|
HC ISOLATION AIRBORNE W/HEPA
|
Facility
|
OP
|
$183.84
|
|
| Hospital Charge Code |
6078003
|
|
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
|
|
|
HC ISOLATION AIRBORNE W/HEPA
|
Facility
|
IP
|
$183.84
|
|
| Hospital Charge Code |
6078003
|
|
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 CONTACT
|
Facility
|
OP
|
$108.20
|
|
| Hospital Charge Code |
6078000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$100.63 |
| Rate for Payer: Aetna Commercial |
$91.32
|
| Rate for Payer: Aetna Medicare |
$34.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.09
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Centivo All Commercial |
$58.86
|
| Rate for Payer: Cigna All Commercial |
$93.38
|
| Rate for Payer: CORVEL All Commercial |
$100.63
|
| Rate for Payer: Coventry All Commercial |
$95.22
|
| Rate for Payer: Encore All Commercial |
$99.60
|
| Rate for Payer: Frontpath All Commercial |
$99.54
|
| Rate for Payer: Humana ChoiceCare |
$93.45
|
| Rate for Payer: Humana Medicare |
$34.62
|
| Rate for Payer: Lucent All Commercial |
$58.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.38
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$81.15
|
| Rate for Payer: PHP All Commercial |
$82.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.20
|
| Rate for Payer: Sagamore Health Network All Products |
$83.53
|
| Rate for Payer: Signature Care EPO |
$89.81
|
| Rate for Payer: Signature Care PPO |
$95.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.97
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
| Rate for Payer: United Healthcare Medicare |
$34.62
|
|
|
HC ISOLATION CONTACT
|
Facility
|
IP
|
$108.20
|
|
| Hospital Charge Code |
6078000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$100.63 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cigna All Commercial |
$93.38
|
| Rate for Payer: CORVEL All Commercial |
$100.63
|
| Rate for Payer: Coventry All Commercial |
$95.22
|
| Rate for Payer: Encore All Commercial |
$99.60
|
| Rate for Payer: Frontpath All Commercial |
$99.54
|
| Rate for Payer: Humana ChoiceCare |
$93.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.38
|
| Rate for Payer: PHCS All Commercial |
$81.15
|
| Rate for Payer: PHP All Commercial |
$82.06
|
| Rate for Payer: Sagamore Health Network All Products |
$83.53
|
| Rate for Payer: Signature Care EPO |
$89.81
|
| Rate for Payer: Signature Care PPO |
$95.22
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
|
|
HC ISOLATION DROPLET
|
Facility
|
OP
|
$64.92
|
|
| Hospital Charge Code |
6078001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.13 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Aetna Commercial |
$54.79
|
| Rate for Payer: Aetna Medicare |
$20.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.85
|
| Rate for Payer: Cash Price |
$38.95
|
| Rate for Payer: Cash Price |
$38.95
|
| Rate for Payer: Centivo All Commercial |
$35.32
|
| Rate for Payer: Cigna All Commercial |
$56.03
|
| Rate for Payer: CORVEL All Commercial |
$60.38
|
| Rate for Payer: Coventry All Commercial |
$57.13
|
| Rate for Payer: Encore All Commercial |
$59.76
|
| Rate for Payer: Frontpath All Commercial |
$59.73
|
| Rate for Payer: Humana ChoiceCare |
$56.07
|
| Rate for Payer: Humana Medicare |
$20.77
|
| Rate for Payer: Lucent All Commercial |
$35.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.43
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$48.69
|
| Rate for Payer: PHP All Commercial |
$49.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.32
|
| Rate for Payer: Sagamore Health Network All Products |
$50.12
|
| Rate for Payer: Signature Care EPO |
$53.88
|
| Rate for Payer: Signature Care PPO |
$57.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.18
|
| Rate for Payer: United Healthcare Commercial |
$51.16
|
| Rate for Payer: United Healthcare Medicare |
$20.77
|
|
|
HC ISOLATION DROPLET
|
Facility
|
IP
|
$64.92
|
|
| Hospital Charge Code |
6078001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Aetna Commercial |
$56.09
|
| Rate for Payer: Cash Price |
$38.95
|
| Rate for Payer: Cigna All Commercial |
$56.03
|
| Rate for Payer: CORVEL All Commercial |
$60.38
|
| Rate for Payer: Coventry All Commercial |
$57.13
|
| Rate for Payer: Encore All Commercial |
$59.76
|
| Rate for Payer: Frontpath All Commercial |
$59.73
|
| Rate for Payer: Humana ChoiceCare |
$56.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.43
|
| Rate for Payer: PHCS All Commercial |
$48.69
|
| Rate for Payer: PHP All Commercial |
$49.24
|
| Rate for Payer: Sagamore Health Network All Products |
$50.12
|
| Rate for Payer: Signature Care EPO |
$53.88
|
| Rate for Payer: Signature Care PPO |
$57.13
|
| Rate for Payer: United Healthcare Commercial |
$51.16
|
|
|
HC ISOLATION DROPLET & CONTACT
|
Facility
|
OP
|
$108.20
|
|
| Hospital Charge Code |
6078002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$100.63 |
| Rate for Payer: Aetna Commercial |
$91.32
|
| Rate for Payer: Aetna Medicare |
$34.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.09
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Centivo All Commercial |
$58.86
|
| Rate for Payer: Cigna All Commercial |
$93.38
|
| Rate for Payer: CORVEL All Commercial |
$100.63
|
| Rate for Payer: Coventry All Commercial |
$95.22
|
| Rate for Payer: Encore All Commercial |
$99.60
|
| Rate for Payer: Frontpath All Commercial |
$99.54
|
| Rate for Payer: Humana ChoiceCare |
$93.45
|
| Rate for Payer: Humana Medicare |
$34.62
|
| Rate for Payer: Lucent All Commercial |
$58.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.38
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$81.15
|
| Rate for Payer: PHP All Commercial |
$82.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.20
|
| Rate for Payer: Sagamore Health Network All Products |
$83.53
|
| Rate for Payer: Signature Care EPO |
$89.81
|
| Rate for Payer: Signature Care PPO |
$95.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.97
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
| Rate for Payer: United Healthcare Medicare |
$34.62
|
|
|
HC ISOLATION DROPLET & CONTACT
|
Facility
|
IP
|
$108.20
|
|
| Hospital Charge Code |
6078002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$100.63 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cigna All Commercial |
$93.38
|
| Rate for Payer: CORVEL All Commercial |
$100.63
|
| Rate for Payer: Coventry All Commercial |
$95.22
|
| Rate for Payer: Encore All Commercial |
$99.60
|
| Rate for Payer: Frontpath All Commercial |
$99.54
|
| Rate for Payer: Humana ChoiceCare |
$93.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.38
|
| Rate for Payer: PHCS All Commercial |
$81.15
|
| Rate for Payer: PHP All Commercial |
$82.06
|
| Rate for Payer: Sagamore Health Network All Products |
$83.53
|
| Rate for Payer: Signature Care EPO |
$89.81
|
| Rate for Payer: Signature Care PPO |
$95.22
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
|
|
HC ISTENT
|
Facility
|
IP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41607043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,695.00 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,864.64
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
|
|
HC ISTENT
|
Facility
|
OP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41607043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,659.44
|
| Rate for Payer: Aetna Medicare |
$3,283.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,180.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,892.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,413.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,775.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,611.52
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Centivo All Commercial |
$5,581.44
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Humana Medicare |
$3,283.20
|
| Rate for Payer: Lucent All Commercial |
$5,581.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,001.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,721.00
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
| Rate for Payer: United Healthcare Medicare |
$3,283.20
|
|
|
HC ISTENT INJECT
|
Facility
|
OP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41606635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,659.44
|
| Rate for Payer: Aetna Medicare |
$3,283.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,180.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,892.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,413.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,775.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,611.52
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Centivo All Commercial |
$5,581.44
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Humana Medicare |
$3,283.20
|
| Rate for Payer: Lucent All Commercial |
$5,581.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,001.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,721.00
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
| Rate for Payer: United Healthcare Medicare |
$3,283.20
|
|
|
HC ISTENT INJECT
|
Facility
|
IP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41606635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,695.00 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,864.64
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
|
|
HC I STENT RIGHT
|
Facility
|
IP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41602464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,695.00 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,864.64
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
|
|
HC I STENT RIGHT
|
Facility
|
OP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41602464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,659.44
|
| Rate for Payer: Aetna Medicare |
$3,283.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,180.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,892.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,413.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,775.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,611.52
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Cash Price |
$6,156.00
|
| Rate for Payer: Centivo All Commercial |
$5,581.44
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Humana Medicare |
$3,283.20
|
| Rate for Payer: Lucent All Commercial |
$5,581.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,001.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,721.00
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
| Rate for Payer: United Healthcare Medicare |
$3,283.20
|
|
|
HC IV INF CONCURRENT 16+ MIN
|
Facility
|
OP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
520768
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$234.05 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$80.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.59
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Centivo All Commercial |
$136.91
|
| Rate for Payer: Cigna All Commercial |
$217.19
|
| Rate for Payer: CORVEL All Commercial |
$234.05
|
| Rate for Payer: Coventry All Commercial |
$221.47
|
| Rate for Payer: Encore All Commercial |
$231.66
|
| Rate for Payer: Frontpath All Commercial |
$231.54
|
| Rate for Payer: Humana ChoiceCare |
$217.37
|
| Rate for Payer: Humana Medicare |
$80.53
|
| Rate for Payer: Lucent All Commercial |
$136.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.50
|
| Rate for Payer: Managed Health Services Medicaid |
$18.90
|
| Rate for Payer: MDWise Medicaid |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$188.75
|
| Rate for Payer: PHP All Commercial |
$190.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.15
|
| Rate for Payer: Sagamore Health Network All Products |
$194.29
|
| Rate for Payer: Signature Care EPO |
$208.89
|
| Rate for Payer: Signature Care PPO |
$221.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.92
|
| Rate for Payer: United Healthcare Commercial |
$198.32
|
| Rate for Payer: United Healthcare Medicare |
$80.53
|
|
|
HC IV INF CONCURRENT 16+ MIN
|
Facility
|
IP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
520768
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$188.75 |
| Max. Negotiated Rate |
$234.05 |
| Rate for Payer: Aetna Commercial |
$217.44
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna All Commercial |
$217.19
|
| Rate for Payer: CORVEL All Commercial |
$234.05
|
| Rate for Payer: Coventry All Commercial |
$221.47
|
| Rate for Payer: Encore All Commercial |
$231.66
|
| Rate for Payer: Frontpath All Commercial |
$231.54
|
| Rate for Payer: Humana ChoiceCare |
$217.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.50
|
| Rate for Payer: PHCS All Commercial |
$188.75
|
| Rate for Payer: PHP All Commercial |
$190.87
|
| Rate for Payer: Sagamore Health Network All Products |
$194.29
|
| Rate for Payer: Signature Care EPO |
$208.89
|
| Rate for Payer: Signature Care PPO |
$221.47
|
| Rate for Payer: United Healthcare Commercial |
$198.32
|
|
|
HC IV INF HYD EA ADD 31-60 MIN
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
1689102
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$57.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$102.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.83
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Centivo All Commercial |
$97.10
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Humana Medicare |
$57.12
|
| Rate for Payer: Lucent All Commercial |
$97.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: Managed Health Services Medicaid |
$18.90
|
| Rate for Payer: MDWise Medicaid |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.61
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.72
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
| Rate for Payer: United Healthcare Medicare |
$57.12
|
|
|
HC IV INF HYD EA ADD 31-60 MIN
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
1689102
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
|
|
HC IV INF HYD EA ADD 31-60 MNS
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
520761
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$57.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$102.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.83
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Centivo All Commercial |
$97.10
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Humana Medicare |
$57.12
|
| Rate for Payer: Lucent All Commercial |
$97.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: Managed Health Services Medicaid |
$18.90
|
| Rate for Payer: MDWise Medicaid |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.61
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.72
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
| Rate for Payer: United Healthcare Medicare |
$57.12
|
|
|
HC IV INF HYD EA ADD 31-60 MNS
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
520761
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
|
|
HC IV INF HYD INIT 31-60 MINS
|
Facility
|
OP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
1689103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$380.51
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$258.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$281.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Centivo All Commercial |
$245.26
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Humana Medicare |
$144.27
|
| Rate for Payer: Lucent All Commercial |
$245.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: Managed Health Services Medicaid |
$18.90
|
| Rate for Payer: MDWise Medicaid |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.83
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$383.21
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
| Rate for Payer: United Healthcare Medicare |
$144.27
|
|
|
HC IV INF HYD INIT 31-60 MINS
|
Facility
|
IP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
1689103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$389.53
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
|
|
HC IV INF HYD INIT 31-60 MINS
|
Facility
|
OP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
520760
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$380.51
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$258.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$281.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Centivo All Commercial |
$245.26
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Humana Medicare |
$144.27
|
| Rate for Payer: Lucent All Commercial |
$245.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: Managed Health Services Medicaid |
$18.90
|
| Rate for Payer: MDWise Medicaid |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.83
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$383.21
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
| Rate for Payer: United Healthcare Medicare |
$144.27
|
|
|
HC IV INF HYD INIT 31-60 MINS
|
Facility
|
IP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
520760
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$389.53
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
|
|
HC IV INF SEQUENTIAL 16-60 MIN
|
Facility
|
IP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
520767
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$285.98 |
| Max. Negotiated Rate |
$354.62 |
| Rate for Payer: Aetna Commercial |
$329.45
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cigna All Commercial |
$329.07
|
| Rate for Payer: CORVEL All Commercial |
$354.62
|
| Rate for Payer: Coventry All Commercial |
$335.55
|
| Rate for Payer: Encore All Commercial |
$351.00
|
| Rate for Payer: Frontpath All Commercial |
$350.81
|
| Rate for Payer: Humana ChoiceCare |
$329.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.18
|
| Rate for Payer: PHCS All Commercial |
$285.98
|
| Rate for Payer: PHP All Commercial |
$289.19
|
| Rate for Payer: Sagamore Health Network All Products |
$294.37
|
| Rate for Payer: Signature Care EPO |
$316.49
|
| Rate for Payer: Signature Care PPO |
$335.55
|
| Rate for Payer: United Healthcare Commercial |
$300.47
|
|
