|
HC RELOAD PROX CUTTER 75 BLUE
|
Facility
|
IP
|
$509.96
|
|
| Hospital Charge Code |
41607891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.47 |
| Max. Negotiated Rate |
$474.26 |
| Rate for Payer: Aetna Commercial |
$440.61
|
| Rate for Payer: Cash Price |
$305.98
|
| Rate for Payer: Cigna All Commercial |
$440.10
|
| Rate for Payer: CORVEL All Commercial |
$474.26
|
| Rate for Payer: Coventry All Commercial |
$448.76
|
| Rate for Payer: Encore All Commercial |
$469.42
|
| Rate for Payer: Frontpath All Commercial |
$469.16
|
| Rate for Payer: Humana ChoiceCare |
$440.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$458.96
|
| Rate for Payer: PHCS All Commercial |
$382.47
|
| Rate for Payer: PHP All Commercial |
$386.75
|
| Rate for Payer: Sagamore Health Network All Products |
$393.69
|
| Rate for Payer: Signature Care EPO |
$423.27
|
| Rate for Payer: Signature Care PPO |
$448.76
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
|
|
HC RELOAD PROX CUTTER 75 BLUE
|
Facility
|
OP
|
$509.96
|
|
| Hospital Charge Code |
41607891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$474.26 |
| Rate for Payer: Aetna Commercial |
$430.41
|
| Rate for Payer: Aetna Medicare |
$163.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$292.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$318.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$187.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$179.51
|
| Rate for Payer: Cash Price |
$305.98
|
| Rate for Payer: Cash Price |
$305.98
|
| Rate for Payer: Centivo All Commercial |
$277.42
|
| Rate for Payer: Cigna All Commercial |
$440.10
|
| Rate for Payer: CORVEL All Commercial |
$474.26
|
| Rate for Payer: Coventry All Commercial |
$448.76
|
| Rate for Payer: Encore All Commercial |
$469.42
|
| Rate for Payer: Frontpath All Commercial |
$469.16
|
| Rate for Payer: Humana ChoiceCare |
$440.45
|
| Rate for Payer: Humana Medicare |
$163.19
|
| Rate for Payer: Lucent All Commercial |
$277.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$458.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$382.47
|
| Rate for Payer: PHP All Commercial |
$386.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.88
|
| Rate for Payer: Sagamore Health Network All Products |
$393.69
|
| Rate for Payer: Signature Care EPO |
$423.27
|
| Rate for Payer: Signature Care PPO |
$448.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$433.47
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
| Rate for Payer: United Healthcare Medicare |
$163.19
|
|
|
HC REMOVER STAPLE SKIN
|
Facility
|
IP
|
$4.90
|
|
| Hospital Charge Code |
41607721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna All Commercial |
$4.23
|
| Rate for Payer: CORVEL All Commercial |
$4.56
|
| Rate for Payer: Coventry All Commercial |
$4.31
|
| Rate for Payer: Encore All Commercial |
$4.51
|
| Rate for Payer: Frontpath All Commercial |
$4.51
|
| Rate for Payer: Humana ChoiceCare |
$4.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.41
|
| Rate for Payer: PHCS All Commercial |
$3.67
|
| Rate for Payer: PHP All Commercial |
$3.72
|
| Rate for Payer: Sagamore Health Network All Products |
$3.78
|
| Rate for Payer: Signature Care EPO |
$4.07
|
| Rate for Payer: Signature Care PPO |
$4.31
|
| Rate for Payer: United Healthcare Commercial |
$3.86
|
|
|
HC REMOVER STAPLE SKIN
|
Facility
|
OP
|
$4.90
|
|
| Hospital Charge Code |
41607721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$4.14
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.72
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Centivo All Commercial |
$2.67
|
| Rate for Payer: Cigna All Commercial |
$4.23
|
| Rate for Payer: CORVEL All Commercial |
$4.56
|
| Rate for Payer: Coventry All Commercial |
$4.31
|
| Rate for Payer: Encore All Commercial |
$4.51
|
| Rate for Payer: Frontpath All Commercial |
$4.51
|
| Rate for Payer: Humana ChoiceCare |
$4.23
|
| Rate for Payer: Humana Medicare |
$1.57
|
| Rate for Payer: Lucent All Commercial |
$2.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3.67
|
| Rate for Payer: PHP All Commercial |
$3.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.91
|
| Rate for Payer: Sagamore Health Network All Products |
$3.78
|
| Rate for Payer: Signature Care EPO |
$4.07
|
| Rate for Payer: Signature Care PPO |
$4.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.17
|
| Rate for Payer: United Healthcare Commercial |
$3.86
|
| Rate for Payer: United Healthcare Medicare |
$1.57
|
|
|
HC RENAL BIOPSY PRQ TROCAR/NEEDLE
|
Facility
|
OP
|
$3,319.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
1619200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,028.89 |
| Max. Negotiated Rate |
$3,086.67 |
| Rate for Payer: Aetna Commercial |
$2,801.24
|
| Rate for Payer: Aetna Medicare |
$1,062.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,106.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,028.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,906.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,074.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,106.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,221.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,168.29
|
| Rate for Payer: Cash Price |
$1,991.40
|
| Rate for Payer: Cash Price |
$1,991.40
|
| Rate for Payer: Centivo All Commercial |
$1,805.54
|
| Rate for Payer: Cigna All Commercial |
$2,864.30
|
| Rate for Payer: CORVEL All Commercial |
$3,086.67
|
| Rate for Payer: Coventry All Commercial |
$2,920.72
|
| Rate for Payer: Encore All Commercial |
$3,055.14
|
| Rate for Payer: Frontpath All Commercial |
$3,053.48
|
| Rate for Payer: Humana ChoiceCare |
$2,866.62
|
| Rate for Payer: Humana Medicare |
$1,062.08
|
| Rate for Payer: Lucent All Commercial |
$1,805.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,987.10
|
| Rate for Payer: Managed Health Services Medicaid |
$1,106.60
|
| Rate for Payer: MDWise Medicaid |
$1,106.60
|
| Rate for Payer: PHCS All Commercial |
$2,489.25
|
| Rate for Payer: PHP All Commercial |
$2,517.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,294.41
|
| Rate for Payer: Sagamore Health Network All Products |
$2,562.27
|
| Rate for Payer: Signature Care EPO |
$2,754.77
|
| Rate for Payer: Signature Care PPO |
$2,920.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,821.15
|
| Rate for Payer: United Healthcare Commercial |
$2,615.37
|
| Rate for Payer: United Healthcare Medicare |
$1,062.08
|
|
|
HC RENAL BIOPSY PRQ TROCAR/NEEDLE
|
Facility
|
IP
|
$3,319.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
1619200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,489.25 |
| Max. Negotiated Rate |
$3,086.67 |
| Rate for Payer: Aetna Commercial |
$2,867.62
|
| Rate for Payer: Cash Price |
$1,991.40
|
| Rate for Payer: Cigna All Commercial |
$2,864.30
|
| Rate for Payer: CORVEL All Commercial |
$3,086.67
|
| Rate for Payer: Coventry All Commercial |
$2,920.72
|
| Rate for Payer: Encore All Commercial |
$3,055.14
|
| Rate for Payer: Frontpath All Commercial |
$3,053.48
|
| Rate for Payer: Humana ChoiceCare |
$2,866.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,987.10
|
| Rate for Payer: PHCS All Commercial |
$2,489.25
|
| Rate for Payer: PHP All Commercial |
$2,517.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2,562.27
|
| Rate for Payer: Signature Care EPO |
$2,754.77
|
| Rate for Payer: Signature Care PPO |
$2,920.72
|
| Rate for Payer: United Healthcare Commercial |
$2,615.37
|
|
|
HC RENAL FLOW WITH INTERVENTION
|
Facility
|
OP
|
$2,358.77
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
1638463
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$2,193.66 |
| Rate for Payer: Aetna Commercial |
$1,990.80
|
| Rate for Payer: Aetna Medicare |
$754.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$80.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$731.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,354.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,474.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$80.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$868.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$830.29
|
| Rate for Payer: Cash Price |
$1,415.26
|
| Rate for Payer: Cash Price |
$1,415.26
|
| Rate for Payer: Centivo All Commercial |
$1,283.17
|
| Rate for Payer: Cigna All Commercial |
$2,035.62
|
| Rate for Payer: CORVEL All Commercial |
$2,193.66
|
| Rate for Payer: Coventry All Commercial |
$2,075.72
|
| Rate for Payer: Encore All Commercial |
$2,171.25
|
| Rate for Payer: Frontpath All Commercial |
$2,170.07
|
| Rate for Payer: Humana ChoiceCare |
$2,037.27
|
| Rate for Payer: Humana Medicare |
$754.81
|
| Rate for Payer: Lucent All Commercial |
$1,283.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,122.89
|
| Rate for Payer: Managed Health Services Medicaid |
$80.51
|
| Rate for Payer: MDWise Medicaid |
$80.51
|
| Rate for Payer: PHCS All Commercial |
$1,769.08
|
| Rate for Payer: PHP All Commercial |
$1,788.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$919.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,820.97
|
| Rate for Payer: Signature Care EPO |
$1,957.78
|
| Rate for Payer: Signature Care PPO |
$2,075.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,004.95
|
| Rate for Payer: United Healthcare Commercial |
$1,858.71
|
| Rate for Payer: United Healthcare Medicare |
$754.81
|
|
|
HC RENAL FLOW WITH INTERVENTION
|
Facility
|
IP
|
$2,358.77
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
1638463
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,769.08 |
| Max. Negotiated Rate |
$2,193.66 |
| Rate for Payer: Aetna Commercial |
$2,037.98
|
| Rate for Payer: Cash Price |
$1,415.26
|
| Rate for Payer: Cigna All Commercial |
$2,035.62
|
| Rate for Payer: CORVEL All Commercial |
$2,193.66
|
| Rate for Payer: Coventry All Commercial |
$2,075.72
|
| Rate for Payer: Encore All Commercial |
$2,171.25
|
| Rate for Payer: Frontpath All Commercial |
$2,170.07
|
| Rate for Payer: Humana ChoiceCare |
$2,037.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,122.89
|
| Rate for Payer: PHCS All Commercial |
$1,769.08
|
| Rate for Payer: PHP All Commercial |
$1,788.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,820.97
|
| Rate for Payer: Signature Care EPO |
$1,957.78
|
| Rate for Payer: Signature Care PPO |
$2,075.72
|
| Rate for Payer: United Healthcare Commercial |
$1,858.71
|
|
|
HC RENAL PANEL
|
Facility
|
IP
|
$115.57
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
63001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.68 |
| Max. Negotiated Rate |
$107.48 |
| Rate for Payer: Aetna Commercial |
$99.85
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cigna All Commercial |
$99.74
|
| Rate for Payer: CORVEL All Commercial |
$107.48
|
| Rate for Payer: Coventry All Commercial |
$101.70
|
| Rate for Payer: Encore All Commercial |
$106.38
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.01
|
| Rate for Payer: PHCS All Commercial |
$86.68
|
| Rate for Payer: PHP All Commercial |
$87.65
|
| Rate for Payer: Sagamore Health Network All Products |
$89.22
|
| Rate for Payer: Signature Care EPO |
$95.92
|
| Rate for Payer: Signature Care PPO |
$101.70
|
| Rate for Payer: United Healthcare Commercial |
$91.07
|
|
|
HC RENAL PANEL
|
Facility
|
OP
|
$115.57
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
63001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$107.48 |
| Rate for Payer: Aetna Commercial |
$97.54
|
| Rate for Payer: Aetna Medicare |
$36.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$53.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.68
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Centivo All Commercial |
$62.87
|
| Rate for Payer: Cigna All Commercial |
$99.74
|
| Rate for Payer: CORVEL All Commercial |
$107.48
|
| Rate for Payer: Coventry All Commercial |
$101.70
|
| Rate for Payer: Encore All Commercial |
$106.38
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.82
|
| Rate for Payer: Humana Medicare |
$36.98
|
| Rate for Payer: Lucent All Commercial |
$62.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.68
|
| Rate for Payer: MDWise Medicaid |
$8.68
|
| Rate for Payer: PHCS All Commercial |
$86.68
|
| Rate for Payer: PHP All Commercial |
$87.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.07
|
| Rate for Payer: Sagamore Health Network All Products |
$89.22
|
| Rate for Payer: Signature Care EPO |
$95.92
|
| Rate for Payer: Signature Care PPO |
$101.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.23
|
| Rate for Payer: United Healthcare Commercial |
$91.07
|
| Rate for Payer: United Healthcare Medicare |
$36.98
|
|
|
HC RENAL SCAN
|
Facility
|
IP
|
$1,975.95
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
1638345
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,481.96 |
| Max. Negotiated Rate |
$1,837.63 |
| Rate for Payer: Aetna Commercial |
$1,707.22
|
| Rate for Payer: Cash Price |
$1,185.57
|
| Rate for Payer: Cigna All Commercial |
$1,705.24
|
| Rate for Payer: CORVEL All Commercial |
$1,837.63
|
| Rate for Payer: Coventry All Commercial |
$1,738.84
|
| Rate for Payer: Encore All Commercial |
$1,818.86
|
| Rate for Payer: Frontpath All Commercial |
$1,817.87
|
| Rate for Payer: Humana ChoiceCare |
$1,706.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,778.36
|
| Rate for Payer: PHCS All Commercial |
$1,481.96
|
| Rate for Payer: PHP All Commercial |
$1,498.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,525.43
|
| Rate for Payer: Signature Care EPO |
$1,640.04
|
| Rate for Payer: Signature Care PPO |
$1,738.84
|
| Rate for Payer: United Healthcare Commercial |
$1,557.05
|
|
|
HC RENAL SCAN
|
Facility
|
OP
|
$1,975.95
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
1638345
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.55 |
| Max. Negotiated Rate |
$1,837.63 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Medicare |
$632.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$130.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,134.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,235.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$130.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$727.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$695.53
|
| Rate for Payer: Cash Price |
$1,185.57
|
| Rate for Payer: Cash Price |
$1,185.57
|
| Rate for Payer: Centivo All Commercial |
$1,074.92
|
| Rate for Payer: Cigna All Commercial |
$1,705.24
|
| Rate for Payer: CORVEL All Commercial |
$1,837.63
|
| Rate for Payer: Coventry All Commercial |
$1,738.84
|
| Rate for Payer: Encore All Commercial |
$1,818.86
|
| Rate for Payer: Frontpath All Commercial |
$1,817.87
|
| Rate for Payer: Humana ChoiceCare |
$1,706.63
|
| Rate for Payer: Humana Medicare |
$632.30
|
| Rate for Payer: Lucent All Commercial |
$1,074.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,778.36
|
| Rate for Payer: Managed Health Services Medicaid |
$130.55
|
| Rate for Payer: MDWise Medicaid |
$130.55
|
| Rate for Payer: PHCS All Commercial |
$1,481.96
|
| Rate for Payer: PHP All Commercial |
$1,498.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$770.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,525.43
|
| Rate for Payer: Signature Care EPO |
$1,640.04
|
| Rate for Payer: Signature Care PPO |
$1,738.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,679.56
|
| Rate for Payer: United Healthcare Commercial |
$1,557.05
|
| Rate for Payer: United Healthcare Medicare |
$632.30
|
|
|
HC RENIN
|
Facility
|
IP
|
$398.31
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
63001673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$370.43 |
| Rate for Payer: Aetna Commercial |
$344.14
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cigna All Commercial |
$343.74
|
| Rate for Payer: CORVEL All Commercial |
$370.43
|
| Rate for Payer: Coventry All Commercial |
$350.51
|
| Rate for Payer: Encore All Commercial |
$366.64
|
| Rate for Payer: Frontpath All Commercial |
$366.45
|
| Rate for Payer: Humana ChoiceCare |
$344.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.48
|
| Rate for Payer: PHCS All Commercial |
$298.73
|
| Rate for Payer: PHP All Commercial |
$302.08
|
| Rate for Payer: Sagamore Health Network All Products |
$307.50
|
| Rate for Payer: Signature Care EPO |
$330.60
|
| Rate for Payer: Signature Care PPO |
$350.51
|
| Rate for Payer: United Healthcare Commercial |
$313.87
|
|
|
HC RENIN
|
Facility
|
OP
|
$398.31
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
63001673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$370.43 |
| Rate for Payer: Aetna Commercial |
$336.17
|
| Rate for Payer: Aetna Medicare |
$127.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$183.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.21
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Centivo All Commercial |
$216.68
|
| Rate for Payer: Cigna All Commercial |
$343.74
|
| Rate for Payer: CORVEL All Commercial |
$370.43
|
| Rate for Payer: Coventry All Commercial |
$350.51
|
| Rate for Payer: Encore All Commercial |
$366.64
|
| Rate for Payer: Frontpath All Commercial |
$366.45
|
| Rate for Payer: Humana ChoiceCare |
$344.02
|
| Rate for Payer: Humana Medicare |
$127.46
|
| Rate for Payer: Lucent All Commercial |
$216.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.48
|
| Rate for Payer: Managed Health Services Medicaid |
$21.99
|
| Rate for Payer: MDWise Medicaid |
$21.99
|
| Rate for Payer: PHCS All Commercial |
$298.73
|
| Rate for Payer: PHP All Commercial |
$302.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.34
|
| Rate for Payer: Sagamore Health Network All Products |
$307.50
|
| Rate for Payer: Signature Care EPO |
$330.60
|
| Rate for Payer: Signature Care PPO |
$350.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.56
|
| Rate for Payer: United Healthcare Commercial |
$313.87
|
| Rate for Payer: United Healthcare Medicare |
$127.46
|
|
|
HC RESOLUTION CLIP
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
41601201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$472.64
|
| Rate for Payer: Aetna Medicare |
$179.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$321.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$350.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$206.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$197.12
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Centivo All Commercial |
$304.64
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Humana Medicare |
$179.20
|
| Rate for Payer: Lucent All Commercial |
$304.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.40
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$476.00
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
| Rate for Payer: United Healthcare Medicare |
$179.20
|
|
|
HC RESOLUTION CLIP
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
41601201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$483.84
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
|
|
HC RESOLUTION ULTRA 17MM
|
Facility
|
IP
|
$1,127.85
|
|
| Hospital Charge Code |
41608201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.89 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Aetna Commercial |
$974.46
|
| Rate for Payer: Cash Price |
$676.71
|
| Rate for Payer: Cigna All Commercial |
$973.33
|
| Rate for Payer: CORVEL All Commercial |
$1,048.90
|
| Rate for Payer: Coventry All Commercial |
$992.51
|
| Rate for Payer: Encore All Commercial |
$1,038.19
|
| Rate for Payer: Frontpath All Commercial |
$1,037.62
|
| Rate for Payer: Humana ChoiceCare |
$974.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,015.07
|
| Rate for Payer: PHCS All Commercial |
$845.89
|
| Rate for Payer: PHP All Commercial |
$855.36
|
| Rate for Payer: Sagamore Health Network All Products |
$870.70
|
| Rate for Payer: Signature Care EPO |
$936.12
|
| Rate for Payer: Signature Care PPO |
$992.51
|
| Rate for Payer: United Healthcare Commercial |
$888.75
|
|
|
HC RESOLUTION ULTRA 17MM
|
Facility
|
OP
|
$1,127.85
|
|
| Hospital Charge Code |
41608201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Aetna Commercial |
$951.91
|
| Rate for Payer: Aetna Medicare |
$360.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$349.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$647.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$705.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$415.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$397.00
|
| Rate for Payer: Cash Price |
$676.71
|
| Rate for Payer: Cash Price |
$676.71
|
| Rate for Payer: Centivo All Commercial |
$613.55
|
| Rate for Payer: Cigna All Commercial |
$973.33
|
| Rate for Payer: CORVEL All Commercial |
$1,048.90
|
| Rate for Payer: Coventry All Commercial |
$992.51
|
| Rate for Payer: Encore All Commercial |
$1,038.19
|
| Rate for Payer: Frontpath All Commercial |
$1,037.62
|
| Rate for Payer: Humana ChoiceCare |
$974.12
|
| Rate for Payer: Humana Medicare |
$360.91
|
| Rate for Payer: Lucent All Commercial |
$613.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,015.07
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$845.89
|
| Rate for Payer: PHP All Commercial |
$855.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$439.86
|
| Rate for Payer: Sagamore Health Network All Products |
$870.70
|
| Rate for Payer: Signature Care EPO |
$936.12
|
| Rate for Payer: Signature Care PPO |
$992.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$958.67
|
| Rate for Payer: United Healthcare Commercial |
$888.75
|
| Rate for Payer: United Healthcare Medicare |
$360.91
|
|
|
HC RESPIRATORY PATHOGENS PANEL - QUAL-PCR
|
Facility
|
OP
|
$1,082.73
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
63002049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$335.65 |
| Max. Negotiated Rate |
$1,006.94 |
| Rate for Payer: Aetna Commercial |
$913.82
|
| Rate for Payer: Aetna Medicare |
$346.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$416.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$335.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$497.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$497.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$416.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.12
|
| Rate for Payer: Cash Price |
$649.64
|
| Rate for Payer: Cash Price |
$649.64
|
| Rate for Payer: Centivo All Commercial |
$589.01
|
| Rate for Payer: Cigna All Commercial |
$934.40
|
| Rate for Payer: CORVEL All Commercial |
$1,006.94
|
| Rate for Payer: Coventry All Commercial |
$952.80
|
| Rate for Payer: Encore All Commercial |
$996.65
|
| Rate for Payer: Frontpath All Commercial |
$996.11
|
| Rate for Payer: Humana ChoiceCare |
$935.15
|
| Rate for Payer: Humana Medicare |
$346.47
|
| Rate for Payer: Lucent All Commercial |
$589.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$974.46
|
| Rate for Payer: Managed Health Services Medicaid |
$416.78
|
| Rate for Payer: MDWise Medicaid |
$416.78
|
| Rate for Payer: PHCS All Commercial |
$812.05
|
| Rate for Payer: PHP All Commercial |
$821.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$422.26
|
| Rate for Payer: Sagamore Health Network All Products |
$835.87
|
| Rate for Payer: Signature Care EPO |
$898.67
|
| Rate for Payer: Signature Care PPO |
$952.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$920.32
|
| Rate for Payer: United Healthcare Commercial |
$853.19
|
| Rate for Payer: United Healthcare Medicare |
$346.47
|
|
|
HC RESPIRATORY PATHOGENS PANEL - QUAL-PCR
|
Facility
|
IP
|
$1,082.73
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
63002049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$812.05 |
| Max. Negotiated Rate |
$1,006.94 |
| Rate for Payer: Aetna Commercial |
$935.48
|
| Rate for Payer: Cash Price |
$649.64
|
| Rate for Payer: Cigna All Commercial |
$934.40
|
| Rate for Payer: CORVEL All Commercial |
$1,006.94
|
| Rate for Payer: Coventry All Commercial |
$952.80
|
| Rate for Payer: Encore All Commercial |
$996.65
|
| Rate for Payer: Frontpath All Commercial |
$996.11
|
| Rate for Payer: Humana ChoiceCare |
$935.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$974.46
|
| Rate for Payer: PHCS All Commercial |
$812.05
|
| Rate for Payer: PHP All Commercial |
$821.14
|
| Rate for Payer: Sagamore Health Network All Products |
$835.87
|
| Rate for Payer: Signature Care EPO |
$898.67
|
| Rate for Payer: Signature Care PPO |
$952.80
|
| Rate for Payer: United Healthcare Commercial |
$853.19
|
|
|
HC RESUSCITATOR/AMBU BAG ADULT
|
Facility
|
IP
|
$199.56
|
|
| Hospital Charge Code |
41601213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.67 |
| Max. Negotiated Rate |
$185.59 |
| Rate for Payer: Aetna Commercial |
$172.42
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cigna All Commercial |
$172.22
|
| Rate for Payer: CORVEL All Commercial |
$185.59
|
| Rate for Payer: Coventry All Commercial |
$175.61
|
| Rate for Payer: Encore All Commercial |
$183.69
|
| Rate for Payer: Frontpath All Commercial |
$183.60
|
| Rate for Payer: Humana ChoiceCare |
$172.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.60
|
| Rate for Payer: PHCS All Commercial |
$149.67
|
| Rate for Payer: PHP All Commercial |
$151.35
|
| Rate for Payer: Sagamore Health Network All Products |
$154.06
|
| Rate for Payer: Signature Care EPO |
$165.63
|
| Rate for Payer: Signature Care PPO |
$175.61
|
| Rate for Payer: United Healthcare Commercial |
$157.25
|
|
|
HC RESUSCITATOR/AMBU BAG ADULT
|
Facility
|
OP
|
$199.56
|
|
| Hospital Charge Code |
41601213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$185.59 |
| Rate for Payer: Aetna Commercial |
$168.43
|
| Rate for Payer: Aetna Medicare |
$63.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$114.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.25
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Centivo All Commercial |
$108.56
|
| Rate for Payer: Cigna All Commercial |
$172.22
|
| Rate for Payer: CORVEL All Commercial |
$185.59
|
| Rate for Payer: Coventry All Commercial |
$175.61
|
| Rate for Payer: Encore All Commercial |
$183.69
|
| Rate for Payer: Frontpath All Commercial |
$183.60
|
| Rate for Payer: Humana ChoiceCare |
$172.36
|
| Rate for Payer: Humana Medicare |
$63.86
|
| Rate for Payer: Lucent All Commercial |
$108.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.60
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$149.67
|
| Rate for Payer: PHP All Commercial |
$151.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.83
|
| Rate for Payer: Sagamore Health Network All Products |
$154.06
|
| Rate for Payer: Signature Care EPO |
$165.63
|
| Rate for Payer: Signature Care PPO |
$175.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare |
$63.86
|
|
|
HC RETIC-AUTOMATED
|
Facility
|
IP
|
$108.73
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
63001044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cigna All Commercial |
$93.83
|
| Rate for Payer: CORVEL All Commercial |
$101.12
|
| Rate for Payer: Coventry All Commercial |
$95.68
|
| Rate for Payer: Encore All Commercial |
$100.09
|
| Rate for Payer: Frontpath All Commercial |
$100.03
|
| Rate for Payer: Humana ChoiceCare |
$93.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.86
|
| Rate for Payer: PHCS All Commercial |
$81.55
|
| Rate for Payer: PHP All Commercial |
$82.46
|
| Rate for Payer: Sagamore Health Network All Products |
$83.94
|
| Rate for Payer: Signature Care EPO |
$90.25
|
| Rate for Payer: Signature Care PPO |
$95.68
|
| Rate for Payer: United Healthcare Commercial |
$85.68
|
|
|
HC RETIC-AUTOMATED
|
Facility
|
OP
|
$108.73
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
63001044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$91.77
|
| Rate for Payer: Aetna Medicare |
$34.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.27
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Centivo All Commercial |
$59.15
|
| Rate for Payer: Cigna All Commercial |
$93.83
|
| Rate for Payer: CORVEL All Commercial |
$101.12
|
| Rate for Payer: Coventry All Commercial |
$95.68
|
| Rate for Payer: Encore All Commercial |
$100.09
|
| Rate for Payer: Frontpath All Commercial |
$100.03
|
| Rate for Payer: Humana ChoiceCare |
$93.91
|
| Rate for Payer: Humana Medicare |
$34.79
|
| Rate for Payer: Lucent All Commercial |
$59.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.86
|
| Rate for Payer: Managed Health Services Medicaid |
$3.99
|
| Rate for Payer: MDWise Medicaid |
$3.99
|
| Rate for Payer: PHCS All Commercial |
$81.55
|
| Rate for Payer: PHP All Commercial |
$82.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.40
|
| Rate for Payer: Sagamore Health Network All Products |
$83.94
|
| Rate for Payer: Signature Care EPO |
$90.25
|
| Rate for Payer: Signature Care PPO |
$95.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.42
|
| Rate for Payer: United Healthcare Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicare |
$34.79
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
IP
|
$103.20
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
63001045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$95.98 |
| Rate for Payer: Aetna Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$61.92
|
| Rate for Payer: Cigna All Commercial |
$89.06
|
| Rate for Payer: CORVEL All Commercial |
$95.98
|
| Rate for Payer: Coventry All Commercial |
$90.82
|
| Rate for Payer: Encore All Commercial |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$94.94
|
| Rate for Payer: Humana ChoiceCare |
$89.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.88
|
| Rate for Payer: PHCS All Commercial |
$77.40
|
| Rate for Payer: PHP All Commercial |
$78.27
|
| Rate for Payer: Sagamore Health Network All Products |
$79.67
|
| Rate for Payer: Signature Care EPO |
$85.66
|
| Rate for Payer: Signature Care PPO |
$90.82
|
| Rate for Payer: United Healthcare Commercial |
$81.32
|
|
