|
HC INTRODUCER SHEATH 7FR 13CM
|
Facility
|
IP
|
$254.80
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$236.96 |
| Rate for Payer: Aetna Commercial |
$220.15
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cigna All Commercial |
$219.89
|
| Rate for Payer: CORVEL All Commercial |
$236.96
|
| Rate for Payer: Coventry All Commercial |
$224.22
|
| Rate for Payer: Encore All Commercial |
$234.54
|
| Rate for Payer: Frontpath All Commercial |
$234.42
|
| Rate for Payer: Humana ChoiceCare |
$220.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.32
|
| Rate for Payer: PHCS All Commercial |
$191.10
|
| Rate for Payer: PHP All Commercial |
$193.24
|
| Rate for Payer: Sagamore Health Network All Products |
$196.71
|
| Rate for Payer: Signature Care EPO |
$211.48
|
| Rate for Payer: Signature Care PPO |
$224.22
|
| Rate for Payer: United Healthcare Commercial |
$200.78
|
|
|
HC INTUBATION
|
Facility
|
IP
|
$611.64
|
|
| Hospital Charge Code |
1701287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$458.73 |
| Max. Negotiated Rate |
$568.83 |
| Rate for Payer: Aetna Commercial |
$528.46
|
| Rate for Payer: Cash Price |
$366.98
|
| Rate for Payer: Cigna All Commercial |
$527.85
|
| Rate for Payer: CORVEL All Commercial |
$568.83
|
| Rate for Payer: Coventry All Commercial |
$538.24
|
| Rate for Payer: Encore All Commercial |
$563.01
|
| Rate for Payer: Frontpath All Commercial |
$562.71
|
| Rate for Payer: Humana ChoiceCare |
$528.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$550.48
|
| Rate for Payer: PHCS All Commercial |
$458.73
|
| Rate for Payer: PHP All Commercial |
$463.87
|
| Rate for Payer: Sagamore Health Network All Products |
$472.19
|
| Rate for Payer: Signature Care EPO |
$507.66
|
| Rate for Payer: Signature Care PPO |
$538.24
|
| Rate for Payer: United Healthcare Commercial |
$481.97
|
|
|
HC INTUBATION
|
Facility
|
OP
|
$611.64
|
|
| Hospital Charge Code |
1701287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.61 |
| Max. Negotiated Rate |
$568.83 |
| Rate for Payer: Aetna Commercial |
$516.22
|
| Rate for Payer: Aetna Medicare |
$195.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$189.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$351.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$382.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.30
|
| Rate for Payer: Cash Price |
$366.98
|
| Rate for Payer: Centivo All Commercial |
$332.73
|
| Rate for Payer: Cigna All Commercial |
$527.85
|
| Rate for Payer: CORVEL All Commercial |
$568.83
|
| Rate for Payer: Coventry All Commercial |
$538.24
|
| Rate for Payer: Encore All Commercial |
$563.01
|
| Rate for Payer: Frontpath All Commercial |
$562.71
|
| Rate for Payer: Humana ChoiceCare |
$528.27
|
| Rate for Payer: Humana Medicare |
$195.72
|
| Rate for Payer: Lucent All Commercial |
$332.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$550.48
|
| Rate for Payer: PHCS All Commercial |
$458.73
|
| Rate for Payer: PHP All Commercial |
$463.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$238.54
|
| Rate for Payer: Sagamore Health Network All Products |
$472.19
|
| Rate for Payer: Signature Care EPO |
$507.66
|
| Rate for Payer: Signature Care PPO |
$538.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$519.89
|
| Rate for Payer: United Healthcare Commercial |
$481.97
|
| Rate for Payer: United Healthcare Medicare |
$195.72
|
|
|
HC IODINE SERUM OR PLASMA
|
Facility
|
OP
|
$233.38
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$74.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.15
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Centivo All Commercial |
$126.96
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Humana Medicare |
$74.68
|
| Rate for Payer: Lucent All Commercial |
$126.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: Managed Health Services Medicaid |
$21.96
|
| Rate for Payer: MDWise Medicaid |
$21.96
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.02
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
| Rate for Payer: United Healthcare Medicare |
$74.68
|
|
|
HC IODINE SERUM OR PLASMA
|
Facility
|
IP
|
$233.38
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$201.64
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$175.03
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
63001105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.27 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna Commercial |
$151.23
|
| Rate for Payer: Cash Price |
$105.02
|
| Rate for Payer: Cigna All Commercial |
$151.05
|
| Rate for Payer: CORVEL All Commercial |
$162.78
|
| Rate for Payer: Coventry All Commercial |
$154.03
|
| Rate for Payer: Encore All Commercial |
$161.12
|
| Rate for Payer: Frontpath All Commercial |
$161.03
|
| Rate for Payer: Humana ChoiceCare |
$151.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.53
|
| Rate for Payer: PHCS All Commercial |
$131.27
|
| Rate for Payer: PHP All Commercial |
$132.74
|
| Rate for Payer: Sagamore Health Network All Products |
$135.12
|
| Rate for Payer: Signature Care EPO |
$145.27
|
| Rate for Payer: Signature Care PPO |
$154.03
|
| Rate for Payer: United Healthcare Commercial |
$137.92
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$175.03
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
63001105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna Commercial |
$147.73
|
| Rate for Payer: Aetna Medicare |
$56.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.61
|
| Rate for Payer: Cash Price |
$105.02
|
| Rate for Payer: Cash Price |
$105.02
|
| Rate for Payer: Centivo All Commercial |
$95.22
|
| Rate for Payer: Cigna All Commercial |
$151.05
|
| Rate for Payer: CORVEL All Commercial |
$162.78
|
| Rate for Payer: Coventry All Commercial |
$154.03
|
| Rate for Payer: Encore All Commercial |
$161.12
|
| Rate for Payer: Frontpath All Commercial |
$161.03
|
| Rate for Payer: Humana ChoiceCare |
$151.17
|
| Rate for Payer: Humana Medicare |
$56.01
|
| Rate for Payer: Lucent All Commercial |
$95.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.53
|
| Rate for Payer: Managed Health Services Medicaid |
$13.68
|
| Rate for Payer: MDWise Medicaid |
$13.68
|
| Rate for Payer: PHCS All Commercial |
$131.27
|
| Rate for Payer: PHP All Commercial |
$132.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.26
|
| Rate for Payer: Sagamore Health Network All Products |
$135.12
|
| Rate for Payer: Signature Care EPO |
$145.27
|
| Rate for Payer: Signature Care PPO |
$154.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148.78
|
| Rate for Payer: United Healthcare Commercial |
$137.92
|
| Rate for Payer: United Healthcare Medicare |
$56.01
|
|
|
HC IONTOPHORESIS/15 MIN-OT
|
Facility
|
IP
|
$143.02
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
1738045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC IONTOPHORESIS/15 MIN-OT
|
Facility
|
OP
|
$143.02
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
1738045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.34
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Centivo All Commercial |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$45.77
|
| Rate for Payer: Lucent All Commercial |
$77.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
|
HC IONTOPHORESIS/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
1728045
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC IONTOPHORESIS/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
1728045
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
HC IPRISM CLIP
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
41602462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
|
|
HC IPRISM CLIP
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
41602462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$295.40
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.20
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Centivo All Commercial |
$190.40
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Humana Medicare |
$112.00
|
| Rate for Payer: Lucent All Commercial |
$190.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.50
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.50
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
| Rate for Payer: United Healthcare Medicare |
$112.00
|
|
|
HC IRON
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
63001087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.12 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$101.52
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna All Commercial |
$101.40
|
| Rate for Payer: CORVEL All Commercial |
$109.28
|
| Rate for Payer: Coventry All Commercial |
$103.40
|
| Rate for Payer: Encore All Commercial |
$108.16
|
| Rate for Payer: Frontpath All Commercial |
$108.10
|
| Rate for Payer: Humana ChoiceCare |
$101.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.75
|
| Rate for Payer: PHCS All Commercial |
$88.12
|
| Rate for Payer: PHP All Commercial |
$89.11
|
| Rate for Payer: Sagamore Health Network All Products |
$90.71
|
| Rate for Payer: Signature Care EPO |
$97.53
|
| Rate for Payer: Signature Care PPO |
$103.40
|
| Rate for Payer: United Healthcare Commercial |
$92.59
|
|
|
HC IRON
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
63001087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$99.17
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.36
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Centivo All Commercial |
$63.92
|
| Rate for Payer: Cigna All Commercial |
$101.40
|
| Rate for Payer: CORVEL All Commercial |
$109.28
|
| Rate for Payer: Coventry All Commercial |
$103.40
|
| Rate for Payer: Encore All Commercial |
$108.16
|
| Rate for Payer: Frontpath All Commercial |
$108.10
|
| Rate for Payer: Humana ChoiceCare |
$101.48
|
| Rate for Payer: Humana Medicare |
$37.60
|
| Rate for Payer: Lucent All Commercial |
$63.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.75
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$88.12
|
| Rate for Payer: PHP All Commercial |
$89.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.83
|
| Rate for Payer: Sagamore Health Network All Products |
$90.71
|
| Rate for Payer: Signature Care EPO |
$97.53
|
| Rate for Payer: Signature Care PPO |
$103.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.88
|
| Rate for Payer: United Healthcare Commercial |
$92.59
|
| Rate for Payer: United Healthcare Medicare |
$37.60
|
|
|
HC IRON BINDING QUANT
|
Facility
|
IP
|
$139.13
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
63001148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$120.21
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Cigna All Commercial |
$120.07
|
| Rate for Payer: CORVEL All Commercial |
$129.39
|
| Rate for Payer: Coventry All Commercial |
$122.43
|
| Rate for Payer: Encore All Commercial |
$128.07
|
| Rate for Payer: Frontpath All Commercial |
$128.00
|
| Rate for Payer: Humana ChoiceCare |
$120.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.22
|
| Rate for Payer: PHCS All Commercial |
$104.35
|
| Rate for Payer: PHP All Commercial |
$105.52
|
| Rate for Payer: Sagamore Health Network All Products |
$107.41
|
| Rate for Payer: Signature Care EPO |
$115.48
|
| Rate for Payer: Signature Care PPO |
$122.43
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
|
|
HC IRON BINDING QUANT
|
Facility
|
OP
|
$139.13
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
63001148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$117.43
|
| Rate for Payer: Aetna Medicare |
$44.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.97
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Centivo All Commercial |
$75.69
|
| Rate for Payer: Cigna All Commercial |
$120.07
|
| Rate for Payer: CORVEL All Commercial |
$129.39
|
| Rate for Payer: Coventry All Commercial |
$122.43
|
| Rate for Payer: Encore All Commercial |
$128.07
|
| Rate for Payer: Frontpath All Commercial |
$128.00
|
| Rate for Payer: Humana ChoiceCare |
$120.17
|
| Rate for Payer: Humana Medicare |
$44.52
|
| Rate for Payer: Lucent All Commercial |
$75.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.22
|
| Rate for Payer: Managed Health Services Medicaid |
$8.74
|
| Rate for Payer: MDWise Medicaid |
$8.74
|
| Rate for Payer: PHCS All Commercial |
$104.35
|
| Rate for Payer: PHP All Commercial |
$105.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.26
|
| Rate for Payer: Sagamore Health Network All Products |
$107.41
|
| Rate for Payer: Signature Care EPO |
$115.48
|
| Rate for Payer: Signature Care PPO |
$122.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.26
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
| Rate for Payer: United Healthcare Medicare |
$44.52
|
|
|
HC ISLET CELL AUTOANTIBODY
|
Facility
|
OP
|
$138.61
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
63001908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$128.91 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$44.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$23.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.79
|
| Rate for Payer: Cash Price |
$83.17
|
| Rate for Payer: Cash Price |
$83.17
|
| Rate for Payer: Centivo All Commercial |
$75.40
|
| Rate for Payer: Cigna All Commercial |
$119.62
|
| Rate for Payer: CORVEL All Commercial |
$128.91
|
| Rate for Payer: Coventry All Commercial |
$121.98
|
| Rate for Payer: Encore All Commercial |
$127.59
|
| Rate for Payer: Frontpath All Commercial |
$127.52
|
| Rate for Payer: Humana ChoiceCare |
$119.72
|
| Rate for Payer: Humana Medicare |
$44.36
|
| Rate for Payer: Lucent All Commercial |
$75.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.75
|
| Rate for Payer: Managed Health Services Medicaid |
$23.57
|
| Rate for Payer: MDWise Medicaid |
$23.57
|
| Rate for Payer: PHCS All Commercial |
$103.96
|
| Rate for Payer: PHP All Commercial |
$105.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.06
|
| Rate for Payer: Sagamore Health Network All Products |
$107.01
|
| Rate for Payer: Signature Care EPO |
$115.05
|
| Rate for Payer: Signature Care PPO |
$121.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.82
|
| Rate for Payer: United Healthcare Commercial |
$109.22
|
| Rate for Payer: United Healthcare Medicare |
$44.36
|
|
|
HC ISLET CELL AUTOANTIBODY
|
Facility
|
IP
|
$138.61
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
63001908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$128.91 |
| Rate for Payer: Aetna Commercial |
$119.76
|
| Rate for Payer: Cash Price |
$83.17
|
| Rate for Payer: Cigna All Commercial |
$119.62
|
| Rate for Payer: CORVEL All Commercial |
$128.91
|
| Rate for Payer: Coventry All Commercial |
$121.98
|
| Rate for Payer: Encore All Commercial |
$127.59
|
| Rate for Payer: Frontpath All Commercial |
$127.52
|
| Rate for Payer: Humana ChoiceCare |
$119.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.75
|
| Rate for Payer: PHCS All Commercial |
$103.96
|
| Rate for Payer: PHP All Commercial |
$105.12
|
| Rate for Payer: Sagamore Health Network All Products |
$107.01
|
| Rate for Payer: Signature Care EPO |
$115.05
|
| Rate for Payer: Signature Care PPO |
$121.98
|
| Rate for Payer: United Healthcare Commercial |
$109.22
|
|
|
HC ISODOSE PLAN-COMPLEX
|
Facility
|
OP
|
$2,864.16
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
1547315
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$2,663.67 |
| Rate for Payer: Aetna Commercial |
$2,417.35
|
| Rate for Payer: Aetna Medicare |
$916.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$96.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$887.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,644.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,790.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$96.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,054.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,008.18
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: Centivo All Commercial |
$1,558.10
|
| Rate for Payer: Cigna All Commercial |
$2,471.77
|
| Rate for Payer: CORVEL All Commercial |
$2,663.67
|
| Rate for Payer: Coventry All Commercial |
$2,520.46
|
| Rate for Payer: Encore All Commercial |
$2,636.46
|
| Rate for Payer: Frontpath All Commercial |
$2,635.03
|
| Rate for Payer: Humana ChoiceCare |
$2,473.77
|
| Rate for Payer: Humana Medicare |
$916.53
|
| Rate for Payer: Lucent All Commercial |
$1,558.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,577.74
|
| Rate for Payer: Managed Health Services Medicaid |
$96.98
|
| Rate for Payer: MDWise Medicaid |
$96.98
|
| Rate for Payer: PHCS All Commercial |
$2,148.12
|
| Rate for Payer: PHP All Commercial |
$2,172.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,117.02
|
| Rate for Payer: Sagamore Health Network All Products |
$2,211.13
|
| Rate for Payer: Signature Care EPO |
$2,377.25
|
| Rate for Payer: Signature Care PPO |
$2,520.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,434.54
|
| Rate for Payer: United Healthcare Commercial |
$2,256.96
|
| Rate for Payer: United Healthcare Medicare |
$916.53
|
|
|
HC ISODOSE PLAN-COMPLEX
|
Facility
|
IP
|
$2,864.16
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
1547315
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,148.12 |
| Max. Negotiated Rate |
$2,663.67 |
| Rate for Payer: Aetna Commercial |
$2,474.63
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: Cigna All Commercial |
$2,471.77
|
| Rate for Payer: CORVEL All Commercial |
$2,663.67
|
| Rate for Payer: Coventry All Commercial |
$2,520.46
|
| Rate for Payer: Encore All Commercial |
$2,636.46
|
| Rate for Payer: Frontpath All Commercial |
$2,635.03
|
| Rate for Payer: Humana ChoiceCare |
$2,473.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,577.74
|
| Rate for Payer: PHCS All Commercial |
$2,148.12
|
| Rate for Payer: PHP All Commercial |
$2,172.18
|
| Rate for Payer: Sagamore Health Network All Products |
$2,211.13
|
| Rate for Payer: Signature Care EPO |
$2,377.25
|
| Rate for Payer: Signature Care PPO |
$2,520.46
|
| Rate for Payer: United Healthcare Commercial |
$2,256.96
|
|
|
HC ISODOSE PLAN-SIMPLE
|
Facility
|
IP
|
$1,856.40
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
1547305
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,392.30 |
| Max. Negotiated Rate |
$1,726.45 |
| Rate for Payer: Aetna Commercial |
$1,603.93
|
| Rate for Payer: Cash Price |
$1,113.84
|
| Rate for Payer: Cigna All Commercial |
$1,602.07
|
| Rate for Payer: CORVEL All Commercial |
$1,726.45
|
| Rate for Payer: Coventry All Commercial |
$1,633.63
|
| Rate for Payer: Encore All Commercial |
$1,708.82
|
| Rate for Payer: Frontpath All Commercial |
$1,707.89
|
| Rate for Payer: Humana ChoiceCare |
$1,603.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.76
|
| Rate for Payer: PHCS All Commercial |
$1,392.30
|
| Rate for Payer: PHP All Commercial |
$1,407.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.14
|
| Rate for Payer: Signature Care EPO |
$1,540.81
|
| Rate for Payer: Signature Care PPO |
$1,633.63
|
| Rate for Payer: United Healthcare Commercial |
$1,462.84
|
|
|
HC ISODOSE PLAN-SIMPLE
|
Facility
|
OP
|
$1,856.40
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
1547305
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.97 |
| Max. Negotiated Rate |
$1,726.45 |
| Rate for Payer: Aetna Commercial |
$1,566.80
|
| Rate for Payer: Aetna Medicare |
$594.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$52.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$575.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,066.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$683.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$653.45
|
| Rate for Payer: Cash Price |
$1,113.84
|
| Rate for Payer: Cash Price |
$1,113.84
|
| Rate for Payer: Centivo All Commercial |
$1,009.88
|
| Rate for Payer: Cigna All Commercial |
$1,602.07
|
| Rate for Payer: CORVEL All Commercial |
$1,726.45
|
| Rate for Payer: Coventry All Commercial |
$1,633.63
|
| Rate for Payer: Encore All Commercial |
$1,708.82
|
| Rate for Payer: Frontpath All Commercial |
$1,707.89
|
| Rate for Payer: Humana ChoiceCare |
$1,603.37
|
| Rate for Payer: Humana Medicare |
$594.05
|
| Rate for Payer: Lucent All Commercial |
$1,009.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.76
|
| Rate for Payer: Managed Health Services Medicaid |
$52.97
|
| Rate for Payer: MDWise Medicaid |
$52.97
|
| Rate for Payer: PHCS All Commercial |
$1,392.30
|
| Rate for Payer: PHP All Commercial |
$1,407.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$724.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.14
|
| Rate for Payer: Signature Care EPO |
$1,540.81
|
| Rate for Payer: Signature Care PPO |
$1,633.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.94
|
| Rate for Payer: United Healthcare Commercial |
$1,462.84
|
| Rate for Payer: United Healthcare Medicare |
$594.05
|
|
|
HC ISOLATION AIRBORNE & CONTACT
|
Facility
|
IP
|
$183.84
|
|
| Hospital Charge Code |
6078004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.88 |
| Max. Negotiated Rate |
$170.97 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: Cash Price |
$110.30
|
| Rate for Payer: Cigna All Commercial |
$158.65
|
| Rate for Payer: CORVEL All Commercial |
$170.97
|
| Rate for Payer: Coventry All Commercial |
$161.78
|
| Rate for Payer: Encore All Commercial |
$169.22
|
| Rate for Payer: Frontpath All Commercial |
$169.13
|
| Rate for Payer: Humana ChoiceCare |
$158.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.46
|
| Rate for Payer: PHCS All Commercial |
$137.88
|
| Rate for Payer: PHP All Commercial |
$139.42
|
| Rate for Payer: Sagamore Health Network All Products |
$141.92
|
| Rate for Payer: Signature Care EPO |
$152.59
|
| Rate for Payer: Signature Care PPO |
$161.78
|
| Rate for Payer: United Healthcare Commercial |
$144.87
|
|
|
HC ISOLATION AIRBORNE & CONTACT
|
Facility
|
OP
|
$183.84
|
|
| Hospital Charge Code |
6078004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$170.97 |
| Rate for Payer: Aetna Commercial |
$155.16
|
| Rate for Payer: Aetna Medicare |
$58.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.71
|
| Rate for Payer: Cash Price |
$110.30
|
| Rate for Payer: Cash Price |
$110.30
|
| Rate for Payer: Centivo All Commercial |
$100.01
|
| Rate for Payer: Cigna All Commercial |
$158.65
|
| Rate for Payer: CORVEL All Commercial |
$170.97
|
| Rate for Payer: Coventry All Commercial |
$161.78
|
| Rate for Payer: Encore All Commercial |
$169.22
|
| Rate for Payer: Frontpath All Commercial |
$169.13
|
| Rate for Payer: Humana ChoiceCare |
$158.78
|
| Rate for Payer: Humana Medicare |
$58.83
|
| Rate for Payer: Lucent All Commercial |
$100.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$137.88
|
| Rate for Payer: PHP All Commercial |
$139.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.70
|
| Rate for Payer: Sagamore Health Network All Products |
$141.92
|
| Rate for Payer: Signature Care EPO |
$152.59
|
| Rate for Payer: Signature Care PPO |
$161.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.26
|
| Rate for Payer: United Healthcare Commercial |
$144.87
|
| Rate for Payer: United Healthcare Medicare |
$58.83
|
|
