|
HC PLATELET COUNT AUTO
|
Facility
IP
|
$46.95
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: Aetna Commercial |
$40.57
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cigna All Commercial |
$40.52
|
| Rate for Payer: CORVEL All Commercial |
$43.66
|
| Rate for Payer: Coventry All Commercial |
$41.32
|
| Rate for Payer: Encore All Commercial |
$43.22
|
| Rate for Payer: Frontpath All Commercial |
$43.19
|
| Rate for Payer: Humana ChoiceCare |
$40.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.26
|
| Rate for Payer: PHCS All Commercial |
$35.21
|
| Rate for Payer: PHP All Commercial |
$35.61
|
| Rate for Payer: Sagamore Health Network All Products |
$36.25
|
| Rate for Payer: Signature Care EPO |
$38.97
|
| Rate for Payer: Signature Care PPO |
$41.32
|
| Rate for Payer: United Healthcare Commercial |
$37.00
|
|
|
HC PLATELET COUNT AUTO*
|
Facility
IP
|
$51.21
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.41 |
| Max. Negotiated Rate |
$47.63 |
| Rate for Payer: Cigna All Commercial |
$44.20
|
| Rate for Payer: Aetna Commercial |
$44.25
|
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: CORVEL All Commercial |
$47.63
|
| Rate for Payer: Coventry All Commercial |
$45.07
|
| Rate for Payer: Encore All Commercial |
$47.14
|
| Rate for Payer: Frontpath All Commercial |
$47.12
|
| Rate for Payer: Humana ChoiceCare |
$44.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.09
|
| Rate for Payer: PHCS All Commercial |
$38.41
|
| Rate for Payer: PHP All Commercial |
$38.84
|
| Rate for Payer: Sagamore Health Network All Products |
$39.54
|
| Rate for Payer: Signature Care EPO |
$42.51
|
| Rate for Payer: Signature Care PPO |
$45.07
|
| Rate for Payer: United Healthcare Commercial |
$40.36
|
|
|
HC PLATELET COUNT AUTO*
|
Facility
OP
|
$51.21
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$47.63 |
| Rate for Payer: Aetna Commercial |
$43.22
|
| Rate for Payer: Aetna Medicare |
$16.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.59
|
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Centivo All Commercial |
$26.12
|
| Rate for Payer: Cigna All Commercial |
$44.20
|
| Rate for Payer: CORVEL All Commercial |
$47.63
|
| Rate for Payer: Coventry All Commercial |
$45.07
|
| Rate for Payer: Encore All Commercial |
$47.14
|
| Rate for Payer: Frontpath All Commercial |
$47.12
|
| Rate for Payer: Humana ChoiceCare |
$44.23
|
| Rate for Payer: Humana Medicare |
$26.12
|
| Rate for Payer: Lucent All Commercial |
$26.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.09
|
| Rate for Payer: Managed Health Services Medicaid |
$4.48
|
| Rate for Payer: MDWise Medicaid |
$4.48
|
| Rate for Payer: PHCS All Commercial |
$38.41
|
| Rate for Payer: PHP All Commercial |
$38.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.97
|
| Rate for Payer: Sagamore Health Network All Products |
$39.54
|
| Rate for Payer: Signature Care EPO |
$42.51
|
| Rate for Payer: Signature Care PPO |
$45.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.53
|
| Rate for Payer: United Healthcare Commercial |
$40.36
|
| Rate for Payer: United Healthcare Medicare |
$16.90
|
|
|
HC PLATELET COUNT AUTO - SBMF
|
Facility
OP
|
$51.21
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$47.63 |
| Rate for Payer: Aetna Commercial |
$43.22
|
| Rate for Payer: Aetna Medicare |
$16.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.59
|
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Centivo All Commercial |
$26.12
|
| Rate for Payer: Cigna All Commercial |
$44.20
|
| Rate for Payer: CORVEL All Commercial |
$47.63
|
| Rate for Payer: Coventry All Commercial |
$45.07
|
| Rate for Payer: Encore All Commercial |
$47.14
|
| Rate for Payer: Frontpath All Commercial |
$47.12
|
| Rate for Payer: Humana ChoiceCare |
$44.23
|
| Rate for Payer: Humana Medicare |
$26.12
|
| Rate for Payer: Lucent All Commercial |
$26.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.09
|
| Rate for Payer: Managed Health Services Medicaid |
$4.48
|
| Rate for Payer: MDWise Medicaid |
$4.48
|
| Rate for Payer: PHCS All Commercial |
$38.41
|
| Rate for Payer: PHP All Commercial |
$38.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.97
|
| Rate for Payer: Sagamore Health Network All Products |
$39.54
|
| Rate for Payer: Signature Care EPO |
$42.51
|
| Rate for Payer: Signature Care PPO |
$45.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.53
|
| Rate for Payer: United Healthcare Commercial |
$40.36
|
| Rate for Payer: United Healthcare Medicare |
$16.90
|
|
|
HC PLATELET COUNT AUTO - SBMF
|
Facility
IP
|
$51.21
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.41 |
| Max. Negotiated Rate |
$47.63 |
| Rate for Payer: Aetna Commercial |
$44.25
|
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Cigna All Commercial |
$44.20
|
| Rate for Payer: CORVEL All Commercial |
$47.63
|
| Rate for Payer: Coventry All Commercial |
$45.07
|
| Rate for Payer: Encore All Commercial |
$47.14
|
| Rate for Payer: Frontpath All Commercial |
$47.12
|
| Rate for Payer: Humana ChoiceCare |
$44.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.09
|
| Rate for Payer: PHCS All Commercial |
$38.41
|
| Rate for Payer: PHP All Commercial |
$38.84
|
| Rate for Payer: Sagamore Health Network All Products |
$39.54
|
| Rate for Payer: Signature Care EPO |
$42.51
|
| Rate for Payer: Signature Care PPO |
$45.07
|
| Rate for Payer: United Healthcare Commercial |
$40.36
|
|
|
HC PLATELET FUNCTION AS
|
Facility
OP
|
$147.88
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
63001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: Aetna Commercial |
$124.81
|
| Rate for Payer: Aetna Medicare |
$48.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.68
|
| Rate for Payer: Cash Price |
$91.69
|
| Rate for Payer: Cash Price |
$91.69
|
| Rate for Payer: Centivo All Commercial |
$75.42
|
| Rate for Payer: Cigna All Commercial |
$127.62
|
| Rate for Payer: CORVEL All Commercial |
$137.53
|
| Rate for Payer: Coventry All Commercial |
$130.13
|
| Rate for Payer: Encore All Commercial |
$136.12
|
| Rate for Payer: Frontpath All Commercial |
$136.05
|
| Rate for Payer: Humana ChoiceCare |
$127.72
|
| Rate for Payer: Humana Medicare |
$75.42
|
| Rate for Payer: Lucent All Commercial |
$75.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.09
|
| Rate for Payer: Managed Health Services Medicaid |
$24.91
|
| Rate for Payer: MDWise Medicaid |
$24.91
|
| Rate for Payer: PHCS All Commercial |
$110.91
|
| Rate for Payer: PHP All Commercial |
$112.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.67
|
| Rate for Payer: Sagamore Health Network All Products |
$114.16
|
| Rate for Payer: Signature Care EPO |
$122.74
|
| Rate for Payer: Signature Care PPO |
$130.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.70
|
| Rate for Payer: United Healthcare Commercial |
$116.53
|
| Rate for Payer: United Healthcare Medicare |
$48.80
|
|
|
HC PLATELET FUNCTION AS
|
Facility
IP
|
$147.88
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
63001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.91 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: Aetna Commercial |
$127.77
|
| Rate for Payer: Cash Price |
$91.69
|
| Rate for Payer: Cigna All Commercial |
$127.62
|
| Rate for Payer: CORVEL All Commercial |
$137.53
|
| Rate for Payer: Coventry All Commercial |
$130.13
|
| Rate for Payer: Encore All Commercial |
$136.12
|
| Rate for Payer: Frontpath All Commercial |
$136.05
|
| Rate for Payer: Humana ChoiceCare |
$127.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.09
|
| Rate for Payer: PHCS All Commercial |
$110.91
|
| Rate for Payer: PHP All Commercial |
$112.15
|
| Rate for Payer: Sagamore Health Network All Products |
$114.16
|
| Rate for Payer: Signature Care EPO |
$122.74
|
| Rate for Payer: Signature Care PPO |
$130.13
|
| Rate for Payer: United Healthcare Commercial |
$116.53
|
|
|
HC PLATELETPHERESIS LR
|
Facility
IP
|
$2,969.18
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
01371004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,226.88 |
| Max. Negotiated Rate |
$2,761.34 |
| Rate for Payer: Aetna Commercial |
$2,565.37
|
| Rate for Payer: Cash Price |
$1,840.89
|
| Rate for Payer: Cigna All Commercial |
$2,562.40
|
| Rate for Payer: CORVEL All Commercial |
$2,761.34
|
| Rate for Payer: Coventry All Commercial |
$2,612.88
|
| Rate for Payer: Encore All Commercial |
$2,733.13
|
| Rate for Payer: Frontpath All Commercial |
$2,731.64
|
| Rate for Payer: Humana ChoiceCare |
$2,564.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,672.26
|
| Rate for Payer: PHCS All Commercial |
$2,226.88
|
| Rate for Payer: PHP All Commercial |
$2,251.83
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.21
|
| Rate for Payer: Signature Care EPO |
$2,464.42
|
| Rate for Payer: Signature Care PPO |
$2,612.88
|
| Rate for Payer: United Healthcare Commercial |
$2,339.71
|
|
|
HC PLATELETPHERESIS LR
|
Facility
OP
|
$2,969.18
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
01371004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$2,761.34 |
| Rate for Payer: Aetna Commercial |
$2,505.99
|
| Rate for Payer: Aetna Medicare |
$979.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$979.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,705.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,126.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,077.81
|
| Rate for Payer: Cash Price |
$1,840.89
|
| Rate for Payer: Cash Price |
$1,840.89
|
| Rate for Payer: Centivo All Commercial |
$1,514.28
|
| Rate for Payer: Cigna All Commercial |
$2,562.40
|
| Rate for Payer: CORVEL All Commercial |
$2,761.34
|
| Rate for Payer: Coventry All Commercial |
$2,612.88
|
| Rate for Payer: Encore All Commercial |
$2,733.13
|
| Rate for Payer: Frontpath All Commercial |
$2,731.64
|
| Rate for Payer: Humana ChoiceCare |
$2,564.48
|
| Rate for Payer: Humana Medicare |
$1,514.28
|
| Rate for Payer: Lucent All Commercial |
$1,514.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,672.26
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$2,226.88
|
| Rate for Payer: PHP All Commercial |
$2,251.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,157.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.21
|
| Rate for Payer: Signature Care EPO |
$2,464.42
|
| Rate for Payer: Signature Care PPO |
$2,612.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,523.80
|
| Rate for Payer: United Healthcare Commercial |
$2,339.71
|
| Rate for Payer: United Healthcare Medicare |
$979.83
|
|
|
HC PLATELETPHERESIS LR CMV IRRAD
|
Facility
IP
|
$3,100.91
|
|
|
Service Code
|
CPT P9053
|
| Hospital Charge Code |
01379037
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,325.68 |
| Max. Negotiated Rate |
$2,883.85 |
| Rate for Payer: Aetna Commercial |
$2,679.19
|
| Rate for Payer: Cash Price |
$1,922.57
|
| Rate for Payer: Cigna All Commercial |
$2,676.09
|
| Rate for Payer: CORVEL All Commercial |
$2,883.85
|
| Rate for Payer: Coventry All Commercial |
$2,728.80
|
| Rate for Payer: Encore All Commercial |
$2,854.39
|
| Rate for Payer: Frontpath All Commercial |
$2,852.84
|
| Rate for Payer: Humana ChoiceCare |
$2,678.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,790.82
|
| Rate for Payer: PHCS All Commercial |
$2,325.68
|
| Rate for Payer: PHP All Commercial |
$2,351.73
|
| Rate for Payer: Sagamore Health Network All Products |
$2,393.90
|
| Rate for Payer: Signature Care EPO |
$2,573.76
|
| Rate for Payer: Signature Care PPO |
$2,728.80
|
| Rate for Payer: United Healthcare Commercial |
$2,443.52
|
|
|
HC PLATELETPHERESIS LR CMV IRRAD
|
Facility
OP
|
$3,100.91
|
|
|
Service Code
|
CPT P9053
|
| Hospital Charge Code |
01379037
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$2,883.85 |
| Rate for Payer: Aetna Commercial |
$2,617.17
|
| Rate for Payer: Aetna Medicare |
$1,023.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,023.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,780.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,938.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,176.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,125.63
|
| Rate for Payer: Cash Price |
$1,922.57
|
| Rate for Payer: Cash Price |
$1,922.57
|
| Rate for Payer: Centivo All Commercial |
$1,581.47
|
| Rate for Payer: Cigna All Commercial |
$2,676.09
|
| Rate for Payer: CORVEL All Commercial |
$2,883.85
|
| Rate for Payer: Coventry All Commercial |
$2,728.80
|
| Rate for Payer: Encore All Commercial |
$2,854.39
|
| Rate for Payer: Frontpath All Commercial |
$2,852.84
|
| Rate for Payer: Humana ChoiceCare |
$2,678.26
|
| Rate for Payer: Humana Medicare |
$1,581.47
|
| Rate for Payer: Lucent All Commercial |
$1,581.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,790.82
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$2,325.68
|
| Rate for Payer: PHP All Commercial |
$2,351.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,209.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,393.90
|
| Rate for Payer: Signature Care EPO |
$2,573.76
|
| Rate for Payer: Signature Care PPO |
$2,728.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,635.78
|
| Rate for Payer: United Healthcare Commercial |
$2,443.52
|
| Rate for Payer: United Healthcare Medicare |
$1,023.30
|
|
|
HC PLATELETPHERESIS LR CMV NEG
|
Facility
OP
|
$3,313.41
|
|
|
Service Code
|
CPT P9055
|
| Hospital Charge Code |
01371008
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$3,081.47 |
| Rate for Payer: Aetna Commercial |
$2,796.52
|
| Rate for Payer: Aetna Medicare |
$1,093.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,093.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,071.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,257.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.77
|
| Rate for Payer: Cash Price |
$2,054.31
|
| Rate for Payer: Cash Price |
$2,054.31
|
| Rate for Payer: Centivo All Commercial |
$1,689.84
|
| Rate for Payer: Cigna All Commercial |
$2,859.47
|
| Rate for Payer: CORVEL All Commercial |
$3,081.47
|
| Rate for Payer: Coventry All Commercial |
$2,915.80
|
| Rate for Payer: Encore All Commercial |
$3,049.99
|
| Rate for Payer: Frontpath All Commercial |
$3,048.34
|
| Rate for Payer: Humana ChoiceCare |
$2,861.79
|
| Rate for Payer: Humana Medicare |
$1,689.84
|
| Rate for Payer: Lucent All Commercial |
$1,689.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,982.07
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$2,485.06
|
| Rate for Payer: PHP All Commercial |
$2,512.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,292.23
|
| Rate for Payer: Sagamore Health Network All Products |
$2,557.95
|
| Rate for Payer: Signature Care EPO |
$2,750.13
|
| Rate for Payer: Signature Care PPO |
$2,915.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,816.40
|
| Rate for Payer: United Healthcare Commercial |
$2,610.97
|
| Rate for Payer: United Healthcare Medicare |
$1,093.42
|
|
|
HC PLATELETPHERESIS LR CMV NEG
|
Facility
IP
|
$3,313.41
|
|
|
Service Code
|
CPT P9055
|
| Hospital Charge Code |
01371008
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,485.06 |
| Max. Negotiated Rate |
$3,081.47 |
| Rate for Payer: Aetna Commercial |
$2,862.79
|
| Rate for Payer: Cash Price |
$2,054.31
|
| Rate for Payer: Cigna All Commercial |
$2,859.47
|
| Rate for Payer: CORVEL All Commercial |
$3,081.47
|
| Rate for Payer: Coventry All Commercial |
$2,915.80
|
| Rate for Payer: Encore All Commercial |
$3,049.99
|
| Rate for Payer: Frontpath All Commercial |
$3,048.34
|
| Rate for Payer: Humana ChoiceCare |
$2,861.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,982.07
|
| Rate for Payer: PHCS All Commercial |
$2,485.06
|
| Rate for Payer: PHP All Commercial |
$2,512.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,557.95
|
| Rate for Payer: Signature Care EPO |
$2,750.13
|
| Rate for Payer: Signature Care PPO |
$2,915.80
|
| Rate for Payer: United Healthcare Commercial |
$2,610.97
|
|
|
HC PLATELETPHERESIS LR IRRAD
|
Facility
OP
|
$2,723.49
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
01371010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$2,532.85 |
| Rate for Payer: Aetna Commercial |
$2,298.63
|
| Rate for Payer: Aetna Medicare |
$898.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$898.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,564.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,702.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,033.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$988.63
|
| Rate for Payer: Cash Price |
$1,688.57
|
| Rate for Payer: Cash Price |
$1,688.57
|
| Rate for Payer: Centivo All Commercial |
$1,388.98
|
| Rate for Payer: Cigna All Commercial |
$2,350.37
|
| Rate for Payer: CORVEL All Commercial |
$2,532.85
|
| Rate for Payer: Coventry All Commercial |
$2,396.67
|
| Rate for Payer: Encore All Commercial |
$2,506.97
|
| Rate for Payer: Frontpath All Commercial |
$2,505.61
|
| Rate for Payer: Humana ChoiceCare |
$2,352.28
|
| Rate for Payer: Humana Medicare |
$1,388.98
|
| Rate for Payer: Lucent All Commercial |
$1,388.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,451.14
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$2,042.62
|
| Rate for Payer: PHP All Commercial |
$2,065.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,062.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2,102.54
|
| Rate for Payer: Signature Care EPO |
$2,260.50
|
| Rate for Payer: Signature Care PPO |
$2,396.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,314.97
|
| Rate for Payer: United Healthcare Commercial |
$2,146.11
|
| Rate for Payer: United Healthcare Medicare |
$898.75
|
|
|
HC PLATELETPHERESIS LR IRRAD
|
Facility
IP
|
$2,723.49
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
01371010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,042.62 |
| Max. Negotiated Rate |
$2,532.85 |
| Rate for Payer: Aetna Commercial |
$2,353.10
|
| Rate for Payer: Cash Price |
$1,688.57
|
| Rate for Payer: Cigna All Commercial |
$2,350.37
|
| Rate for Payer: CORVEL All Commercial |
$2,532.85
|
| Rate for Payer: Coventry All Commercial |
$2,396.67
|
| Rate for Payer: Encore All Commercial |
$2,506.97
|
| Rate for Payer: Frontpath All Commercial |
$2,505.61
|
| Rate for Payer: Humana ChoiceCare |
$2,352.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,451.14
|
| Rate for Payer: PHCS All Commercial |
$2,042.62
|
| Rate for Payer: PHP All Commercial |
$2,065.50
|
| Rate for Payer: Sagamore Health Network All Products |
$2,102.54
|
| Rate for Payer: Signature Care EPO |
$2,260.50
|
| Rate for Payer: Signature Care PPO |
$2,396.67
|
| Rate for Payer: United Healthcare Commercial |
$2,146.11
|
|
|
HC PLATE LP ST MTP LONG ACFS
|
Facility
OP
|
$3,544.20
|
|
| Hospital Charge Code |
41601274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC PLATE LP ST MTP LONG ACFS
|
Facility
IP
|
$3,544.20
|
|
| Hospital Charge Code |
41601274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC PLATE LP ST MTP SHT ACFS
|
Facility
IP
|
$3,544.20
|
|
| Hospital Charge Code |
41601275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC PLATE LP ST MTP SHT ACFS
|
Facility
OP
|
$3,544.20
|
|
| Hospital Charge Code |
41601275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC PLATE LP STRAIGHT 2.4MM X 4 HOLE
|
Facility
OP
|
$2,752.20
|
|
| Hospital Charge Code |
41601276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,322.86
|
| Rate for Payer: Aetna Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,580.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,720.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,044.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$999.05
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Centivo All Commercial |
$1,403.62
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Humana Medicare |
$1,403.62
|
| Rate for Payer: Lucent All Commercial |
$1,403.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,073.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,339.37
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
| Rate for Payer: United Healthcare Medicare |
$908.23
|
|
|
HC PLATE LP STRAIGHT 2.4MM X 4 HOLE
|
Facility
IP
|
$2,752.20
|
|
| Hospital Charge Code |
41601276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.15 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,377.90
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
|
|
HC PLATE LP STRAIGHT 2.4MM X 5 HOLE
|
Facility
IP
|
$2,752.20
|
|
| Hospital Charge Code |
41601277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.15 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,377.90
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
|
|
HC PLATE LP STRAIGHT 2.4MM X 5 HOLE
|
Facility
OP
|
$2,752.20
|
|
| Hospital Charge Code |
41601277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,322.86
|
| Rate for Payer: Aetna Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,580.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,720.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,044.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$999.05
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Centivo All Commercial |
$1,403.62
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Humana Medicare |
$1,403.62
|
| Rate for Payer: Lucent All Commercial |
$1,403.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,073.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,339.37
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
| Rate for Payer: United Healthcare Medicare |
$908.23
|
|
|
HC PLATE LP STRAIGHT 2.4MM X 6 HOLE
|
Facility
OP
|
$2,752.20
|
|
| Hospital Charge Code |
41601278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,322.86
|
| Rate for Payer: Aetna Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,580.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,720.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,044.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$999.05
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Centivo All Commercial |
$1,403.62
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Humana Medicare |
$1,403.62
|
| Rate for Payer: Lucent All Commercial |
$1,403.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,073.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,339.37
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
| Rate for Payer: United Healthcare Medicare |
$908.23
|
|
|
HC PLATE LP STRAIGHT 2.4MM X 6 HOLE
|
Facility
IP
|
$2,752.20
|
|
| Hospital Charge Code |
41601278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.15 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,377.90
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
|
