|
HC NORTRIPTYLINE
|
Facility
OP
|
$155.23
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.23 |
| Max. Negotiated Rate |
$144.37 |
| Rate for Payer: Aetna Commercial |
$131.02
|
| Rate for Payer: Aetna Medicare |
$51.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.35
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: Centivo All Commercial |
$79.17
|
| Rate for Payer: Cigna All Commercial |
$133.97
|
| Rate for Payer: CORVEL All Commercial |
$144.37
|
| Rate for Payer: Coventry All Commercial |
$136.61
|
| Rate for Payer: Encore All Commercial |
$142.89
|
| Rate for Payer: Frontpath All Commercial |
$142.82
|
| Rate for Payer: Humana ChoiceCare |
$134.08
|
| Rate for Payer: Humana Medicare |
$79.17
|
| Rate for Payer: Lucent All Commercial |
$79.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.71
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$116.43
|
| Rate for Payer: PHP All Commercial |
$117.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.54
|
| Rate for Payer: Sagamore Health Network All Products |
$119.84
|
| Rate for Payer: Signature Care EPO |
$128.84
|
| Rate for Payer: Signature Care PPO |
$136.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.95
|
| Rate for Payer: United Healthcare Commercial |
$122.32
|
| Rate for Payer: United Healthcare Medicare |
$51.23
|
|
|
HC NOSE CULTURE
|
Facility
OP
|
$139.98
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Aetna Commercial |
$118.15
|
| Rate for Payer: Aetna Medicare |
$46.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.81
|
| Rate for Payer: Cash Price |
$86.79
|
| Rate for Payer: Cash Price |
$86.79
|
| Rate for Payer: Centivo All Commercial |
$71.39
|
| Rate for Payer: Cigna All Commercial |
$120.81
|
| Rate for Payer: CORVEL All Commercial |
$130.19
|
| Rate for Payer: Coventry All Commercial |
$123.19
|
| Rate for Payer: Encore All Commercial |
$128.86
|
| Rate for Payer: Frontpath All Commercial |
$128.79
|
| Rate for Payer: Humana ChoiceCare |
$120.90
|
| Rate for Payer: Humana Medicare |
$71.39
|
| Rate for Payer: Lucent All Commercial |
$71.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.99
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$104.99
|
| Rate for Payer: PHP All Commercial |
$106.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.59
|
| Rate for Payer: Sagamore Health Network All Products |
$108.07
|
| Rate for Payer: Signature Care EPO |
$116.19
|
| Rate for Payer: Signature Care PPO |
$123.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.99
|
| Rate for Payer: United Healthcare Commercial |
$110.31
|
| Rate for Payer: United Healthcare Medicare |
$46.19
|
|
|
HC NOSE CULTURE
|
Facility
IP
|
$139.98
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.99 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Aetna Commercial |
$120.95
|
| Rate for Payer: Cash Price |
$86.79
|
| Rate for Payer: Cigna All Commercial |
$120.81
|
| Rate for Payer: CORVEL All Commercial |
$130.19
|
| Rate for Payer: Coventry All Commercial |
$123.19
|
| Rate for Payer: Encore All Commercial |
$128.86
|
| Rate for Payer: Frontpath All Commercial |
$128.79
|
| Rate for Payer: Humana ChoiceCare |
$120.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.99
|
| Rate for Payer: PHCS All Commercial |
$104.99
|
| Rate for Payer: PHP All Commercial |
$106.16
|
| Rate for Payer: Sagamore Health Network All Products |
$108.07
|
| Rate for Payer: Signature Care EPO |
$116.19
|
| Rate for Payer: Signature Care PPO |
$123.19
|
| Rate for Payer: United Healthcare Commercial |
$110.31
|
|
|
HC NOVASURE ADVANCE
|
Facility
OP
|
$4,560.00
|
|
| Hospital Charge Code |
41603422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,240.80 |
| Rate for Payer: Aetna Commercial |
$3,848.64
|
| Rate for Payer: Aetna Medicare |
$1,504.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,504.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,618.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,850.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,730.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,655.28
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Centivo All Commercial |
$2,325.60
|
| Rate for Payer: Cigna All Commercial |
$3,935.28
|
| Rate for Payer: CORVEL All Commercial |
$4,240.80
|
| Rate for Payer: Coventry All Commercial |
$4,012.80
|
| Rate for Payer: Encore All Commercial |
$4,197.48
|
| Rate for Payer: Frontpath All Commercial |
$4,195.20
|
| Rate for Payer: Humana ChoiceCare |
$3,938.47
|
| Rate for Payer: Humana Medicare |
$2,325.60
|
| Rate for Payer: Lucent All Commercial |
$2,325.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,104.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,420.00
|
| Rate for Payer: PHP All Commercial |
$3,458.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,778.40
|
| Rate for Payer: Sagamore Health Network All Products |
$3,520.32
|
| Rate for Payer: Signature Care EPO |
$3,784.80
|
| Rate for Payer: Signature Care PPO |
$4,012.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare Commercial |
$3,593.28
|
| Rate for Payer: United Healthcare Medicare |
$1,504.80
|
|
|
HC NOVASURE ADVANCE
|
Facility
IP
|
$4,560.00
|
|
| Hospital Charge Code |
41603422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,420.00 |
| Max. Negotiated Rate |
$4,240.80 |
| Rate for Payer: Aetna Commercial |
$3,939.84
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cigna All Commercial |
$3,935.28
|
| Rate for Payer: CORVEL All Commercial |
$4,240.80
|
| Rate for Payer: Coventry All Commercial |
$4,012.80
|
| Rate for Payer: Encore All Commercial |
$4,197.48
|
| Rate for Payer: Frontpath All Commercial |
$4,195.20
|
| Rate for Payer: Humana ChoiceCare |
$3,938.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,104.00
|
| Rate for Payer: PHCS All Commercial |
$3,420.00
|
| Rate for Payer: PHP All Commercial |
$3,458.30
|
| Rate for Payer: Sagamore Health Network All Products |
$3,520.32
|
| Rate for Payer: Signature Care EPO |
$3,784.80
|
| Rate for Payer: Signature Care PPO |
$4,012.80
|
| Rate for Payer: United Healthcare Commercial |
$3,593.28
|
|
|
HC N-TELOPEPTIDE UR
|
Facility
IP
|
$182.58
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.94 |
| Max. Negotiated Rate |
$169.80 |
| Rate for Payer: Aetna Commercial |
$157.75
|
| Rate for Payer: Cash Price |
$113.20
|
| Rate for Payer: Cigna All Commercial |
$157.57
|
| Rate for Payer: CORVEL All Commercial |
$169.80
|
| Rate for Payer: Coventry All Commercial |
$160.67
|
| Rate for Payer: Encore All Commercial |
$168.06
|
| Rate for Payer: Frontpath All Commercial |
$167.97
|
| Rate for Payer: Humana ChoiceCare |
$157.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.32
|
| Rate for Payer: PHCS All Commercial |
$136.94
|
| Rate for Payer: PHP All Commercial |
$138.47
|
| Rate for Payer: Sagamore Health Network All Products |
$140.95
|
| Rate for Payer: Signature Care EPO |
$151.54
|
| Rate for Payer: Signature Care PPO |
$160.67
|
| Rate for Payer: United Healthcare Commercial |
$143.87
|
|
|
HC N-TELOPEPTIDE UR
|
Facility
OP
|
$182.58
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$169.80 |
| Rate for Payer: Aetna Commercial |
$154.10
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$104.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.28
|
| Rate for Payer: Cash Price |
$113.20
|
| Rate for Payer: Cash Price |
$113.20
|
| Rate for Payer: Centivo All Commercial |
$93.12
|
| Rate for Payer: Cigna All Commercial |
$157.57
|
| Rate for Payer: CORVEL All Commercial |
$169.80
|
| Rate for Payer: Coventry All Commercial |
$160.67
|
| Rate for Payer: Encore All Commercial |
$168.06
|
| Rate for Payer: Frontpath All Commercial |
$167.97
|
| Rate for Payer: Humana ChoiceCare |
$157.69
|
| Rate for Payer: Humana Medicare |
$93.12
|
| Rate for Payer: Lucent All Commercial |
$93.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.32
|
| Rate for Payer: Managed Health Services Medicaid |
$18.68
|
| Rate for Payer: MDWise Medicaid |
$18.68
|
| Rate for Payer: PHCS All Commercial |
$136.94
|
| Rate for Payer: PHP All Commercial |
$138.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.21
|
| Rate for Payer: Sagamore Health Network All Products |
$140.95
|
| Rate for Payer: Signature Care EPO |
$151.54
|
| Rate for Payer: Signature Care PPO |
$160.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155.19
|
| Rate for Payer: United Healthcare Commercial |
$143.87
|
| Rate for Payer: United Healthcare Medicare |
$60.25
|
|
|
HC NUTRITION THERAPY GROUP/30 MIN
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
72001004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$47.43 |
| Rate for Payer: Aetna Commercial |
$43.04
|
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.51
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Centivo All Commercial |
$26.01
|
| Rate for Payer: Cigna All Commercial |
$44.01
|
| Rate for Payer: CORVEL All Commercial |
$47.43
|
| Rate for Payer: Coventry All Commercial |
$44.88
|
| Rate for Payer: Encore All Commercial |
$46.95
|
| Rate for Payer: Frontpath All Commercial |
$46.92
|
| Rate for Payer: Humana ChoiceCare |
$44.05
|
| Rate for Payer: Humana Medicare |
$26.01
|
| Rate for Payer: Lucent All Commercial |
$26.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.90
|
| Rate for Payer: PHCS All Commercial |
$38.25
|
| Rate for Payer: PHP All Commercial |
$38.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.89
|
| Rate for Payer: Sagamore Health Network All Products |
$39.37
|
| Rate for Payer: Signature Care EPO |
$42.33
|
| Rate for Payer: Signature Care PPO |
$44.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.35
|
| Rate for Payer: United Healthcare Commercial |
$40.19
|
| Rate for Payer: United Healthcare Medicare |
$16.83
|
|
|
HC NUTRITION THERAPY GROUP/30 MIN
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
72001004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$47.43 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cigna All Commercial |
$44.01
|
| Rate for Payer: CORVEL All Commercial |
$47.43
|
| Rate for Payer: Coventry All Commercial |
$44.88
|
| Rate for Payer: Encore All Commercial |
$46.95
|
| Rate for Payer: Frontpath All Commercial |
$46.92
|
| Rate for Payer: Humana ChoiceCare |
$44.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.90
|
| Rate for Payer: PHCS All Commercial |
$38.25
|
| Rate for Payer: PHP All Commercial |
$38.68
|
| Rate for Payer: Sagamore Health Network All Products |
$39.37
|
| Rate for Payer: Signature Care EPO |
$42.33
|
| Rate for Payer: Signature Care PPO |
$44.88
|
| Rate for Payer: United Healthcare Commercial |
$40.19
|
|
|
HC NUTRITION THERAPY INITL/15 MIN
|
Facility
IP
|
$40.80
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
72001002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
|
|
HC NUTRITION THERAPY INITL/15 MIN
|
Facility
OP
|
$40.80
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
72001002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.81
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Centivo All Commercial |
$20.81
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Lucent All Commercial |
$20.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.91
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.68
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
| Rate for Payer: United Healthcare Medicare |
$13.46
|
|
|
HC NUTRITION THERAPY SUBSQ/15 MIN
|
Facility
OP
|
$40.80
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
72001003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.81
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Centivo All Commercial |
$20.81
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Lucent All Commercial |
$20.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.91
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.68
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
| Rate for Payer: United Healthcare Medicare |
$13.46
|
|
|
HC NUTRITION THERAPY SUBSQ/15 MIN
|
Facility
IP
|
$40.80
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
72001003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
|
|
HC OBSERVATION EA ADDTNL HR DA
|
Facility
IP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01688101
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC OBSERVATION EA ADDTNL HR DA
|
Facility
OP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01688101
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.99
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC OBSERVATION INITIAL HOUR DA
|
Facility
IP
|
$1,154.97
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
01688100
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$866.22 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$997.89
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: PHCS All Commercial |
$866.22
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Sagamore Health Network All Products |
$891.63
|
| Rate for Payer: Signature Care EPO |
$958.62
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: United Healthcare Commercial |
$910.11
|
|
|
HC OBSERVATION INITIAL HOUR DA
|
Facility
OP
|
$1,154.97
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
01688100
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$381.14 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$974.79
|
| Rate for Payer: Aetna Medicare |
$381.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$381.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$663.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$438.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$419.25
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Centivo All Commercial |
$589.03
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.54
|
| Rate for Payer: Humana Medicare |
$589.03
|
| Rate for Payer: Lucent All Commercial |
$589.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$866.22
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$891.63
|
| Rate for Payer: Signature Care EPO |
$958.62
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$981.72
|
| Rate for Payer: United Healthcare Commercial |
$910.11
|
| Rate for Payer: United Healthcare Medicare |
$381.14
|
|
|
HC OBSERVATION MED SURG
|
Facility
IP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$866.22 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$997.89
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: PHCS All Commercial |
$866.22
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Sagamore Health Network All Products |
$891.63
|
| Rate for Payer: Signature Care EPO |
$958.62
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: United Healthcare Commercial |
$910.11
|
|
|
HC OBSERVATION MED SURG
|
Facility
OP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$381.14 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$974.79
|
| Rate for Payer: Aetna Medicare |
$381.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$381.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$663.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$438.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$419.25
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Centivo All Commercial |
$589.03
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.54
|
| Rate for Payer: Humana Medicare |
$589.03
|
| Rate for Payer: Lucent All Commercial |
$589.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$866.22
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$891.63
|
| Rate for Payer: Signature Care EPO |
$958.62
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$981.72
|
| Rate for Payer: United Healthcare Commercial |
$910.11
|
| Rate for Payer: United Healthcare Medicare |
$381.14
|
|
|
HC OBSERVATION M/S <24 HR
|
Facility
OP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.99
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC OBSERVATION M/S <24 HR
|
Facility
IP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC OBSERVATION M/S >24 HR
|
Facility
IP
|
$68.50
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$63.71 |
| Rate for Payer: Aetna Commercial |
$59.19
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.71
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.06
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.86
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
|
|
HC OBSERVATION M/S >24 HR
|
Facility
OP
|
$68.50
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$57.82
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.87
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Centivo All Commercial |
$34.94
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.71
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.06
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.17
|
| Rate for Payer: Humana Medicare |
$34.94
|
| Rate for Payer: Lucent All Commercial |
$34.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.72
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.86
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.23
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare |
$22.61
|
|
|
HC OBSERVATION NUR < 24 HR
|
Facility
OP
|
$10.75
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Aetna Medicare |
$3.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.90
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Centivo All Commercial |
$5.48
|
| Rate for Payer: Cigna All Commercial |
$9.28
|
| Rate for Payer: CORVEL All Commercial |
$10.00
|
| Rate for Payer: Coventry All Commercial |
$9.46
|
| Rate for Payer: Encore All Commercial |
$9.90
|
| Rate for Payer: Frontpath All Commercial |
$9.89
|
| Rate for Payer: Humana ChoiceCare |
$9.29
|
| Rate for Payer: Humana Medicare |
$5.48
|
| Rate for Payer: Lucent All Commercial |
$5.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.68
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$8.06
|
| Rate for Payer: PHP All Commercial |
$8.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8.30
|
| Rate for Payer: Signature Care EPO |
$8.92
|
| Rate for Payer: Signature Care PPO |
$9.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.14
|
| Rate for Payer: United Healthcare Commercial |
$8.47
|
| Rate for Payer: United Healthcare Medicare |
$3.55
|
|
|
HC OBSERVATION NUR < 24 HR
|
Facility
IP
|
$10.75
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.29
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna All Commercial |
$9.28
|
| Rate for Payer: CORVEL All Commercial |
$10.00
|
| Rate for Payer: Coventry All Commercial |
$9.46
|
| Rate for Payer: Encore All Commercial |
$9.90
|
| Rate for Payer: Frontpath All Commercial |
$9.89
|
| Rate for Payer: Humana ChoiceCare |
$9.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.68
|
| Rate for Payer: PHCS All Commercial |
$8.06
|
| Rate for Payer: PHP All Commercial |
$8.15
|
| Rate for Payer: Sagamore Health Network All Products |
$8.30
|
| Rate for Payer: Signature Care EPO |
$8.92
|
| Rate for Payer: Signature Care PPO |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$8.47
|
|
