate for Payer: CORVEL All Commercial |
$846.36
|
| Rate for Payer: Coventry All Commercial |
$800.85
|
| 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 |
$819.05
|
| Rate for Payer: PHCS All Commercial |
$682.54
|
| 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 |
$800.85
|
| Rate for Payer: United Healthcare Commercial |
$717.13
|
|
|
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 |
$291.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$282.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$418.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$418.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$51.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$334.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.34
|
| Rate for Payer: Cash Price |
$546.04
|
| Rate for Payer: Cash Price |
$546.04
|
| Rate for Payer: Centivo All Commercial |
$495.07
|
| Rate for Payer: Cigna All Commercial |
$785.38
|
| Rate for Payer: CORVEL All Commercial |
$846.36
|
| Rate for Payer: Coventry All Commercial |
$800.85
|
| 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 |
$291.22
|
| Rate for Payer: Lucent All Commercial |
$495.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$819.05
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: MDWise Medicaid |
$51.19
|
| Rate for Payer: PHCS All Commercial |
$682.54
|
| Rate for Payer: PHP All Commercial |
$690.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$354.92
|
| Rate for Payer: Sagamore Health Network All Products |
$702.57
|
| Rate for Payer: Signature Care EPO |
$755.35
|
| Rate for Payer: Signature Care PPO |
$800.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$773.55
|
| Rate for Payer: United Healthcare Commercial |
$717.13
|
| Rate for Payer: United Healthcare Medicare |
$291.22
|
|
