|
HC OL ELEVIEW
|
Facility
|
IP
|
$2,090.00
|
|
| Hospital Charge Code |
41606540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$1,943.70 |
| Rate for Payer: Aetna Commercial |
$1,805.76
|
| Rate for Payer: Cash Price |
$1,254.00
|
| Rate for Payer: Cigna All Commercial |
$1,803.67
|
| Rate for Payer: CORVEL All Commercial |
$1,943.70
|
| Rate for Payer: Coventry All Commercial |
$1,839.20
|
| Rate for Payer: Encore All Commercial |
$1,923.85
|
| Rate for Payer: Frontpath All Commercial |
$1,922.80
|
| Rate for Payer: Humana ChoiceCare |
$1,805.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,881.00
|
| Rate for Payer: PHCS All Commercial |
$1,567.50
|
| Rate for Payer: PHP All Commercial |
$1,585.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,613.48
|
| Rate for Payer: Signature Care EPO |
$1,734.70
|
| Rate for Payer: Signature Care PPO |
$1,839.20
|
| Rate for Payer: United Healthcare Commercial |
$1,646.92
|
|
|
HC OL ELEVIEW
|
Facility
|
OP
|
$2,090.00
|
|
| Hospital Charge Code |
41606540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,943.70 |
| Rate for Payer: Aetna Commercial |
$1,763.96
|
| Rate for Payer: Aetna Medicare |
$668.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$647.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,200.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,306.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$769.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$735.68
|
| Rate for Payer: Cash Price |
$1,254.00
|
| Rate for Payer: Cash Price |
$1,254.00
|
| Rate for Payer: Centivo All Commercial |
$1,136.96
|
| Rate for Payer: Cigna All Commercial |
$1,803.67
|
| Rate for Payer: CORVEL All Commercial |
$1,943.70
|
| Rate for Payer: Coventry All Commercial |
$1,839.20
|
| Rate for Payer: Encore All Commercial |
$1,923.85
|
| Rate for Payer: Frontpath All Commercial |
$1,922.80
|
| Rate for Payer: Humana ChoiceCare |
$1,805.13
|
| Rate for Payer: Humana Medicare |
$668.80
|
| Rate for Payer: Lucent All Commercial |
$1,136.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,881.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,567.50
|
| Rate for Payer: PHP All Commercial |
$1,585.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$815.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,613.48
|
| Rate for Payer: Signature Care EPO |
$1,734.70
|
| Rate for Payer: Signature Care PPO |
$1,839.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,776.50
|
| Rate for Payer: United Healthcare Commercial |
$1,646.92
|
| Rate for Payer: United Healthcare Medicare |
$668.80
|
|
|
HC OMNI ERGO SYSTEM
|
Facility
|
OP
|
$6,120.00
|
|
| Hospital Charge Code |
41608386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,165.28
|
| Rate for Payer: Aetna Medicare |
$1,958.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,897.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,514.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,825.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,252.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,154.24
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Centivo All Commercial |
$3,329.28
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Humana Medicare |
$1,958.40
|
| Rate for Payer: Lucent All Commercial |
$3,329.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,386.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,202.00
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
| Rate for Payer: United Healthcare Medicare |
$1,958.40
|
|
|
HC OMNI ERGO SYSTEM
|
Facility
|
IP
|
$6,120.00
|
|
| Hospital Charge Code |
41608386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,590.00 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,287.68
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
|
|
HC O MOD HUM HD 45
|
Facility
|
OP
|
$11,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$10,713.60 |
| Rate for Payer: Aetna Commercial |
$9,722.88
|
| Rate for Payer: Aetna Medicare |
$3,686.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,571.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,201.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,239.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,055.04
|
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Centivo All Commercial |
$6,266.88
|
| Rate for Payer: Cigna All Commercial |
$9,941.76
|
| Rate for Payer: CORVEL All Commercial |
$10,713.60
|
| Rate for Payer: Coventry All Commercial |
$10,137.60
|
| Rate for Payer: Encore All Commercial |
$10,604.16
|
| Rate for Payer: Frontpath All Commercial |
$10,598.40
|
| Rate for Payer: Humana ChoiceCare |
$9,949.82
|
| Rate for Payer: Humana Medicare |
$3,686.40
|
| Rate for Payer: Lucent All Commercial |
$6,266.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,368.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$8,640.00
|
| Rate for Payer: PHP All Commercial |
$8,736.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,492.80
|
| Rate for Payer: Sagamore Health Network All Products |
$8,893.44
|
| Rate for Payer: Signature Care EPO |
$9,561.60
|
| Rate for Payer: Signature Care PPO |
$10,137.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,792.00
|
| Rate for Payer: United Healthcare Commercial |
$9,077.76
|
| Rate for Payer: United Healthcare Medicare |
$3,686.40
|
|
|
HC O MOD HUM HD 45
|
Facility
|
IP
|
$11,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.00 |
| Max. Negotiated Rate |
$10,713.60 |
| Rate for Payer: Aetna Commercial |
$9,953.28
|
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Cigna All Commercial |
$9,941.76
|
| Rate for Payer: CORVEL All Commercial |
$10,713.60
|
| Rate for Payer: Coventry All Commercial |
$10,137.60
|
| Rate for Payer: Encore All Commercial |
$10,604.16
|
| Rate for Payer: Frontpath All Commercial |
$10,598.40
|
| Rate for Payer: Humana ChoiceCare |
$9,949.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,368.00
|
| Rate for Payer: PHCS All Commercial |
$8,640.00
|
| Rate for Payer: PHP All Commercial |
$8,736.77
|
| Rate for Payer: Sagamore Health Network All Products |
$8,893.44
|
| Rate for Payer: Signature Care EPO |
$9,561.60
|
| Rate for Payer: Signature Care PPO |
$10,137.60
|
| Rate for Payer: United Healthcare Commercial |
$9,077.76
|
|
|
HC O MOD HUM STEM 10X116
|
Facility
|
OP
|
$11,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$10,713.60 |
| Rate for Payer: Aetna Commercial |
$9,722.88
|
| Rate for Payer: Aetna Medicare |
$3,686.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,571.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,201.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,239.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,055.04
|
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Centivo All Commercial |
$6,266.88
|
| Rate for Payer: Cigna All Commercial |
$9,941.76
|
| Rate for Payer: CORVEL All Commercial |
$10,713.60
|
| Rate for Payer: Coventry All Commercial |
$10,137.60
|
| Rate for Payer: Encore All Commercial |
$10,604.16
|
| Rate for Payer: Frontpath All Commercial |
$10,598.40
|
| Rate for Payer: Humana ChoiceCare |
$9,949.82
|
| Rate for Payer: Humana Medicare |
$3,686.40
|
| Rate for Payer: Lucent All Commercial |
$6,266.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,368.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$8,640.00
|
| Rate for Payer: PHP All Commercial |
$8,736.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,492.80
|
| Rate for Payer: Sagamore Health Network All Products |
$8,893.44
|
| Rate for Payer: Signature Care EPO |
$9,561.60
|
| Rate for Payer: Signature Care PPO |
$10,137.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,792.00
|
| Rate for Payer: United Healthcare Commercial |
$9,077.76
|
| Rate for Payer: United Healthcare Medicare |
$3,686.40
|
|
|
HC O MOD HUM STEM 10X116
|
Facility
|
IP
|
$11,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.00 |
| Max. Negotiated Rate |
$10,713.60 |
| Rate for Payer: Aetna Commercial |
$9,953.28
|
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Cigna All Commercial |
$9,941.76
|
| Rate for Payer: CORVEL All Commercial |
$10,713.60
|
| Rate for Payer: Coventry All Commercial |
$10,137.60
|
| Rate for Payer: Encore All Commercial |
$10,604.16
|
| Rate for Payer: Frontpath All Commercial |
$10,598.40
|
| Rate for Payer: Humana ChoiceCare |
$9,949.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,368.00
|
| Rate for Payer: PHCS All Commercial |
$8,640.00
|
| Rate for Payer: PHP All Commercial |
$8,736.77
|
| Rate for Payer: Sagamore Health Network All Products |
$8,893.44
|
| Rate for Payer: Signature Care EPO |
$9,561.60
|
| Rate for Payer: Signature Care PPO |
$10,137.60
|
| Rate for Payer: United Healthcare Commercial |
$9,077.76
|
|
|
HC OPIATES,QT-URINE CHARGE2
|
Facility
|
IP
|
$38.36
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
63001423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
|
|
HC OPIATES,QT-URINE CHARGE2
|
Facility
|
OP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$114.43 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.50
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centivo All Commercial |
$20.87
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Lucent All Commercial |
$20.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.28
|
|
|
HC OPIATES,QT-URINE CHARGE2
|
Facility
|
OP
|
$38.36
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
63001423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.50
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centivo All Commercial |
$20.87
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Lucent All Commercial |
$20.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.28
|
|
|
HC OPIATES,QT-URINE CHARGE2
|
Facility
|
IP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
|
|
HC OPIATES QT-URINE CHARGE3
|
Facility
|
OP
|
$38.36
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
63001425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.50
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centivo All Commercial |
$20.87
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Lucent All Commercial |
$20.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.28
|
|
|
HC OPIATES QT-URINE CHARGE3
|
Facility
|
OP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$114.43 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.50
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centivo All Commercial |
$20.87
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Lucent All Commercial |
$20.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.28
|
|
|
HC OPIATES QT-URINE CHARGE3
|
Facility
|
IP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
|
|
HC OPIATES QT-URINE CHARGE3
|
Facility
|
IP
|
$38.36
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
63001425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cigna All Commercial |
$33.10
|
| Rate for Payer: CORVEL All Commercial |
$35.67
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Sagamore Health Network All Products |
$29.61
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
|
|
HC OP IMMUNIZATION ADMINISTRATION
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1299047
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC OP IMMUNIZATION ADMINISTRATION
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1299047
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
HC O&P MICRO EXAM
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
63001291
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
|
|
HC O&P MICRO EXAM
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
63001291
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Aetna Medicare |
$22.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.41
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Centivo All Commercial |
$37.73
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Humana Medicare |
$22.20
|
| Rate for Payer: Lucent All Commercial |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.90
|
| Rate for Payer: MDWise Medicaid |
$8.90
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.05
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.96
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
| Rate for Payer: United Healthcare Medicare |
$22.20
|
|
|
HC ORGANISM AEROBIC ID - REFERRED
|
Facility
|
OP
|
$50.18
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63002229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.66
|
| Rate for Payer: Cash Price |
$30.11
|
| Rate for Payer: Cash Price |
$30.11
|
| Rate for Payer: Centivo All Commercial |
$27.30
|
| Rate for Payer: Cigna All Commercial |
$43.31
|
| Rate for Payer: CORVEL All Commercial |
$46.67
|
| Rate for Payer: Coventry All Commercial |
$44.16
|
| Rate for Payer: Encore All Commercial |
$46.19
|
| Rate for Payer: Frontpath All Commercial |
$46.17
|
| Rate for Payer: Humana ChoiceCare |
$43.34
|
| Rate for Payer: Humana Medicare |
$16.06
|
| Rate for Payer: Lucent All Commercial |
$27.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.16
|
| Rate for Payer: Managed Health Services Medicaid |
$8.08
|
| Rate for Payer: MDWise Medicaid |
$8.08
|
| Rate for Payer: PHCS All Commercial |
$37.63
|
| Rate for Payer: PHP All Commercial |
$38.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.57
|
| Rate for Payer: Sagamore Health Network All Products |
$38.74
|
| Rate for Payer: Signature Care EPO |
$41.65
|
| Rate for Payer: Signature Care PPO |
$44.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.65
|
| Rate for Payer: United Healthcare Commercial |
$39.54
|
| Rate for Payer: United Healthcare Medicare |
$16.06
|
|
|
HC ORGANISM AEROBIC ID - REFERRED
|
Facility
|
IP
|
$50.18
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63002229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial |
$43.36
|
| Rate for Payer: Cash Price |
$30.11
|
| Rate for Payer: Cigna All Commercial |
$43.31
|
| Rate for Payer: CORVEL All Commercial |
$46.67
|
| Rate for Payer: Coventry All Commercial |
$44.16
|
| Rate for Payer: Encore All Commercial |
$46.19
|
| Rate for Payer: Frontpath All Commercial |
$46.17
|
| Rate for Payer: Humana ChoiceCare |
$43.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.16
|
| Rate for Payer: PHCS All Commercial |
$37.63
|
| Rate for Payer: PHP All Commercial |
$38.06
|
| Rate for Payer: Sagamore Health Network All Products |
$38.74
|
| Rate for Payer: Signature Care EPO |
$41.65
|
| Rate for Payer: Signature Care PPO |
$44.16
|
| Rate for Payer: United Healthcare Commercial |
$39.54
|
|
|
HC ORGANISM FOR MIC - REFERRED
|
Facility
|
IP
|
$58.91
|
|
| Hospital Charge Code |
63002230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$54.79 |
| Rate for Payer: Aetna Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$35.35
|
| Rate for Payer: Cigna All Commercial |
$50.84
|
| Rate for Payer: CORVEL All Commercial |
$54.79
|
| Rate for Payer: Coventry All Commercial |
$51.84
|
| Rate for Payer: Encore All Commercial |
$54.23
|
| Rate for Payer: Frontpath All Commercial |
$54.20
|
| Rate for Payer: Humana ChoiceCare |
$50.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.02
|
| Rate for Payer: PHCS All Commercial |
$44.18
|
| Rate for Payer: PHP All Commercial |
$44.68
|
| Rate for Payer: Sagamore Health Network All Products |
$45.48
|
| Rate for Payer: Signature Care EPO |
$48.90
|
| Rate for Payer: Signature Care PPO |
$51.84
|
| Rate for Payer: United Healthcare Commercial |
$46.42
|
|
|
HC ORGANISM FOR MIC - REFERRED
|
Facility
|
OP
|
$58.91
|
|
| Hospital Charge Code |
63002230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$54.79 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Aetna Medicare |
$18.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.74
|
| Rate for Payer: Cash Price |
$35.35
|
| Rate for Payer: Centivo All Commercial |
$32.05
|
| Rate for Payer: Cigna All Commercial |
$50.84
|
| Rate for Payer: CORVEL All Commercial |
$54.79
|
| Rate for Payer: Coventry All Commercial |
$51.84
|
| Rate for Payer: Encore All Commercial |
$54.23
|
| Rate for Payer: Frontpath All Commercial |
$54.20
|
| Rate for Payer: Humana ChoiceCare |
$50.88
|
| Rate for Payer: Humana Medicare |
$18.85
|
| Rate for Payer: Lucent All Commercial |
$32.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.02
|
| Rate for Payer: PHCS All Commercial |
$44.18
|
| Rate for Payer: PHP All Commercial |
$44.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.97
|
| Rate for Payer: Sagamore Health Network All Products |
$45.48
|
| Rate for Payer: Signature Care EPO |
$48.90
|
| Rate for Payer: Signature Care PPO |
$51.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.07
|
| Rate for Payer: United Healthcare Commercial |
$46.42
|
| Rate for Payer: United Healthcare Medicare |
$18.85
|
|
|
HC OSMOLALITY (BLOOD)
|
Facility
|
OP
|
$139.13
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
63001121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$129.39 |
| Rate for Payer: Aetna Commercial |
$117.43
|
| Rate for Payer: Aetna Medicare |
$44.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.97
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Centivo All Commercial |
$75.69
|
| Rate for Payer: Cigna All Commercial |
$120.07
|
| Rate for Payer: CORVEL All Commercial |
$129.39
|
| Rate for Payer: Coventry All Commercial |
$122.43
|
| Rate for Payer: Encore All Commercial |
$128.07
|
| Rate for Payer: Frontpath All Commercial |
$128.00
|
| Rate for Payer: Humana ChoiceCare |
$120.17
|
| Rate for Payer: Humana Medicare |
$44.52
|
| Rate for Payer: Lucent All Commercial |
$75.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.22
|
| Rate for Payer: Managed Health Services Medicaid |
$6.61
|
| Rate for Payer: MDWise Medicaid |
$6.61
|
| Rate for Payer: PHCS All Commercial |
$104.35
|
| Rate for Payer: PHP All Commercial |
$105.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.26
|
| Rate for Payer: Sagamore Health Network All Products |
$107.41
|
| Rate for Payer: Signature Care EPO |
$115.48
|
| Rate for Payer: Signature Care PPO |
$122.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.26
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
| Rate for Payer: United Healthcare Medicare |
$44.52
|
|
