|
HC METERED DOSE INHALER
|
Facility
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
01701292
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.47
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centivo All Commercial |
$86.36
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Humana Medicare |
$86.36
|
| Rate for Payer: Lucent All Commercial |
$86.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.04
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
| Rate for Payer: United Healthcare Medicare |
$55.88
|
|
|
HC METER PEAK FLOW
|
Facility
OP
|
$61.25
|
|
| Hospital Charge Code |
41601078
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$51.70
|
| Rate for Payer: Aetna Medicare |
$20.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.23
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Centivo All Commercial |
$31.24
|
| Rate for Payer: Cigna All Commercial |
$52.86
|
| Rate for Payer: CORVEL All Commercial |
$56.96
|
| Rate for Payer: Coventry All Commercial |
$53.90
|
| Rate for Payer: Encore All Commercial |
$56.38
|
| Rate for Payer: Frontpath All Commercial |
$56.35
|
| Rate for Payer: Humana ChoiceCare |
$52.90
|
| Rate for Payer: Humana Medicare |
$31.24
|
| Rate for Payer: Lucent All Commercial |
$31.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.12
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$45.94
|
| Rate for Payer: PHP All Commercial |
$46.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.89
|
| Rate for Payer: Sagamore Health Network All Products |
$47.28
|
| Rate for Payer: Signature Care EPO |
$50.84
|
| Rate for Payer: Signature Care PPO |
$53.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.06
|
| Rate for Payer: United Healthcare Commercial |
$48.26
|
| Rate for Payer: United Healthcare Medicare |
$20.21
|
|
|
HC METER PEAK FLOW
|
Facility
IP
|
$61.25
|
|
| Hospital Charge Code |
41601078
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$56.96 |
| Rate for Payer: Aetna Commercial |
$52.92
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cigna All Commercial |
$52.86
|
| Rate for Payer: CORVEL All Commercial |
$56.96
|
| Rate for Payer: Coventry All Commercial |
$53.90
|
| Rate for Payer: Encore All Commercial |
$56.38
|
| Rate for Payer: Frontpath All Commercial |
$56.35
|
| Rate for Payer: Humana ChoiceCare |
$52.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.12
|
| Rate for Payer: PHCS All Commercial |
$45.94
|
| Rate for Payer: PHP All Commercial |
$46.45
|
| Rate for Payer: Sagamore Health Network All Products |
$47.28
|
| Rate for Payer: Signature Care EPO |
$50.84
|
| Rate for Payer: Signature Care PPO |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$48.26
|
|
|
HC METHADONE MS
|
Facility
OP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$131.97
|
| Rate for Payer: Aetna Medicare |
$51.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.76
|
| Rate for Payer: Cash Price |
$96.95
|
| Rate for Payer: Cash Price |
$96.95
|
| Rate for Payer: Centivo All Commercial |
$79.75
|
| Rate for Payer: Cigna All Commercial |
$134.94
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.60
|
| Rate for Payer: Encore All Commercial |
$143.93
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.05
|
| Rate for Payer: Humana Medicare |
$79.75
|
| Rate for Payer: Lucent All Commercial |
$79.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$117.27
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.98
|
| Rate for Payer: Sagamore Health Network All Products |
$120.71
|
| Rate for Payer: Signature Care EPO |
$129.78
|
| Rate for Payer: Signature Care PPO |
$137.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
| Rate for Payer: United Healthcare Medicare |
$51.60
|
|
|
HC METHADONE MS
|
Facility
IP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.27 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$135.10
|
| Rate for Payer: Cash Price |
$96.95
|
| Rate for Payer: Cigna All Commercial |
$134.94
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.60
|
| Rate for Payer: Encore All Commercial |
$143.93
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.27
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Sagamore Health Network All Products |
$120.71
|
| Rate for Payer: Signature Care EPO |
$129.78
|
| Rate for Payer: Signature Care PPO |
$137.60
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
|
|
HC METHAQUALONE MS
|
Facility
OP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$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 METHAQUALONE MS
|
Facility
IP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001430
|
|
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 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 |
$62.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.28
|
| Rate for Payer: Cash Price |
$118.34
|
| Rate for Payer: Cash Price |
$118.34
|
| Rate for Payer: Centivo All Commercial |
$97.34
|
| 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 |
$97.34
|
| Rate for Payer: Lucent All Commercial |
$97.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.78
|
| 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 |
$147.35
|
| Rate for Payer: Signature Care EPO |
$158.42
|
| 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 |
$62.98
|
|
|
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 |
$164.91
|
| Rate for Payer: Cash Price |
$118.34
|
| 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 |
$171.78
|
| Rate for Payer: PHCS All Commercial |
$143.15
|
| Rate for Payer: PHP All Commercial |
$144.75
|
| Rate for Payer: Sagamore Health Network All Products |
$147.35
|
| Rate for Payer: Signature Care EPO |
$158.42
|
| Rate for Payer: Signature Care PPO |
$167.96
|
| Rate for Payer: United Healthcare Commercial |
$150.40
|
|
|
HC METHOTREXATE-BLOOD
|
Facility
IP
|
$222.36
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.77 |
| Max. Negotiated Rate |
$206.79 |
| Rate for Payer: Aetna Commercial |
$192.12
|
| Rate for Payer: Cash Price |
$137.86
|
| Rate for Payer: Cigna All Commercial |
$191.90
|
| Rate for Payer: CORVEL All Commercial |
$206.79
|
| Rate for Payer: Coventry All Commercial |
$195.68
|
| Rate for Payer: Encore All Commercial |
$204.68
|
| Rate for Payer: Frontpath All Commercial |
$204.57
|
| Rate for Payer: Humana ChoiceCare |
$192.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.12
|
| Rate for Payer: PHCS All Commercial |
$166.77
|
| Rate for Payer: PHP All Commercial |
$168.64
|
| Rate for Payer: Sagamore Health Network All Products |
$171.66
|
| Rate for Payer: Signature Care EPO |
$184.56
|
| Rate for Payer: Signature Care PPO |
$195.68
|
| Rate for Payer: United Healthcare Commercial |
$175.22
|
|
|
HC METHOTREXATE-BLOOD
|
Facility
OP
|
$222.36
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$206.79 |
| Rate for Payer: Aetna Commercial |
$187.67
|
| Rate for Payer: Aetna Medicare |
$73.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$127.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.72
|
| Rate for Payer: Cash Price |
$137.86
|
| Rate for Payer: Cash Price |
$137.86
|
| Rate for Payer: Centivo All Commercial |
$113.40
|
| Rate for Payer: Cigna All Commercial |
$191.90
|
| Rate for Payer: CORVEL All Commercial |
$206.79
|
| Rate for Payer: Coventry All Commercial |
$195.68
|
| Rate for Payer: Encore All Commercial |
$204.68
|
| Rate for Payer: Frontpath All Commercial |
$204.57
|
| Rate for Payer: Humana ChoiceCare |
$192.05
|
| Rate for Payer: Humana Medicare |
$113.40
|
| Rate for Payer: Lucent All Commercial |
$113.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.12
|
| Rate for Payer: Managed Health Services Medicaid |
$18.64
|
| Rate for Payer: MDWise Medicaid |
$18.64
|
| Rate for Payer: PHCS All Commercial |
$166.77
|
| Rate for Payer: PHP All Commercial |
$168.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.72
|
| Rate for Payer: Sagamore Health Network All Products |
$171.66
|
| Rate for Payer: Signature Care EPO |
$184.56
|
| Rate for Payer: Signature Care PPO |
$195.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$189.01
|
| Rate for Payer: United Healthcare Commercial |
$175.22
|
| Rate for Payer: United Healthcare Medicare |
$73.38
|
|
|
HC METHYLENE TETRA HYDROFOL MUTATION
|
Facility
OP
|
$684.42
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
63001440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.86 |
| Max. Negotiated Rate |
$636.51 |
| Rate for Payer: Aetna Commercial |
$577.65
|
| Rate for Payer: Aetna Medicare |
$225.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$225.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$393.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$427.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$248.44
|
| Rate for Payer: Cash Price |
$424.34
|
| Rate for Payer: Centivo All Commercial |
$349.05
|
| 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 |
$349.05
|
| Rate for Payer: Lucent All Commercial |
$349.05
|
| 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 |
$225.86
|
|
|
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 |
$424.34
|
| 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 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 |
$84.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.27
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Centivo All Commercial |
$131.04
|
| 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 |
$131.04
|
| Rate for Payer: Lucent All Commercial |
$131.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.24
|
| Rate for Payer: Managed Health Services Medicaid |
$21.21
|
| Rate for Payer: MDWise Medicaid |
$21.21
|
| Rate for Payer: PHCS All Commercial |
$192.70
|
| 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 |
$84.79
|
|
|
HC METHYLMALONIC A
|
Facility
IP
|
$256.94
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
63001646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$192.70 |
| Max. Negotiated Rate |
$238.95 |
| Rate for Payer: Aetna Commercial |
$221.99
|
| Rate for Payer: Cash Price |
$159.30
|
| 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 |
$231.24
|
| Rate for Payer: PHCS All Commercial |
$192.70
|
| 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 MEXILETINE
|
Facility
OP
|
$189.16
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$159.65
|
| Rate for Payer: Aetna Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.66
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Centivo All Commercial |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Humana Medicare |
$96.47
|
| Rate for Payer: Lucent All Commercial |
$96.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: Managed Health Services Medicaid |
$18.64
|
| Rate for Payer: MDWise Medicaid |
$18.64
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.77
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.79
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
| Rate for Payer: United Healthcare Medicare |
$62.42
|
|
|
HC MEXILETINE
|
Facility
IP
|
$189.16
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$163.43
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
|
|
HC MICRA
|
Facility
OP
|
$38,052.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607432
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$35,388.36 |
| Rate for Payer: Aetna Commercial |
$32,115.89
|
| Rate for Payer: Aetna Medicare |
$12,557.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12,557.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21,853.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23,786.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14,440.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13,812.88
|
| Rate for Payer: Cash Price |
$23,592.24
|
| Rate for Payer: Cash Price |
$23,592.24
|
| Rate for Payer: Centivo All Commercial |
$19,406.52
|
| Rate for Payer: Cigna All Commercial |
$32,838.88
|
| Rate for Payer: CORVEL All Commercial |
$35,388.36
|
| Rate for Payer: Coventry All Commercial |
$33,485.76
|
| Rate for Payer: Encore All Commercial |
$35,026.87
|
| Rate for Payer: Frontpath All Commercial |
$35,007.84
|
| Rate for Payer: Humana ChoiceCare |
$32,865.51
|
| Rate for Payer: Humana Medicare |
$19,406.52
|
| Rate for Payer: Lucent All Commercial |
$19,406.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34,246.80
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$28,539.00
|
| Rate for Payer: PHP All Commercial |
$28,858.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14,840.28
|
| Rate for Payer: Sagamore Health Network All Products |
$29,376.14
|
| Rate for Payer: Signature Care EPO |
$31,583.16
|
| Rate for Payer: Signature Care PPO |
$33,485.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32,344.20
|
| Rate for Payer: United Healthcare Commercial |
$29,984.98
|
| Rate for Payer: United Healthcare Medicare |
$12,557.16
|
|
|
HC MICRA
|
Facility
IP
|
$38,052.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607432
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,539.00 |
| Max. Negotiated Rate |
$35,388.36 |
| Rate for Payer: Aetna Commercial |
$32,876.93
|
| Rate for Payer: Cash Price |
$23,592.24
|
| Rate for Payer: Cigna All Commercial |
$32,838.88
|
| Rate for Payer: CORVEL All Commercial |
$35,388.36
|
| Rate for Payer: Coventry All Commercial |
$33,485.76
|
| Rate for Payer: Encore All Commercial |
$35,026.87
|
| Rate for Payer: Frontpath All Commercial |
$35,007.84
|
| Rate for Payer: Humana ChoiceCare |
$32,865.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34,246.80
|
| Rate for Payer: PHCS All Commercial |
$28,539.00
|
| Rate for Payer: PHP All Commercial |
$28,858.64
|
| Rate for Payer: Sagamore Health Network All Products |
$29,376.14
|
| Rate for Payer: Signature Care EPO |
$31,583.16
|
| Rate for Payer: Signature Care PPO |
$33,485.76
|
| Rate for Payer: United Healthcare Commercial |
$29,984.98
|
|
|
HC MICRA AV
|
Facility
IP
|
$47,700.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607433
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$35,775.00 |
| Max. Negotiated Rate |
$44,361.00 |
| Rate for Payer: Aetna Commercial |
$41,212.80
|
| Rate for Payer: Cash Price |
$29,574.00
|
| Rate for Payer: Cigna All Commercial |
$41,165.10
|
| Rate for Payer: CORVEL All Commercial |
$44,361.00
|
| Rate for Payer: Coventry All Commercial |
$41,976.00
|
| Rate for Payer: Encore All Commercial |
$43,907.85
|
| Rate for Payer: Frontpath All Commercial |
$43,884.00
|
| Rate for Payer: Humana ChoiceCare |
$41,198.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42,930.00
|
| Rate for Payer: PHCS All Commercial |
$35,775.00
|
| Rate for Payer: PHP All Commercial |
$36,175.68
|
| Rate for Payer: Sagamore Health Network All Products |
$36,824.40
|
| Rate for Payer: Signature Care EPO |
$39,591.00
|
| Rate for Payer: Signature Care PPO |
$41,976.00
|
| Rate for Payer: United Healthcare Commercial |
$37,587.60
|
|
|
HC MICRA AV
|
Facility
OP
|
$47,700.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607433
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$44,361.00 |
| Rate for Payer: Aetna Commercial |
$40,258.80
|
| Rate for Payer: Aetna Medicare |
$15,741.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15,741.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27,394.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29,817.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18,102.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17,315.10
|
| Rate for Payer: Cash Price |
$29,574.00
|
| Rate for Payer: Cash Price |
$29,574.00
|
| Rate for Payer: Centivo All Commercial |
$24,327.00
|
| Rate for Payer: Cigna All Commercial |
$41,165.10
|
| Rate for Payer: CORVEL All Commercial |
$44,361.00
|
| Rate for Payer: Coventry All Commercial |
$41,976.00
|
| Rate for Payer: Encore All Commercial |
$43,907.85
|
| Rate for Payer: Frontpath All Commercial |
$43,884.00
|
| Rate for Payer: Humana ChoiceCare |
$41,198.49
|
| Rate for Payer: Humana Medicare |
$24,327.00
|
| Rate for Payer: Lucent All Commercial |
$24,327.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42,930.00
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$35,775.00
|
| Rate for Payer: PHP All Commercial |
$36,175.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18,603.00
|
| Rate for Payer: Sagamore Health Network All Products |
$36,824.40
|
| Rate for Payer: Signature Care EPO |
$39,591.00
|
| Rate for Payer: Signature Care PPO |
$41,976.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40,545.00
|
| Rate for Payer: United Healthcare Commercial |
$37,587.60
|
| Rate for Payer: United Healthcare Medicare |
$15,741.00
|
|
|
HC MICRA INTRODUCER SHEATH
|
Facility
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,866.24
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
|
|
HC MICRA INTRODUCER SHEATH
|
Facility
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Aetna Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,240.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,350.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$819.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.08
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Centivo All Commercial |
$1,101.60
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Humana Medicare |
$1,101.60
|
| Rate for Payer: Lucent All Commercial |
$1,101.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare Medicare |
$712.80
|
|
|
HC MICROALBUMIN
|
Facility
IP
|
$121.18
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
63001131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.88 |
| Max. Negotiated Rate |
$112.69 |
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Cash Price |
$75.13
|
| Rate for Payer: Cigna All Commercial |
$104.57
|
| Rate for Payer: CORVEL All Commercial |
$112.69
|
| Rate for Payer: Coventry All Commercial |
$106.63
|
| Rate for Payer: Encore All Commercial |
$111.54
|
| Rate for Payer: Frontpath All Commercial |
$111.48
|
| Rate for Payer: Humana ChoiceCare |
$104.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.06
|
| Rate for Payer: PHCS All Commercial |
$90.88
|
| 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 |
$106.63
|
| Rate for Payer: United Healthcare Commercial |
$95.49
|
|
|
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 |
$112.69 |
| Rate for Payer: Aetna Commercial |
$102.27
|
| Rate for Payer: Aetna Medicare |
$39.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.99
|
| Rate for Payer: Cash Price |
$75.13
|
| Rate for Payer: Cash Price |
$75.13
|
| Rate for Payer: Centivo All Commercial |
$61.80
|
| Rate for Payer: Cigna All Commercial |
$104.57
|
| Rate for Payer: CORVEL All Commercial |
$112.69
|
| Rate for Payer: Coventry All Commercial |
$106.63
|
| Rate for Payer: Encore All Commercial |
$111.54
|
| Rate for Payer: Frontpath All Commercial |
$111.48
|
| Rate for Payer: Humana ChoiceCare |
$104.66
|
| Rate for Payer: Humana Medicare |
$61.80
|
| Rate for Payer: Lucent All Commercial |
$61.80
|
| 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 |
$90.88
|
| 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 |
$106.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.00
|
| Rate for Payer: United Healthcare Commercial |
$95.49
|
| Rate for Payer: United Healthcare Medicare |
$39.99
|
|
