|
HC PH-BLOOD
|
Facility
IP
|
$95.07
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
63001112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.31 |
| Max. Negotiated Rate |
$88.42 |
| Rate for Payer: Aetna Commercial |
$82.14
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cigna All Commercial |
$82.05
|
| Rate for Payer: CORVEL All Commercial |
$88.42
|
| Rate for Payer: Coventry All Commercial |
$83.67
|
| Rate for Payer: Encore All Commercial |
$87.52
|
| Rate for Payer: Frontpath All Commercial |
$87.47
|
| Rate for Payer: Humana ChoiceCare |
$82.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.57
|
| Rate for Payer: PHCS All Commercial |
$71.31
|
| Rate for Payer: PHP All Commercial |
$72.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.40
|
| Rate for Payer: Signature Care EPO |
$78.91
|
| Rate for Payer: Signature Care PPO |
$83.67
|
| Rate for Payer: United Healthcare Commercial |
$74.92
|
|
|
HC PH-BODY FLUID
|
Facility
OP
|
$72.79
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$67.69 |
| Rate for Payer: Aetna Commercial |
$61.43
|
| Rate for Payer: Aetna Medicare |
$24.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.42
|
| Rate for Payer: Cash Price |
$45.13
|
| Rate for Payer: Cash Price |
$45.13
|
| Rate for Payer: Centivo All Commercial |
$37.12
|
| Rate for Payer: Cigna All Commercial |
$62.82
|
| Rate for Payer: CORVEL All Commercial |
$67.69
|
| Rate for Payer: Coventry All Commercial |
$64.05
|
| Rate for Payer: Encore All Commercial |
$67.00
|
| Rate for Payer: Frontpath All Commercial |
$66.96
|
| Rate for Payer: Humana ChoiceCare |
$62.87
|
| Rate for Payer: Humana Medicare |
$37.12
|
| Rate for Payer: Lucent All Commercial |
$37.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.51
|
| Rate for Payer: Managed Health Services Medicaid |
$3.58
|
| Rate for Payer: MDWise Medicaid |
$3.58
|
| Rate for Payer: PHCS All Commercial |
$54.59
|
| Rate for Payer: PHP All Commercial |
$55.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.39
|
| Rate for Payer: Sagamore Health Network All Products |
$56.19
|
| Rate for Payer: Signature Care EPO |
$60.41
|
| Rate for Payer: Signature Care PPO |
$64.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.87
|
| Rate for Payer: United Healthcare Commercial |
$57.36
|
| Rate for Payer: United Healthcare Medicare |
$24.02
|
|
|
HC PH-BODY FLUID
|
Facility
IP
|
$72.79
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$67.69 |
| Rate for Payer: Aetna Commercial |
$62.89
|
| Rate for Payer: Cash Price |
$45.13
|
| Rate for Payer: Cigna All Commercial |
$62.82
|
| Rate for Payer: CORVEL All Commercial |
$67.69
|
| Rate for Payer: Coventry All Commercial |
$64.05
|
| Rate for Payer: Encore All Commercial |
$67.00
|
| Rate for Payer: Frontpath All Commercial |
$66.96
|
| Rate for Payer: Humana ChoiceCare |
$62.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.51
|
| Rate for Payer: PHCS All Commercial |
$54.59
|
| Rate for Payer: PHP All Commercial |
$55.20
|
| Rate for Payer: Sagamore Health Network All Products |
$56.19
|
| Rate for Payer: Signature Care EPO |
$60.41
|
| Rate for Payer: Signature Care PPO |
$64.05
|
| Rate for Payer: United Healthcare Commercial |
$57.36
|
|
|
HC PHENCYCLIDINE(PCP) MS
|
Facility
IP
|
$50.43
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
63001651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.82 |
| Max. Negotiated Rate |
$46.90 |
| Rate for Payer: Aetna Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Cigna All Commercial |
$43.52
|
| Rate for Payer: CORVEL All Commercial |
$46.90
|
| Rate for Payer: Coventry All Commercial |
$44.38
|
| Rate for Payer: Encore All Commercial |
$46.42
|
| Rate for Payer: Frontpath All Commercial |
$46.39
|
| Rate for Payer: Humana ChoiceCare |
$43.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.39
|
| Rate for Payer: PHCS All Commercial |
$37.82
|
| Rate for Payer: PHP All Commercial |
$38.25
|
| Rate for Payer: Sagamore Health Network All Products |
$38.93
|
| Rate for Payer: Signature Care EPO |
$41.86
|
| Rate for Payer: Signature Care PPO |
$44.38
|
| Rate for Payer: United Healthcare Commercial |
$39.74
|
|
|
HC PHENCYCLIDINE(PCP) MS
|
Facility
OP
|
$50.43
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
63001651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$78.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.31
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Centivo All Commercial |
$25.72
|
| Rate for Payer: Cigna All Commercial |
$43.52
|
| Rate for Payer: CORVEL All Commercial |
$46.90
|
| Rate for Payer: Coventry All Commercial |
$44.38
|
| Rate for Payer: Encore All Commercial |
$46.42
|
| Rate for Payer: Frontpath All Commercial |
$46.39
|
| Rate for Payer: Humana ChoiceCare |
$43.56
|
| Rate for Payer: Humana Medicare |
$25.72
|
| Rate for Payer: Lucent All Commercial |
$25.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.39
|
| Rate for Payer: Managed Health Services Medicaid |
$78.00
|
| Rate for Payer: MDWise Medicaid |
$78.00
|
| Rate for Payer: PHCS All Commercial |
$37.82
|
| Rate for Payer: PHP All Commercial |
$38.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.67
|
| Rate for Payer: Sagamore Health Network All Products |
$38.93
|
| Rate for Payer: Signature Care EPO |
$41.86
|
| Rate for Payer: Signature Care PPO |
$44.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.86
|
| Rate for Payer: United Healthcare Commercial |
$39.74
|
| Rate for Payer: United Healthcare Medicare |
$16.64
|
|
|
HC PHENOBARBITAL
|
Facility
OP
|
$233.38
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
63001315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$77.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.72
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Centivo All Commercial |
$119.02
|
| Rate for Payer: Cigna All Commercial |
$201.40
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.82
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Humana Medicare |
$119.02
|
| Rate for Payer: Lucent All Commercial |
$119.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: Managed Health Services Medicaid |
$15.30
|
| Rate for Payer: MDWise Medicaid |
$15.30
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$176.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.02
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.70
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
| Rate for Payer: United Healthcare Medicare |
$77.01
|
|
|
HC PHENOBARBITAL
|
Facility
IP
|
$233.38
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
63001315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$201.64
|
| Rate for Payer: Cash Price |
$144.69
|
| Rate for Payer: Cigna All Commercial |
$201.40
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.82
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$176.99
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.70
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
|
|
HC PHENOTYPE
|
Facility
OP
|
$400.34
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
63001056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$372.32 |
| Rate for Payer: Aetna Commercial |
$337.89
|
| Rate for Payer: Aetna Medicare |
$132.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$229.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$250.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.32
|
| Rate for Payer: Cash Price |
$248.21
|
| Rate for Payer: Cash Price |
$248.21
|
| Rate for Payer: Centivo All Commercial |
$204.17
|
| Rate for Payer: Cigna All Commercial |
$345.49
|
| Rate for Payer: CORVEL All Commercial |
$372.32
|
| Rate for Payer: Coventry All Commercial |
$352.30
|
| Rate for Payer: Encore All Commercial |
$368.51
|
| Rate for Payer: Frontpath All Commercial |
$368.31
|
| Rate for Payer: Humana ChoiceCare |
$345.77
|
| Rate for Payer: Humana Medicare |
$204.17
|
| Rate for Payer: Lucent All Commercial |
$204.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$360.31
|
| Rate for Payer: Managed Health Services Medicaid |
$7.75
|
| Rate for Payer: MDWise Medicaid |
$7.75
|
| Rate for Payer: PHCS All Commercial |
$300.25
|
| Rate for Payer: PHP All Commercial |
$303.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.13
|
| Rate for Payer: Sagamore Health Network All Products |
$309.06
|
| Rate for Payer: Signature Care EPO |
$332.28
|
| Rate for Payer: Signature Care PPO |
$352.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$340.29
|
| Rate for Payer: United Healthcare Commercial |
$315.47
|
| Rate for Payer: United Healthcare Medicare |
$132.11
|
|
|
HC PHENOTYPE
|
Facility
IP
|
$400.34
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
63001056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.25 |
| Max. Negotiated Rate |
$372.32 |
| Rate for Payer: Aetna Commercial |
$345.89
|
| Rate for Payer: Cash Price |
$248.21
|
| Rate for Payer: Cigna All Commercial |
$345.49
|
| Rate for Payer: CORVEL All Commercial |
$372.32
|
| Rate for Payer: Coventry All Commercial |
$352.30
|
| Rate for Payer: Encore All Commercial |
$368.51
|
| Rate for Payer: Frontpath All Commercial |
$368.31
|
| Rate for Payer: Humana ChoiceCare |
$345.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$360.31
|
| Rate for Payer: PHCS All Commercial |
$300.25
|
| Rate for Payer: PHP All Commercial |
$303.62
|
| Rate for Payer: Sagamore Health Network All Products |
$309.06
|
| Rate for Payer: Signature Care EPO |
$332.28
|
| Rate for Payer: Signature Care PPO |
$352.30
|
| Rate for Payer: United Healthcare Commercial |
$315.47
|
|
|
HC PHENYTOIN
|
Facility
OP
|
$231.09
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$214.91 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna Medicare |
$76.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.89
|
| Rate for Payer: Cash Price |
$143.28
|
| Rate for Payer: Cash Price |
$143.28
|
| Rate for Payer: Centivo All Commercial |
$117.86
|
| Rate for Payer: Cigna All Commercial |
$199.43
|
| Rate for Payer: CORVEL All Commercial |
$214.91
|
| Rate for Payer: Coventry All Commercial |
$203.36
|
| Rate for Payer: Encore All Commercial |
$212.72
|
| Rate for Payer: Frontpath All Commercial |
$212.60
|
| Rate for Payer: Humana ChoiceCare |
$199.59
|
| Rate for Payer: Humana Medicare |
$117.86
|
| Rate for Payer: Lucent All Commercial |
$117.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.98
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$173.32
|
| Rate for Payer: PHP All Commercial |
$175.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.13
|
| Rate for Payer: Sagamore Health Network All Products |
$178.40
|
| Rate for Payer: Signature Care EPO |
$191.81
|
| Rate for Payer: Signature Care PPO |
$203.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196.43
|
| Rate for Payer: United Healthcare Commercial |
$182.10
|
| Rate for Payer: United Healthcare Medicare |
$76.26
|
|
|
HC PHENYTOIN
|
Facility
IP
|
$231.09
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.32 |
| Max. Negotiated Rate |
$214.91 |
| Rate for Payer: Aetna Commercial |
$199.66
|
| Rate for Payer: Cash Price |
$143.28
|
| Rate for Payer: Cigna All Commercial |
$199.43
|
| Rate for Payer: CORVEL All Commercial |
$214.91
|
| Rate for Payer: Coventry All Commercial |
$203.36
|
| Rate for Payer: Encore All Commercial |
$212.72
|
| Rate for Payer: Frontpath All Commercial |
$212.60
|
| Rate for Payer: Humana ChoiceCare |
$199.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.98
|
| Rate for Payer: PHCS All Commercial |
$173.32
|
| Rate for Payer: PHP All Commercial |
$175.26
|
| Rate for Payer: Sagamore Health Network All Products |
$178.40
|
| Rate for Payer: Signature Care EPO |
$191.81
|
| Rate for Payer: Signature Care PPO |
$203.36
|
| Rate for Payer: United Healthcare Commercial |
$182.10
|
|
|
HC PHENYTOIN FREE
|
Facility
OP
|
$171.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
63001113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$144.89
|
| Rate for Payer: Aetna Medicare |
$56.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.31
|
| Rate for Payer: Cash Price |
$106.43
|
| Rate for Payer: Cash Price |
$106.43
|
| Rate for Payer: Centivo All Commercial |
$87.55
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.93
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Humana Medicare |
$87.55
|
| Rate for Payer: Lucent All Commercial |
$87.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: Managed Health Services Medicaid |
$13.76
|
| Rate for Payer: MDWise Medicaid |
$13.76
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.95
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.48
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.92
|
| Rate for Payer: United Healthcare Commercial |
$135.27
|
| Rate for Payer: United Healthcare Medicare |
$56.65
|
|
|
HC PHENYTOIN FREE
|
Facility
IP
|
$171.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
63001113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$148.32
|
| Rate for Payer: Cash Price |
$106.43
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.93
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.48
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: United Healthcare Commercial |
$135.27
|
|
|
HC PHILIPS WATER TRAP
|
Facility
IP
|
$238.06
|
|
| Hospital Charge Code |
41603511
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$178.54 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$205.68
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna All Commercial |
$205.45
|
| Rate for Payer: CORVEL All Commercial |
$221.40
|
| Rate for Payer: Coventry All Commercial |
$209.49
|
| Rate for Payer: Encore All Commercial |
$219.13
|
| Rate for Payer: Frontpath All Commercial |
$219.02
|
| Rate for Payer: Humana ChoiceCare |
$205.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.25
|
| Rate for Payer: PHCS All Commercial |
$178.54
|
| Rate for Payer: PHP All Commercial |
$180.54
|
| Rate for Payer: Sagamore Health Network All Products |
$183.78
|
| Rate for Payer: Signature Care EPO |
$197.59
|
| Rate for Payer: Signature Care PPO |
$209.49
|
| Rate for Payer: United Healthcare Commercial |
$187.59
|
|
|
HC PHILIPS WATER TRAP
|
Facility
OP
|
$238.06
|
|
| Hospital Charge Code |
41603511
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.56 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$200.92
|
| Rate for Payer: Aetna Medicare |
$78.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.42
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Centivo All Commercial |
$121.41
|
| Rate for Payer: Cigna All Commercial |
$205.45
|
| Rate for Payer: CORVEL All Commercial |
$221.40
|
| Rate for Payer: Coventry All Commercial |
$209.49
|
| Rate for Payer: Encore All Commercial |
$219.13
|
| Rate for Payer: Frontpath All Commercial |
$219.02
|
| Rate for Payer: Humana ChoiceCare |
$205.61
|
| Rate for Payer: Humana Medicare |
$121.41
|
| Rate for Payer: Lucent All Commercial |
$121.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.25
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$178.54
|
| Rate for Payer: PHP All Commercial |
$180.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.84
|
| Rate for Payer: Sagamore Health Network All Products |
$183.78
|
| Rate for Payer: Signature Care EPO |
$197.59
|
| Rate for Payer: Signature Care PPO |
$209.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202.35
|
| Rate for Payer: United Healthcare Commercial |
$187.59
|
| Rate for Payer: United Healthcare Medicare |
$78.56
|
|
|
HC PHLEBOTOMY/500/250CC
|
Facility
IP
|
$253.91
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
63002146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.43 |
| Max. Negotiated Rate |
$236.13 |
| Rate for Payer: Aetna Commercial |
$219.38
|
| Rate for Payer: Cash Price |
$157.42
|
| Rate for Payer: Cigna All Commercial |
$219.12
|
| Rate for Payer: CORVEL All Commercial |
$236.13
|
| Rate for Payer: Coventry All Commercial |
$223.44
|
| Rate for Payer: Encore All Commercial |
$233.72
|
| Rate for Payer: Frontpath All Commercial |
$233.60
|
| Rate for Payer: Humana ChoiceCare |
$219.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.52
|
| Rate for Payer: PHCS All Commercial |
$190.43
|
| Rate for Payer: PHP All Commercial |
$192.56
|
| Rate for Payer: Sagamore Health Network All Products |
$196.02
|
| Rate for Payer: Signature Care EPO |
$210.74
|
| Rate for Payer: Signature Care PPO |
$223.44
|
| Rate for Payer: United Healthcare Commercial |
$200.08
|
|
|
HC PHLEBOTOMY/500/250CC
|
Facility
OP
|
$253.91
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
63002146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$409.66 |
| Rate for Payer: Aetna Commercial |
$214.30
|
| Rate for Payer: Aetna Medicare |
$83.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$145.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$158.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$409.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.17
|
| Rate for Payer: Cash Price |
$157.42
|
| Rate for Payer: Cash Price |
$157.42
|
| Rate for Payer: Centivo All Commercial |
$129.49
|
| Rate for Payer: Cigna All Commercial |
$219.12
|
| Rate for Payer: CORVEL All Commercial |
$236.13
|
| Rate for Payer: Coventry All Commercial |
$223.44
|
| Rate for Payer: Encore All Commercial |
$233.72
|
| Rate for Payer: Frontpath All Commercial |
$233.60
|
| Rate for Payer: Humana ChoiceCare |
$219.30
|
| Rate for Payer: Humana Medicare |
$129.49
|
| Rate for Payer: Lucent All Commercial |
$129.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.52
|
| Rate for Payer: Managed Health Services Medicaid |
$409.66
|
| Rate for Payer: MDWise Medicaid |
$409.66
|
| Rate for Payer: PHCS All Commercial |
$190.43
|
| Rate for Payer: PHP All Commercial |
$192.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.02
|
| Rate for Payer: Sagamore Health Network All Products |
$196.02
|
| Rate for Payer: Signature Care EPO |
$210.74
|
| Rate for Payer: Signature Care PPO |
$223.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.82
|
| Rate for Payer: United Healthcare Commercial |
$200.08
|
| Rate for Payer: United Healthcare Medicare |
$83.79
|
|
|
HC PHOSPHATIDYLETHANOLAMINE IGA
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLETHANOLAMINE IGA
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLETHANOLAMINE IGG
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLETHANOLAMINE IGG
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLETHANOLAMINE IGM
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLETHANOLAMINE IGM
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLGLYCEROL IGA
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLGLYCEROL IGA
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
