|
HC INTRODUCER SHEATH 8FR 13CM
|
Facility
OP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$110.78
|
| Rate for Payer: Aetna Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.64
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Centivo All Commercial |
$66.94
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$66.94
|
| Rate for Payer: Lucent All Commercial |
$66.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.19
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.56
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
|
|
HC INTRODUCER SHEATH 8FR 13CM
|
Facility
IP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC INTRODUCER SHEATH 8FR 25CM
|
Facility
OP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$140.18
|
| Rate for Payer: Aetna Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.29
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Centivo All Commercial |
$84.71
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Humana Medicare |
$84.71
|
| Rate for Payer: Lucent All Commercial |
$84.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.78
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.18
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
| Rate for Payer: United Healthcare Medicare |
$54.81
|
|
|
HC INTRODUCER SHEATH 8FR 25CM
|
Facility
IP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$143.50
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
|
|
HC INTRODUCER SHEATH 9FR 13CM
|
Facility
OP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$110.78
|
| Rate for Payer: Aetna Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.64
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Centivo All Commercial |
$66.94
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$66.94
|
| Rate for Payer: Lucent All Commercial |
$66.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.19
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.56
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
|
|
HC INTRODUCER SHEATH 9FR 13CM
|
Facility
IP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC INTRODUCER SHEATH 9FR 25CM
|
Facility
IP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$143.50
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
|
|
HC INTRODUCER SHEATH 9FR 25CM
|
Facility
OP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$140.18
|
| Rate for Payer: Aetna Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.29
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Centivo All Commercial |
$84.71
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Humana Medicare |
$84.71
|
| Rate for Payer: Lucent All Commercial |
$84.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.78
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.18
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
| Rate for Payer: United Healthcare Medicare |
$54.81
|
|
|
HC INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN
|
Facility
IP
|
$260.96
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
01296000
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.72 |
| Max. Negotiated Rate |
$242.69 |
| Rate for Payer: Aetna Commercial |
$225.47
|
| Rate for Payer: Cash Price |
$161.79
|
| Rate for Payer: Cigna All Commercial |
$225.21
|
| Rate for Payer: CORVEL All Commercial |
$242.69
|
| Rate for Payer: Coventry All Commercial |
$229.64
|
| Rate for Payer: Encore All Commercial |
$240.21
|
| Rate for Payer: Frontpath All Commercial |
$240.08
|
| Rate for Payer: Humana ChoiceCare |
$225.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.86
|
| Rate for Payer: PHCS All Commercial |
$195.72
|
| Rate for Payer: PHP All Commercial |
$197.91
|
| Rate for Payer: Sagamore Health Network All Products |
$201.46
|
| Rate for Payer: Signature Care EPO |
$216.59
|
| Rate for Payer: Signature Care PPO |
$229.64
|
| Rate for Payer: United Healthcare Commercial |
$205.63
|
|
|
HC INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN
|
Facility
OP
|
$260.96
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
01296000
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$242.69 |
| Rate for Payer: Aetna Commercial |
$220.25
|
| Rate for Payer: Aetna Medicare |
$86.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$159.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.73
|
| Rate for Payer: Cash Price |
$161.79
|
| Rate for Payer: Cash Price |
$161.79
|
| Rate for Payer: Centivo All Commercial |
$133.09
|
| Rate for Payer: Cigna All Commercial |
$225.21
|
| Rate for Payer: CORVEL All Commercial |
$242.69
|
| Rate for Payer: Coventry All Commercial |
$229.64
|
| Rate for Payer: Encore All Commercial |
$240.21
|
| Rate for Payer: Frontpath All Commercial |
$240.08
|
| Rate for Payer: Humana ChoiceCare |
$225.39
|
| Rate for Payer: Humana Medicare |
$133.09
|
| Rate for Payer: Lucent All Commercial |
$133.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.86
|
| Rate for Payer: Managed Health Services Medicaid |
$159.12
|
| Rate for Payer: MDWise Medicaid |
$159.12
|
| Rate for Payer: PHCS All Commercial |
$195.72
|
| Rate for Payer: PHP All Commercial |
$197.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.77
|
| Rate for Payer: Sagamore Health Network All Products |
$201.46
|
| Rate for Payer: Signature Care EPO |
$216.59
|
| Rate for Payer: Signature Care PPO |
$229.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.81
|
| Rate for Payer: United Healthcare Commercial |
$205.63
|
| Rate for Payer: United Healthcare Medicare |
$86.12
|
|
|
HC INTUBATION
|
Facility
IP
|
$611.64
|
|
| Hospital Charge Code |
01701287
|
|
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 |
$379.22
|
| Rate for Payer: Cigna All Commercial |
$527.85
|
| Rate for Payer: CORVEL All Commercial |
$568.83
|
| Rate for Payer: Coventry All Commercial |
$538.25
|
| Rate for Payer: Encore All Commercial |
$563.02
|
| Rate for Payer: Frontpath All Commercial |
$562.71
|
| Rate for Payer: Humana ChoiceCare |
$528.28
|
| 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 |
$538.25
|
| Rate for Payer: United Healthcare Commercial |
$481.97
|
|
|
HC INTUBATION
|
Facility
OP
|
$611.64
|
|
| Hospital Charge Code |
01701287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.84 |
| Max. Negotiated Rate |
$568.83 |
| Rate for Payer: Aetna Commercial |
$516.23
|
| Rate for Payer: Aetna Medicare |
$201.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$201.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$351.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$382.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.03
|
| Rate for Payer: Cash Price |
$379.22
|
| Rate for Payer: Centivo All Commercial |
$311.94
|
| Rate for Payer: Cigna All Commercial |
$527.85
|
| Rate for Payer: CORVEL All Commercial |
$568.83
|
| Rate for Payer: Coventry All Commercial |
$538.25
|
| Rate for Payer: Encore All Commercial |
$563.02
|
| Rate for Payer: Frontpath All Commercial |
$562.71
|
| Rate for Payer: Humana ChoiceCare |
$528.28
|
| Rate for Payer: Humana Medicare |
$311.94
|
| Rate for Payer: Lucent All Commercial |
$311.94
|
| 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 |
$538.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$519.90
|
| Rate for Payer: United Healthcare Commercial |
$481.97
|
| Rate for Payer: United Healthcare Medicare |
$201.84
|
|
|
HC IODINE SERUM OR PLASMA
|
Facility
OP
|
$233.38
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$77.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.72
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Centivo All Commercial |
$119.02
|
| Rate for Payer: Cigna All Commercial |
$201.40
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.82
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Humana Medicare |
$119.02
|
| Rate for Payer: Lucent All Commercial |
$119.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: Managed Health Services Medicaid |
$12.48
|
| Rate for Payer: MDWise Medicaid |
$12.48
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$176.99
|
| 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 |
$193.70
|
| 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 |
$77.01
|
|
|
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 |
$144.69
|
| Rate for Payer: Cigna All Commercial |
$201.40
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.82
|
| 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 |
$176.99
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.70
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
|
|
HC IONIZED CALCIUM
|
Facility
OP
|
$175.03
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
63001105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna Commercial |
$147.73
|
| Rate for Payer: Aetna Medicare |
$57.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.54
|
| Rate for Payer: Cash Price |
$108.52
|
| Rate for Payer: Cash Price |
$108.52
|
| Rate for Payer: Centivo All Commercial |
$89.27
|
| 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 |
$151.18
|
| Rate for Payer: Humana Medicare |
$89.27
|
| Rate for Payer: Lucent All Commercial |
$89.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.53
|
| Rate for Payer: Managed Health Services Medicaid |
$9.62
|
| Rate for Payer: MDWise Medicaid |
$9.62
|
| 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 |
$145.28
|
| Rate for Payer: Signature Care PPO |
$154.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148.78
|
| Rate for Payer: United Healthcare Commercial |
$137.93
|
| Rate for Payer: United Healthcare Medicare |
$57.76
|
|
|
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 |
$108.52
|
| 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 |
$151.18
|
| 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 |
$145.28
|
| Rate for Payer: Signature Care PPO |
$154.03
|
| Rate for Payer: United Healthcare Commercial |
$137.93
|
|
|
HC IONTOPHORESIS/15 MIN-OT
|
Facility
OP
|
$143.02
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
01738045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.92
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Centivo All Commercial |
$72.94
|
| 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 |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$72.94
|
| 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: 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 |
$47.20
|
|
|
HC IONTOPHORESIS/15 MIN-OT
|
Facility
IP
|
$143.02
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
01738045
|
|
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 |
$88.68
|
| 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-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
01728045
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| 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 |
$121.02
|
| 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 |
01728045
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| 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 |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC IPPB TX INITIAL
|
Facility
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
01706001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.47
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centivo All Commercial |
$86.36
|
| 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 |
$86.36
|
| Rate for Payer: Lucent All Commercial |
$86.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| 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 |
$55.88
|
|
|
HC IPPB TX INITIAL
|
Facility
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
01706001
|
|
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 |
$104.99
|
| 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 IPPB TX SUBSEQUENT
|
Facility
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
01706003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.88 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.47
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centivo All Commercial |
$86.36
|
| 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 |
$86.36
|
| Rate for Payer: Lucent All Commercial |
$86.36
|
| 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: 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 |
$55.88
|
|
|
HC IPPB TX SUBSEQUENT
|
Facility
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
01706003
|
|
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 |
$104.99
|
| 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 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 |
$217.00
|
| 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
|
|
