|
HC MESH VENTRIO ST SM OVAL 8 X 12
|
Facility
|
IP
|
$2,203.92
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.94 |
| Max. Negotiated Rate |
$2,049.65 |
| Rate for Payer: Aetna Commercial |
$1,904.19
|
| Rate for Payer: Cash Price |
$1,322.35
|
| Rate for Payer: Cigna All Commercial |
$1,901.98
|
| Rate for Payer: CORVEL All Commercial |
$2,049.65
|
| Rate for Payer: Coventry All Commercial |
$1,939.45
|
| Rate for Payer: Encore All Commercial |
$2,028.71
|
| Rate for Payer: Frontpath All Commercial |
$2,027.61
|
| Rate for Payer: Humana ChoiceCare |
$1,903.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,983.53
|
| Rate for Payer: PHCS All Commercial |
$1,652.94
|
| Rate for Payer: PHP All Commercial |
$1,671.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,701.43
|
| Rate for Payer: Signature Care EPO |
$1,829.25
|
| Rate for Payer: Signature Care PPO |
$1,939.45
|
| Rate for Payer: United Healthcare Commercial |
$1,736.69
|
|
|
HC MESH VENTRIO ST XL OVAL 19 X 24
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,709.52
|
| Rate for Payer: Aetna Medicare |
$1,785.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,729.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,204.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,488.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.16
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Humana Medicare |
$1,785.60
|
| Rate for Payer: Lucent All Commercial |
$3,035.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,176.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,743.00
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
| Rate for Payer: United Healthcare Medicare |
$1,785.60
|
|
|
HC MESH VENTRIO ST XL OVAL 19 X 24
|
Facility
|
IP
|
$5,580.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,185.00 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,821.12
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
|
|
HC MESH VENTRIO ST XL OVAL 22 X 2
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,456.60
|
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,371.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,393.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,782.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,815.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,692.80
|
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Centivo All Commercial |
$4,161.60
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.31
|
| Rate for Payer: Humana Medicare |
$2,448.00
|
| Rate for Payer: Lucent All Commercial |
$4,161.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.50
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
| Rate for Payer: United Healthcare Medicare |
$2,448.00
|
|
|
HC MESH VENTRIO ST XL OVAL 22 X 2
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.50 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,609.60
|
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
|
|
HC MESH VICRYL 12X12
|
Facility
|
OP
|
$6,551.45
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,092.85 |
| Rate for Payer: Aetna Commercial |
$5,529.42
|
| Rate for Payer: Aetna Medicare |
$2,096.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,030.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,762.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,095.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,410.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,306.11
|
| Rate for Payer: Cash Price |
$3,930.87
|
| Rate for Payer: Cash Price |
$3,930.87
|
| Rate for Payer: Centivo All Commercial |
$3,563.99
|
| Rate for Payer: Cigna All Commercial |
$5,653.90
|
| Rate for Payer: CORVEL All Commercial |
$6,092.85
|
| Rate for Payer: Coventry All Commercial |
$5,765.28
|
| Rate for Payer: Encore All Commercial |
$6,030.61
|
| Rate for Payer: Frontpath All Commercial |
$6,027.33
|
| Rate for Payer: Humana ChoiceCare |
$5,658.49
|
| Rate for Payer: Humana Medicare |
$2,096.46
|
| Rate for Payer: Lucent All Commercial |
$3,563.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,896.31
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,913.59
|
| Rate for Payer: PHP All Commercial |
$4,968.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,555.07
|
| Rate for Payer: Sagamore Health Network All Products |
$5,057.72
|
| Rate for Payer: Signature Care EPO |
$5,437.70
|
| Rate for Payer: Signature Care PPO |
$5,765.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,568.73
|
| Rate for Payer: United Healthcare Commercial |
$5,162.54
|
| Rate for Payer: United Healthcare Medicare |
$2,096.46
|
|
|
HC MESH VICRYL 12X12
|
Facility
|
IP
|
$6,551.45
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,913.59 |
| Max. Negotiated Rate |
$6,092.85 |
| Rate for Payer: Aetna Commercial |
$5,660.45
|
| Rate for Payer: Cash Price |
$3,930.87
|
| Rate for Payer: Cigna All Commercial |
$5,653.90
|
| Rate for Payer: CORVEL All Commercial |
$6,092.85
|
| Rate for Payer: Coventry All Commercial |
$5,765.28
|
| Rate for Payer: Encore All Commercial |
$6,030.61
|
| Rate for Payer: Frontpath All Commercial |
$6,027.33
|
| Rate for Payer: Humana ChoiceCare |
$5,658.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,896.31
|
| Rate for Payer: PHCS All Commercial |
$4,913.59
|
| Rate for Payer: PHP All Commercial |
$4,968.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,057.72
|
| Rate for Payer: Signature Care EPO |
$5,437.70
|
| Rate for Payer: Signature Care PPO |
$5,765.28
|
| Rate for Payer: United Healthcare Commercial |
$5,162.54
|
|
|
HC METANEPHRINES
|
Facility
|
IP
|
$307.43
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
63001636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.57 |
| Max. Negotiated Rate |
$285.91 |
| Rate for Payer: Aetna Commercial |
$265.62
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Cigna All Commercial |
$265.31
|
| Rate for Payer: CORVEL All Commercial |
$285.91
|
| Rate for Payer: Coventry All Commercial |
$270.54
|
| Rate for Payer: Encore All Commercial |
$282.99
|
| Rate for Payer: Frontpath All Commercial |
$282.84
|
| Rate for Payer: Humana ChoiceCare |
$265.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.69
|
| Rate for Payer: PHCS All Commercial |
$230.57
|
| Rate for Payer: PHP All Commercial |
$233.15
|
| Rate for Payer: Sagamore Health Network All Products |
$237.34
|
| Rate for Payer: Signature Care EPO |
$255.17
|
| Rate for Payer: Signature Care PPO |
$270.54
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
|
|
HC METANEPHRINES
|
Facility
|
OP
|
$307.43
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
63001636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$285.91 |
| Rate for Payer: Aetna Commercial |
$259.47
|
| Rate for Payer: Aetna Medicare |
$98.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.22
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Centivo All Commercial |
$167.24
|
| Rate for Payer: Cigna All Commercial |
$265.31
|
| Rate for Payer: CORVEL All Commercial |
$285.91
|
| Rate for Payer: Coventry All Commercial |
$270.54
|
| Rate for Payer: Encore All Commercial |
$282.99
|
| Rate for Payer: Frontpath All Commercial |
$282.84
|
| Rate for Payer: Humana ChoiceCare |
$265.53
|
| Rate for Payer: Humana Medicare |
$98.38
|
| Rate for Payer: Lucent All Commercial |
$167.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.69
|
| Rate for Payer: Managed Health Services Medicaid |
$16.94
|
| Rate for Payer: MDWise Medicaid |
$16.94
|
| Rate for Payer: PHCS All Commercial |
$230.57
|
| Rate for Payer: PHP All Commercial |
$233.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.90
|
| Rate for Payer: Sagamore Health Network All Products |
$237.34
|
| Rate for Payer: Signature Care EPO |
$255.17
|
| Rate for Payer: Signature Care PPO |
$270.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.32
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
| Rate for Payer: United Healthcare Medicare |
$98.38
|
|
|
HC METANEPHRINES 24HR
|
Facility
|
OP
|
$307.43
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
63001637
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$285.91 |
| Rate for Payer: Aetna Commercial |
$259.47
|
| Rate for Payer: Aetna Medicare |
$98.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.22
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Centivo All Commercial |
$167.24
|
| Rate for Payer: Cigna All Commercial |
$265.31
|
| Rate for Payer: CORVEL All Commercial |
$285.91
|
| Rate for Payer: Coventry All Commercial |
$270.54
|
| Rate for Payer: Encore All Commercial |
$282.99
|
| Rate for Payer: Frontpath All Commercial |
$282.84
|
| Rate for Payer: Humana ChoiceCare |
$265.53
|
| Rate for Payer: Humana Medicare |
$98.38
|
| Rate for Payer: Lucent All Commercial |
$167.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.69
|
| Rate for Payer: Managed Health Services Medicaid |
$16.94
|
| Rate for Payer: MDWise Medicaid |
$16.94
|
| Rate for Payer: PHCS All Commercial |
$230.57
|
| Rate for Payer: PHP All Commercial |
$233.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.90
|
| Rate for Payer: Sagamore Health Network All Products |
$237.34
|
| Rate for Payer: Signature Care EPO |
$255.17
|
| Rate for Payer: Signature Care PPO |
$270.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.32
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
| Rate for Payer: United Healthcare Medicare |
$98.38
|
|
|
HC METANEPHRINES 24HR
|
Facility
|
IP
|
$307.43
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
63001637
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.57 |
| Max. Negotiated Rate |
$285.91 |
| Rate for Payer: Aetna Commercial |
$265.62
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Cigna All Commercial |
$265.31
|
| Rate for Payer: CORVEL All Commercial |
$285.91
|
| Rate for Payer: Coventry All Commercial |
$270.54
|
| Rate for Payer: Encore All Commercial |
$282.99
|
| Rate for Payer: Frontpath All Commercial |
$282.84
|
| Rate for Payer: Humana ChoiceCare |
$265.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.69
|
| Rate for Payer: PHCS All Commercial |
$230.57
|
| Rate for Payer: PHP All Commercial |
$233.15
|
| Rate for Payer: Sagamore Health Network All Products |
$237.34
|
| Rate for Payer: Signature Care EPO |
$255.17
|
| Rate for Payer: Signature Care PPO |
$270.54
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
|
|
HC METANEPHRINES, PHEOCHROMOCYTOMA EVALUATION
|
Facility
|
IP
|
$106.52
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.89 |
| Max. Negotiated Rate |
$99.06 |
| Rate for Payer: Aetna Commercial |
$92.03
|
| Rate for Payer: Cash Price |
$63.91
|
| Rate for Payer: Cigna All Commercial |
$91.93
|
| Rate for Payer: CORVEL All Commercial |
$99.06
|
| Rate for Payer: Coventry All Commercial |
$93.74
|
| Rate for Payer: Encore All Commercial |
$98.05
|
| Rate for Payer: Frontpath All Commercial |
$98.00
|
| Rate for Payer: Humana ChoiceCare |
$92.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.87
|
| Rate for Payer: PHCS All Commercial |
$79.89
|
| Rate for Payer: PHP All Commercial |
$80.78
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$88.41
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: United Healthcare Commercial |
$83.94
|
|
|
HC METANEPHRINES, PHEOCHROMOCYTOMA EVALUATION
|
Facility
|
OP
|
$106.52
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$99.06 |
| Rate for Payer: Aetna Commercial |
$89.90
|
| Rate for Payer: Aetna Medicare |
$34.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.50
|
| Rate for Payer: Cash Price |
$63.91
|
| Rate for Payer: Cash Price |
$63.91
|
| Rate for Payer: Centivo All Commercial |
$57.95
|
| Rate for Payer: Cigna All Commercial |
$91.93
|
| Rate for Payer: CORVEL All Commercial |
$99.06
|
| Rate for Payer: Coventry All Commercial |
$93.74
|
| Rate for Payer: Encore All Commercial |
$98.05
|
| Rate for Payer: Frontpath All Commercial |
$98.00
|
| Rate for Payer: Humana ChoiceCare |
$92.00
|
| Rate for Payer: Humana Medicare |
$34.09
|
| Rate for Payer: Lucent All Commercial |
$57.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.87
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$79.89
|
| Rate for Payer: PHP All Commercial |
$80.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.54
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$88.41
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.54
|
| Rate for Payer: United Healthcare Commercial |
$83.94
|
| Rate for Payer: United Healthcare Medicare |
$34.09
|
|
|
HC METANEPHRINES, PHEOCHROMOCYTOMA EVALUATION-B
|
Facility
|
IP
|
$307.43
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
63044065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.57 |
| Max. Negotiated Rate |
$285.91 |
| Rate for Payer: Aetna Commercial |
$265.62
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Cigna All Commercial |
$265.31
|
| Rate for Payer: CORVEL All Commercial |
$285.91
|
| Rate for Payer: Coventry All Commercial |
$270.54
|
| Rate for Payer: Encore All Commercial |
$282.99
|
| Rate for Payer: Frontpath All Commercial |
$282.84
|
| Rate for Payer: Humana ChoiceCare |
$265.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.69
|
| Rate for Payer: PHCS All Commercial |
$230.57
|
| Rate for Payer: PHP All Commercial |
$233.15
|
| Rate for Payer: Sagamore Health Network All Products |
$237.34
|
| Rate for Payer: Signature Care EPO |
$255.17
|
| Rate for Payer: Signature Care PPO |
$270.54
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
|
|
HC METANEPHRINES, PHEOCHROMOCYTOMA EVALUATION-B
|
Facility
|
OP
|
$307.43
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
63044065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$285.91 |
| Rate for Payer: Aetna Commercial |
$259.47
|
| Rate for Payer: Aetna Medicare |
$98.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.22
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Cash Price |
$184.46
|
| Rate for Payer: Centivo All Commercial |
$167.24
|
| Rate for Payer: Cigna All Commercial |
$265.31
|
| Rate for Payer: CORVEL All Commercial |
$285.91
|
| Rate for Payer: Coventry All Commercial |
$270.54
|
| Rate for Payer: Encore All Commercial |
$282.99
|
| Rate for Payer: Frontpath All Commercial |
$282.84
|
| Rate for Payer: Humana ChoiceCare |
$265.53
|
| Rate for Payer: Humana Medicare |
$98.38
|
| Rate for Payer: Lucent All Commercial |
$167.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.69
|
| Rate for Payer: Managed Health Services Medicaid |
$16.94
|
| Rate for Payer: MDWise Medicaid |
$16.94
|
| Rate for Payer: PHCS All Commercial |
$230.57
|
| Rate for Payer: PHP All Commercial |
$233.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.90
|
| Rate for Payer: Sagamore Health Network All Products |
$237.34
|
| Rate for Payer: Signature Care EPO |
$255.17
|
| Rate for Payer: Signature Care PPO |
$270.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.32
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
| Rate for Payer: United Healthcare Medicare |
$98.38
|
|
|
HC METERED DOSE INHALER
|
Facility
|
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
1701292
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
|
|
HC METERED DOSE INHALER
|
Facility
|
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
1701292
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$54.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Centivo All Commercial |
$92.12
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Humana Medicare |
$54.19
|
| Rate for Payer: Lucent All Commercial |
$92.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.04
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
| Rate for Payer: United Healthcare Medicare |
$54.19
|
|
|
HC METER PEAK FLOW
|
Facility
|
IP
|
$54.25
|
|
| Hospital Charge Code |
41601078
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Cash Price |
$32.55
|
| Rate for Payer: Cigna All Commercial |
$46.82
|
| Rate for Payer: CORVEL All Commercial |
$50.45
|
| Rate for Payer: Coventry All Commercial |
$47.74
|
| Rate for Payer: Encore All Commercial |
$49.94
|
| Rate for Payer: Frontpath All Commercial |
$49.91
|
| Rate for Payer: Humana ChoiceCare |
$46.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.83
|
| Rate for Payer: PHCS All Commercial |
$40.69
|
| Rate for Payer: PHP All Commercial |
$41.14
|
| Rate for Payer: Sagamore Health Network All Products |
$41.88
|
| Rate for Payer: Signature Care EPO |
$45.03
|
| Rate for Payer: Signature Care PPO |
$47.74
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
|
|
HC METER PEAK FLOW
|
Facility
|
OP
|
$54.25
|
|
| Hospital Charge Code |
41601078
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Aetna Commercial |
$45.79
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.10
|
| Rate for Payer: Cash Price |
$32.55
|
| Rate for Payer: Cash Price |
$32.55
|
| Rate for Payer: Centivo All Commercial |
$29.51
|
| Rate for Payer: Cigna All Commercial |
$46.82
|
| Rate for Payer: CORVEL All Commercial |
$50.45
|
| Rate for Payer: Coventry All Commercial |
$47.74
|
| Rate for Payer: Encore All Commercial |
$49.94
|
| Rate for Payer: Frontpath All Commercial |
$49.91
|
| Rate for Payer: Humana ChoiceCare |
$46.86
|
| Rate for Payer: Humana Medicare |
$17.36
|
| Rate for Payer: Lucent All Commercial |
$29.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.83
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$40.69
|
| Rate for Payer: PHP All Commercial |
$41.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.16
|
| Rate for Payer: Sagamore Health Network All Products |
$41.88
|
| Rate for Payer: Signature Care EPO |
$45.03
|
| Rate for Payer: Signature Care PPO |
$47.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.11
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$17.36
|
|
|
HC METHADONE MS
|
Facility
|
IP
|
$156.37
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
63001422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$135.10
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
|
|
HC METHADONE MS
|
Facility
|
OP
|
$156.37
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
63001422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Medicare |
$50.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Centivo All Commercial |
$85.07
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Humana Medicare |
$50.04
|
| Rate for Payer: Lucent All Commercial |
$85.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.98
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
| Rate for Payer: United Healthcare Medicare |
$50.04
|
|
|
HC METHADONE MS
|
Facility
|
OP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Medicare |
$50.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Centivo All Commercial |
$85.07
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Humana Medicare |
$50.04
|
| Rate for Payer: Lucent All Commercial |
$85.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.98
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
| Rate for Payer: United Healthcare Medicare |
$50.04
|
|
|
HC METHADONE MS
|
Facility
|
IP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$135.10
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
|
|
HC METHAQUALONE MS
|
Facility
|
OP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$265.57
|
| Rate for Payer: Aetna Medicare |
$100.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.76
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Centivo All Commercial |
$171.18
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Humana Medicare |
$100.69
|
| Rate for Payer: Lucent All Commercial |
$171.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$236.00
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.72
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.46
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$100.69
|
|
|
HC METHAQUALONE MS
|
Facility
|
IP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.00 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$271.87
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: PHCS All Commercial |
$236.00
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
