|
HC MARGIN MAP 5MM
|
Facility
IP
|
$142.33
|
|
| Hospital Charge Code |
41601349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$132.37 |
| Rate for Payer: Aetna Commercial |
$122.97
|
| Rate for Payer: Cash Price |
$88.25
|
| Rate for Payer: Cigna All Commercial |
$122.83
|
| Rate for Payer: CORVEL All Commercial |
$132.37
|
| Rate for Payer: Coventry All Commercial |
$125.25
|
| Rate for Payer: Encore All Commercial |
$131.01
|
| Rate for Payer: Frontpath All Commercial |
$130.94
|
| Rate for Payer: Humana ChoiceCare |
$122.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.10
|
| Rate for Payer: PHCS All Commercial |
$106.75
|
| Rate for Payer: PHP All Commercial |
$107.94
|
| Rate for Payer: Sagamore Health Network All Products |
$109.88
|
| Rate for Payer: Signature Care EPO |
$118.13
|
| Rate for Payer: Signature Care PPO |
$125.25
|
| Rate for Payer: United Healthcare Commercial |
$112.16
|
|
|
HC MARIJUANA(THC) MS
|
Facility
OP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.12 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$265.57
|
| Rate for Payer: Aetna Medicare |
$103.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.22
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Centivo All Commercial |
$160.48
|
| 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 |
$160.48
|
| Rate for Payer: Lucent All Commercial |
$160.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$235.99
|
| 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 |
$103.84
|
|
|
HC MARIJUANA(THC) MS
|
Facility
IP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$235.99 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$271.87
|
| Rate for Payer: Cash Price |
$195.09
|
| 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 |
$235.99
|
| 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 MASK AEROSOL ADULT
|
Facility
IP
|
$2.58
|
|
| Hospital Charge Code |
41601074
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cigna All Commercial |
$2.23
|
| Rate for Payer: CORVEL All Commercial |
$2.40
|
| Rate for Payer: Coventry All Commercial |
$2.27
|
| Rate for Payer: Encore All Commercial |
$2.37
|
| Rate for Payer: Frontpath All Commercial |
$2.37
|
| Rate for Payer: Humana ChoiceCare |
$2.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.32
|
| Rate for Payer: PHCS All Commercial |
$1.94
|
| Rate for Payer: PHP All Commercial |
$1.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1.99
|
| Rate for Payer: Signature Care EPO |
$2.14
|
| Rate for Payer: Signature Care PPO |
$2.27
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
|
|
HC MASK AEROSOL ADULT
|
Facility
OP
|
$2.58
|
|
| Hospital Charge Code |
41601074
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$0.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.94
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Centivo All Commercial |
$1.32
|
| Rate for Payer: Cigna All Commercial |
$2.23
|
| Rate for Payer: CORVEL All Commercial |
$2.40
|
| Rate for Payer: Coventry All Commercial |
$2.27
|
| Rate for Payer: Encore All Commercial |
$2.37
|
| Rate for Payer: Frontpath All Commercial |
$2.37
|
| Rate for Payer: Humana ChoiceCare |
$2.23
|
| Rate for Payer: Humana Medicare |
$1.32
|
| Rate for Payer: Lucent All Commercial |
$1.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.32
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$1.94
|
| Rate for Payer: PHP All Commercial |
$1.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1.99
|
| Rate for Payer: Signature Care EPO |
$2.14
|
| Rate for Payer: Signature Care PPO |
$2.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.19
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicare |
$0.85
|
|
|
HC MASK AEROSOL PEDIATRIC
|
Facility
OP
|
$3.28
|
|
| Hospital Charge Code |
41601075
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.19
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Centivo All Commercial |
$1.67
|
| Rate for Payer: Cigna All Commercial |
$2.83
|
| Rate for Payer: CORVEL All Commercial |
$3.05
|
| Rate for Payer: Coventry All Commercial |
$2.89
|
| Rate for Payer: Encore All Commercial |
$3.02
|
| Rate for Payer: Frontpath All Commercial |
$3.02
|
| Rate for Payer: Humana ChoiceCare |
$2.83
|
| Rate for Payer: Humana Medicare |
$1.67
|
| Rate for Payer: Lucent All Commercial |
$1.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.95
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$2.46
|
| Rate for Payer: PHP All Commercial |
$2.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2.53
|
| Rate for Payer: Signature Care EPO |
$2.72
|
| Rate for Payer: Signature Care PPO |
$2.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.79
|
| Rate for Payer: United Healthcare Commercial |
$2.58
|
| Rate for Payer: United Healthcare Medicare |
$1.08
|
|
|
HC MASK AEROSOL PEDIATRIC
|
Facility
IP
|
$3.28
|
|
| Hospital Charge Code |
41601075
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna All Commercial |
$2.83
|
| Rate for Payer: CORVEL All Commercial |
$3.05
|
| Rate for Payer: Coventry All Commercial |
$2.89
|
| Rate for Payer: Encore All Commercial |
$3.02
|
| Rate for Payer: Frontpath All Commercial |
$3.02
|
| Rate for Payer: Humana ChoiceCare |
$2.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.95
|
| Rate for Payer: PHCS All Commercial |
$2.46
|
| Rate for Payer: PHP All Commercial |
$2.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2.53
|
| Rate for Payer: Signature Care EPO |
$2.72
|
| Rate for Payer: Signature Care PPO |
$2.89
|
| Rate for Payer: United Healthcare Commercial |
$2.58
|
|
|
HC MASSAGE/15 MIN-OT
|
Facility
IP
|
$127.30
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
01738035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$109.98
|
| Rate for Payer: Cash Price |
$78.92
|
| Rate for Payer: Cigna All Commercial |
$109.86
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.02
|
| Rate for Payer: Encore All Commercial |
$117.18
|
| Rate for Payer: Frontpath All Commercial |
$117.11
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.57
|
| Rate for Payer: PHCS All Commercial |
$95.47
|
| Rate for Payer: PHP All Commercial |
$96.54
|
| Rate for Payer: Sagamore Health Network All Products |
$98.27
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.02
|
| Rate for Payer: United Healthcare Commercial |
$100.31
|
|
|
HC MASSAGE/15 MIN-OT
|
Facility
OP
|
$127.30
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
01738035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$107.44
|
| Rate for Payer: Aetna Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.21
|
| Rate for Payer: Cash Price |
$78.92
|
| Rate for Payer: Centivo All Commercial |
$64.92
|
| Rate for Payer: Cigna All Commercial |
$109.86
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.02
|
| Rate for Payer: Encore All Commercial |
$117.18
|
| Rate for Payer: Frontpath All Commercial |
$117.11
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Humana Medicare |
$64.92
|
| Rate for Payer: Lucent All Commercial |
$64.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.57
|
| Rate for Payer: PHCS All Commercial |
$95.47
|
| Rate for Payer: PHP All Commercial |
$96.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.27
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.20
|
| Rate for Payer: United Healthcare Commercial |
$100.31
|
| Rate for Payer: United Healthcare Medicare |
$42.01
|
|
|
HC MASSAGE/15 MIN-PT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
01728048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC MASSAGE/15 MIN-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
01728048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC MDMA & MDA GC/MS - URINE
|
Facility
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$127.74
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Centivo All Commercial |
$77.19
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Humana Medicare |
$77.19
|
| Rate for Payer: Lucent All Commercial |
$77.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.03
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.65
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
| Rate for Payer: United Healthcare Medicare |
$49.94
|
|
|
HC MDMA & MDA GC/MS - URINE
|
Facility
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
|
|
HC MEAT FIBERS-FECES
|
Facility
OP
|
$84.38
|
|
|
Service Code
|
CPT 89160
|
| Hospital Charge Code |
63002143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$78.48 |
| Rate for Payer: Aetna Commercial |
$71.22
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.63
|
| Rate for Payer: Cash Price |
$52.32
|
| Rate for Payer: Cash Price |
$52.32
|
| Rate for Payer: Centivo All Commercial |
$43.04
|
| Rate for Payer: Cigna All Commercial |
$72.82
|
| Rate for Payer: CORVEL All Commercial |
$78.48
|
| Rate for Payer: Coventry All Commercial |
$74.26
|
| Rate for Payer: Encore All Commercial |
$77.68
|
| Rate for Payer: Frontpath All Commercial |
$77.63
|
| Rate for Payer: Humana ChoiceCare |
$72.88
|
| Rate for Payer: Humana Medicare |
$43.04
|
| Rate for Payer: Lucent All Commercial |
$43.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.95
|
| Rate for Payer: Managed Health Services Medicaid |
$4.85
|
| Rate for Payer: MDWise Medicaid |
$4.85
|
| Rate for Payer: PHCS All Commercial |
$63.29
|
| Rate for Payer: PHP All Commercial |
$64.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.91
|
| Rate for Payer: Sagamore Health Network All Products |
$65.14
|
| Rate for Payer: Signature Care EPO |
$70.04
|
| Rate for Payer: Signature Care PPO |
$74.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.73
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare |
$27.85
|
|
|
HC MEAT FIBERS-FECES
|
Facility
IP
|
$84.38
|
|
|
Service Code
|
CPT 89160
|
| Hospital Charge Code |
63002143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$78.48 |
| Rate for Payer: Aetna Commercial |
$72.91
|
| Rate for Payer: Cash Price |
$52.32
|
| Rate for Payer: Cigna All Commercial |
$72.82
|
| Rate for Payer: CORVEL All Commercial |
$78.48
|
| Rate for Payer: Coventry All Commercial |
$74.26
|
| Rate for Payer: Encore All Commercial |
$77.68
|
| Rate for Payer: Frontpath All Commercial |
$77.63
|
| Rate for Payer: Humana ChoiceCare |
$72.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.95
|
| Rate for Payer: PHCS All Commercial |
$63.29
|
| Rate for Payer: PHP All Commercial |
$64.00
|
| Rate for Payer: Sagamore Health Network All Products |
$65.14
|
| Rate for Payer: Signature Care EPO |
$70.04
|
| Rate for Payer: Signature Care PPO |
$74.26
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
IP
|
$163.07
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
01704669
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$151.65 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.65
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.10
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
OP
|
$163.07
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
01704669
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$151.65 |
| Rate for Payer: Aetna Commercial |
$137.63
|
| Rate for Payer: Aetna Medicare |
$53.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.19
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Centivo All Commercial |
$83.16
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.65
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.10
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Humana Medicare |
$83.16
|
| Rate for Payer: Lucent All Commercial |
$83.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.60
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.61
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
| Rate for Payer: United Healthcare Medicare |
$53.81
|
|
|
HC MECHANICAL VENT 1ST DAY
|
Facility
IP
|
$1,667.53
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
01701421
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,250.64 |
| Max. Negotiated Rate |
$1,550.80 |
| Rate for Payer: Aetna Commercial |
$1,440.74
|
| Rate for Payer: Cash Price |
$1,033.87
|
| Rate for Payer: Cigna All Commercial |
$1,439.08
|
| Rate for Payer: CORVEL All Commercial |
$1,550.80
|
| Rate for Payer: Coventry All Commercial |
$1,467.42
|
| Rate for Payer: Encore All Commercial |
$1,534.96
|
| Rate for Payer: Frontpath All Commercial |
$1,534.12
|
| Rate for Payer: Humana ChoiceCare |
$1,440.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,500.77
|
| Rate for Payer: PHCS All Commercial |
$1,250.64
|
| Rate for Payer: PHP All Commercial |
$1,264.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,287.33
|
| Rate for Payer: Signature Care EPO |
$1,384.05
|
| Rate for Payer: Signature Care PPO |
$1,467.42
|
| Rate for Payer: United Healthcare Commercial |
$1,314.01
|
|
|
HC MECHANICAL VENT 1ST DAY
|
Facility
OP
|
$1,667.53
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
01701421
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$1,550.80 |
| Rate for Payer: Aetna Commercial |
$1,407.39
|
| Rate for Payer: Aetna Medicare |
$550.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$550.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$957.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,042.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$632.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$605.31
|
| Rate for Payer: Cash Price |
$1,033.87
|
| Rate for Payer: Cash Price |
$1,033.87
|
| Rate for Payer: Centivo All Commercial |
$850.44
|
| Rate for Payer: Cigna All Commercial |
$1,439.08
|
| Rate for Payer: CORVEL All Commercial |
$1,550.80
|
| Rate for Payer: Coventry All Commercial |
$1,467.42
|
| Rate for Payer: Encore All Commercial |
$1,534.96
|
| Rate for Payer: Frontpath All Commercial |
$1,534.12
|
| Rate for Payer: Humana ChoiceCare |
$1,440.24
|
| Rate for Payer: Humana Medicare |
$850.44
|
| Rate for Payer: Lucent All Commercial |
$850.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,500.77
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$1,250.64
|
| Rate for Payer: PHP All Commercial |
$1,264.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$650.34
|
| Rate for Payer: Sagamore Health Network All Products |
$1,287.33
|
| Rate for Payer: Signature Care EPO |
$1,384.05
|
| Rate for Payer: Signature Care PPO |
$1,467.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,417.40
|
| Rate for Payer: United Healthcare Commercial |
$1,314.01
|
| Rate for Payer: United Healthcare Medicare |
$550.28
|
|
|
HC MECHANICAL VENT SUB DAYS
|
Facility
OP
|
$1,625.04
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
01706457
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$1,511.29 |
| Rate for Payer: Aetna Commercial |
$1,371.54
|
| Rate for Payer: Aetna Medicare |
$536.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$536.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$933.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$616.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$589.89
|
| Rate for Payer: Cash Price |
$1,007.53
|
| Rate for Payer: Cash Price |
$1,007.53
|
| Rate for Payer: Centivo All Commercial |
$828.77
|
| Rate for Payer: Cigna All Commercial |
$1,402.41
|
| Rate for Payer: CORVEL All Commercial |
$1,511.29
|
| Rate for Payer: Coventry All Commercial |
$1,430.04
|
| Rate for Payer: Encore All Commercial |
$1,495.85
|
| Rate for Payer: Frontpath All Commercial |
$1,495.04
|
| Rate for Payer: Humana ChoiceCare |
$1,403.55
|
| Rate for Payer: Humana Medicare |
$828.77
|
| Rate for Payer: Lucent All Commercial |
$828.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.54
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$1,218.78
|
| Rate for Payer: PHP All Commercial |
$1,232.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.53
|
| Rate for Payer: Signature Care EPO |
$1,348.79
|
| Rate for Payer: Signature Care PPO |
$1,430.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,381.29
|
| Rate for Payer: United Healthcare Commercial |
$1,280.53
|
| Rate for Payer: United Healthcare Medicare |
$536.26
|
|
|
HC MECHANICAL VENT SUB DAYS
|
Facility
IP
|
$1,625.04
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
01706457
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,218.78 |
| Max. Negotiated Rate |
$1,511.29 |
| Rate for Payer: Aetna Commercial |
$1,404.04
|
| Rate for Payer: Cash Price |
$1,007.53
|
| Rate for Payer: Cigna All Commercial |
$1,402.41
|
| Rate for Payer: CORVEL All Commercial |
$1,511.29
|
| Rate for Payer: Coventry All Commercial |
$1,430.04
|
| Rate for Payer: Encore All Commercial |
$1,495.85
|
| Rate for Payer: Frontpath All Commercial |
$1,495.04
|
| Rate for Payer: Humana ChoiceCare |
$1,403.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.54
|
| Rate for Payer: PHCS All Commercial |
$1,218.78
|
| Rate for Payer: PHP All Commercial |
$1,232.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.53
|
| Rate for Payer: Signature Care EPO |
$1,348.79
|
| Rate for Payer: Signature Care PPO |
$1,430.04
|
| Rate for Payer: United Healthcare Commercial |
$1,280.53
|
|
|
HC MECKLES SCAN
|
Facility
IP
|
$1,166.83
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
01638450
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$875.12 |
| Max. Negotiated Rate |
$1,085.15 |
| Rate for Payer: Aetna Commercial |
$1,008.14
|
| Rate for Payer: Cash Price |
$723.43
|
| Rate for Payer: Cigna All Commercial |
$1,006.97
|
| Rate for Payer: CORVEL All Commercial |
$1,085.15
|
| Rate for Payer: Coventry All Commercial |
$1,026.81
|
| Rate for Payer: Encore All Commercial |
$1,074.07
|
| Rate for Payer: Frontpath All Commercial |
$1,073.48
|
| Rate for Payer: Humana ChoiceCare |
$1,007.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.15
|
| Rate for Payer: PHCS All Commercial |
$875.12
|
| Rate for Payer: PHP All Commercial |
$884.92
|
| Rate for Payer: Sagamore Health Network All Products |
$900.79
|
| Rate for Payer: Signature Care EPO |
$968.47
|
| Rate for Payer: Signature Care PPO |
$1,026.81
|
| Rate for Payer: United Healthcare Commercial |
$919.46
|
|
|
HC MECKLES SCAN
|
Facility
OP
|
$1,166.83
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
01638450
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$385.05 |
| Max. Negotiated Rate |
$1,085.15 |
| Rate for Payer: Aetna Commercial |
$984.80
|
| Rate for Payer: Aetna Medicare |
$385.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$385.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$670.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$729.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$826.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$423.56
|
| Rate for Payer: Cash Price |
$723.43
|
| Rate for Payer: Cash Price |
$723.43
|
| Rate for Payer: Centivo All Commercial |
$595.08
|
| Rate for Payer: Cigna All Commercial |
$1,006.97
|
| Rate for Payer: CORVEL All Commercial |
$1,085.15
|
| Rate for Payer: Coventry All Commercial |
$1,026.81
|
| Rate for Payer: Encore All Commercial |
$1,074.07
|
| Rate for Payer: Frontpath All Commercial |
$1,073.48
|
| Rate for Payer: Humana ChoiceCare |
$1,007.79
|
| Rate for Payer: Humana Medicare |
$595.08
|
| Rate for Payer: Lucent All Commercial |
$595.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.15
|
| Rate for Payer: Managed Health Services Medicaid |
$826.96
|
| Rate for Payer: MDWise Medicaid |
$826.96
|
| Rate for Payer: PHCS All Commercial |
$875.12
|
| Rate for Payer: PHP All Commercial |
$884.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$455.06
|
| Rate for Payer: Sagamore Health Network All Products |
$900.79
|
| Rate for Payer: Signature Care EPO |
$968.47
|
| Rate for Payer: Signature Care PPO |
$1,026.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$919.46
|
| Rate for Payer: United Healthcare Medicare |
$385.05
|
|
|
HC MEDICATION REVIEW ATU
|
Facility
OP
|
$35.70
|
|
|
Service Code
|
CPT MEDRE
|
| Hospital Charge Code |
00418822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$159.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.96
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Centivo All Commercial |
$18.21
|
| Rate for Payer: Cigna All Commercial |
$30.81
|
| Rate for Payer: CORVEL All Commercial |
$33.20
|
| Rate for Payer: Coventry All Commercial |
$31.42
|
| Rate for Payer: Encore All Commercial |
$32.86
|
| Rate for Payer: Frontpath All Commercial |
$32.84
|
| Rate for Payer: Humana ChoiceCare |
$30.83
|
| Rate for Payer: Humana Medicare |
$18.21
|
| Rate for Payer: Lucent All Commercial |
$18.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.13
|
| Rate for Payer: Managed Health Services Medicaid |
$159.12
|
| Rate for Payer: MDWise Medicaid |
$159.12
|
| Rate for Payer: PHCS All Commercial |
$26.78
|
| Rate for Payer: PHP All Commercial |
$27.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.92
|
| Rate for Payer: Sagamore Health Network All Products |
$27.56
|
| Rate for Payer: Signature Care EPO |
$29.63
|
| Rate for Payer: Signature Care PPO |
$31.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.34
|
| Rate for Payer: United Healthcare Commercial |
$28.13
|
| Rate for Payer: United Healthcare Medicare |
$11.78
|
|
|
HC MEDICATION REVIEW ATU
|
Facility
IP
|
$35.70
|
|
|
Service Code
|
CPT MEDRE
|
| Hospital Charge Code |
00418822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cigna All Commercial |
$30.81
|
| Rate for Payer: CORVEL All Commercial |
$33.20
|
| Rate for Payer: Coventry All Commercial |
$31.42
|
| Rate for Payer: Encore All Commercial |
$32.86
|
| Rate for Payer: Frontpath All Commercial |
$32.84
|
| Rate for Payer: Humana ChoiceCare |
$30.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.13
|
| Rate for Payer: PHCS All Commercial |
$26.78
|
| Rate for Payer: PHP All Commercial |
$27.07
|
| Rate for Payer: Sagamore Health Network All Products |
$27.56
|
| Rate for Payer: Signature Care EPO |
$29.63
|
| Rate for Payer: Signature Care PPO |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$28.13
|
|
