|
HC KOH PREP
|
Facility
OP
|
$73.61
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
63001209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$68.46 |
| Rate for Payer: Aetna Commercial |
$62.13
|
| Rate for Payer: Aetna Medicare |
$24.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.72
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Centivo All Commercial |
$37.54
|
| Rate for Payer: Cigna All Commercial |
$63.53
|
| Rate for Payer: CORVEL All Commercial |
$68.46
|
| Rate for Payer: Coventry All Commercial |
$64.78
|
| Rate for Payer: Encore All Commercial |
$67.76
|
| Rate for Payer: Frontpath All Commercial |
$67.72
|
| Rate for Payer: Humana ChoiceCare |
$63.58
|
| Rate for Payer: Humana Medicare |
$37.54
|
| Rate for Payer: Lucent All Commercial |
$37.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.25
|
| Rate for Payer: Managed Health Services Medicaid |
$5.81
|
| Rate for Payer: MDWise Medicaid |
$5.81
|
| Rate for Payer: PHCS All Commercial |
$55.21
|
| Rate for Payer: PHP All Commercial |
$55.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.71
|
| Rate for Payer: Sagamore Health Network All Products |
$56.83
|
| Rate for Payer: Signature Care EPO |
$61.10
|
| Rate for Payer: Signature Care PPO |
$64.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.57
|
| Rate for Payer: United Healthcare Commercial |
$58.01
|
| Rate for Payer: United Healthcare Medicare |
$24.29
|
|
|
HC KUMAR CATHETER
|
Facility
OP
|
$11.73
|
|
| Hospital Charge Code |
41605872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Medicare |
$3.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.26
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Centivo All Commercial |
$5.98
|
| Rate for Payer: Cigna All Commercial |
$10.12
|
| Rate for Payer: CORVEL All Commercial |
$10.91
|
| Rate for Payer: Coventry All Commercial |
$10.32
|
| Rate for Payer: Encore All Commercial |
$10.80
|
| Rate for Payer: Frontpath All Commercial |
$10.79
|
| Rate for Payer: Humana ChoiceCare |
$10.13
|
| Rate for Payer: Humana Medicare |
$5.98
|
| Rate for Payer: Lucent All Commercial |
$5.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.80
|
| Rate for Payer: PHP All Commercial |
$8.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.57
|
| Rate for Payer: Sagamore Health Network All Products |
$9.06
|
| Rate for Payer: Signature Care EPO |
$9.74
|
| Rate for Payer: Signature Care PPO |
$10.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$9.24
|
| Rate for Payer: United Healthcare Medicare |
$3.87
|
|
|
HC KUMAR CATHETER
|
Facility
IP
|
$11.73
|
|
| Hospital Charge Code |
41605872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Cigna All Commercial |
$10.12
|
| Rate for Payer: CORVEL All Commercial |
$10.91
|
| Rate for Payer: Coventry All Commercial |
$10.32
|
| Rate for Payer: Encore All Commercial |
$10.80
|
| Rate for Payer: Frontpath All Commercial |
$10.79
|
| Rate for Payer: Humana ChoiceCare |
$10.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.56
|
| Rate for Payer: PHCS All Commercial |
$8.80
|
| Rate for Payer: PHP All Commercial |
$8.90
|
| Rate for Payer: Sagamore Health Network All Products |
$9.06
|
| Rate for Payer: Signature Care EPO |
$9.74
|
| Rate for Payer: Signature Care PPO |
$10.32
|
| Rate for Payer: United Healthcare Commercial |
$9.24
|
|
|
HC K-WIRE .045, 15.2CM DIAMOND BOTH ENDS
|
Facility
OP
|
$155.17
|
|
| Hospital Charge Code |
41601824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.21 |
| Max. Negotiated Rate |
$144.31 |
| Rate for Payer: Aetna Commercial |
$130.96
|
| Rate for Payer: Aetna Medicare |
$51.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.33
|
| Rate for Payer: Cash Price |
$96.21
|
| Rate for Payer: Cash Price |
$96.21
|
| Rate for Payer: Centivo All Commercial |
$79.14
|
| Rate for Payer: Cigna All Commercial |
$133.91
|
| Rate for Payer: CORVEL All Commercial |
$144.31
|
| Rate for Payer: Coventry All Commercial |
$136.55
|
| Rate for Payer: Encore All Commercial |
$142.83
|
| Rate for Payer: Frontpath All Commercial |
$142.76
|
| Rate for Payer: Humana ChoiceCare |
$134.02
|
| Rate for Payer: Humana Medicare |
$79.14
|
| Rate for Payer: Lucent All Commercial |
$79.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.65
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$116.38
|
| Rate for Payer: PHP All Commercial |
$117.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.52
|
| Rate for Payer: Sagamore Health Network All Products |
$119.79
|
| Rate for Payer: Signature Care EPO |
$128.79
|
| Rate for Payer: Signature Care PPO |
$136.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.89
|
| Rate for Payer: United Healthcare Commercial |
$122.27
|
| Rate for Payer: United Healthcare Medicare |
$51.21
|
|
|
HC K-WIRE .045, 15.2CM DIAMOND BOTH ENDS
|
Facility
IP
|
$155.17
|
|
| Hospital Charge Code |
41601824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.38 |
| Max. Negotiated Rate |
$144.31 |
| Rate for Payer: Aetna Commercial |
$134.07
|
| Rate for Payer: Cash Price |
$96.21
|
| Rate for Payer: Cigna All Commercial |
$133.91
|
| Rate for Payer: CORVEL All Commercial |
$144.31
|
| Rate for Payer: Coventry All Commercial |
$136.55
|
| Rate for Payer: Encore All Commercial |
$142.83
|
| Rate for Payer: Frontpath All Commercial |
$142.76
|
| Rate for Payer: Humana ChoiceCare |
$134.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.65
|
| Rate for Payer: PHCS All Commercial |
$116.38
|
| Rate for Payer: PHP All Commercial |
$117.68
|
| Rate for Payer: Sagamore Health Network All Products |
$119.79
|
| Rate for Payer: Signature Care EPO |
$128.79
|
| Rate for Payer: Signature Care PPO |
$136.55
|
| Rate for Payer: United Healthcare Commercial |
$122.27
|
|
|
HC K-WIRE .062, 15.2CM DIAMOND BOTH ENDS
|
Facility
IP
|
$49.58
|
|
| Hospital Charge Code |
41601825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$46.11 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cigna All Commercial |
$42.79
|
| Rate for Payer: CORVEL All Commercial |
$46.11
|
| Rate for Payer: Coventry All Commercial |
$43.63
|
| Rate for Payer: Encore All Commercial |
$45.64
|
| Rate for Payer: Frontpath All Commercial |
$45.61
|
| Rate for Payer: Humana ChoiceCare |
$42.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.62
|
| Rate for Payer: PHCS All Commercial |
$37.18
|
| Rate for Payer: PHP All Commercial |
$37.60
|
| Rate for Payer: Sagamore Health Network All Products |
$38.28
|
| Rate for Payer: Signature Care EPO |
$41.15
|
| Rate for Payer: Signature Care PPO |
$43.63
|
| Rate for Payer: United Healthcare Commercial |
$39.07
|
|
|
HC K-WIRE .062, 15.2CM DIAMOND BOTH ENDS
|
Facility
OP
|
$49.58
|
|
| Hospital Charge Code |
41601825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$41.85
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.00
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Centivo All Commercial |
$25.29
|
| Rate for Payer: Cigna All Commercial |
$42.79
|
| Rate for Payer: CORVEL All Commercial |
$46.11
|
| Rate for Payer: Coventry All Commercial |
$43.63
|
| Rate for Payer: Encore All Commercial |
$45.64
|
| Rate for Payer: Frontpath All Commercial |
$45.61
|
| Rate for Payer: Humana ChoiceCare |
$42.82
|
| Rate for Payer: Humana Medicare |
$25.29
|
| Rate for Payer: Lucent All Commercial |
$25.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.62
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$37.18
|
| Rate for Payer: PHP All Commercial |
$37.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.34
|
| Rate for Payer: Sagamore Health Network All Products |
$38.28
|
| Rate for Payer: Signature Care EPO |
$41.15
|
| Rate for Payer: Signature Care PPO |
$43.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.14
|
| Rate for Payer: United Healthcare Commercial |
$39.07
|
| Rate for Payer: United Healthcare Medicare |
$16.36
|
|
|
HC K WIRE 45X4 DBL TRO
|
Facility
OP
|
$93.33
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$78.77
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.88
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Centivo All Commercial |
$47.60
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Lucent All Commercial |
$47.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.40
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.33
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
| Rate for Payer: United Healthcare Medicare |
$30.80
|
|
|
HC K WIRE 45X4 DBL TRO
|
Facility
IP
|
$93.33
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$80.64
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
|
|
HC K WIRE 54X4 DBL TRO
|
Facility
OP
|
$75.44
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$24.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.38
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Centivo All Commercial |
$38.47
|
| Rate for Payer: Cigna All Commercial |
$65.10
|
| Rate for Payer: CORVEL All Commercial |
$70.16
|
| Rate for Payer: Coventry All Commercial |
$66.39
|
| Rate for Payer: Encore All Commercial |
$69.44
|
| Rate for Payer: Frontpath All Commercial |
$69.40
|
| Rate for Payer: Humana ChoiceCare |
$65.16
|
| Rate for Payer: Humana Medicare |
$38.47
|
| Rate for Payer: Lucent All Commercial |
$38.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$56.58
|
| Rate for Payer: PHP All Commercial |
$57.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.42
|
| Rate for Payer: Sagamore Health Network All Products |
$58.24
|
| Rate for Payer: Signature Care EPO |
$62.62
|
| Rate for Payer: Signature Care PPO |
$66.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.12
|
| Rate for Payer: United Healthcare Commercial |
$59.45
|
| Rate for Payer: United Healthcare Medicare |
$24.90
|
|
|
HC K WIRE 54X4 DBL TRO
|
Facility
IP
|
$75.44
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$70.16 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Cigna All Commercial |
$65.10
|
| Rate for Payer: CORVEL All Commercial |
$70.16
|
| Rate for Payer: Coventry All Commercial |
$66.39
|
| Rate for Payer: Encore All Commercial |
$69.44
|
| Rate for Payer: Frontpath All Commercial |
$69.40
|
| Rate for Payer: Humana ChoiceCare |
$65.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.90
|
| Rate for Payer: PHCS All Commercial |
$56.58
|
| Rate for Payer: PHP All Commercial |
$57.21
|
| Rate for Payer: Sagamore Health Network All Products |
$58.24
|
| Rate for Payer: Signature Care EPO |
$62.62
|
| Rate for Payer: Signature Care PPO |
$66.39
|
| Rate for Payer: United Healthcare Commercial |
$59.45
|
|
|
HC K WIRE 62X4 DBL TRO
|
Facility
OP
|
$75.44
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$24.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.38
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Centivo All Commercial |
$38.47
|
| Rate for Payer: Cigna All Commercial |
$65.10
|
| Rate for Payer: CORVEL All Commercial |
$70.16
|
| Rate for Payer: Coventry All Commercial |
$66.39
|
| Rate for Payer: Encore All Commercial |
$69.44
|
| Rate for Payer: Frontpath All Commercial |
$69.40
|
| Rate for Payer: Humana ChoiceCare |
$65.16
|
| Rate for Payer: Humana Medicare |
$38.47
|
| Rate for Payer: Lucent All Commercial |
$38.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$56.58
|
| Rate for Payer: PHP All Commercial |
$57.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.42
|
| Rate for Payer: Sagamore Health Network All Products |
$58.24
|
| Rate for Payer: Signature Care EPO |
$62.62
|
| Rate for Payer: Signature Care PPO |
$66.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.12
|
| Rate for Payer: United Healthcare Commercial |
$59.45
|
| Rate for Payer: United Healthcare Medicare |
$24.90
|
|
|
HC K WIRE 62X4 DBL TRO
|
Facility
IP
|
$75.44
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$70.16 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Cigna All Commercial |
$65.10
|
| Rate for Payer: CORVEL All Commercial |
$70.16
|
| Rate for Payer: Coventry All Commercial |
$66.39
|
| Rate for Payer: Encore All Commercial |
$69.44
|
| Rate for Payer: Frontpath All Commercial |
$69.40
|
| Rate for Payer: Humana ChoiceCare |
$65.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.90
|
| Rate for Payer: PHCS All Commercial |
$56.58
|
| Rate for Payer: PHP All Commercial |
$57.21
|
| Rate for Payer: Sagamore Health Network All Products |
$58.24
|
| Rate for Payer: Signature Care EPO |
$62.62
|
| Rate for Payer: Signature Care PPO |
$66.39
|
| Rate for Payer: United Healthcare Commercial |
$59.45
|
|
|
HC LABOR HOUR <24 HR
|
Facility
OP
|
$19.27
|
|
| Hospital Charge Code |
01028002
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$538.43 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$538.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.99
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$538.43
|
| Rate for Payer: MDWise Medicaid |
$538.43
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC LABOR HOUR <24 HR
|
Facility
IP
|
$19.27
|
|
| Hospital Charge Code |
01028002
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC LABOR HOUR INITIAL
|
Facility
IP
|
$1,201.16
|
|
| Hospital Charge Code |
01028003
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$900.87 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,037.80
|
| Rate for Payer: Cash Price |
$744.72
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.05
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: United Healthcare Commercial |
$946.52
|
|
|
HC LABOR HOUR INITIAL
|
Facility
OP
|
$1,201.16
|
|
| Hospital Charge Code |
01028003
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$396.38 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,013.78
|
| Rate for Payer: Aetna Medicare |
$396.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$396.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$689.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$538.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$436.02
|
| Rate for Payer: Cash Price |
$744.72
|
| Rate for Payer: Cash Price |
$744.72
|
| Rate for Payer: Centivo All Commercial |
$612.59
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Humana Medicare |
$612.59
|
| Rate for Payer: Lucent All Commercial |
$612.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.05
|
| Rate for Payer: Managed Health Services Medicaid |
$538.43
|
| Rate for Payer: MDWise Medicaid |
$538.43
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.45
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.99
|
| Rate for Payer: United Healthcare Commercial |
$946.52
|
| Rate for Payer: United Healthcare Medicare |
$396.38
|
|
|
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 |
$5,584.50 |
| Rate for Payer: Aetna Commercial |
$1,420.62
|
| Rate for Payer: Aetna Medicare |
$3,285.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,285.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,777.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,613.50
|
| Rate for Payer: Cash Price |
$1,019.43
|
| Rate for Payer: Cash Price |
$1,019.43
|
| Rate for Payer: Centivo All Commercial |
$3,613.50
|
| 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 |
$3,285.00
|
| Rate for Payer: Lucent All Commercial |
$5,584.50
|
| 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 |
$3,285.00
|
|
|
HC LACERATION KIT
|
Facility
IP
|
$95.76
|
|
| Hospital Charge Code |
41601067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$89.06 |
| Rate for Payer: Aetna Commercial |
$82.74
|
| Rate for Payer: Cash Price |
$59.37
|
| Rate for Payer: Cigna All Commercial |
$82.64
|
| Rate for Payer: CORVEL All Commercial |
$89.06
|
| Rate for Payer: Coventry All Commercial |
$84.27
|
| Rate for Payer: Encore All Commercial |
$88.15
|
| Rate for Payer: Frontpath All Commercial |
$88.10
|
| Rate for Payer: Humana ChoiceCare |
$82.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.18
|
| Rate for Payer: PHCS All Commercial |
$71.82
|
| Rate for Payer: PHP All Commercial |
$72.62
|
| Rate for Payer: Sagamore Health Network All Products |
$73.93
|
| Rate for Payer: Signature Care EPO |
$79.48
|
| Rate for Payer: Signature Care PPO |
$84.27
|
| Rate for Payer: United Healthcare Commercial |
$75.46
|
|
|
HC LACERATION KIT
|
Facility
OP
|
$95.76
|
|
| Hospital Charge Code |
41601067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$80.82
|
| Rate for Payer: Aetna Medicare |
$31.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$59.37
|
| Rate for Payer: Cash Price |
$59.37
|
| Rate for Payer: Centivo All Commercial |
$48.84
|
| Rate for Payer: Cigna All Commercial |
$82.64
|
| Rate for Payer: CORVEL All Commercial |
$89.06
|
| Rate for Payer: Coventry All Commercial |
$84.27
|
| Rate for Payer: Encore All Commercial |
$88.15
|
| Rate for Payer: Frontpath All Commercial |
$88.10
|
| Rate for Payer: Humana ChoiceCare |
$82.71
|
| Rate for Payer: Humana Medicare |
$48.84
|
| Rate for Payer: Lucent All Commercial |
$48.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$71.82
|
| Rate for Payer: PHP All Commercial |
$72.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.35
|
| Rate for Payer: Sagamore Health Network All Products |
$73.93
|
| Rate for Payer: Signature Care EPO |
$79.48
|
| Rate for Payer: Signature Care PPO |
$84.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.40
|
| Rate for Payer: United Healthcare Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare |
$31.60
|
|
|
HC LACOSAMIDE, SERUM OR PLASMA
|
Facility
OP
|
$189.16
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$159.65
|
| Rate for Payer: Aetna Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.66
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Centivo All Commercial |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| 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 |
$96.47
|
| Rate for Payer: Lucent All Commercial |
$96.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| 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 |
$62.42
|
|
|
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 |
$117.28
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| 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 |
$156.89
|
| Rate for Payer: Aetna Medicare |
$61.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.48
|
| Rate for Payer: Cash Price |
$115.25
|
| Rate for Payer: Cash Price |
$115.25
|
| Rate for Payer: Centivo All Commercial |
$94.80
|
| Rate for Payer: Cigna All Commercial |
$160.42
|
| Rate for Payer: CORVEL All Commercial |
$172.87
|
| Rate for Payer: Coventry All Commercial |
$163.58
|
| Rate for Payer: Encore All Commercial |
$171.11
|
| Rate for Payer: Frontpath All Commercial |
$171.01
|
| Rate for Payer: Humana ChoiceCare |
$160.55
|
| Rate for Payer: Humana Medicare |
$94.80
|
| Rate for Payer: Lucent All Commercial |
$94.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.30
|
| 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 |
$140.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.50
|
| Rate for Payer: Sagamore Health Network All Products |
$143.50
|
| Rate for Payer: Signature Care EPO |
$154.28
|
| Rate for Payer: Signature Care PPO |
$163.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.00
|
| Rate for Payer: United Healthcare Commercial |
$146.48
|
| Rate for Payer: United Healthcare Medicare |
$61.34
|
|
|
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: Cigna All Commercial |
$160.42
|
| Rate for Payer: Aetna Commercial |
$160.60
|
| Rate for Payer: Cash Price |
$115.25
|
| Rate for Payer: CORVEL All Commercial |
$172.87
|
| Rate for Payer: Coventry All Commercial |
$163.58
|
| Rate for Payer: Encore All Commercial |
$171.11
|
| Rate for Payer: Frontpath All Commercial |
$171.01
|
| Rate for Payer: Humana ChoiceCare |
$160.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.30
|
| Rate for Payer: PHCS All Commercial |
$139.41
|
| Rate for Payer: PHP All Commercial |
$140.98
|
| Rate for Payer: Sagamore Health Network All Products |
$143.50
|
| Rate for Payer: Signature Care EPO |
$154.28
|
| Rate for Payer: Signature Care PPO |
$163.58
|
| Rate for Payer: United Healthcare Commercial |
$146.48
|
|
|
HC LACTOFERRIN - FECES
|
Facility
OP
|
$197.71
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
63001618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$183.87 |
| Rate for Payer: Aetna Commercial |
$166.86
|
| Rate for Payer: Aetna Medicare |
$65.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$113.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.77
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Centivo All Commercial |
$100.83
|
| 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 |
$100.83
|
| Rate for Payer: Lucent All Commercial |
$100.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.94
|
| Rate for Payer: Managed Health Services Medicaid |
$16.00
|
| Rate for Payer: MDWise Medicaid |
$16.00
|
| 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 |
$155.79
|
| Rate for Payer: United Healthcare Medicare |
$65.24
|
|
