|
HC IPRISM CLIP
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
41602462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$295.40
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.05
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Centivo All Commercial |
$178.50
|
| 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 |
$178.50
|
| Rate for Payer: Lucent All Commercial |
$178.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$115.50
|
|
|
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 |
$38.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.65
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Centivo All Commercial |
$59.93
|
| Rate for Payer: Cigna All Commercial |
$101.41
|
| 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 |
$101.49
|
| Rate for Payer: Humana Medicare |
$59.93
|
| Rate for Payer: Lucent All Commercial |
$59.93
|
| 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 |
$88.13
|
| Rate for Payer: PHP All Commercial |
$89.12
|
| 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 |
$38.78
|
|
|
HC IRON
|
Facility
IP
|
$117.50
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
63001087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.13 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$101.52
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cigna All Commercial |
$101.41
|
| 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 |
$101.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.75
|
| Rate for Payer: PHCS All Commercial |
$88.13
|
| Rate for Payer: PHP All Commercial |
$89.12
|
| 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 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 |
$117.42
|
| Rate for Payer: Aetna Medicare |
$45.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Centivo All Commercial |
$70.96
|
| 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 |
$120.16
|
| Rate for Payer: Humana Medicare |
$70.96
|
| Rate for Payer: Lucent All Commercial |
$70.96
|
| 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 |
$105.51
|
| 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 |
$45.91
|
|
|
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 |
$86.26
|
| 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 |
$120.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.22
|
| Rate for Payer: PHCS All Commercial |
$104.35
|
| Rate for Payer: PHP All Commercial |
$105.51
|
| 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 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 |
$116.98
|
| Rate for Payer: Aetna Medicare |
$45.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.31
|
| Rate for Payer: Cash Price |
$85.94
|
| Rate for Payer: Cash Price |
$85.94
|
| Rate for Payer: Centivo All Commercial |
$70.69
|
| Rate for Payer: Cigna All Commercial |
$119.62
|
| Rate for Payer: CORVEL All Commercial |
$128.91
|
| Rate for Payer: Coventry All Commercial |
$121.97
|
| 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 |
$70.69
|
| Rate for Payer: Lucent All Commercial |
$70.69
|
| 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 |
$115.04
|
| Rate for Payer: Signature Care PPO |
$121.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.82
|
| Rate for Payer: United Healthcare Commercial |
$109.22
|
| Rate for Payer: United Healthcare Medicare |
$45.74
|
|
|
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 |
$85.94
|
| Rate for Payer: Cigna All Commercial |
$119.62
|
| Rate for Payer: CORVEL All Commercial |
$128.91
|
| Rate for Payer: Coventry All Commercial |
$121.97
|
| 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 |
$115.04
|
| Rate for Payer: Signature Care PPO |
$121.97
|
| Rate for Payer: United Healthcare Commercial |
$109.22
|
|
|
HC ISODOSE PLAN-COMPLEX
|
Facility
IP
|
$2,864.16
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
01547315
|
|
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 |
$1,775.78
|
| 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-COMPLEX
|
Facility
OP
|
$2,864.16
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
01547315
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$378.22 |
| Max. Negotiated Rate |
$2,663.67 |
| Rate for Payer: Aetna Commercial |
$2,417.35
|
| Rate for Payer: Aetna Medicare |
$945.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$945.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,644.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,790.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$378.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,086.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,039.69
|
| Rate for Payer: Cash Price |
$1,775.78
|
| Rate for Payer: Cash Price |
$1,775.78
|
| Rate for Payer: Centivo All Commercial |
$1,460.72
|
| 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 |
$1,460.72
|
| Rate for Payer: Lucent All Commercial |
$1,460.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,577.74
|
| Rate for Payer: Managed Health Services Medicaid |
$378.22
|
| Rate for Payer: MDWise Medicaid |
$378.22
|
| 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 |
$945.17
|
|
|
HC ISODOSE PLAN-SIMPLE
|
Facility
OP
|
$1,856.40
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
01547305
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$206.58 |
| Max. Negotiated Rate |
$1,726.45 |
| Rate for Payer: Aetna Commercial |
$1,566.80
|
| Rate for Payer: Aetna Medicare |
$612.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$206.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.87
|
| Rate for Payer: Cash Price |
$1,150.97
|
| Rate for Payer: Cash Price |
$1,150.97
|
| Rate for Payer: Centivo All Commercial |
$946.76
|
| 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 |
$946.76
|
| Rate for Payer: Lucent All Commercial |
$946.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.76
|
| Rate for Payer: Managed Health Services Medicaid |
$206.58
|
| Rate for Payer: MDWise Medicaid |
$206.58
|
| 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 |
$612.61
|
|
|
HC ISODOSE PLAN-SIMPLE
|
Facility
IP
|
$1,856.40
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
01547305
|
|
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 |
$1,150.97
|
| 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 ISOFLURANE (FORANE) 99.9% CMCH
|
Facility
OP
|
$5.15
|
|
| Hospital Charge Code |
61301000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$4.35
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.87
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Centivo All Commercial |
$2.63
|
| Rate for Payer: Cigna All Commercial |
$4.44
|
| Rate for Payer: CORVEL All Commercial |
$4.79
|
| Rate for Payer: Coventry All Commercial |
$4.53
|
| Rate for Payer: Encore All Commercial |
$4.74
|
| Rate for Payer: Frontpath All Commercial |
$4.74
|
| Rate for Payer: Humana ChoiceCare |
$4.45
|
| Rate for Payer: Humana Medicare |
$2.63
|
| Rate for Payer: Lucent All Commercial |
$2.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.64
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: PHP All Commercial |
$3.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.01
|
| Rate for Payer: Sagamore Health Network All Products |
$3.98
|
| Rate for Payer: Signature Care EPO |
$4.27
|
| Rate for Payer: Signature Care PPO |
$4.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.38
|
| Rate for Payer: United Healthcare Commercial |
$4.06
|
| Rate for Payer: United Healthcare Medicare |
$1.70
|
|
|
HC ISOFLURANE (FORANE) 99.9% CMCH
|
Facility
IP
|
$5.15
|
|
| Hospital Charge Code |
61301000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cigna All Commercial |
$4.44
|
| Rate for Payer: CORVEL All Commercial |
$4.79
|
| Rate for Payer: Coventry All Commercial |
$4.53
|
| Rate for Payer: Encore All Commercial |
$4.74
|
| Rate for Payer: Frontpath All Commercial |
$4.74
|
| Rate for Payer: Humana ChoiceCare |
$4.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.64
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: PHP All Commercial |
$3.91
|
| Rate for Payer: Sagamore Health Network All Products |
$3.98
|
| Rate for Payer: Signature Care EPO |
$4.27
|
| Rate for Payer: Signature Care PPO |
$4.53
|
| Rate for Payer: United Healthcare Commercial |
$4.06
|
|
|
HC ISOLATION AIRBORNE & CONTACT
|
Facility
OP
|
$183.84
|
|
| Hospital Charge Code |
06078004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.67 |
| Max. Negotiated Rate |
$170.98 |
| Rate for Payer: Aetna Commercial |
$155.17
|
| Rate for Payer: Aetna Medicare |
$60.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.74
|
| Rate for Payer: Cash Price |
$113.98
|
| Rate for Payer: Cash Price |
$113.98
|
| Rate for Payer: Centivo All Commercial |
$93.76
|
| Rate for Payer: Cigna All Commercial |
$158.66
|
| Rate for Payer: CORVEL All Commercial |
$170.98
|
| Rate for Payer: Coventry All Commercial |
$161.78
|
| Rate for Payer: Encore All Commercial |
$169.23
|
| Rate for Payer: Frontpath All Commercial |
$169.14
|
| Rate for Payer: Humana ChoiceCare |
$158.79
|
| Rate for Payer: Humana Medicare |
$93.76
|
| Rate for Payer: Lucent All Commercial |
$93.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$137.88
|
| Rate for Payer: PHP All Commercial |
$139.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.70
|
| Rate for Payer: Sagamore Health Network All Products |
$141.93
|
| Rate for Payer: Signature Care EPO |
$152.59
|
| Rate for Payer: Signature Care PPO |
$161.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.27
|
| Rate for Payer: United Healthcare Commercial |
$144.87
|
| Rate for Payer: United Healthcare Medicare |
$60.67
|
|
|
HC ISOLATION AIRBORNE & CONTACT
|
Facility
IP
|
$183.84
|
|
| Hospital Charge Code |
06078004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.88 |
| Max. Negotiated Rate |
$170.98 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: Cash Price |
$113.98
|
| Rate for Payer: Cigna All Commercial |
$158.66
|
| Rate for Payer: CORVEL All Commercial |
$170.98
|
| Rate for Payer: Coventry All Commercial |
$161.78
|
| Rate for Payer: Encore All Commercial |
$169.23
|
| Rate for Payer: Frontpath All Commercial |
$169.14
|
| Rate for Payer: Humana ChoiceCare |
$158.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.46
|
| Rate for Payer: PHCS All Commercial |
$137.88
|
| Rate for Payer: PHP All Commercial |
$139.43
|
| Rate for Payer: Sagamore Health Network All Products |
$141.93
|
| 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 W/HEPA
|
Facility
OP
|
$183.84
|
|
| Hospital Charge Code |
06078003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.67 |
| Max. Negotiated Rate |
$170.98 |
| Rate for Payer: Aetna Commercial |
$155.17
|
| Rate for Payer: Aetna Medicare |
$60.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.74
|
| Rate for Payer: Cash Price |
$113.98
|
| Rate for Payer: Cash Price |
$113.98
|
| Rate for Payer: Centivo All Commercial |
$93.76
|
| Rate for Payer: Cigna All Commercial |
$158.66
|
| Rate for Payer: CORVEL All Commercial |
$170.98
|
| Rate for Payer: Coventry All Commercial |
$161.78
|
| Rate for Payer: Encore All Commercial |
$169.23
|
| Rate for Payer: Frontpath All Commercial |
$169.14
|
| Rate for Payer: Humana ChoiceCare |
$158.79
|
| Rate for Payer: Humana Medicare |
$93.76
|
| Rate for Payer: Lucent All Commercial |
$93.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$137.88
|
| Rate for Payer: PHP All Commercial |
$139.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.70
|
| Rate for Payer: Sagamore Health Network All Products |
$141.93
|
| Rate for Payer: Signature Care EPO |
$152.59
|
| Rate for Payer: Signature Care PPO |
$161.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.27
|
| Rate for Payer: United Healthcare Commercial |
$144.87
|
| Rate for Payer: United Healthcare Medicare |
$60.67
|
|
|
HC ISOLATION AIRBORNE W/HEPA
|
Facility
IP
|
$183.84
|
|
| Hospital Charge Code |
06078003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.88 |
| Max. Negotiated Rate |
$170.98 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: Cash Price |
$113.98
|
| Rate for Payer: Cigna All Commercial |
$158.66
|
| Rate for Payer: CORVEL All Commercial |
$170.98
|
| Rate for Payer: Coventry All Commercial |
$161.78
|
| Rate for Payer: Encore All Commercial |
$169.23
|
| Rate for Payer: Frontpath All Commercial |
$169.14
|
| Rate for Payer: Humana ChoiceCare |
$158.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.46
|
| Rate for Payer: PHCS All Commercial |
$137.88
|
| Rate for Payer: PHP All Commercial |
$139.43
|
| Rate for Payer: Sagamore Health Network All Products |
$141.93
|
| 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
IP
|
$108.20
|
|
| Hospital Charge Code |
06078000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$100.63 |
| Rate for Payer: Aetna Commercial |
$93.49
|
| Rate for Payer: Cash Price |
$67.09
|
| 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 |
$99.55
|
| 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 CONTACT
|
Facility
OP
|
$108.20
|
|
| Hospital Charge Code |
06078000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$91.32
|
| Rate for Payer: Aetna Medicare |
$35.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.28
|
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Centivo All Commercial |
$55.18
|
| 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 |
$99.55
|
| Rate for Payer: Humana ChoiceCare |
$93.45
|
| Rate for Payer: Humana Medicare |
$55.18
|
| Rate for Payer: Lucent All Commercial |
$55.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$35.71
|
|
|
HC ISOLATION DROPLET
|
Facility
OP
|
$64.92
|
|
| Hospital Charge Code |
06078001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$54.80
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$40.25
|
| Rate for Payer: Cash Price |
$40.25
|
| Rate for Payer: Centivo All Commercial |
$33.11
|
| 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 |
$33.11
|
| Rate for Payer: Lucent All Commercial |
$33.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.43
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$53.89
|
| 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 |
$21.42
|
|
|
HC ISOLATION DROPLET
|
Facility
IP
|
$64.92
|
|
| Hospital Charge Code |
06078001
|
|
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 |
$40.25
|
| 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 |
$53.89
|
| Rate for Payer: Signature Care PPO |
$57.13
|
| Rate for Payer: United Healthcare Commercial |
$51.16
|
|
|
HC ISOLATION DROPLET & CONTACT
|
Facility
IP
|
$108.20
|
|
| Hospital Charge Code |
06078002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$100.63 |
| Rate for Payer: Aetna Commercial |
$93.49
|
| Rate for Payer: Cash Price |
$67.09
|
| 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 |
$99.55
|
| 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 & CONTACT
|
Facility
OP
|
$108.20
|
|
| Hospital Charge Code |
06078002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$91.32
|
| Rate for Payer: Aetna Medicare |
$35.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.28
|
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Centivo All Commercial |
$55.18
|
| 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 |
$99.55
|
| Rate for Payer: Humana ChoiceCare |
$93.45
|
| Rate for Payer: Humana Medicare |
$55.18
|
| Rate for Payer: Lucent All Commercial |
$55.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$35.71
|
|
|
HC ISTENT
|
Facility
OP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41607043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,659.44
|
| Rate for Payer: Aetna Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,892.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,413.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,893.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,724.38
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Centivo All Commercial |
$5,232.60
|
| 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 |
$5,232.60
|
| Rate for Payer: Lucent All Commercial |
$5,232.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| 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 |
$3,385.80
|
|
|
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 |
$6,361.20
|
| 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
|
|
