|
HC PHOSPHORUS
|
Facility
|
OP
|
$47.12
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
63001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$43.82 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.59
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Centivo All Commercial |
$25.63
|
| Rate for Payer: Cigna All Commercial |
$40.66
|
| Rate for Payer: CORVEL All Commercial |
$43.82
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.37
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Lucent All Commercial |
$25.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: Managed Health Services Medicaid |
$4.74
|
| Rate for Payer: MDWise Medicaid |
$4.74
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.38
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$15.08
|
|
|
HC PHOSPHORUS
|
Facility
|
IP
|
$47.12
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
63001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$43.82 |
| Rate for Payer: Aetna Commercial |
$40.71
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cigna All Commercial |
$40.66
|
| Rate for Payer: CORVEL All Commercial |
$43.82
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.37
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-OT
|
Facility
|
OP
|
$143.02
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
1738062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.34
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Centivo All Commercial |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$45.77
|
| Rate for Payer: Lucent All Commercial |
$77.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-OT
|
Facility
|
IP
|
$143.02
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
1738062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$85.81
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
1728064
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| 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 |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
1728064
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| 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 |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC PICC DOUBLE LUMEN POWER 4FR
|
Facility
|
IP
|
$1,385.95
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,039.46 |
| Max. Negotiated Rate |
$1,288.93 |
| Rate for Payer: Aetna Commercial |
$1,197.46
|
| Rate for Payer: Cash Price |
$831.57
|
| Rate for Payer: Cigna All Commercial |
$1,196.07
|
| Rate for Payer: CORVEL All Commercial |
$1,288.93
|
| Rate for Payer: Coventry All Commercial |
$1,219.64
|
| Rate for Payer: Encore All Commercial |
$1,275.77
|
| Rate for Payer: Frontpath All Commercial |
$1,275.07
|
| Rate for Payer: Humana ChoiceCare |
$1,197.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,247.36
|
| Rate for Payer: PHCS All Commercial |
$1,039.46
|
| Rate for Payer: PHP All Commercial |
$1,051.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,069.95
|
| Rate for Payer: Signature Care EPO |
$1,150.34
|
| Rate for Payer: Signature Care PPO |
$1,219.64
|
| Rate for Payer: United Healthcare Commercial |
$1,092.13
|
|
|
HC PICC DOUBLE LUMEN POWER 4FR
|
Facility
|
OP
|
$1,385.95
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,288.93 |
| Rate for Payer: Aetna Commercial |
$1,169.74
|
| Rate for Payer: Aetna Medicare |
$443.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$795.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$866.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$510.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$487.85
|
| Rate for Payer: Cash Price |
$831.57
|
| Rate for Payer: Cash Price |
$831.57
|
| Rate for Payer: Centivo All Commercial |
$753.96
|
| Rate for Payer: Cigna All Commercial |
$1,196.07
|
| Rate for Payer: CORVEL All Commercial |
$1,288.93
|
| Rate for Payer: Coventry All Commercial |
$1,219.64
|
| Rate for Payer: Encore All Commercial |
$1,275.77
|
| Rate for Payer: Frontpath All Commercial |
$1,275.07
|
| Rate for Payer: Humana ChoiceCare |
$1,197.05
|
| Rate for Payer: Humana Medicare |
$443.50
|
| Rate for Payer: Lucent All Commercial |
$753.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,247.36
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,039.46
|
| Rate for Payer: PHP All Commercial |
$1,051.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$540.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,069.95
|
| Rate for Payer: Signature Care EPO |
$1,150.34
|
| Rate for Payer: Signature Care PPO |
$1,219.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,178.06
|
| Rate for Payer: United Healthcare Commercial |
$1,092.13
|
| Rate for Payer: United Healthcare Medicare |
$443.50
|
|
|
HC PICC LINE INSERTION <5 YR W/IMAGING GUIDANCE
|
Facility
|
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
950572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
|
|
HC PICC LINE INSERTION <5 YR W/IMAGING GUIDANCE
|
Facility
|
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
950572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$658.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$637.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$582.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$757.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$724.40
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Centivo All Commercial |
$1,119.52
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$658.54
|
| Rate for Payer: Lucent All Commercial |
$1,119.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: Managed Health Services Medicaid |
$582.98
|
| Rate for Payer: MDWise Medicaid |
$582.98
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
| Rate for Payer: United Healthcare Medicare |
$658.54
|
|
|
HC PICC LINE INSERTION 5+ YR W/IMAGING GUIDANCE
|
Facility
|
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
950573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$637.96 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$658.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,079.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$637.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,079.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$757.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$724.40
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Centivo All Commercial |
$1,119.52
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$658.54
|
| Rate for Payer: Lucent All Commercial |
$1,119.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: Managed Health Services Medicaid |
$1,079.83
|
| Rate for Payer: MDWise Medicaid |
$1,079.83
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
| Rate for Payer: United Healthcare Medicare |
$658.54
|
|
|
HC PICC LINE INSERTION 5+ YR W/IMAGING GUIDANCE
|
Facility
|
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
950573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
|
|
HC PICC LINE INSERTION <5 YR W/O IMAGING
|
Facility
|
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
950568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$658.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$637.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$582.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$757.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$724.40
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Centivo All Commercial |
$1,119.52
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$658.54
|
| Rate for Payer: Lucent All Commercial |
$1,119.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: Managed Health Services Medicaid |
$582.98
|
| Rate for Payer: MDWise Medicaid |
$582.98
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
| Rate for Payer: United Healthcare Medicare |
$658.54
|
|
|
HC PICC LINE INSERTION <5 YR W/O IMAGING
|
Facility
|
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
950568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
|
|
HC PICC LINE INSERTION 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
950569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
|
|
HC PICC LINE INSERTION 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
950569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.54 |
| Max. Negotiated Rate |
$1,913.89 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$658.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$318.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$637.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$318.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$757.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$724.40
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Cash Price |
$1,234.77
|
| Rate for Payer: Centivo All Commercial |
$1,119.52
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.89
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.31
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$658.54
|
| Rate for Payer: Lucent All Commercial |
$1,119.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.15
|
| Rate for Payer: Managed Health Services Medicaid |
$318.54
|
| Rate for Payer: MDWise Medicaid |
$318.54
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.66
|
| Rate for Payer: United Healthcare Medicare |
$658.54
|
|
|
HC PICC SINGLE LUMEN POWER 4FR
|
Facility
|
IP
|
$1,363.25
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,022.44 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,177.85
|
| Rate for Payer: Cash Price |
$817.95
|
| Rate for Payer: Cigna All Commercial |
$1,176.48
|
| Rate for Payer: CORVEL All Commercial |
$1,267.82
|
| Rate for Payer: Coventry All Commercial |
$1,199.66
|
| Rate for Payer: Encore All Commercial |
$1,254.87
|
| Rate for Payer: Frontpath All Commercial |
$1,254.19
|
| Rate for Payer: Humana ChoiceCare |
$1,177.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,226.92
|
| Rate for Payer: PHCS All Commercial |
$1,022.44
|
| Rate for Payer: PHP All Commercial |
$1,033.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,052.43
|
| Rate for Payer: Signature Care EPO |
$1,131.50
|
| Rate for Payer: Signature Care PPO |
$1,199.66
|
| Rate for Payer: United Healthcare Commercial |
$1,074.24
|
|
|
HC PICC SINGLE LUMEN POWER 4FR
|
Facility
|
OP
|
$1,363.25
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,150.58
|
| Rate for Payer: Aetna Medicare |
$436.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$422.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$782.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$852.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$501.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$479.86
|
| Rate for Payer: Cash Price |
$817.95
|
| Rate for Payer: Cash Price |
$817.95
|
| Rate for Payer: Centivo All Commercial |
$741.61
|
| Rate for Payer: Cigna All Commercial |
$1,176.48
|
| Rate for Payer: CORVEL All Commercial |
$1,267.82
|
| Rate for Payer: Coventry All Commercial |
$1,199.66
|
| Rate for Payer: Encore All Commercial |
$1,254.87
|
| Rate for Payer: Frontpath All Commercial |
$1,254.19
|
| Rate for Payer: Humana ChoiceCare |
$1,177.44
|
| Rate for Payer: Humana Medicare |
$436.24
|
| Rate for Payer: Lucent All Commercial |
$741.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,226.92
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,022.44
|
| Rate for Payer: PHP All Commercial |
$1,033.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$531.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,052.43
|
| Rate for Payer: Signature Care EPO |
$1,131.50
|
| Rate for Payer: Signature Care PPO |
$1,199.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,158.76
|
| Rate for Payer: United Healthcare Commercial |
$1,074.24
|
| Rate for Payer: United Healthcare Medicare |
$436.24
|
|
|
HC PLATELET COUNT AUTO
|
Facility
|
IP
|
$57.22
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001228
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$53.21 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.21
|
| Rate for Payer: Coventry All Commercial |
$50.35
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.91
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.17
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.35
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC PLATELET COUNT AUTO
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001228
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$53.21 |
| Rate for Payer: Aetna Commercial |
$48.29
|
| Rate for Payer: Aetna Medicare |
$18.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.14
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Centivo All Commercial |
$31.13
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.21
|
| Rate for Payer: Coventry All Commercial |
$50.35
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$18.31
|
| Rate for Payer: Lucent All Commercial |
$31.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$4.48
|
| Rate for Payer: MDWise Medicaid |
$4.48
|
| Rate for Payer: PHCS All Commercial |
$42.91
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.17
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.31
|
|
|
HC PLATELET COUNT AUTO
|
Facility
|
IP
|
$46.95
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cigna All Commercial |
$40.52
|
| Rate for Payer: CORVEL All Commercial |
$43.66
|
| Rate for Payer: Coventry All Commercial |
$41.32
|
| Rate for Payer: Encore All Commercial |
$43.22
|
| Rate for Payer: Frontpath All Commercial |
$43.19
|
| Rate for Payer: Humana ChoiceCare |
$40.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.26
|
| Rate for Payer: PHCS All Commercial |
$35.21
|
| Rate for Payer: PHP All Commercial |
$35.61
|
| Rate for Payer: Sagamore Health Network All Products |
$36.25
|
| Rate for Payer: Signature Care EPO |
$38.97
|
| Rate for Payer: Signature Care PPO |
$41.32
|
| Rate for Payer: United Healthcare Commercial |
$37.00
|
|
|
HC PLATELET COUNT AUTO
|
Facility
|
OP
|
$46.95
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: Aetna Commercial |
$39.63
|
| Rate for Payer: Aetna Medicare |
$15.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.53
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Centivo All Commercial |
$25.54
|
| Rate for Payer: Cigna All Commercial |
$40.52
|
| Rate for Payer: CORVEL All Commercial |
$43.66
|
| Rate for Payer: Coventry All Commercial |
$41.32
|
| Rate for Payer: Encore All Commercial |
$43.22
|
| Rate for Payer: Frontpath All Commercial |
$43.19
|
| Rate for Payer: Humana ChoiceCare |
$40.55
|
| Rate for Payer: Humana Medicare |
$15.02
|
| Rate for Payer: Lucent All Commercial |
$25.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.26
|
| Rate for Payer: Managed Health Services Medicaid |
$4.48
|
| Rate for Payer: MDWise Medicaid |
$4.48
|
| Rate for Payer: PHCS All Commercial |
$35.21
|
| Rate for Payer: PHP All Commercial |
$35.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.31
|
| Rate for Payer: Sagamore Health Network All Products |
$36.25
|
| Rate for Payer: Signature Care EPO |
$38.97
|
| Rate for Payer: Signature Care PPO |
$41.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.91
|
| Rate for Payer: United Healthcare Commercial |
$37.00
|
| Rate for Payer: United Healthcare Medicare |
$15.02
|
|
|
HC PLATELET FUNCTION AS
|
Facility
|
IP
|
$147.88
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
63001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.91 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: Aetna Commercial |
$127.77
|
| Rate for Payer: Cash Price |
$88.73
|
| Rate for Payer: Cigna All Commercial |
$127.62
|
| Rate for Payer: CORVEL All Commercial |
$137.53
|
| Rate for Payer: Coventry All Commercial |
$130.13
|
| Rate for Payer: Encore All Commercial |
$136.12
|
| Rate for Payer: Frontpath All Commercial |
$136.05
|
| Rate for Payer: Humana ChoiceCare |
$127.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.09
|
| Rate for Payer: PHCS All Commercial |
$110.91
|
| Rate for Payer: PHP All Commercial |
$112.15
|
| Rate for Payer: Sagamore Health Network All Products |
$114.16
|
| Rate for Payer: Signature Care EPO |
$122.74
|
| Rate for Payer: Signature Care PPO |
$130.13
|
| Rate for Payer: United Healthcare Commercial |
$116.53
|
|
|
HC PLATELET FUNCTION AS
|
Facility
|
OP
|
$147.88
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
63001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: Aetna Commercial |
$124.81
|
| Rate for Payer: Aetna Medicare |
$47.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.05
|
| Rate for Payer: Cash Price |
$88.73
|
| Rate for Payer: Cash Price |
$88.73
|
| Rate for Payer: Centivo All Commercial |
$80.45
|
| Rate for Payer: Cigna All Commercial |
$127.62
|
| Rate for Payer: CORVEL All Commercial |
$137.53
|
| Rate for Payer: Coventry All Commercial |
$130.13
|
| Rate for Payer: Encore All Commercial |
$136.12
|
| Rate for Payer: Frontpath All Commercial |
$136.05
|
| Rate for Payer: Humana ChoiceCare |
$127.72
|
| Rate for Payer: Humana Medicare |
$47.32
|
| Rate for Payer: Lucent All Commercial |
$80.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.09
|
| Rate for Payer: Managed Health Services Medicaid |
$24.91
|
| Rate for Payer: MDWise Medicaid |
$24.91
|
| Rate for Payer: PHCS All Commercial |
$110.91
|
| Rate for Payer: PHP All Commercial |
$112.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.67
|
| Rate for Payer: Sagamore Health Network All Products |
$114.16
|
| Rate for Payer: Signature Care EPO |
$122.74
|
| Rate for Payer: Signature Care PPO |
$130.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.70
|
| Rate for Payer: United Healthcare Commercial |
$116.53
|
| Rate for Payer: United Healthcare Medicare |
$47.32
|
|
|
HC PLATELETPHERESIS LR
|
Facility
|
OP
|
$2,969.18
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
1371004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$71.47 |
| Max. Negotiated Rate |
$2,761.34 |
| Rate for Payer: Aetna Commercial |
$2,505.99
|
| Rate for Payer: Aetna Medicare |
$950.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$71.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$920.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,092.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,045.15
|
| Rate for Payer: Cash Price |
$1,781.51
|
| Rate for Payer: Cash Price |
$1,781.51
|
| Rate for Payer: Centivo All Commercial |
$1,615.23
|
| Rate for Payer: Cigna All Commercial |
$2,562.40
|
| Rate for Payer: CORVEL All Commercial |
$2,761.34
|
| Rate for Payer: Coventry All Commercial |
$2,612.88
|
| Rate for Payer: Encore All Commercial |
$2,733.13
|
| Rate for Payer: Frontpath All Commercial |
$2,731.65
|
| Rate for Payer: Humana ChoiceCare |
$2,564.48
|
| Rate for Payer: Humana Medicare |
$950.14
|
| Rate for Payer: Lucent All Commercial |
$1,615.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,672.26
|
| Rate for Payer: Managed Health Services Medicaid |
$71.47
|
| Rate for Payer: MDWise Medicaid |
$71.47
|
| Rate for Payer: PHCS All Commercial |
$2,226.89
|
| Rate for Payer: PHP All Commercial |
$2,251.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,157.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.21
|
| Rate for Payer: Signature Care EPO |
$2,464.42
|
| Rate for Payer: Signature Care PPO |
$2,612.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,523.80
|
| Rate for Payer: United Healthcare Commercial |
$2,339.71
|
| Rate for Payer: United Healthcare Medicare |
$950.14
|
|
