|
HC LABORING ROOM
|
Facility
|
IP
|
$1,644.24
|
|
| Hospital Charge Code |
10010025
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,233.18 |
| Max. Negotiated Rate |
$6,636.80 |
| Rate for Payer: Aetna Commercial |
$1,420.62
|
| Rate for Payer: Aetna Medicare |
$3,904.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,864.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,489.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,294.40
|
| Rate for Payer: Cash Price |
$986.54
|
| Rate for Payer: Cash Price |
$986.54
|
| Rate for Payer: Centivo All Commercial |
$6,636.80
|
| Rate for Payer: Cigna All Commercial |
$1,418.98
|
| Rate for Payer: CORVEL All Commercial |
$1,529.14
|
| Rate for Payer: Coventry All Commercial |
$1,446.93
|
| Rate for Payer: Encore All Commercial |
$1,513.52
|
| Rate for Payer: Frontpath All Commercial |
$1,512.70
|
| Rate for Payer: Humana ChoiceCare |
$1,420.13
|
| Rate for Payer: Humana Medicare |
$3,904.00
|
| Rate for Payer: Lucent All Commercial |
$6,636.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,479.82
|
| Rate for Payer: PHCS All Commercial |
$1,233.18
|
| Rate for Payer: PHP All Commercial |
$1,246.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,269.35
|
| Rate for Payer: Signature Care EPO |
$1,364.72
|
| Rate for Payer: Signature Care PPO |
$1,446.93
|
| Rate for Payer: United Healthcare Commercial |
$1,295.66
|
| Rate for Payer: United Healthcare Medicare |
$3,904.00
|
|
|
HC LACOSAMIDE, SERUM OR PLASMA
|
Facility
|
OP
|
$189.16
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
63001409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$159.65
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.58
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Centivo All Commercial |
$102.90
|
| Rate for Payer: Cigna All Commercial |
$163.25
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Humana Medicare |
$60.53
|
| Rate for Payer: Lucent All Commercial |
$102.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.77
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.79
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
| Rate for Payer: United Healthcare Medicare |
$60.53
|
|
|
HC LACOSAMIDE, SERUM OR PLASMA
|
Facility
|
IP
|
$189.16
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
63001409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$163.43
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna All Commercial |
$163.25
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
|
|
HC LACOSAMIDE, SERUM OR PLASMA
|
Facility
|
OP
|
$189.16
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$159.65
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.58
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Centivo All Commercial |
$102.90
|
| Rate for Payer: Cigna All Commercial |
$163.25
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Humana Medicare |
$60.53
|
| Rate for Payer: Lucent All Commercial |
$102.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.77
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.79
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
| Rate for Payer: United Healthcare Medicare |
$60.53
|
|
|
HC LACOSAMIDE, SERUM OR PLASMA
|
Facility
|
IP
|
$189.16
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$163.43
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna All Commercial |
$163.25
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
|
|
HC LACTIC ACID
|
Facility
|
OP
|
$185.88
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
63001200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$172.87 |
| Rate for Payer: Aetna Commercial |
$156.88
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.43
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Centivo All Commercial |
$101.12
|
| Rate for Payer: Cigna All Commercial |
$160.41
|
| Rate for Payer: CORVEL All Commercial |
$172.87
|
| Rate for Payer: Coventry All Commercial |
$163.57
|
| Rate for Payer: Encore All Commercial |
$171.10
|
| Rate for Payer: Frontpath All Commercial |
$171.01
|
| Rate for Payer: Humana ChoiceCare |
$160.54
|
| Rate for Payer: Humana Medicare |
$59.48
|
| Rate for Payer: Lucent All Commercial |
$101.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.29
|
| Rate for Payer: Managed Health Services Medicaid |
$11.57
|
| Rate for Payer: MDWise Medicaid |
$11.57
|
| Rate for Payer: PHCS All Commercial |
$139.41
|
| Rate for Payer: PHP All Commercial |
$140.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.49
|
| Rate for Payer: Sagamore Health Network All Products |
$143.50
|
| Rate for Payer: Signature Care EPO |
$154.28
|
| Rate for Payer: Signature Care PPO |
$163.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.00
|
| Rate for Payer: United Healthcare Commercial |
$146.47
|
| Rate for Payer: United Healthcare Medicare |
$59.48
|
|
|
HC LACTIC ACID
|
Facility
|
IP
|
$185.88
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
63001200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.41 |
| Max. Negotiated Rate |
$172.87 |
| Rate for Payer: Aetna Commercial |
$160.60
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cigna All Commercial |
$160.41
|
| Rate for Payer: CORVEL All Commercial |
$172.87
|
| Rate for Payer: Coventry All Commercial |
$163.57
|
| Rate for Payer: Encore All Commercial |
$171.10
|
| Rate for Payer: Frontpath All Commercial |
$171.01
|
| Rate for Payer: Humana ChoiceCare |
$160.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.29
|
| Rate for Payer: PHCS All Commercial |
$139.41
|
| Rate for Payer: PHP All Commercial |
$140.97
|
| Rate for Payer: Sagamore Health Network All Products |
$143.50
|
| Rate for Payer: Signature Care EPO |
$154.28
|
| Rate for Payer: Signature Care PPO |
$163.57
|
| Rate for Payer: United Healthcare Commercial |
$146.47
|
|
|
HC LACTOFERRIN - FECES
|
Facility
|
OP
|
$197.71
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
63001618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$183.87 |
| Rate for Payer: Aetna Commercial |
$166.87
|
| Rate for Payer: Aetna Medicare |
$63.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$90.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.59
|
| Rate for Payer: Cash Price |
$118.63
|
| Rate for Payer: Cash Price |
$118.63
|
| Rate for Payer: Centivo All Commercial |
$107.55
|
| Rate for Payer: Cigna All Commercial |
$170.62
|
| Rate for Payer: CORVEL All Commercial |
$183.87
|
| Rate for Payer: Coventry All Commercial |
$173.98
|
| Rate for Payer: Encore All Commercial |
$181.99
|
| Rate for Payer: Frontpath All Commercial |
$181.89
|
| Rate for Payer: Humana ChoiceCare |
$170.76
|
| Rate for Payer: Humana Medicare |
$63.27
|
| Rate for Payer: Lucent All Commercial |
$107.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.94
|
| Rate for Payer: Managed Health Services Medicaid |
$19.70
|
| Rate for Payer: MDWise Medicaid |
$19.70
|
| Rate for Payer: PHCS All Commercial |
$148.28
|
| Rate for Payer: PHP All Commercial |
$149.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.11
|
| Rate for Payer: Sagamore Health Network All Products |
$152.63
|
| Rate for Payer: Signature Care EPO |
$164.10
|
| Rate for Payer: Signature Care PPO |
$173.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$168.05
|
| Rate for Payer: United Healthcare Commercial |
$155.80
|
| Rate for Payer: United Healthcare Medicare |
$63.27
|
|
|
HC LACTOFERRIN - FECES
|
Facility
|
IP
|
$197.71
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
63001618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.28 |
| Max. Negotiated Rate |
$183.87 |
| Rate for Payer: Aetna Commercial |
$170.82
|
| Rate for Payer: Cash Price |
$118.63
|
| Rate for Payer: Cigna All Commercial |
$170.62
|
| Rate for Payer: CORVEL All Commercial |
$183.87
|
| Rate for Payer: Coventry All Commercial |
$173.98
|
| Rate for Payer: Encore All Commercial |
$181.99
|
| Rate for Payer: Frontpath All Commercial |
$181.89
|
| Rate for Payer: Humana ChoiceCare |
$170.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.94
|
| Rate for Payer: PHCS All Commercial |
$148.28
|
| Rate for Payer: PHP All Commercial |
$149.94
|
| Rate for Payer: Sagamore Health Network All Products |
$152.63
|
| Rate for Payer: Signature Care EPO |
$164.10
|
| Rate for Payer: Signature Care PPO |
$173.98
|
| Rate for Payer: United Healthcare Commercial |
$155.80
|
|
|
HC LAMOTRIGINE/LAMI
|
Facility
|
IP
|
$271.17
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
63001007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$252.19 |
| Rate for Payer: Aetna Commercial |
$234.29
|
| Rate for Payer: Cash Price |
$162.70
|
| Rate for Payer: Cigna All Commercial |
$234.02
|
| Rate for Payer: CORVEL All Commercial |
$252.19
|
| Rate for Payer: Coventry All Commercial |
$238.63
|
| Rate for Payer: Encore All Commercial |
$249.61
|
| Rate for Payer: Frontpath All Commercial |
$249.48
|
| Rate for Payer: Humana ChoiceCare |
$234.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.05
|
| Rate for Payer: PHCS All Commercial |
$203.38
|
| Rate for Payer: PHP All Commercial |
$205.66
|
| Rate for Payer: Sagamore Health Network All Products |
$209.34
|
| Rate for Payer: Signature Care EPO |
$225.07
|
| Rate for Payer: Signature Care PPO |
$238.63
|
| Rate for Payer: United Healthcare Commercial |
$213.68
|
|
|
HC LAMOTRIGINE/LAMI
|
Facility
|
OP
|
$271.17
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
63001007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$252.19 |
| Rate for Payer: Aetna Commercial |
$228.87
|
| Rate for Payer: Aetna Medicare |
$86.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.45
|
| Rate for Payer: Cash Price |
$162.70
|
| Rate for Payer: Cash Price |
$162.70
|
| Rate for Payer: Centivo All Commercial |
$147.52
|
| Rate for Payer: Cigna All Commercial |
$234.02
|
| Rate for Payer: CORVEL All Commercial |
$252.19
|
| Rate for Payer: Coventry All Commercial |
$238.63
|
| Rate for Payer: Encore All Commercial |
$249.61
|
| Rate for Payer: Frontpath All Commercial |
$249.48
|
| Rate for Payer: Humana ChoiceCare |
$234.21
|
| Rate for Payer: Humana Medicare |
$86.77
|
| Rate for Payer: Lucent All Commercial |
$147.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.05
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$203.38
|
| Rate for Payer: PHP All Commercial |
$205.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.76
|
| Rate for Payer: Sagamore Health Network All Products |
$209.34
|
| Rate for Payer: Signature Care EPO |
$225.07
|
| Rate for Payer: Signature Care PPO |
$238.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$230.49
|
| Rate for Payer: United Healthcare Commercial |
$213.68
|
| Rate for Payer: United Healthcare Medicare |
$86.77
|
|
|
HC LDH BF
|
Facility
|
IP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cigna All Commercial |
$93.46
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.30
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: PHCS All Commercial |
$81.22
|
| Rate for Payer: PHP All Commercial |
$82.13
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.30
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
|
|
HC LDH BF
|
Facility
|
OP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$91.41
|
| Rate for Payer: Aetna Medicare |
$34.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Centivo All Commercial |
$58.92
|
| Rate for Payer: Cigna All Commercial |
$93.46
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.30
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Humana Medicare |
$34.66
|
| Rate for Payer: Lucent All Commercial |
$58.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: Managed Health Services Medicaid |
$6.04
|
| Rate for Payer: MDWise Medicaid |
$6.04
|
| Rate for Payer: PHCS All Commercial |
$81.22
|
| Rate for Payer: PHP All Commercial |
$82.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.24
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.06
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
| Rate for Payer: United Healthcare Medicare |
$34.66
|
|
|
HC LDH BLOOD
|
Facility
|
IP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cigna All Commercial |
$93.46
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.30
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: PHCS All Commercial |
$81.22
|
| Rate for Payer: PHP All Commercial |
$82.13
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.30
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
|
|
HC LDH BLOOD
|
Facility
|
OP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$91.41
|
| Rate for Payer: Aetna Medicare |
$34.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Centivo All Commercial |
$58.92
|
| Rate for Payer: Cigna All Commercial |
$93.46
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.30
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Humana Medicare |
$34.66
|
| Rate for Payer: Lucent All Commercial |
$58.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: Managed Health Services Medicaid |
$6.04
|
| Rate for Payer: MDWise Medicaid |
$6.04
|
| Rate for Payer: PHCS All Commercial |
$81.22
|
| Rate for Payer: PHP All Commercial |
$82.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.24
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.06
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
| Rate for Payer: United Healthcare Medicare |
$34.66
|
|
|
HC LDL, DIRECT
|
Facility
|
IP
|
$113.25
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
63001142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.94 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna All Commercial |
$97.73
|
| Rate for Payer: CORVEL All Commercial |
$105.32
|
| Rate for Payer: Coventry All Commercial |
$99.66
|
| Rate for Payer: Encore All Commercial |
$104.25
|
| Rate for Payer: Frontpath All Commercial |
$104.19
|
| Rate for Payer: Humana ChoiceCare |
$97.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.92
|
| Rate for Payer: PHCS All Commercial |
$84.94
|
| Rate for Payer: PHP All Commercial |
$85.89
|
| Rate for Payer: Sagamore Health Network All Products |
$87.43
|
| Rate for Payer: Signature Care EPO |
$94.00
|
| Rate for Payer: Signature Care PPO |
$99.66
|
| Rate for Payer: United Healthcare Commercial |
$89.24
|
|
|
HC LDL, DIRECT
|
Facility
|
OP
|
$113.25
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
63001142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Aetna Commercial |
$95.58
|
| Rate for Payer: Aetna Medicare |
$36.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.86
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Centivo All Commercial |
$61.61
|
| Rate for Payer: Cigna All Commercial |
$97.73
|
| Rate for Payer: CORVEL All Commercial |
$105.32
|
| Rate for Payer: Coventry All Commercial |
$99.66
|
| Rate for Payer: Encore All Commercial |
$104.25
|
| Rate for Payer: Frontpath All Commercial |
$104.19
|
| Rate for Payer: Humana ChoiceCare |
$97.81
|
| Rate for Payer: Humana Medicare |
$36.24
|
| Rate for Payer: Lucent All Commercial |
$61.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.92
|
| Rate for Payer: Managed Health Services Medicaid |
$10.50
|
| Rate for Payer: MDWise Medicaid |
$10.50
|
| Rate for Payer: PHCS All Commercial |
$84.94
|
| Rate for Payer: PHP All Commercial |
$85.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.17
|
| Rate for Payer: Sagamore Health Network All Products |
$87.43
|
| Rate for Payer: Signature Care EPO |
$94.00
|
| Rate for Payer: Signature Care PPO |
$99.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.26
|
| Rate for Payer: United Healthcare Commercial |
$89.24
|
| Rate for Payer: United Healthcare Medicare |
$36.24
|
|
|
HC LEAD
|
Facility
|
IP
|
$128.13
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
63001620
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$119.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Cash Price |
$76.88
|
| Rate for Payer: Cigna All Commercial |
$110.58
|
| Rate for Payer: CORVEL All Commercial |
$119.16
|
| Rate for Payer: Coventry All Commercial |
$112.75
|
| Rate for Payer: Encore All Commercial |
$117.94
|
| Rate for Payer: Frontpath All Commercial |
$117.88
|
| Rate for Payer: Humana ChoiceCare |
$110.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.32
|
| Rate for Payer: PHCS All Commercial |
$96.10
|
| Rate for Payer: PHP All Commercial |
$97.17
|
| Rate for Payer: Sagamore Health Network All Products |
$98.92
|
| Rate for Payer: Signature Care EPO |
$106.35
|
| Rate for Payer: Signature Care PPO |
$112.75
|
| Rate for Payer: United Healthcare Commercial |
$100.97
|
|
|
HC LEAD
|
Facility
|
OP
|
$84.05
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
63001619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$78.17 |
| Rate for Payer: Aetna Commercial |
$70.94
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.59
|
| Rate for Payer: Cash Price |
$50.43
|
| Rate for Payer: Cash Price |
$50.43
|
| Rate for Payer: Centivo All Commercial |
$45.72
|
| Rate for Payer: Cigna All Commercial |
$72.54
|
| Rate for Payer: CORVEL All Commercial |
$78.17
|
| Rate for Payer: Coventry All Commercial |
$73.96
|
| Rate for Payer: Encore All Commercial |
$77.37
|
| Rate for Payer: Frontpath All Commercial |
$77.33
|
| Rate for Payer: Humana ChoiceCare |
$72.59
|
| Rate for Payer: Humana Medicare |
$26.90
|
| Rate for Payer: Lucent All Commercial |
$45.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12.11
|
| Rate for Payer: MDWise Medicaid |
$12.11
|
| Rate for Payer: PHCS All Commercial |
$63.04
|
| Rate for Payer: PHP All Commercial |
$63.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.78
|
| Rate for Payer: Sagamore Health Network All Products |
$64.89
|
| Rate for Payer: Signature Care EPO |
$69.76
|
| Rate for Payer: Signature Care PPO |
$73.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.44
|
| Rate for Payer: United Healthcare Commercial |
$66.23
|
| Rate for Payer: United Healthcare Medicare |
$26.90
|
|
|
HC LEAD
|
Facility
|
IP
|
$84.05
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
63001619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.04 |
| Max. Negotiated Rate |
$78.17 |
| Rate for Payer: Aetna Commercial |
$72.62
|
| Rate for Payer: Cash Price |
$50.43
|
| Rate for Payer: Cigna All Commercial |
$72.54
|
| Rate for Payer: CORVEL All Commercial |
$78.17
|
| Rate for Payer: Coventry All Commercial |
$73.96
|
| Rate for Payer: Encore All Commercial |
$77.37
|
| Rate for Payer: Frontpath All Commercial |
$77.33
|
| Rate for Payer: Humana ChoiceCare |
$72.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.64
|
| Rate for Payer: PHCS All Commercial |
$63.04
|
| Rate for Payer: PHP All Commercial |
$63.74
|
| Rate for Payer: Sagamore Health Network All Products |
$64.89
|
| Rate for Payer: Signature Care EPO |
$69.76
|
| Rate for Payer: Signature Care PPO |
$73.96
|
| Rate for Payer: United Healthcare Commercial |
$66.23
|
|
|
HC LEAD
|
Facility
|
OP
|
$128.13
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
63001620
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$119.16 |
| Rate for Payer: Aetna Commercial |
$108.14
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.10
|
| Rate for Payer: Cash Price |
$76.88
|
| Rate for Payer: Cash Price |
$76.88
|
| Rate for Payer: Centivo All Commercial |
$69.70
|
| Rate for Payer: Cigna All Commercial |
$110.58
|
| Rate for Payer: CORVEL All Commercial |
$119.16
|
| Rate for Payer: Coventry All Commercial |
$112.75
|
| Rate for Payer: Encore All Commercial |
$117.94
|
| Rate for Payer: Frontpath All Commercial |
$117.88
|
| Rate for Payer: Humana ChoiceCare |
$110.67
|
| Rate for Payer: Humana Medicare |
$41.00
|
| Rate for Payer: Lucent All Commercial |
$69.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.32
|
| Rate for Payer: Managed Health Services Medicaid |
$12.11
|
| Rate for Payer: MDWise Medicaid |
$12.11
|
| Rate for Payer: PHCS All Commercial |
$96.10
|
| Rate for Payer: PHP All Commercial |
$97.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.97
|
| Rate for Payer: Sagamore Health Network All Products |
$98.92
|
| Rate for Payer: Signature Care EPO |
$106.35
|
| Rate for Payer: Signature Care PPO |
$112.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.91
|
| Rate for Payer: United Healthcare Commercial |
$100.97
|
| Rate for Payer: United Healthcare Medicare |
$41.00
|
|
|
HC LEAD PM CAP NOVUS 5076-45
|
Facility
|
OP
|
$2,317.50
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
41607338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,155.28 |
| Rate for Payer: Aetna Commercial |
$1,955.97
|
| Rate for Payer: Aetna Medicare |
$741.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$718.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,330.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,448.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$852.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$815.76
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Centivo All Commercial |
$1,260.72
|
| Rate for Payer: Cigna All Commercial |
$2,000.00
|
| Rate for Payer: CORVEL All Commercial |
$2,155.28
|
| Rate for Payer: Coventry All Commercial |
$2,039.40
|
| Rate for Payer: Encore All Commercial |
$2,133.26
|
| Rate for Payer: Frontpath All Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$2,001.62
|
| Rate for Payer: Humana Medicare |
$741.60
|
| Rate for Payer: Lucent All Commercial |
$1,260.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,085.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,738.12
|
| Rate for Payer: PHP All Commercial |
$1,757.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$903.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,789.11
|
| Rate for Payer: Signature Care EPO |
$1,923.53
|
| Rate for Payer: Signature Care PPO |
$2,039.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,969.88
|
| Rate for Payer: United Healthcare Commercial |
$1,826.19
|
| Rate for Payer: United Healthcare Medicare |
$741.60
|
|
|
HC LEAD PM CAP NOVUS 5076-45
|
Facility
|
IP
|
$2,317.50
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
41607338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$2,155.28 |
| Rate for Payer: Aetna Commercial |
$2,002.32
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cigna All Commercial |
$2,000.00
|
| Rate for Payer: CORVEL All Commercial |
$2,155.28
|
| Rate for Payer: Coventry All Commercial |
$2,039.40
|
| Rate for Payer: Encore All Commercial |
$2,133.26
|
| Rate for Payer: Frontpath All Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$2,001.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,085.75
|
| Rate for Payer: PHCS All Commercial |
$1,738.12
|
| Rate for Payer: PHP All Commercial |
$1,757.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,789.11
|
| Rate for Payer: Signature Care EPO |
$1,923.53
|
| Rate for Payer: Signature Care PPO |
$2,039.40
|
| Rate for Payer: United Healthcare Commercial |
$1,826.19
|
|
|
HC LEAD PM CAP NOVUS 5076-52
|
Facility
|
IP
|
$2,317.50
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
41607339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$2,155.28 |
| Rate for Payer: Aetna Commercial |
$2,002.32
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cigna All Commercial |
$2,000.00
|
| Rate for Payer: CORVEL All Commercial |
$2,155.28
|
| Rate for Payer: Coventry All Commercial |
$2,039.40
|
| Rate for Payer: Encore All Commercial |
$2,133.26
|
| Rate for Payer: Frontpath All Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$2,001.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,085.75
|
| Rate for Payer: PHCS All Commercial |
$1,738.12
|
| Rate for Payer: PHP All Commercial |
$1,757.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,789.11
|
| Rate for Payer: Signature Care EPO |
$1,923.53
|
| Rate for Payer: Signature Care PPO |
$2,039.40
|
| Rate for Payer: United Healthcare Commercial |
$1,826.19
|
|
|
HC LEAD PM CAP NOVUS 5076-52
|
Facility
|
OP
|
$2,317.50
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
41607339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,155.28 |
| Rate for Payer: Aetna Commercial |
$1,955.97
|
| Rate for Payer: Aetna Medicare |
$741.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$718.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,330.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,448.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$852.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$815.76
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Centivo All Commercial |
$1,260.72
|
| Rate for Payer: Cigna All Commercial |
$2,000.00
|
| Rate for Payer: CORVEL All Commercial |
$2,155.28
|
| Rate for Payer: Coventry All Commercial |
$2,039.40
|
| Rate for Payer: Encore All Commercial |
$2,133.26
|
| Rate for Payer: Frontpath All Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$2,001.62
|
| Rate for Payer: Humana Medicare |
$741.60
|
| Rate for Payer: Lucent All Commercial |
$1,260.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,085.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,738.12
|
| Rate for Payer: PHP All Commercial |
$1,757.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$903.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,789.11
|
| Rate for Payer: Signature Care EPO |
$1,923.53
|
| Rate for Payer: Signature Care PPO |
$2,039.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,969.88
|
| Rate for Payer: United Healthcare Commercial |
$1,826.19
|
| Rate for Payer: United Healthcare Medicare |
$741.60
|
|
