|
HC OPIATES,QUANTITATIVE-URINE
|
Facility
OP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001421
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$77.12 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.93
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Centivo All Commercial |
$19.56
|
| Rate for Payer: Cigna All Commercial |
$33.11
|
| Rate for Payer: CORVEL All Commercial |
$35.68
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$19.56
|
| Rate for Payer: Lucent All Commercial |
$19.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.53
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.62
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.66
|
|
|
HC OP IMMUNIZATION ADMIN EA ADD
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
01298047
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Centivo All Commercial |
$46.82
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent All Commercial |
$46.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$30.29
|
|
|
HC OP IMMUNIZATION ADMIN EA ADD
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
01298047
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC OP IMMUNIZATION ADMINISTRATION
|
Facility
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
01299047
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.53
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Centivo All Commercial |
$48.51
|
| Rate for Payer: Cigna All Commercial |
$82.08
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.70
|
| Rate for Payer: Encore All Commercial |
$87.55
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.15
|
| Rate for Payer: Humana Medicare |
$48.51
|
| Rate for Payer: Lucent All Commercial |
$48.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.60
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.09
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$31.39
|
|
|
HC OP IMMUNIZATION ADMINISTRATION
|
Facility
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
01299047
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna All Commercial |
$82.08
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.70
|
| Rate for Payer: Encore All Commercial |
$87.55
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.60
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC O&P MICRO EXAM
|
Facility
OP
|
$69.36
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
63001291
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.18
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Centivo All Commercial |
$35.37
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Humana Medicare |
$35.37
|
| Rate for Payer: Lucent All Commercial |
$35.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.90
|
| Rate for Payer: MDWise Medicaid |
$8.90
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.05
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.96
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
| Rate for Payer: United Healthcare Medicare |
$22.89
|
|
|
HC O&P MICRO EXAM
|
Facility
IP
|
$69.36
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
63001291
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
|
|
HC OPTECURE PLUS CCC 1CC
|
Facility
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna Commercial |
$1,244.16
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cigna All Commercial |
$1,242.72
|
| Rate for Payer: CORVEL All Commercial |
$1,339.20
|
| Rate for Payer: Coventry All Commercial |
$1,267.20
|
| Rate for Payer: Encore All Commercial |
$1,325.52
|
| Rate for Payer: Frontpath All Commercial |
$1,324.80
|
| Rate for Payer: Humana ChoiceCare |
$1,243.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,296.00
|
| Rate for Payer: PHCS All Commercial |
$1,080.00
|
| Rate for Payer: PHP All Commercial |
$1,092.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,111.68
|
| Rate for Payer: Signature Care EPO |
$1,195.20
|
| Rate for Payer: Signature Care PPO |
$1,267.20
|
| Rate for Payer: United Healthcare Commercial |
$1,134.72
|
|
|
HC OPTECURE PLUS CCC 1CC
|
Facility
OP
|
$1,440.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna Commercial |
$1,215.36
|
| Rate for Payer: Aetna Medicare |
$475.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$475.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$826.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$900.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$546.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$522.72
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Centivo All Commercial |
$734.40
|
| Rate for Payer: Cigna All Commercial |
$1,242.72
|
| Rate for Payer: CORVEL All Commercial |
$1,339.20
|
| Rate for Payer: Coventry All Commercial |
$1,267.20
|
| Rate for Payer: Encore All Commercial |
$1,325.52
|
| Rate for Payer: Frontpath All Commercial |
$1,324.80
|
| Rate for Payer: Humana ChoiceCare |
$1,243.73
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Lucent All Commercial |
$734.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,296.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,080.00
|
| Rate for Payer: PHP All Commercial |
$1,092.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$561.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,111.68
|
| Rate for Payer: Signature Care EPO |
$1,195.20
|
| Rate for Payer: Signature Care PPO |
$1,267.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare Commercial |
$1,134.72
|
| Rate for Payer: United Healthcare Medicare |
$475.20
|
|
|
HC OPTECURE PLUS CCC 5CC
|
Facility
OP
|
$2,610.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,427.30 |
| Rate for Payer: Aetna Commercial |
$2,202.84
|
| Rate for Payer: Aetna Medicare |
$861.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$861.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,498.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,631.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$990.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$947.43
|
| Rate for Payer: Cash Price |
$1,618.20
|
| Rate for Payer: Cash Price |
$1,618.20
|
| Rate for Payer: Centivo All Commercial |
$1,331.10
|
| Rate for Payer: Cigna All Commercial |
$2,252.43
|
| Rate for Payer: CORVEL All Commercial |
$2,427.30
|
| Rate for Payer: Coventry All Commercial |
$2,296.80
|
| Rate for Payer: Encore All Commercial |
$2,402.50
|
| Rate for Payer: Frontpath All Commercial |
$2,401.20
|
| Rate for Payer: Humana ChoiceCare |
$2,254.26
|
| Rate for Payer: Humana Medicare |
$1,331.10
|
| Rate for Payer: Lucent All Commercial |
$1,331.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,349.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,957.50
|
| Rate for Payer: PHP All Commercial |
$1,979.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,017.90
|
| Rate for Payer: Sagamore Health Network All Products |
$2,014.92
|
| Rate for Payer: Signature Care EPO |
$2,166.30
|
| Rate for Payer: Signature Care PPO |
$2,296.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare Commercial |
$2,056.68
|
| Rate for Payer: United Healthcare Medicare |
$861.30
|
|
|
HC OPTECURE PLUS CCC 5CC
|
Facility
IP
|
$2,610.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,957.50 |
| Max. Negotiated Rate |
$2,427.30 |
| Rate for Payer: Aetna Commercial |
$2,255.04
|
| Rate for Payer: Cash Price |
$1,618.20
|
| Rate for Payer: Cigna All Commercial |
$2,252.43
|
| Rate for Payer: CORVEL All Commercial |
$2,427.30
|
| Rate for Payer: Coventry All Commercial |
$2,296.80
|
| Rate for Payer: Encore All Commercial |
$2,402.50
|
| Rate for Payer: Frontpath All Commercial |
$2,401.20
|
| Rate for Payer: Humana ChoiceCare |
$2,254.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,349.00
|
| Rate for Payer: PHCS All Commercial |
$1,957.50
|
| Rate for Payer: PHP All Commercial |
$1,979.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,014.92
|
| Rate for Payer: Signature Care EPO |
$2,166.30
|
| Rate for Payer: Signature Care PPO |
$2,296.80
|
| Rate for Payer: United Healthcare Commercial |
$2,056.68
|
|
|
HC ORGANIC ACID, PLASMA
|
Facility
IP
|
$351.09
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
63001645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$326.52 |
| Rate for Payer: Aetna Commercial |
$303.35
|
| Rate for Payer: Cash Price |
$217.68
|
| Rate for Payer: Cigna All Commercial |
$302.99
|
| Rate for Payer: CORVEL All Commercial |
$326.52
|
| Rate for Payer: Coventry All Commercial |
$308.96
|
| Rate for Payer: Encore All Commercial |
$323.18
|
| Rate for Payer: Frontpath All Commercial |
$323.01
|
| Rate for Payer: Humana ChoiceCare |
$303.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.98
|
| Rate for Payer: PHCS All Commercial |
$263.32
|
| Rate for Payer: PHP All Commercial |
$266.27
|
| Rate for Payer: Sagamore Health Network All Products |
$271.04
|
| Rate for Payer: Signature Care EPO |
$291.41
|
| Rate for Payer: Signature Care PPO |
$308.96
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
|
|
HC ORGANIC ACID, PLASMA
|
Facility
OP
|
$351.09
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
63001645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$326.52 |
| Rate for Payer: Aetna Commercial |
$296.32
|
| Rate for Payer: Aetna Medicare |
$115.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$219.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.45
|
| Rate for Payer: Cash Price |
$217.68
|
| Rate for Payer: Cash Price |
$217.68
|
| Rate for Payer: Centivo All Commercial |
$179.06
|
| Rate for Payer: Cigna All Commercial |
$302.99
|
| Rate for Payer: CORVEL All Commercial |
$326.52
|
| Rate for Payer: Coventry All Commercial |
$308.96
|
| Rate for Payer: Encore All Commercial |
$323.18
|
| Rate for Payer: Frontpath All Commercial |
$323.01
|
| Rate for Payer: Humana ChoiceCare |
$303.24
|
| Rate for Payer: Humana Medicare |
$179.06
|
| Rate for Payer: Lucent All Commercial |
$179.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.98
|
| Rate for Payer: Managed Health Services Medicaid |
$22.39
|
| Rate for Payer: MDWise Medicaid |
$22.39
|
| Rate for Payer: PHCS All Commercial |
$263.32
|
| Rate for Payer: PHP All Commercial |
$266.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.93
|
| Rate for Payer: Sagamore Health Network All Products |
$271.04
|
| Rate for Payer: Signature Care EPO |
$291.41
|
| Rate for Payer: Signature Care PPO |
$308.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$298.43
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$115.86
|
|
|
HC ORGANIC ACID UR RAND
|
Facility
OP
|
$231.47
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
63001644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$215.27 |
| Rate for Payer: Aetna Commercial |
$195.36
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.02
|
| Rate for Payer: Cash Price |
$143.51
|
| Rate for Payer: Cash Price |
$143.51
|
| Rate for Payer: Centivo All Commercial |
$118.05
|
| Rate for Payer: Cigna All Commercial |
$199.76
|
| Rate for Payer: CORVEL All Commercial |
$215.27
|
| Rate for Payer: Coventry All Commercial |
$203.69
|
| Rate for Payer: Encore All Commercial |
$213.07
|
| Rate for Payer: Frontpath All Commercial |
$212.95
|
| Rate for Payer: Humana ChoiceCare |
$199.92
|
| Rate for Payer: Humana Medicare |
$118.05
|
| Rate for Payer: Lucent All Commercial |
$118.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.32
|
| Rate for Payer: Managed Health Services Medicaid |
$22.39
|
| Rate for Payer: MDWise Medicaid |
$22.39
|
| Rate for Payer: PHCS All Commercial |
$173.60
|
| Rate for Payer: PHP All Commercial |
$175.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.27
|
| Rate for Payer: Sagamore Health Network All Products |
$178.69
|
| Rate for Payer: Signature Care EPO |
$192.12
|
| Rate for Payer: Signature Care PPO |
$203.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196.75
|
| Rate for Payer: United Healthcare Commercial |
$182.40
|
| Rate for Payer: United Healthcare Medicare |
$76.38
|
|
|
HC ORGANIC ACID UR RAND
|
Facility
IP
|
$231.47
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
63001644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$215.27 |
| Rate for Payer: Aetna Commercial |
$199.99
|
| Rate for Payer: Cash Price |
$143.51
|
| Rate for Payer: Cigna All Commercial |
$199.76
|
| Rate for Payer: CORVEL All Commercial |
$215.27
|
| Rate for Payer: Coventry All Commercial |
$203.69
|
| Rate for Payer: Encore All Commercial |
$213.07
|
| Rate for Payer: Frontpath All Commercial |
$212.95
|
| Rate for Payer: Humana ChoiceCare |
$199.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.32
|
| Rate for Payer: PHCS All Commercial |
$173.60
|
| Rate for Payer: PHP All Commercial |
$175.55
|
| Rate for Payer: Sagamore Health Network All Products |
$178.69
|
| Rate for Payer: Signature Care EPO |
$192.12
|
| Rate for Payer: Signature Care PPO |
$203.69
|
| Rate for Payer: United Healthcare Commercial |
$182.40
|
|
|
HC ORGANISM AEROBIC ID - REFERRED
|
Facility
OP
|
$50.18
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63002229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial |
$42.36
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.22
|
| Rate for Payer: Cash Price |
$31.11
|
| Rate for Payer: Cash Price |
$31.11
|
| Rate for Payer: Centivo All Commercial |
$25.59
|
| Rate for Payer: Cigna All Commercial |
$43.31
|
| Rate for Payer: CORVEL All Commercial |
$46.67
|
| Rate for Payer: Coventry All Commercial |
$44.16
|
| Rate for Payer: Encore All Commercial |
$46.19
|
| Rate for Payer: Frontpath All Commercial |
$46.17
|
| Rate for Payer: Humana ChoiceCare |
$43.34
|
| Rate for Payer: Humana Medicare |
$25.59
|
| Rate for Payer: Lucent All Commercial |
$25.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.17
|
| Rate for Payer: Managed Health Services Medicaid |
$8.08
|
| Rate for Payer: MDWise Medicaid |
$8.08
|
| Rate for Payer: PHCS All Commercial |
$37.64
|
| Rate for Payer: PHP All Commercial |
$38.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.57
|
| Rate for Payer: Sagamore Health Network All Products |
$38.74
|
| Rate for Payer: Signature Care EPO |
$41.65
|
| Rate for Payer: Signature Care PPO |
$44.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.66
|
| Rate for Payer: United Healthcare Commercial |
$39.54
|
| Rate for Payer: United Healthcare Medicare |
$16.56
|
|
|
HC ORGANISM AEROBIC ID - REFERRED
|
Facility
IP
|
$50.18
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63002229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.64 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial |
$43.36
|
| Rate for Payer: Cash Price |
$31.11
|
| Rate for Payer: Cigna All Commercial |
$43.31
|
| Rate for Payer: CORVEL All Commercial |
$46.67
|
| Rate for Payer: Coventry All Commercial |
$44.16
|
| Rate for Payer: Encore All Commercial |
$46.19
|
| Rate for Payer: Frontpath All Commercial |
$46.17
|
| Rate for Payer: Humana ChoiceCare |
$43.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.17
|
| Rate for Payer: PHCS All Commercial |
$37.64
|
| Rate for Payer: PHP All Commercial |
$38.06
|
| Rate for Payer: Sagamore Health Network All Products |
$38.74
|
| Rate for Payer: Signature Care EPO |
$41.65
|
| Rate for Payer: Signature Care PPO |
$44.16
|
| Rate for Payer: United Healthcare Commercial |
$39.54
|
|
|
HC ORGANISM FOR MIC - REFERRED
|
Facility
OP
|
$58.91
|
|
| Hospital Charge Code |
63002230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$54.78 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Aetna Medicare |
$19.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.38
|
| Rate for Payer: Cash Price |
$36.52
|
| Rate for Payer: Centivo All Commercial |
$30.04
|
| Rate for Payer: Cigna All Commercial |
$50.84
|
| Rate for Payer: CORVEL All Commercial |
$54.78
|
| Rate for Payer: Coventry All Commercial |
$51.84
|
| Rate for Payer: Encore All Commercial |
$54.22
|
| Rate for Payer: Frontpath All Commercial |
$54.19
|
| Rate for Payer: Humana ChoiceCare |
$50.88
|
| Rate for Payer: Humana Medicare |
$30.04
|
| Rate for Payer: Lucent All Commercial |
$30.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.01
|
| Rate for Payer: PHCS All Commercial |
$44.18
|
| Rate for Payer: PHP All Commercial |
$44.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.97
|
| Rate for Payer: Sagamore Health Network All Products |
$45.47
|
| Rate for Payer: Signature Care EPO |
$48.89
|
| Rate for Payer: Signature Care PPO |
$51.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.07
|
| Rate for Payer: United Healthcare Commercial |
$46.42
|
| Rate for Payer: United Healthcare Medicare |
$19.44
|
|
|
HC ORGANISM FOR MIC - REFERRED
|
Facility
IP
|
$58.91
|
|
| Hospital Charge Code |
63002230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$54.78 |
| Rate for Payer: Aetna Commercial |
$50.89
|
| Rate for Payer: Cash Price |
$36.52
|
| Rate for Payer: Cigna All Commercial |
$50.84
|
| Rate for Payer: CORVEL All Commercial |
$54.78
|
| Rate for Payer: Coventry All Commercial |
$51.84
|
| Rate for Payer: Encore All Commercial |
$54.22
|
| Rate for Payer: Frontpath All Commercial |
$54.19
|
| Rate for Payer: Humana ChoiceCare |
$50.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.01
|
| Rate for Payer: PHCS All Commercial |
$44.18
|
| Rate for Payer: PHP All Commercial |
$44.67
|
| Rate for Payer: Sagamore Health Network All Products |
$45.47
|
| Rate for Payer: Signature Care EPO |
$48.89
|
| Rate for Payer: Signature Care PPO |
$51.84
|
| Rate for Payer: United Healthcare Commercial |
$46.42
|
|
|
HC OR GENERAL LEV 2 EA ADD MIN
|
Facility
IP
|
$84.93
|
|
| Hospital Charge Code |
01206653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$78.98 |
| Rate for Payer: Aetna Commercial |
$73.38
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna All Commercial |
$73.29
|
| Rate for Payer: CORVEL All Commercial |
$78.98
|
| Rate for Payer: Coventry All Commercial |
$74.73
|
| Rate for Payer: Encore All Commercial |
$78.17
|
| Rate for Payer: Frontpath All Commercial |
$78.13
|
| Rate for Payer: Humana ChoiceCare |
$73.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.43
|
| Rate for Payer: PHCS All Commercial |
$63.69
|
| Rate for Payer: PHP All Commercial |
$64.41
|
| Rate for Payer: Sagamore Health Network All Products |
$65.56
|
| Rate for Payer: Signature Care EPO |
$70.49
|
| Rate for Payer: Signature Care PPO |
$74.73
|
| Rate for Payer: United Healthcare Commercial |
$66.92
|
|
|
HC OR GENERAL LEV 2 EA ADD MIN
|
Facility
OP
|
$84.93
|
|
| Hospital Charge Code |
01206653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$78.98 |
| Rate for Payer: Aetna Commercial |
$71.68
|
| Rate for Payer: Aetna Medicare |
$28.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.83
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Centivo All Commercial |
$43.31
|
| Rate for Payer: Cigna All Commercial |
$73.29
|
| Rate for Payer: CORVEL All Commercial |
$78.98
|
| Rate for Payer: Coventry All Commercial |
$74.73
|
| Rate for Payer: Encore All Commercial |
$78.17
|
| Rate for Payer: Frontpath All Commercial |
$78.13
|
| Rate for Payer: Humana ChoiceCare |
$73.35
|
| Rate for Payer: Humana Medicare |
$43.31
|
| Rate for Payer: Lucent All Commercial |
$43.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.43
|
| Rate for Payer: PHCS All Commercial |
$63.69
|
| Rate for Payer: PHP All Commercial |
$64.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.12
|
| Rate for Payer: Sagamore Health Network All Products |
$65.56
|
| Rate for Payer: Signature Care EPO |
$70.49
|
| Rate for Payer: Signature Care PPO |
$74.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.19
|
| Rate for Payer: United Healthcare Commercial |
$66.92
|
| Rate for Payer: United Healthcare Medicare |
$28.03
|
|
|
HC OR GENERAL LEV 3 EA ADD MIN
|
Facility
OP
|
$99.17
|
|
| Hospital Charge Code |
01206655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$92.23 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.00
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Centivo All Commercial |
$50.58
|
| Rate for Payer: Cigna All Commercial |
$85.59
|
| Rate for Payer: CORVEL All Commercial |
$92.23
|
| Rate for Payer: Coventry All Commercial |
$87.27
|
| Rate for Payer: Encore All Commercial |
$91.29
|
| Rate for Payer: Frontpath All Commercial |
$91.24
|
| Rate for Payer: Humana ChoiceCare |
$85.66
|
| Rate for Payer: Humana Medicare |
$50.58
|
| Rate for Payer: Lucent All Commercial |
$50.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.26
|
| Rate for Payer: PHCS All Commercial |
$74.38
|
| Rate for Payer: PHP All Commercial |
$75.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.68
|
| Rate for Payer: Sagamore Health Network All Products |
$76.56
|
| Rate for Payer: Signature Care EPO |
$82.31
|
| Rate for Payer: Signature Care PPO |
$87.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.30
|
| Rate for Payer: United Healthcare Commercial |
$78.15
|
| Rate for Payer: United Healthcare Medicare |
$32.73
|
|
|
HC OR GENERAL LEV 3 EA ADD MIN
|
Facility
IP
|
$99.17
|
|
| Hospital Charge Code |
01206655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$92.23 |
| Rate for Payer: Aetna Commercial |
$85.69
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cigna All Commercial |
$85.59
|
| Rate for Payer: CORVEL All Commercial |
$92.23
|
| Rate for Payer: Coventry All Commercial |
$87.27
|
| Rate for Payer: Encore All Commercial |
$91.29
|
| Rate for Payer: Frontpath All Commercial |
$91.24
|
| Rate for Payer: Humana ChoiceCare |
$85.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.26
|
| Rate for Payer: PHCS All Commercial |
$74.38
|
| Rate for Payer: PHP All Commercial |
$75.21
|
| Rate for Payer: Sagamore Health Network All Products |
$76.56
|
| Rate for Payer: Signature Care EPO |
$82.31
|
| Rate for Payer: Signature Care PPO |
$87.27
|
| Rate for Payer: United Healthcare Commercial |
$78.15
|
|
|
HC OR GENERAL LEVEL 1 INIT'L 15 MIN
|
Facility
IP
|
$1,977.39
|
|
| Hospital Charge Code |
01206650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.04 |
| Max. Negotiated Rate |
$1,838.97 |
| Rate for Payer: Aetna Commercial |
$1,708.47
|
| Rate for Payer: Cash Price |
$1,225.98
|
| Rate for Payer: Cigna All Commercial |
$1,706.49
|
| Rate for Payer: CORVEL All Commercial |
$1,838.97
|
| Rate for Payer: Coventry All Commercial |
$1,740.11
|
| Rate for Payer: Encore All Commercial |
$1,820.19
|
| Rate for Payer: Frontpath All Commercial |
$1,819.20
|
| Rate for Payer: Humana ChoiceCare |
$1,707.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,779.65
|
| Rate for Payer: PHCS All Commercial |
$1,483.04
|
| Rate for Payer: PHP All Commercial |
$1,499.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,526.55
|
| Rate for Payer: Signature Care EPO |
$1,641.24
|
| Rate for Payer: Signature Care PPO |
$1,740.11
|
| Rate for Payer: United Healthcare Commercial |
$1,558.19
|
|
|
HC OR GENERAL LEVEL 1 INIT'L 15 MIN
|
Facility
OP
|
$1,977.39
|
|
| Hospital Charge Code |
01206650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.54 |
| Max. Negotiated Rate |
$1,838.97 |
| Rate for Payer: Aetna Commercial |
$1,668.92
|
| Rate for Payer: Aetna Medicare |
$652.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$652.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,135.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,236.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.79
|
| Rate for Payer: Cash Price |
$1,225.98
|
| Rate for Payer: Centivo All Commercial |
$1,008.47
|
| Rate for Payer: Cigna All Commercial |
$1,706.49
|
| Rate for Payer: CORVEL All Commercial |
$1,838.97
|
| Rate for Payer: Coventry All Commercial |
$1,740.11
|
| Rate for Payer: Encore All Commercial |
$1,820.19
|
| Rate for Payer: Frontpath All Commercial |
$1,819.20
|
| Rate for Payer: Humana ChoiceCare |
$1,707.87
|
| Rate for Payer: Humana Medicare |
$1,008.47
|
| Rate for Payer: Lucent All Commercial |
$1,008.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,779.65
|
| Rate for Payer: PHCS All Commercial |
$1,483.04
|
| Rate for Payer: PHP All Commercial |
$1,499.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$771.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,526.55
|
| Rate for Payer: Signature Care EPO |
$1,641.24
|
| Rate for Payer: Signature Care PPO |
$1,740.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,680.78
|
| Rate for Payer: United Healthcare Commercial |
$1,558.19
|
| Rate for Payer: United Healthcare Medicare |
$652.54
|
|
