|
HC PARVOVIRUS B19 AB, IGM
|
Facility
OP
|
$165.06
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
63001965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$153.50 |
| Rate for Payer: Aetna Commercial |
$139.31
|
| Rate for Payer: Aetna Medicare |
$54.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.92
|
| Rate for Payer: Cash Price |
$102.34
|
| Rate for Payer: Cash Price |
$102.34
|
| Rate for Payer: Centivo All Commercial |
$84.18
|
| Rate for Payer: Cigna All Commercial |
$142.44
|
| Rate for Payer: CORVEL All Commercial |
$153.50
|
| Rate for Payer: Coventry All Commercial |
$145.25
|
| Rate for Payer: Encore All Commercial |
$151.93
|
| Rate for Payer: Frontpath All Commercial |
$151.85
|
| Rate for Payer: Humana ChoiceCare |
$142.56
|
| Rate for Payer: Humana Medicare |
$84.18
|
| Rate for Payer: Lucent All Commercial |
$84.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.55
|
| Rate for Payer: Managed Health Services Medicaid |
$15.03
|
| Rate for Payer: MDWise Medicaid |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$123.79
|
| Rate for Payer: PHP All Commercial |
$125.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.37
|
| Rate for Payer: Sagamore Health Network All Products |
$127.42
|
| Rate for Payer: Signature Care EPO |
$137.00
|
| Rate for Payer: Signature Care PPO |
$145.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.30
|
| Rate for Payer: United Healthcare Commercial |
$130.06
|
| Rate for Payer: United Healthcare Medicare |
$54.47
|
|
|
HC PARVOVIRUS B19 TOTAL AB
|
Facility
OP
|
$125.46
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
63001966
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna Commercial |
$105.89
|
| Rate for Payer: Aetna Medicare |
$41.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.54
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Centivo All Commercial |
$63.98
|
| Rate for Payer: Cigna All Commercial |
$108.27
|
| Rate for Payer: CORVEL All Commercial |
$116.68
|
| Rate for Payer: Coventry All Commercial |
$110.40
|
| Rate for Payer: Encore All Commercial |
$115.49
|
| Rate for Payer: Frontpath All Commercial |
$115.42
|
| Rate for Payer: Humana ChoiceCare |
$108.36
|
| Rate for Payer: Humana Medicare |
$63.98
|
| Rate for Payer: Lucent All Commercial |
$63.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.91
|
| Rate for Payer: Managed Health Services Medicaid |
$15.03
|
| Rate for Payer: MDWise Medicaid |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$94.10
|
| Rate for Payer: PHP All Commercial |
$95.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.93
|
| Rate for Payer: Sagamore Health Network All Products |
$96.86
|
| Rate for Payer: Signature Care EPO |
$104.13
|
| Rate for Payer: Signature Care PPO |
$110.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.64
|
| Rate for Payer: United Healthcare Commercial |
$98.86
|
| Rate for Payer: United Healthcare Medicare |
$41.40
|
|
|
HC PARVOVIRUS B19 TOTAL AB
|
Facility
IP
|
$125.46
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
63001966
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.10 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna Commercial |
$108.40
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cigna All Commercial |
$108.27
|
| Rate for Payer: CORVEL All Commercial |
$116.68
|
| Rate for Payer: Coventry All Commercial |
$110.40
|
| Rate for Payer: Encore All Commercial |
$115.49
|
| Rate for Payer: Frontpath All Commercial |
$115.42
|
| Rate for Payer: Humana ChoiceCare |
$108.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.91
|
| Rate for Payer: PHCS All Commercial |
$94.10
|
| Rate for Payer: PHP All Commercial |
$95.15
|
| Rate for Payer: Sagamore Health Network All Products |
$96.86
|
| Rate for Payer: Signature Care EPO |
$104.13
|
| Rate for Payer: Signature Care PPO |
$110.40
|
| Rate for Payer: United Healthcare Commercial |
$98.86
|
|
|
HC PASTE OSTOMY ADAPT
|
Facility
OP
|
$11.41
|
|
| Hospital Charge Code |
41601086
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$9.63
|
| Rate for Payer: Aetna Medicare |
$3.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.14
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Centivo All Commercial |
$5.82
|
| Rate for Payer: Cigna All Commercial |
$9.85
|
| Rate for Payer: CORVEL All Commercial |
$10.61
|
| Rate for Payer: Coventry All Commercial |
$10.04
|
| Rate for Payer: Encore All Commercial |
$10.50
|
| Rate for Payer: Frontpath All Commercial |
$10.50
|
| Rate for Payer: Humana ChoiceCare |
$9.85
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Lucent All Commercial |
$5.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.27
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$8.56
|
| Rate for Payer: PHP All Commercial |
$8.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.45
|
| Rate for Payer: Sagamore Health Network All Products |
$8.81
|
| Rate for Payer: Signature Care EPO |
$9.47
|
| Rate for Payer: Signature Care PPO |
$10.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.70
|
| Rate for Payer: United Healthcare Commercial |
$8.99
|
| Rate for Payer: United Healthcare Medicare |
$3.77
|
|
|
HC PASTE OSTOMY ADAPT
|
Facility
IP
|
$11.41
|
|
| Hospital Charge Code |
41601086
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cigna All Commercial |
$9.85
|
| Rate for Payer: CORVEL All Commercial |
$10.61
|
| Rate for Payer: Coventry All Commercial |
$10.04
|
| Rate for Payer: Encore All Commercial |
$10.50
|
| Rate for Payer: Frontpath All Commercial |
$10.50
|
| Rate for Payer: Humana ChoiceCare |
$9.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.27
|
| Rate for Payer: PHCS All Commercial |
$8.56
|
| Rate for Payer: PHP All Commercial |
$8.65
|
| Rate for Payer: Sagamore Health Network All Products |
$8.81
|
| Rate for Payer: Signature Care EPO |
$9.47
|
| Rate for Payer: Signature Care PPO |
$10.04
|
| Rate for Payer: United Healthcare Commercial |
$8.99
|
|
|
HC PATHOLOGY CONSULT-BLOOD
|
Facility
OP
|
$77.79
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
63001731
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$72.34 |
| Rate for Payer: Aetna Commercial |
$65.65
|
| Rate for Payer: Aetna Medicare |
$25.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$40.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.24
|
| Rate for Payer: Cash Price |
$48.23
|
| Rate for Payer: Cash Price |
$48.23
|
| Rate for Payer: Centivo All Commercial |
$39.67
|
| Rate for Payer: Cigna All Commercial |
$67.13
|
| Rate for Payer: CORVEL All Commercial |
$72.34
|
| Rate for Payer: Coventry All Commercial |
$68.45
|
| Rate for Payer: Encore All Commercial |
$71.60
|
| Rate for Payer: Frontpath All Commercial |
$71.56
|
| Rate for Payer: Humana ChoiceCare |
$67.18
|
| Rate for Payer: Humana Medicare |
$39.67
|
| Rate for Payer: Lucent All Commercial |
$39.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.01
|
| Rate for Payer: Managed Health Services Medicaid |
$40.87
|
| Rate for Payer: MDWise Medicaid |
$40.87
|
| Rate for Payer: PHCS All Commercial |
$58.34
|
| Rate for Payer: PHP All Commercial |
$58.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.34
|
| Rate for Payer: Sagamore Health Network All Products |
$60.05
|
| Rate for Payer: Signature Care EPO |
$64.56
|
| Rate for Payer: Signature Care PPO |
$68.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$61.29
|
| Rate for Payer: United Healthcare Medicare |
$25.67
|
|
|
HC PATHOLOGY CONSULT-BLOOD
|
Facility
IP
|
$77.79
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
63001731
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$72.34 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Cash Price |
$48.23
|
| Rate for Payer: Cigna All Commercial |
$67.13
|
| Rate for Payer: CORVEL All Commercial |
$72.34
|
| Rate for Payer: Coventry All Commercial |
$68.45
|
| Rate for Payer: Encore All Commercial |
$71.60
|
| Rate for Payer: Frontpath All Commercial |
$71.56
|
| Rate for Payer: Humana ChoiceCare |
$67.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.01
|
| Rate for Payer: PHCS All Commercial |
$58.34
|
| Rate for Payer: PHP All Commercial |
$58.99
|
| Rate for Payer: Sagamore Health Network All Products |
$60.05
|
| Rate for Payer: Signature Care EPO |
$64.56
|
| Rate for Payer: Signature Care PPO |
$68.45
|
| Rate for Payer: United Healthcare Commercial |
$61.29
|
|
|
HC P DRILL 2.5 CANN
|
Facility
OP
|
$1,571.50
|
|
| Hospital Charge Code |
41608018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,461.50 |
| Rate for Payer: Aetna Commercial |
$1,326.35
|
| Rate for Payer: Aetna Medicare |
$518.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$518.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$902.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$982.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$596.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$570.45
|
| Rate for Payer: Cash Price |
$974.33
|
| Rate for Payer: Cash Price |
$974.33
|
| Rate for Payer: Centivo All Commercial |
$801.46
|
| Rate for Payer: Cigna All Commercial |
$1,356.20
|
| Rate for Payer: CORVEL All Commercial |
$1,461.50
|
| Rate for Payer: Coventry All Commercial |
$1,382.92
|
| Rate for Payer: Encore All Commercial |
$1,446.57
|
| Rate for Payer: Frontpath All Commercial |
$1,445.78
|
| Rate for Payer: Humana ChoiceCare |
$1,357.30
|
| Rate for Payer: Humana Medicare |
$801.46
|
| Rate for Payer: Lucent All Commercial |
$801.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,414.35
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,178.62
|
| Rate for Payer: PHP All Commercial |
$1,191.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,213.20
|
| Rate for Payer: Signature Care EPO |
$1,304.34
|
| Rate for Payer: Signature Care PPO |
$1,382.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,335.78
|
| Rate for Payer: United Healthcare Commercial |
$1,238.34
|
| Rate for Payer: United Healthcare Medicare |
$518.60
|
|
|
HC P DRILL 2.5 CANN
|
Facility
IP
|
$1,571.50
|
|
| Hospital Charge Code |
41608018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,178.62 |
| Max. Negotiated Rate |
$1,461.50 |
| Rate for Payer: Aetna Commercial |
$1,357.78
|
| Rate for Payer: Cash Price |
$974.33
|
| Rate for Payer: Cigna All Commercial |
$1,356.20
|
| Rate for Payer: CORVEL All Commercial |
$1,461.50
|
| Rate for Payer: Coventry All Commercial |
$1,382.92
|
| Rate for Payer: Encore All Commercial |
$1,446.57
|
| Rate for Payer: Frontpath All Commercial |
$1,445.78
|
| Rate for Payer: Humana ChoiceCare |
$1,357.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,414.35
|
| Rate for Payer: PHCS All Commercial |
$1,178.62
|
| Rate for Payer: PHP All Commercial |
$1,191.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,213.20
|
| Rate for Payer: Signature Care EPO |
$1,304.34
|
| Rate for Payer: Signature Care PPO |
$1,382.92
|
| Rate for Payer: United Healthcare Commercial |
$1,238.34
|
|
|
HC P DRILL 4.0
|
Facility
IP
|
$700.00
|
|
| Hospital Charge Code |
41606978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cigna All Commercial |
$604.10
|
| Rate for Payer: CORVEL All Commercial |
$651.00
|
| Rate for Payer: Coventry All Commercial |
$616.00
|
| Rate for Payer: Encore All Commercial |
$644.35
|
| Rate for Payer: Frontpath All Commercial |
$644.00
|
| Rate for Payer: Humana ChoiceCare |
$604.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| Rate for Payer: Sagamore Health Network All Products |
$540.40
|
| Rate for Payer: Signature Care EPO |
$581.00
|
| Rate for Payer: Signature Care PPO |
$616.00
|
| Rate for Payer: United Healthcare Commercial |
$551.60
|
|
|
HC P DRILL 4.0
|
Facility
OP
|
$700.00
|
|
| Hospital Charge Code |
41606978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$590.80
|
| Rate for Payer: Aetna Medicare |
$231.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$402.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.10
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Centivo All Commercial |
$357.00
|
| Rate for Payer: Cigna All Commercial |
$604.10
|
| Rate for Payer: CORVEL All Commercial |
$651.00
|
| Rate for Payer: Coventry All Commercial |
$616.00
|
| Rate for Payer: Encore All Commercial |
$644.35
|
| Rate for Payer: Frontpath All Commercial |
$644.00
|
| Rate for Payer: Humana ChoiceCare |
$604.59
|
| Rate for Payer: Humana Medicare |
$357.00
|
| Rate for Payer: Lucent All Commercial |
$357.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.00
|
| Rate for Payer: Sagamore Health Network All Products |
$540.40
|
| Rate for Payer: Signature Care EPO |
$581.00
|
| Rate for Payer: Signature Care PPO |
$616.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$595.00
|
| Rate for Payer: United Healthcare Commercial |
$551.60
|
| Rate for Payer: United Healthcare Medicare |
$231.00
|
|
|
HC P DRILL BIT 1.7 CANN
|
Facility
OP
|
$2,475.00
|
|
| Hospital Charge Code |
41608184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,301.75 |
| Rate for Payer: Aetna Commercial |
$2,088.90
|
| Rate for Payer: Aetna Medicare |
$816.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$816.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,421.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,547.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$939.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$898.42
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Centivo All Commercial |
$1,262.25
|
| Rate for Payer: Cigna All Commercial |
$2,135.92
|
| Rate for Payer: CORVEL All Commercial |
$2,301.75
|
| Rate for Payer: Coventry All Commercial |
$2,178.00
|
| Rate for Payer: Encore All Commercial |
$2,278.24
|
| Rate for Payer: Frontpath All Commercial |
$2,277.00
|
| Rate for Payer: Humana ChoiceCare |
$2,137.66
|
| Rate for Payer: Humana Medicare |
$1,262.25
|
| Rate for Payer: Lucent All Commercial |
$1,262.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,227.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,856.25
|
| Rate for Payer: PHP All Commercial |
$1,877.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$965.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,910.70
|
| Rate for Payer: Signature Care EPO |
$2,054.25
|
| Rate for Payer: Signature Care PPO |
$2,178.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,103.75
|
| Rate for Payer: United Healthcare Commercial |
$1,950.30
|
| Rate for Payer: United Healthcare Medicare |
$816.75
|
|
|
HC P DRILL BIT 1.7 CANN
|
Facility
IP
|
$2,475.00
|
|
| Hospital Charge Code |
41608184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,856.25 |
| Max. Negotiated Rate |
$2,301.75 |
| Rate for Payer: Aetna Commercial |
$2,138.40
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Cigna All Commercial |
$2,135.92
|
| Rate for Payer: CORVEL All Commercial |
$2,301.75
|
| Rate for Payer: Coventry All Commercial |
$2,178.00
|
| Rate for Payer: Encore All Commercial |
$2,278.24
|
| Rate for Payer: Frontpath All Commercial |
$2,277.00
|
| Rate for Payer: Humana ChoiceCare |
$2,137.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,227.50
|
| Rate for Payer: PHCS All Commercial |
$1,856.25
|
| Rate for Payer: PHP All Commercial |
$1,877.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,910.70
|
| Rate for Payer: Signature Care EPO |
$2,054.25
|
| Rate for Payer: Signature Care PPO |
$2,178.00
|
| Rate for Payer: United Healthcare Commercial |
$1,950.30
|
|
|
HC PEP THERAPY
|
Facility
IP
|
$275.66
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
01704640
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$256.36 |
| Rate for Payer: Aetna Commercial |
$238.17
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cigna All Commercial |
$237.89
|
| Rate for Payer: CORVEL All Commercial |
$256.36
|
| Rate for Payer: Coventry All Commercial |
$242.58
|
| Rate for Payer: Encore All Commercial |
$253.74
|
| Rate for Payer: Frontpath All Commercial |
$253.60
|
| Rate for Payer: Humana ChoiceCare |
$238.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.09
|
| Rate for Payer: PHCS All Commercial |
$206.74
|
| Rate for Payer: PHP All Commercial |
$209.06
|
| Rate for Payer: Sagamore Health Network All Products |
$212.81
|
| Rate for Payer: Signature Care EPO |
$228.79
|
| Rate for Payer: Signature Care PPO |
$242.58
|
| Rate for Payer: United Healthcare Commercial |
$217.22
|
|
|
HC PEP THERAPY
|
Facility
OP
|
$275.66
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
01704640
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$256.36 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$90.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$158.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.06
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Centivo All Commercial |
$140.58
|
| Rate for Payer: Cigna All Commercial |
$237.89
|
| Rate for Payer: CORVEL All Commercial |
$256.36
|
| Rate for Payer: Coventry All Commercial |
$242.58
|
| Rate for Payer: Encore All Commercial |
$253.74
|
| Rate for Payer: Frontpath All Commercial |
$253.60
|
| Rate for Payer: Humana ChoiceCare |
$238.08
|
| Rate for Payer: Humana Medicare |
$140.58
|
| Rate for Payer: Lucent All Commercial |
$140.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.09
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$206.74
|
| Rate for Payer: PHP All Commercial |
$209.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.51
|
| Rate for Payer: Sagamore Health Network All Products |
$212.81
|
| Rate for Payer: Signature Care EPO |
$228.79
|
| Rate for Payer: Signature Care PPO |
$242.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$234.31
|
| Rate for Payer: United Healthcare Commercial |
$217.22
|
| Rate for Payer: United Healthcare Medicare |
$90.97
|
|
|
HC PERIVAC W 8.3FR PIGTAIL
|
Facility
OP
|
$617.50
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
41607159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$574.28 |
| Rate for Payer: Aetna Commercial |
$521.17
|
| Rate for Payer: Aetna Medicare |
$203.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$386.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$224.15
|
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Centivo All Commercial |
$314.92
|
| Rate for Payer: Cigna All Commercial |
$532.90
|
| Rate for Payer: CORVEL All Commercial |
$574.28
|
| Rate for Payer: Coventry All Commercial |
$543.40
|
| Rate for Payer: Encore All Commercial |
$568.41
|
| Rate for Payer: Frontpath All Commercial |
$568.10
|
| Rate for Payer: Humana ChoiceCare |
$533.33
|
| Rate for Payer: Humana Medicare |
$314.92
|
| Rate for Payer: Lucent All Commercial |
$314.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$463.12
|
| Rate for Payer: PHP All Commercial |
$468.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.82
|
| Rate for Payer: Sagamore Health Network All Products |
$476.71
|
| Rate for Payer: Signature Care EPO |
$512.52
|
| Rate for Payer: Signature Care PPO |
$543.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.88
|
| Rate for Payer: United Healthcare Commercial |
$486.59
|
| Rate for Payer: United Healthcare Medicare |
$203.78
|
|
|
HC PERIVAC W 8.3FR PIGTAIL
|
Facility
IP
|
$617.50
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
41607159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.12 |
| Max. Negotiated Rate |
$574.28 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Cigna All Commercial |
$532.90
|
| Rate for Payer: CORVEL All Commercial |
$574.28
|
| Rate for Payer: Coventry All Commercial |
$543.40
|
| Rate for Payer: Encore All Commercial |
$568.41
|
| Rate for Payer: Frontpath All Commercial |
$568.10
|
| Rate for Payer: Humana ChoiceCare |
$533.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.75
|
| Rate for Payer: PHCS All Commercial |
$463.12
|
| Rate for Payer: PHP All Commercial |
$468.31
|
| Rate for Payer: Sagamore Health Network All Products |
$476.71
|
| Rate for Payer: Signature Care EPO |
$512.52
|
| Rate for Payer: Signature Care PPO |
$543.40
|
| Rate for Payer: United Healthcare Commercial |
$486.59
|
|
|
HC PERQ DEV PLCMNT BREAST 1ST LES MR GUIDE
|
Facility
OP
|
$1,251.85
|
|
| Hospital Charge Code |
01579287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.11 |
| Max. Negotiated Rate |
$1,164.22 |
| Rate for Payer: Aetna Commercial |
$1,056.56
|
| Rate for Payer: Aetna Medicare |
$413.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$413.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$718.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$782.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$475.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$454.42
|
| Rate for Payer: Cash Price |
$776.15
|
| Rate for Payer: Centivo All Commercial |
$638.44
|
| Rate for Payer: Cigna All Commercial |
$1,080.34
|
| Rate for Payer: CORVEL All Commercial |
$1,164.22
|
| Rate for Payer: Coventry All Commercial |
$1,101.62
|
| Rate for Payer: Encore All Commercial |
$1,152.32
|
| Rate for Payer: Frontpath All Commercial |
$1,151.70
|
| Rate for Payer: Humana ChoiceCare |
$1,081.22
|
| Rate for Payer: Humana Medicare |
$638.44
|
| Rate for Payer: Lucent All Commercial |
$638.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,126.66
|
| Rate for Payer: PHCS All Commercial |
$938.88
|
| Rate for Payer: PHP All Commercial |
$949.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$488.22
|
| Rate for Payer: Sagamore Health Network All Products |
$966.43
|
| Rate for Payer: Signature Care EPO |
$1,039.03
|
| Rate for Payer: Signature Care PPO |
$1,101.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,064.07
|
| Rate for Payer: United Healthcare Commercial |
$986.45
|
| Rate for Payer: United Healthcare Medicare |
$413.11
|
|
|
HC PERQ DEV PLCMNT BREAST 1ST LES MR GUIDE
|
Facility
IP
|
$1,251.85
|
|
| Hospital Charge Code |
01579287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$938.88 |
| Max. Negotiated Rate |
$1,164.22 |
| Rate for Payer: Aetna Commercial |
$1,081.59
|
| Rate for Payer: Cash Price |
$776.15
|
| Rate for Payer: Cigna All Commercial |
$1,080.34
|
| Rate for Payer: CORVEL All Commercial |
$1,164.22
|
| Rate for Payer: Coventry All Commercial |
$1,101.62
|
| Rate for Payer: Encore All Commercial |
$1,152.32
|
| Rate for Payer: Frontpath All Commercial |
$1,151.70
|
| Rate for Payer: Humana ChoiceCare |
$1,081.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,126.66
|
| Rate for Payer: PHCS All Commercial |
$938.88
|
| Rate for Payer: PHP All Commercial |
$949.40
|
| Rate for Payer: Sagamore Health Network All Products |
$966.43
|
| Rate for Payer: Signature Care EPO |
$1,039.03
|
| Rate for Payer: Signature Care PPO |
$1,101.62
|
| Rate for Payer: United Healthcare Commercial |
$986.45
|
|
|
HC PERQ DEV PLCMT BREAST EA AD LES MR GUIDE
|
Facility
IP
|
$754.89
|
|
| Hospital Charge Code |
01579288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$566.17 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$652.23
|
| Rate for Payer: Cash Price |
$468.03
|
| Rate for Payer: Cigna All Commercial |
$651.47
|
| Rate for Payer: CORVEL All Commercial |
$702.05
|
| Rate for Payer: Coventry All Commercial |
$664.30
|
| Rate for Payer: Encore All Commercial |
$694.88
|
| Rate for Payer: Frontpath All Commercial |
$694.50
|
| Rate for Payer: Humana ChoiceCare |
$652.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.40
|
| Rate for Payer: PHCS All Commercial |
$566.17
|
| Rate for Payer: PHP All Commercial |
$572.51
|
| Rate for Payer: Sagamore Health Network All Products |
$582.78
|
| Rate for Payer: Signature Care EPO |
$626.56
|
| Rate for Payer: Signature Care PPO |
$664.30
|
| Rate for Payer: United Healthcare Commercial |
$594.85
|
|
|
HC PERQ DEV PLCMT BREAST EA AD LES MR GUIDE
|
Facility
OP
|
$754.89
|
|
| Hospital Charge Code |
01579288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.11 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$637.13
|
| Rate for Payer: Aetna Medicare |
$249.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$249.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$433.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$286.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$274.03
|
| Rate for Payer: Cash Price |
$468.03
|
| Rate for Payer: Centivo All Commercial |
$384.99
|
| Rate for Payer: Cigna All Commercial |
$651.47
|
| Rate for Payer: CORVEL All Commercial |
$702.05
|
| Rate for Payer: Coventry All Commercial |
$664.30
|
| Rate for Payer: Encore All Commercial |
$694.88
|
| Rate for Payer: Frontpath All Commercial |
$694.50
|
| Rate for Payer: Humana ChoiceCare |
$652.00
|
| Rate for Payer: Humana Medicare |
$384.99
|
| Rate for Payer: Lucent All Commercial |
$384.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.40
|
| Rate for Payer: PHCS All Commercial |
$566.17
|
| Rate for Payer: PHP All Commercial |
$572.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$294.41
|
| Rate for Payer: Sagamore Health Network All Products |
$582.78
|
| Rate for Payer: Signature Care EPO |
$626.56
|
| Rate for Payer: Signature Care PPO |
$664.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$641.66
|
| Rate for Payer: United Healthcare Commercial |
$594.85
|
| Rate for Payer: United Healthcare Medicare |
$249.11
|
|
|
HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
IP
|
$4,612.95
|
|
| Hospital Charge Code |
01662557
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,459.71 |
| Max. Negotiated Rate |
$4,290.04 |
| Rate for Payer: Aetna Commercial |
$3,985.59
|
| Rate for Payer: Cash Price |
$2,860.03
|
| Rate for Payer: Cigna All Commercial |
$3,980.98
|
| Rate for Payer: CORVEL All Commercial |
$4,290.04
|
| Rate for Payer: Coventry All Commercial |
$4,059.40
|
| Rate for Payer: Encore All Commercial |
$4,246.22
|
| Rate for Payer: Frontpath All Commercial |
$4,243.91
|
| Rate for Payer: Humana ChoiceCare |
$3,984.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,151.66
|
| Rate for Payer: PHCS All Commercial |
$3,459.71
|
| Rate for Payer: PHP All Commercial |
$3,498.46
|
| Rate for Payer: Sagamore Health Network All Products |
$3,561.20
|
| Rate for Payer: Signature Care EPO |
$3,828.75
|
| Rate for Payer: Signature Care PPO |
$4,059.40
|
| Rate for Payer: United Healthcare Commercial |
$3,635.00
|
|
|
HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
OP
|
$4,612.95
|
|
| Hospital Charge Code |
01662557
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,522.27 |
| Max. Negotiated Rate |
$4,290.04 |
| Rate for Payer: Aetna Commercial |
$3,893.33
|
| Rate for Payer: Aetna Medicare |
$1,522.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,522.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,649.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,883.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,750.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,674.50
|
| Rate for Payer: Cash Price |
$2,860.03
|
| Rate for Payer: Centivo All Commercial |
$2,352.60
|
| Rate for Payer: Cigna All Commercial |
$3,980.98
|
| Rate for Payer: CORVEL All Commercial |
$4,290.04
|
| Rate for Payer: Coventry All Commercial |
$4,059.40
|
| Rate for Payer: Encore All Commercial |
$4,246.22
|
| Rate for Payer: Frontpath All Commercial |
$4,243.91
|
| Rate for Payer: Humana ChoiceCare |
$3,984.20
|
| Rate for Payer: Humana Medicare |
$2,352.60
|
| Rate for Payer: Lucent All Commercial |
$2,352.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,151.66
|
| Rate for Payer: PHCS All Commercial |
$3,459.71
|
| Rate for Payer: PHP All Commercial |
$3,498.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,799.05
|
| Rate for Payer: Sagamore Health Network All Products |
$3,561.20
|
| Rate for Payer: Signature Care EPO |
$3,828.75
|
| Rate for Payer: Signature Care PPO |
$4,059.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,921.01
|
| Rate for Payer: United Healthcare Commercial |
$3,635.00
|
| Rate for Payer: United Healthcare Medicare |
$1,522.27
|
|
|
HC PET BRAIN; METABOLIC EVAL
|
Facility
OP
|
$5,795.31
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
01639007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,912.45 |
| Max. Negotiated Rate |
$5,389.64 |
| Rate for Payer: Aetna Commercial |
$4,891.24
|
| Rate for Payer: Aetna Medicare |
$1,912.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,912.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,328.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,622.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3,033.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,199.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,103.70
|
| Rate for Payer: Cash Price |
$3,593.09
|
| Rate for Payer: Cash Price |
$3,593.09
|
| Rate for Payer: Centivo All Commercial |
$2,955.61
|
| Rate for Payer: Cigna All Commercial |
$5,001.36
|
| Rate for Payer: CORVEL All Commercial |
$5,389.64
|
| Rate for Payer: Coventry All Commercial |
$5,099.88
|
| Rate for Payer: Encore All Commercial |
$5,334.59
|
| Rate for Payer: Frontpath All Commercial |
$5,331.69
|
| Rate for Payer: Humana ChoiceCare |
$5,005.41
|
| Rate for Payer: Humana Medicare |
$2,955.61
|
| Rate for Payer: Lucent All Commercial |
$2,955.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,215.78
|
| Rate for Payer: Managed Health Services Medicaid |
$3,033.23
|
| Rate for Payer: MDWise Medicaid |
$3,033.23
|
| Rate for Payer: PHCS All Commercial |
$4,346.49
|
| Rate for Payer: PHP All Commercial |
$4,395.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,260.17
|
| Rate for Payer: Sagamore Health Network All Products |
$4,473.98
|
| Rate for Payer: Signature Care EPO |
$4,810.11
|
| Rate for Payer: Signature Care PPO |
$5,099.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,926.02
|
| Rate for Payer: United Healthcare Commercial |
$4,566.71
|
| Rate for Payer: United Healthcare Medicare |
$1,912.45
|
|
|
HC PET BRAIN; METABOLIC EVAL
|
Facility
IP
|
$5,795.31
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
01639007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,346.49 |
| Max. Negotiated Rate |
$5,389.64 |
| Rate for Payer: Aetna Commercial |
$5,007.15
|
| Rate for Payer: Cash Price |
$3,593.09
|
| Rate for Payer: Cigna All Commercial |
$5,001.36
|
| Rate for Payer: CORVEL All Commercial |
$5,389.64
|
| Rate for Payer: Coventry All Commercial |
$5,099.88
|
| Rate for Payer: Encore All Commercial |
$5,334.59
|
| Rate for Payer: Frontpath All Commercial |
$5,331.69
|
| Rate for Payer: Humana ChoiceCare |
$5,005.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,215.78
|
| Rate for Payer: PHCS All Commercial |
$4,346.49
|
| Rate for Payer: PHP All Commercial |
$4,395.17
|
| Rate for Payer: Sagamore Health Network All Products |
$4,473.98
|
| Rate for Payer: Signature Care EPO |
$4,810.11
|
| Rate for Payer: Signature Care PPO |
$5,099.88
|
| Rate for Payer: United Healthcare Commercial |
$4,566.71
|
|
