|
HC METHAQUALONE MS
|
Facility
|
IP
|
$314.66
|
|
|
Service Code
|
CPT 80368
|
| 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
|
|
|
HC METHAQUALONE MS
|
Facility
|
OP
|
$314.66
|
|
|
Service Code
|
CPT 80368
|
| 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 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 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: 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: 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 METHEMOGLOBIN
|
Facility
|
OP
|
$190.86
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
63001122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$177.50 |
| Rate for Payer: Aetna Commercial |
$161.09
|
| Rate for Payer: Aetna Medicare |
$61.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.18
|
| Rate for Payer: Cash Price |
$114.52
|
| Rate for Payer: Cash Price |
$114.52
|
| Rate for Payer: Centivo All Commercial |
$103.83
|
| Rate for Payer: Cigna All Commercial |
$164.71
|
| Rate for Payer: CORVEL All Commercial |
$177.50
|
| Rate for Payer: Coventry All Commercial |
$167.96
|
| Rate for Payer: Encore All Commercial |
$175.69
|
| Rate for Payer: Frontpath All Commercial |
$175.59
|
| Rate for Payer: Humana ChoiceCare |
$164.85
|
| Rate for Payer: Humana Medicare |
$61.08
|
| Rate for Payer: Lucent All Commercial |
$103.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.77
|
| Rate for Payer: Managed Health Services Medicaid |
$8.20
|
| Rate for Payer: MDWise Medicaid |
$8.20
|
| Rate for Payer: PHCS All Commercial |
$143.15
|
| Rate for Payer: PHP All Commercial |
$144.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.44
|
| Rate for Payer: Sagamore Health Network All Products |
$147.34
|
| Rate for Payer: Signature Care EPO |
$158.41
|
| Rate for Payer: Signature Care PPO |
$167.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.23
|
| Rate for Payer: United Healthcare Commercial |
$150.40
|
| Rate for Payer: United Healthcare Medicare |
$61.08
|
|
|
HC METHEMOGLOBIN
|
Facility
|
IP
|
$190.86
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
63001122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.15 |
| Max. Negotiated Rate |
$177.50 |
| Rate for Payer: Aetna Commercial |
$164.90
|
| Rate for Payer: Cash Price |
$114.52
|
| Rate for Payer: Cigna All Commercial |
$164.71
|
| Rate for Payer: CORVEL All Commercial |
$177.50
|
| Rate for Payer: Coventry All Commercial |
$167.96
|
| Rate for Payer: Encore All Commercial |
$175.69
|
| Rate for Payer: Frontpath All Commercial |
$175.59
|
| Rate for Payer: Humana ChoiceCare |
$164.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.77
|
| Rate for Payer: PHCS All Commercial |
$143.15
|
| Rate for Payer: PHP All Commercial |
$144.75
|
| Rate for Payer: Sagamore Health Network All Products |
$147.34
|
| Rate for Payer: Signature Care EPO |
$158.41
|
| Rate for Payer: Signature Care PPO |
$167.96
|
| Rate for Payer: United Healthcare Commercial |
$150.40
|
|
|
HC METHYLENE TETRA HYDROFOL MUTATION
|
Facility
|
IP
|
$684.42
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
63001440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$513.32 |
| Max. Negotiated Rate |
$636.51 |
| Rate for Payer: Aetna Commercial |
$591.34
|
| Rate for Payer: Cash Price |
$410.65
|
| Rate for Payer: Cigna All Commercial |
$590.65
|
| Rate for Payer: CORVEL All Commercial |
$636.51
|
| Rate for Payer: Coventry All Commercial |
$602.29
|
| Rate for Payer: Encore All Commercial |
$630.01
|
| Rate for Payer: Frontpath All Commercial |
$629.67
|
| Rate for Payer: Humana ChoiceCare |
$591.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$615.98
|
| Rate for Payer: PHCS All Commercial |
$513.32
|
| Rate for Payer: PHP All Commercial |
$519.06
|
| Rate for Payer: Sagamore Health Network All Products |
$528.37
|
| Rate for Payer: Signature Care EPO |
$568.07
|
| Rate for Payer: Signature Care PPO |
$602.29
|
| Rate for Payer: United Healthcare Commercial |
$539.32
|
|
|
HC METHYLENE TETRA HYDROFOL MUTATION
|
Facility
|
OP
|
$684.42
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
63001440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.17 |
| Max. Negotiated Rate |
$636.51 |
| Rate for Payer: Aetna Commercial |
$577.65
|
| Rate for Payer: Aetna Medicare |
$219.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$212.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$314.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$314.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$251.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$240.92
|
| Rate for Payer: Cash Price |
$410.65
|
| Rate for Payer: Centivo All Commercial |
$372.32
|
| Rate for Payer: Cigna All Commercial |
$590.65
|
| Rate for Payer: CORVEL All Commercial |
$636.51
|
| Rate for Payer: Coventry All Commercial |
$602.29
|
| Rate for Payer: Encore All Commercial |
$630.01
|
| Rate for Payer: Frontpath All Commercial |
$629.67
|
| Rate for Payer: Humana ChoiceCare |
$591.13
|
| Rate for Payer: Humana Medicare |
$219.01
|
| Rate for Payer: Lucent All Commercial |
$372.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$615.98
|
| Rate for Payer: PHCS All Commercial |
$513.32
|
| Rate for Payer: PHP All Commercial |
$519.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$266.92
|
| Rate for Payer: Sagamore Health Network All Products |
$528.37
|
| Rate for Payer: Signature Care EPO |
$568.07
|
| Rate for Payer: Signature Care PPO |
$602.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$581.76
|
| Rate for Payer: United Healthcare Commercial |
$539.32
|
| Rate for Payer: United Healthcare Medicare |
$219.01
|
|
|
HC METHYLMALONIC A
|
Facility
|
IP
|
$256.94
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
63001646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$192.71 |
| Max. Negotiated Rate |
$238.95 |
| Rate for Payer: Aetna Commercial |
$222.00
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cigna All Commercial |
$221.74
|
| Rate for Payer: CORVEL All Commercial |
$238.95
|
| Rate for Payer: Coventry All Commercial |
$226.11
|
| Rate for Payer: Encore All Commercial |
$236.51
|
| Rate for Payer: Frontpath All Commercial |
$236.38
|
| Rate for Payer: Humana ChoiceCare |
$221.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.25
|
| Rate for Payer: PHCS All Commercial |
$192.71
|
| Rate for Payer: PHP All Commercial |
$194.86
|
| Rate for Payer: Sagamore Health Network All Products |
$198.36
|
| Rate for Payer: Signature Care EPO |
$213.26
|
| Rate for Payer: Signature Care PPO |
$226.11
|
| Rate for Payer: United Healthcare Commercial |
$202.47
|
|
|
HC METHYLMALONIC A
|
Facility
|
OP
|
$256.94
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
63001646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$238.95 |
| Rate for Payer: Aetna Commercial |
$216.86
|
| Rate for Payer: Aetna Medicare |
$82.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.44
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Centivo All Commercial |
$139.78
|
| Rate for Payer: Cigna All Commercial |
$221.74
|
| Rate for Payer: CORVEL All Commercial |
$238.95
|
| Rate for Payer: Coventry All Commercial |
$226.11
|
| Rate for Payer: Encore All Commercial |
$236.51
|
| Rate for Payer: Frontpath All Commercial |
$236.38
|
| Rate for Payer: Humana ChoiceCare |
$221.92
|
| Rate for Payer: Humana Medicare |
$82.22
|
| Rate for Payer: Lucent All Commercial |
$139.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.25
|
| Rate for Payer: Managed Health Services Medicaid |
$21.21
|
| Rate for Payer: MDWise Medicaid |
$21.21
|
| Rate for Payer: PHCS All Commercial |
$192.71
|
| Rate for Payer: PHP All Commercial |
$194.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.21
|
| Rate for Payer: Sagamore Health Network All Products |
$198.36
|
| Rate for Payer: Signature Care EPO |
$213.26
|
| Rate for Payer: Signature Care PPO |
$226.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$218.40
|
| Rate for Payer: United Healthcare Commercial |
$202.47
|
| Rate for Payer: United Healthcare Medicare |
$82.22
|
|
|
HC MICROALBUMIN
|
Facility
|
OP
|
$121.18
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
63001131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna Commercial |
$102.28
|
| Rate for Payer: Aetna Medicare |
$38.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.66
|
| Rate for Payer: Cash Price |
$72.71
|
| Rate for Payer: Cash Price |
$72.71
|
| Rate for Payer: Centivo All Commercial |
$65.92
|
| Rate for Payer: Cigna All Commercial |
$104.58
|
| Rate for Payer: CORVEL All Commercial |
$112.70
|
| Rate for Payer: Coventry All Commercial |
$106.64
|
| Rate for Payer: Encore All Commercial |
$111.55
|
| Rate for Payer: Frontpath All Commercial |
$111.49
|
| Rate for Payer: Humana ChoiceCare |
$104.66
|
| Rate for Payer: Humana Medicare |
$38.78
|
| Rate for Payer: Lucent All Commercial |
$65.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.06
|
| Rate for Payer: Managed Health Services Medicaid |
$5.78
|
| Rate for Payer: MDWise Medicaid |
$5.78
|
| Rate for Payer: PHCS All Commercial |
$90.89
|
| Rate for Payer: PHP All Commercial |
$91.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.26
|
| Rate for Payer: Sagamore Health Network All Products |
$93.55
|
| Rate for Payer: Signature Care EPO |
$100.58
|
| Rate for Payer: Signature Care PPO |
$106.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.00
|
| Rate for Payer: United Healthcare Commercial |
$95.49
|
| Rate for Payer: United Healthcare Medicare |
$38.78
|
|
|
HC MICROALBUMIN
|
Facility
|
IP
|
$121.18
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
63001131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.89 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Cash Price |
$72.71
|
| Rate for Payer: Cigna All Commercial |
$104.58
|
| Rate for Payer: CORVEL All Commercial |
$112.70
|
| Rate for Payer: Coventry All Commercial |
$106.64
|
| Rate for Payer: Encore All Commercial |
$111.55
|
| Rate for Payer: Frontpath All Commercial |
$111.49
|
| Rate for Payer: Humana ChoiceCare |
$104.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.06
|
| Rate for Payer: PHCS All Commercial |
$90.89
|
| Rate for Payer: PHP All Commercial |
$91.90
|
| Rate for Payer: Sagamore Health Network All Products |
$93.55
|
| Rate for Payer: Signature Care EPO |
$100.58
|
| Rate for Payer: Signature Care PPO |
$106.64
|
| Rate for Payer: United Healthcare Commercial |
$95.49
|
|
|
HC MICROALBUMIN 24H
|
Facility
|
IP
|
$97.92
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
63001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cigna All Commercial |
$84.50
|
| Rate for Payer: CORVEL All Commercial |
$91.07
|
| Rate for Payer: Coventry All Commercial |
$86.17
|
| Rate for Payer: Encore All Commercial |
$90.14
|
| Rate for Payer: Frontpath All Commercial |
$90.09
|
| Rate for Payer: Humana ChoiceCare |
$84.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.13
|
| Rate for Payer: PHCS All Commercial |
$73.44
|
| Rate for Payer: PHP All Commercial |
$74.26
|
| Rate for Payer: Sagamore Health Network All Products |
$75.59
|
| Rate for Payer: Signature Care EPO |
$81.27
|
| Rate for Payer: Signature Care PPO |
$86.17
|
| Rate for Payer: United Healthcare Commercial |
$77.16
|
|
|
HC MICROALBUMIN 24H
|
Facility
|
OP
|
$97.92
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
63001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$82.64
|
| Rate for Payer: Aetna Medicare |
$31.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.47
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Centivo All Commercial |
$53.27
|
| Rate for Payer: Cigna All Commercial |
$84.50
|
| Rate for Payer: CORVEL All Commercial |
$91.07
|
| Rate for Payer: Coventry All Commercial |
$86.17
|
| Rate for Payer: Encore All Commercial |
$90.14
|
| Rate for Payer: Frontpath All Commercial |
$90.09
|
| Rate for Payer: Humana ChoiceCare |
$84.57
|
| Rate for Payer: Humana Medicare |
$31.33
|
| Rate for Payer: Lucent All Commercial |
$53.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.13
|
| Rate for Payer: Managed Health Services Medicaid |
$5.78
|
| Rate for Payer: MDWise Medicaid |
$5.78
|
| Rate for Payer: PHCS All Commercial |
$73.44
|
| Rate for Payer: PHP All Commercial |
$74.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.19
|
| Rate for Payer: Sagamore Health Network All Products |
$75.59
|
| Rate for Payer: Signature Care EPO |
$81.27
|
| Rate for Payer: Signature Care PPO |
$86.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.23
|
| Rate for Payer: United Healthcare Commercial |
$77.16
|
| Rate for Payer: United Healthcare Medicare |
$31.33
|
|
|
HC MIDLINE CATH INSERT BS
|
Facility
|
IP
|
$1,749.26
|
|
| Hospital Charge Code |
1684001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,311.94 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,511.36
|
| Rate for Payer: Cash Price |
$1,049.56
|
| Rate for Payer: Cigna All Commercial |
$1,509.61
|
| Rate for Payer: CORVEL All Commercial |
$1,626.81
|
| Rate for Payer: Coventry All Commercial |
$1,539.35
|
| Rate for Payer: Encore All Commercial |
$1,610.19
|
| Rate for Payer: Frontpath All Commercial |
$1,609.32
|
| Rate for Payer: Humana ChoiceCare |
$1,510.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,574.33
|
| Rate for Payer: PHCS All Commercial |
$1,311.94
|
| Rate for Payer: PHP All Commercial |
$1,326.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,350.43
|
| Rate for Payer: Signature Care EPO |
$1,451.89
|
| Rate for Payer: Signature Care PPO |
$1,539.35
|
| Rate for Payer: United Healthcare Commercial |
$1,378.42
|
|
|
HC MIDLINE CATH INSERT BS
|
Facility
|
OP
|
$1,749.26
|
|
| Hospital Charge Code |
1684001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,476.38
|
| Rate for Payer: Aetna Medicare |
$559.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$542.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,004.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,093.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.74
|
| Rate for Payer: Cash Price |
$1,049.56
|
| Rate for Payer: Cash Price |
$1,049.56
|
| Rate for Payer: Centivo All Commercial |
$951.60
|
| Rate for Payer: Cigna All Commercial |
$1,509.61
|
| Rate for Payer: CORVEL All Commercial |
$1,626.81
|
| Rate for Payer: Coventry All Commercial |
$1,539.35
|
| Rate for Payer: Encore All Commercial |
$1,610.19
|
| Rate for Payer: Frontpath All Commercial |
$1,609.32
|
| Rate for Payer: Humana ChoiceCare |
$1,510.84
|
| Rate for Payer: Humana Medicare |
$559.76
|
| Rate for Payer: Lucent All Commercial |
$951.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,574.33
|
| Rate for Payer: Managed Health Services Medicaid |
$40.80
|
| Rate for Payer: MDWise Medicaid |
$40.80
|
| Rate for Payer: PHCS All Commercial |
$1,311.94
|
| Rate for Payer: PHP All Commercial |
$1,326.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$682.21
|
| Rate for Payer: Sagamore Health Network All Products |
$1,350.43
|
| Rate for Payer: Signature Care EPO |
$1,451.89
|
| Rate for Payer: Signature Care PPO |
$1,539.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,486.87
|
| Rate for Payer: United Healthcare Commercial |
$1,378.42
|
| Rate for Payer: United Healthcare Medicare |
$559.76
|
|
|
HC MIDLINE SINGLE LUMEN 4FR
|
Facility
|
OP
|
$968.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$900.46 |
| Rate for Payer: Aetna Commercial |
$817.19
|
| Rate for Payer: Aetna Medicare |
$309.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$556.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$605.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$356.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$340.82
|
| Rate for Payer: Cash Price |
$580.94
|
| Rate for Payer: Cash Price |
$580.94
|
| Rate for Payer: Centivo All Commercial |
$526.72
|
| Rate for Payer: Cigna All Commercial |
$835.59
|
| Rate for Payer: CORVEL All Commercial |
$900.46
|
| Rate for Payer: Coventry All Commercial |
$852.05
|
| Rate for Payer: Encore All Commercial |
$891.26
|
| Rate for Payer: Frontpath All Commercial |
$890.78
|
| Rate for Payer: Humana ChoiceCare |
$836.27
|
| Rate for Payer: Humana Medicare |
$309.84
|
| Rate for Payer: Lucent All Commercial |
$526.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.42
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$726.18
|
| Rate for Payer: PHP All Commercial |
$734.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$377.61
|
| Rate for Payer: Sagamore Health Network All Products |
$747.48
|
| Rate for Payer: Signature Care EPO |
$803.64
|
| Rate for Payer: Signature Care PPO |
$852.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$823.00
|
| Rate for Payer: United Healthcare Commercial |
$762.97
|
| Rate for Payer: United Healthcare Medicare |
$309.84
|
|
|
HC MIDLINE SINGLE LUMEN 4FR
|
Facility
|
IP
|
$968.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$900.46 |
| Rate for Payer: Aetna Commercial |
$836.56
|
| Rate for Payer: Cash Price |
$580.94
|
| Rate for Payer: Cigna All Commercial |
$835.59
|
| Rate for Payer: CORVEL All Commercial |
$900.46
|
| Rate for Payer: Coventry All Commercial |
$852.05
|
| Rate for Payer: Encore All Commercial |
$891.26
|
| Rate for Payer: Frontpath All Commercial |
$890.78
|
| Rate for Payer: Humana ChoiceCare |
$836.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.42
|
| Rate for Payer: PHCS All Commercial |
$726.18
|
| Rate for Payer: PHP All Commercial |
$734.31
|
| Rate for Payer: Sagamore Health Network All Products |
$747.48
|
| Rate for Payer: Signature Care EPO |
$803.64
|
| Rate for Payer: Signature Care PPO |
$852.05
|
| Rate for Payer: United Healthcare Commercial |
$762.97
|
|
|
HC MITOCHONDRIAL TITER
|
Facility
|
OP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$62.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$89.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.41
|
| Rate for Payer: Cash Price |
$116.62
|
| Rate for Payer: Cash Price |
$116.62
|
| Rate for Payer: Centivo All Commercial |
$105.73
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.75
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Humana Medicare |
$62.20
|
| Rate for Payer: Lucent All Commercial |
$105.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.80
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.21
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
| Rate for Payer: United Healthcare Medicare |
$62.20
|
|
|
HC MITOCHONDRIAL TITER
|
Facility
|
IP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Aetna Commercial |
$167.93
|
| Rate for Payer: Cash Price |
$116.62
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.75
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
|
|
HC MLC DEVICE FOR IMRT
|
Facility
|
IP
|
$3,076.32
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
1547338
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,307.24 |
| Max. Negotiated Rate |
$2,860.98 |
| Rate for Payer: Aetna Commercial |
$2,657.94
|
| Rate for Payer: Cash Price |
$1,845.79
|
| Rate for Payer: Cigna All Commercial |
$2,654.86
|
| Rate for Payer: CORVEL All Commercial |
$2,860.98
|
| Rate for Payer: Coventry All Commercial |
$2,707.16
|
| Rate for Payer: Encore All Commercial |
$2,831.75
|
| Rate for Payer: Frontpath All Commercial |
$2,830.21
|
| Rate for Payer: Humana ChoiceCare |
$2,657.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,768.69
|
| Rate for Payer: PHCS All Commercial |
$2,307.24
|
| Rate for Payer: PHP All Commercial |
$2,333.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2,374.92
|
| Rate for Payer: Signature Care EPO |
$2,553.35
|
| Rate for Payer: Signature Care PPO |
$2,707.16
|
| Rate for Payer: United Healthcare Commercial |
$2,424.14
|
|
|
HC MLC DEVICE FOR IMRT
|
Facility
|
OP
|
$3,076.32
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
1547338
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$192.39 |
| Max. Negotiated Rate |
$2,860.98 |
| Rate for Payer: Aetna Commercial |
$2,596.41
|
| Rate for Payer: Aetna Medicare |
$984.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$192.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$953.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,766.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,923.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$192.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,132.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,082.86
|
| Rate for Payer: Cash Price |
$1,845.79
|
| Rate for Payer: Cash Price |
$1,845.79
|
| Rate for Payer: Centivo All Commercial |
$1,673.52
|
| Rate for Payer: Cigna All Commercial |
$2,654.86
|
| Rate for Payer: CORVEL All Commercial |
$2,860.98
|
| Rate for Payer: Coventry All Commercial |
$2,707.16
|
| Rate for Payer: Encore All Commercial |
$2,831.75
|
| Rate for Payer: Frontpath All Commercial |
$2,830.21
|
| Rate for Payer: Humana ChoiceCare |
$2,657.02
|
| Rate for Payer: Humana Medicare |
$984.42
|
| Rate for Payer: Lucent All Commercial |
$1,673.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,768.69
|
| Rate for Payer: Managed Health Services Medicaid |
$192.39
|
| Rate for Payer: MDWise Medicaid |
$192.39
|
| Rate for Payer: PHCS All Commercial |
$2,307.24
|
| Rate for Payer: PHP All Commercial |
$2,333.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,199.76
|
| Rate for Payer: Sagamore Health Network All Products |
$2,374.92
|
| Rate for Payer: Signature Care EPO |
$2,553.35
|
| Rate for Payer: Signature Care PPO |
$2,707.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,614.87
|
| Rate for Payer: United Healthcare Commercial |
$2,424.14
|
| Rate for Payer: United Healthcare Medicare |
$984.42
|
|
|
HC MOLECULAR CYTOGENICS DNA PROBE EA
|
Facility
|
IP
|
$122.69
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$114.10 |
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Cash Price |
$73.61
|
| Rate for Payer: Cigna All Commercial |
$105.88
|
| Rate for Payer: CORVEL All Commercial |
$114.10
|
| Rate for Payer: Coventry All Commercial |
$107.97
|
| Rate for Payer: Encore All Commercial |
$112.94
|
| Rate for Payer: Frontpath All Commercial |
$112.87
|
| Rate for Payer: Humana ChoiceCare |
$105.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.42
|
| Rate for Payer: PHCS All Commercial |
$92.02
|
| Rate for Payer: PHP All Commercial |
$93.05
|
| Rate for Payer: Sagamore Health Network All Products |
$94.72
|
| Rate for Payer: Signature Care EPO |
$101.83
|
| Rate for Payer: Signature Care PPO |
$107.97
|
| Rate for Payer: United Healthcare Commercial |
$96.68
|
|
|
HC MOLECULAR CYTOGENICS DNA PROBE EA
|
Facility
|
OP
|
$122.69
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$114.10 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Medicare |
$39.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.19
|
| Rate for Payer: Cash Price |
$73.61
|
| Rate for Payer: Cash Price |
$73.61
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$105.88
|
| Rate for Payer: CORVEL All Commercial |
$114.10
|
| Rate for Payer: Coventry All Commercial |
$107.97
|
| Rate for Payer: Encore All Commercial |
$112.94
|
| Rate for Payer: Frontpath All Commercial |
$112.87
|
| Rate for Payer: Humana ChoiceCare |
$105.97
|
| Rate for Payer: Humana Medicare |
$39.26
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.42
|
| Rate for Payer: MDWise Medicaid |
$21.42
|
| Rate for Payer: PHCS All Commercial |
$92.02
|
| Rate for Payer: PHP All Commercial |
$93.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.85
|
| Rate for Payer: Sagamore Health Network All Products |
$94.72
|
| Rate for Payer: Signature Care EPO |
$101.83
|
| Rate for Payer: Signature Care PPO |
$107.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.29
|
| Rate for Payer: United Healthcare Commercial |
$96.68
|
| Rate for Payer: United Healthcare Medicare |
$39.26
|
|
|
HC MONITORED ANESTH EA ADD MIN
|
Facility
|
OP
|
$13.34
|
|
| Hospital Charge Code |
1246655
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$11.26
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.70
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Centivo All Commercial |
$7.26
|
| Rate for Payer: Cigna All Commercial |
$11.51
|
| Rate for Payer: CORVEL All Commercial |
$12.41
|
| Rate for Payer: Coventry All Commercial |
$11.74
|
| Rate for Payer: Encore All Commercial |
$12.28
|
| Rate for Payer: Frontpath All Commercial |
$12.27
|
| Rate for Payer: Humana ChoiceCare |
$11.52
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Lucent All Commercial |
$7.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.01
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$10.01
|
| Rate for Payer: PHP All Commercial |
$10.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.20
|
| Rate for Payer: Sagamore Health Network All Products |
$10.30
|
| Rate for Payer: Signature Care EPO |
$11.07
|
| Rate for Payer: Signature Care PPO |
$11.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.34
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$4.27
|
|
|
HC MONITORED ANESTH EA ADD MIN
|
Facility
|
IP
|
$13.34
|
|
| Hospital Charge Code |
1246655
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.53
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cigna All Commercial |
$11.51
|
| Rate for Payer: CORVEL All Commercial |
$12.41
|
| Rate for Payer: Coventry All Commercial |
$11.74
|
| Rate for Payer: Encore All Commercial |
$12.28
|
| Rate for Payer: Frontpath All Commercial |
$12.27
|
| Rate for Payer: Humana ChoiceCare |
$11.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.01
|
| Rate for Payer: PHCS All Commercial |
$10.01
|
| Rate for Payer: PHP All Commercial |
$10.12
|
| Rate for Payer: Sagamore Health Network All Products |
$10.30
|
| Rate for Payer: Signature Care EPO |
$11.07
|
| Rate for Payer: Signature Care PPO |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
|
|
HC MONITORED ANESTH INITIAL 15 MIN
|
Facility
|
IP
|
$196.43
|
|
| Hospital Charge Code |
1246654
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$147.32 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$169.72
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cigna All Commercial |
$169.52
|
| Rate for Payer: CORVEL All Commercial |
$182.68
|
| Rate for Payer: Coventry All Commercial |
$172.86
|
| Rate for Payer: Encore All Commercial |
$180.81
|
| Rate for Payer: Frontpath All Commercial |
$180.72
|
| Rate for Payer: Humana ChoiceCare |
$169.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.79
|
| Rate for Payer: PHCS All Commercial |
$147.32
|
| Rate for Payer: PHP All Commercial |
$148.97
|
| Rate for Payer: Sagamore Health Network All Products |
$151.64
|
| Rate for Payer: Signature Care EPO |
$163.04
|
| Rate for Payer: Signature Care PPO |
$172.86
|
| Rate for Payer: United Healthcare Commercial |
$154.79
|
|
