|
HC SYSTEM SUCTION DRAINAGE 500ML
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
41607735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
|
|
HC SYSTEM SUCTION DRAINAGE 500ML
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
41607735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$177.24
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.92
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Centivo All Commercial |
$114.24
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Humana Medicare |
$67.20
|
| Rate for Payer: Lucent All Commercial |
$114.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.90
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
| Rate for Payer: United Healthcare Medicare |
$67.20
|
|
|
HC T3 FREE
|
Facility
|
IP
|
$180.62
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
63001701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.47 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Cash Price |
$108.37
|
| Rate for Payer: Cigna All Commercial |
$155.88
|
| Rate for Payer: CORVEL All Commercial |
$167.98
|
| Rate for Payer: Coventry All Commercial |
$158.95
|
| Rate for Payer: Encore All Commercial |
$166.26
|
| Rate for Payer: Frontpath All Commercial |
$166.17
|
| Rate for Payer: Humana ChoiceCare |
$156.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.56
|
| Rate for Payer: PHCS All Commercial |
$135.47
|
| Rate for Payer: PHP All Commercial |
$136.98
|
| Rate for Payer: Sagamore Health Network All Products |
$139.44
|
| Rate for Payer: Signature Care EPO |
$149.91
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: United Healthcare Commercial |
$142.33
|
|
|
HC T3 FREE
|
Facility
|
OP
|
$180.62
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
63001701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$152.44
|
| Rate for Payer: Aetna Medicare |
$57.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.58
|
| Rate for Payer: Cash Price |
$108.37
|
| Rate for Payer: Cash Price |
$108.37
|
| Rate for Payer: Centivo All Commercial |
$98.26
|
| Rate for Payer: Cigna All Commercial |
$155.88
|
| Rate for Payer: CORVEL All Commercial |
$167.98
|
| Rate for Payer: Coventry All Commercial |
$158.95
|
| Rate for Payer: Encore All Commercial |
$166.26
|
| Rate for Payer: Frontpath All Commercial |
$166.17
|
| Rate for Payer: Humana ChoiceCare |
$156.00
|
| Rate for Payer: Humana Medicare |
$57.80
|
| Rate for Payer: Lucent All Commercial |
$98.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.56
|
| Rate for Payer: Managed Health Services Medicaid |
$16.94
|
| Rate for Payer: MDWise Medicaid |
$16.94
|
| Rate for Payer: PHCS All Commercial |
$135.47
|
| Rate for Payer: PHP All Commercial |
$136.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.44
|
| Rate for Payer: Sagamore Health Network All Products |
$139.44
|
| Rate for Payer: Signature Care EPO |
$149.91
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153.53
|
| Rate for Payer: United Healthcare Commercial |
$142.33
|
| Rate for Payer: United Healthcare Medicare |
$57.80
|
|
|
HC T3 REVERSE
|
Facility
|
IP
|
$216.74
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
63001702
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$201.57 |
| Rate for Payer: Aetna Commercial |
$187.26
|
| Rate for Payer: Cash Price |
$130.04
|
| Rate for Payer: Cigna All Commercial |
$187.05
|
| Rate for Payer: CORVEL All Commercial |
$201.57
|
| Rate for Payer: Coventry All Commercial |
$190.73
|
| Rate for Payer: Encore All Commercial |
$199.51
|
| Rate for Payer: Frontpath All Commercial |
$199.40
|
| Rate for Payer: Humana ChoiceCare |
$187.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.07
|
| Rate for Payer: PHCS All Commercial |
$162.56
|
| Rate for Payer: PHP All Commercial |
$164.38
|
| Rate for Payer: Sagamore Health Network All Products |
$167.32
|
| Rate for Payer: Signature Care EPO |
$179.89
|
| Rate for Payer: Signature Care PPO |
$190.73
|
| Rate for Payer: United Healthcare Commercial |
$170.79
|
|
|
HC T3 REVERSE
|
Facility
|
OP
|
$216.74
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
63001702
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$201.57 |
| Rate for Payer: Aetna Commercial |
$182.93
|
| Rate for Payer: Aetna Medicare |
$69.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.29
|
| Rate for Payer: Cash Price |
$130.04
|
| Rate for Payer: Cash Price |
$130.04
|
| Rate for Payer: Centivo All Commercial |
$117.91
|
| Rate for Payer: Cigna All Commercial |
$187.05
|
| Rate for Payer: CORVEL All Commercial |
$201.57
|
| Rate for Payer: Coventry All Commercial |
$190.73
|
| Rate for Payer: Encore All Commercial |
$199.51
|
| Rate for Payer: Frontpath All Commercial |
$199.40
|
| Rate for Payer: Humana ChoiceCare |
$187.20
|
| Rate for Payer: Humana Medicare |
$69.36
|
| Rate for Payer: Lucent All Commercial |
$117.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.07
|
| Rate for Payer: Managed Health Services Medicaid |
$15.76
|
| Rate for Payer: MDWise Medicaid |
$15.76
|
| Rate for Payer: PHCS All Commercial |
$162.56
|
| Rate for Payer: PHP All Commercial |
$164.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.53
|
| Rate for Payer: Sagamore Health Network All Products |
$167.32
|
| Rate for Payer: Signature Care EPO |
$179.89
|
| Rate for Payer: Signature Care PPO |
$190.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$184.23
|
| Rate for Payer: United Healthcare Commercial |
$170.79
|
| Rate for Payer: United Healthcare Medicare |
$69.36
|
|
|
HC T3 TOTAL(TT3)
|
Facility
|
IP
|
$204.50
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
63001324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.38 |
| Max. Negotiated Rate |
$190.19 |
| Rate for Payer: Aetna Commercial |
$176.69
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna All Commercial |
$176.48
|
| Rate for Payer: CORVEL All Commercial |
$190.19
|
| Rate for Payer: Coventry All Commercial |
$179.96
|
| Rate for Payer: Encore All Commercial |
$188.24
|
| Rate for Payer: Frontpath All Commercial |
$188.14
|
| Rate for Payer: Humana ChoiceCare |
$176.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.05
|
| Rate for Payer: PHCS All Commercial |
$153.38
|
| Rate for Payer: PHP All Commercial |
$155.09
|
| Rate for Payer: Sagamore Health Network All Products |
$157.87
|
| Rate for Payer: Signature Care EPO |
$169.74
|
| Rate for Payer: Signature Care PPO |
$179.96
|
| Rate for Payer: United Healthcare Commercial |
$161.15
|
|
|
HC T3 TOTAL(TT3)
|
Facility
|
OP
|
$204.50
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
63001324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$190.19 |
| Rate for Payer: Aetna Commercial |
$172.60
|
| Rate for Payer: Aetna Medicare |
$65.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$93.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.98
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Centivo All Commercial |
$111.25
|
| Rate for Payer: Cigna All Commercial |
$176.48
|
| Rate for Payer: CORVEL All Commercial |
$190.19
|
| Rate for Payer: Coventry All Commercial |
$179.96
|
| Rate for Payer: Encore All Commercial |
$188.24
|
| Rate for Payer: Frontpath All Commercial |
$188.14
|
| Rate for Payer: Humana ChoiceCare |
$176.63
|
| Rate for Payer: Humana Medicare |
$65.44
|
| Rate for Payer: Lucent All Commercial |
$111.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.05
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: MDWise Medicaid |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$153.38
|
| Rate for Payer: PHP All Commercial |
$155.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.75
|
| Rate for Payer: Sagamore Health Network All Products |
$157.87
|
| Rate for Payer: Signature Care EPO |
$169.74
|
| Rate for Payer: Signature Care PPO |
$179.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.82
|
| Rate for Payer: United Healthcare Commercial |
$161.15
|
| Rate for Payer: United Healthcare Medicare |
$65.44
|
|
|
HC T3 UPTAKE
|
Facility
|
OP
|
$254.69
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
63001299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$236.86 |
| Rate for Payer: Aetna Commercial |
$214.96
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.65
|
| Rate for Payer: Cash Price |
$152.81
|
| Rate for Payer: Cash Price |
$152.81
|
| Rate for Payer: Centivo All Commercial |
$138.55
|
| Rate for Payer: Cigna All Commercial |
$219.80
|
| Rate for Payer: CORVEL All Commercial |
$236.86
|
| Rate for Payer: Coventry All Commercial |
$224.13
|
| Rate for Payer: Encore All Commercial |
$234.44
|
| Rate for Payer: Frontpath All Commercial |
$234.31
|
| Rate for Payer: Humana ChoiceCare |
$219.98
|
| Rate for Payer: Humana Medicare |
$81.50
|
| Rate for Payer: Lucent All Commercial |
$138.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.22
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$191.02
|
| Rate for Payer: PHP All Commercial |
$193.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.33
|
| Rate for Payer: Sagamore Health Network All Products |
$196.62
|
| Rate for Payer: Signature Care EPO |
$211.39
|
| Rate for Payer: Signature Care PPO |
$224.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.49
|
| Rate for Payer: United Healthcare Commercial |
$200.70
|
| Rate for Payer: United Healthcare Medicare |
$81.50
|
|
|
HC T3 UPTAKE
|
Facility
|
IP
|
$254.69
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
63001299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.02 |
| Max. Negotiated Rate |
$236.86 |
| Rate for Payer: Aetna Commercial |
$220.05
|
| Rate for Payer: Cash Price |
$152.81
|
| Rate for Payer: Cigna All Commercial |
$219.80
|
| Rate for Payer: CORVEL All Commercial |
$236.86
|
| Rate for Payer: Coventry All Commercial |
$224.13
|
| Rate for Payer: Encore All Commercial |
$234.44
|
| Rate for Payer: Frontpath All Commercial |
$234.31
|
| Rate for Payer: Humana ChoiceCare |
$219.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.22
|
| Rate for Payer: PHCS All Commercial |
$191.02
|
| Rate for Payer: PHP All Commercial |
$193.16
|
| Rate for Payer: Sagamore Health Network All Products |
$196.62
|
| Rate for Payer: Signature Care EPO |
$211.39
|
| Rate for Payer: Signature Care PPO |
$224.13
|
| Rate for Payer: United Healthcare Commercial |
$200.70
|
|
|
HC T4
|
Facility
|
IP
|
$79.76
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
63001311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Aetna Commercial |
$68.91
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cigna All Commercial |
$68.83
|
| Rate for Payer: CORVEL All Commercial |
$74.18
|
| Rate for Payer: Coventry All Commercial |
$70.19
|
| Rate for Payer: Encore All Commercial |
$73.42
|
| Rate for Payer: Frontpath All Commercial |
$73.38
|
| Rate for Payer: Humana ChoiceCare |
$68.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.78
|
| Rate for Payer: PHCS All Commercial |
$59.82
|
| Rate for Payer: PHP All Commercial |
$60.49
|
| Rate for Payer: Sagamore Health Network All Products |
$61.57
|
| Rate for Payer: Signature Care EPO |
$66.20
|
| Rate for Payer: Signature Care PPO |
$70.19
|
| Rate for Payer: United Healthcare Commercial |
$62.85
|
|
|
HC T4
|
Facility
|
OP
|
$79.76
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
63001311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Aetna Commercial |
$67.32
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.08
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Centivo All Commercial |
$43.39
|
| Rate for Payer: Cigna All Commercial |
$68.83
|
| Rate for Payer: CORVEL All Commercial |
$74.18
|
| Rate for Payer: Coventry All Commercial |
$70.19
|
| Rate for Payer: Encore All Commercial |
$73.42
|
| Rate for Payer: Frontpath All Commercial |
$73.38
|
| Rate for Payer: Humana ChoiceCare |
$68.89
|
| Rate for Payer: Humana Medicare |
$25.52
|
| Rate for Payer: Lucent All Commercial |
$43.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.87
|
| Rate for Payer: MDWise Medicaid |
$6.87
|
| Rate for Payer: PHCS All Commercial |
$59.82
|
| Rate for Payer: PHP All Commercial |
$60.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.11
|
| Rate for Payer: Sagamore Health Network All Products |
$61.57
|
| Rate for Payer: Signature Care EPO |
$66.20
|
| Rate for Payer: Signature Care PPO |
$70.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.80
|
| Rate for Payer: United Healthcare Commercial |
$62.85
|
| Rate for Payer: United Healthcare Medicare |
$25.52
|
|
|
HC T4, FREE, ED/HPLC
|
Facility
|
IP
|
$123.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.44 |
| Max. Negotiated Rate |
$114.63 |
| Rate for Payer: Aetna Commercial |
$106.50
|
| Rate for Payer: Cash Price |
$73.96
|
| Rate for Payer: Cigna All Commercial |
$106.37
|
| Rate for Payer: CORVEL All Commercial |
$114.63
|
| Rate for Payer: Coventry All Commercial |
$108.47
|
| Rate for Payer: Encore All Commercial |
$113.46
|
| Rate for Payer: Frontpath All Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$106.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.93
|
| Rate for Payer: PHCS All Commercial |
$92.44
|
| Rate for Payer: PHP All Commercial |
$93.48
|
| Rate for Payer: Sagamore Health Network All Products |
$95.16
|
| Rate for Payer: Signature Care EPO |
$102.31
|
| Rate for Payer: Signature Care PPO |
$108.47
|
| Rate for Payer: United Healthcare Commercial |
$97.13
|
|
|
HC T4, FREE, ED/HPLC
|
Facility
|
OP
|
$123.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$114.63 |
| Rate for Payer: Aetna Commercial |
$104.03
|
| Rate for Payer: Aetna Medicare |
$39.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.39
|
| Rate for Payer: Cash Price |
$73.96
|
| Rate for Payer: Cash Price |
$73.96
|
| Rate for Payer: Centivo All Commercial |
$67.05
|
| Rate for Payer: Cigna All Commercial |
$106.37
|
| Rate for Payer: CORVEL All Commercial |
$114.63
|
| Rate for Payer: Coventry All Commercial |
$108.47
|
| Rate for Payer: Encore All Commercial |
$113.46
|
| Rate for Payer: Frontpath All Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$106.46
|
| Rate for Payer: Humana Medicare |
$39.44
|
| Rate for Payer: Lucent All Commercial |
$67.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.93
|
| Rate for Payer: Managed Health Services Medicaid |
$9.02
|
| Rate for Payer: MDWise Medicaid |
$9.02
|
| Rate for Payer: PHCS All Commercial |
$92.44
|
| Rate for Payer: PHP All Commercial |
$93.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.07
|
| Rate for Payer: Sagamore Health Network All Products |
$95.16
|
| Rate for Payer: Signature Care EPO |
$102.31
|
| Rate for Payer: Signature Care PPO |
$108.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.77
|
| Rate for Payer: United Healthcare Commercial |
$97.13
|
| Rate for Payer: United Healthcare Medicare |
$39.44
|
|
|
HC TACROLIMUS
|
Facility
|
OP
|
$293.96
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
63001115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$273.38 |
| Rate for Payer: Aetna Commercial |
$248.10
|
| Rate for Payer: Aetna Medicare |
$94.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.47
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Centivo All Commercial |
$159.91
|
| Rate for Payer: Cigna All Commercial |
$253.69
|
| Rate for Payer: CORVEL All Commercial |
$273.38
|
| Rate for Payer: Coventry All Commercial |
$258.68
|
| Rate for Payer: Encore All Commercial |
$270.59
|
| Rate for Payer: Frontpath All Commercial |
$270.44
|
| Rate for Payer: Humana ChoiceCare |
$253.89
|
| Rate for Payer: Humana Medicare |
$94.07
|
| Rate for Payer: Lucent All Commercial |
$159.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.56
|
| Rate for Payer: Managed Health Services Medicaid |
$13.73
|
| Rate for Payer: MDWise Medicaid |
$13.73
|
| Rate for Payer: PHCS All Commercial |
$220.47
|
| Rate for Payer: PHP All Commercial |
$222.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.64
|
| Rate for Payer: Sagamore Health Network All Products |
$226.94
|
| Rate for Payer: Signature Care EPO |
$243.99
|
| Rate for Payer: Signature Care PPO |
$258.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$249.87
|
| Rate for Payer: United Healthcare Commercial |
$231.64
|
| Rate for Payer: United Healthcare Medicare |
$94.07
|
|
|
HC TACROLIMUS
|
Facility
|
IP
|
$293.96
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
63001115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$220.47 |
| Max. Negotiated Rate |
$273.38 |
| Rate for Payer: Aetna Commercial |
$253.98
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cigna All Commercial |
$253.69
|
| Rate for Payer: CORVEL All Commercial |
$273.38
|
| Rate for Payer: Coventry All Commercial |
$258.68
|
| Rate for Payer: Encore All Commercial |
$270.59
|
| Rate for Payer: Frontpath All Commercial |
$270.44
|
| Rate for Payer: Humana ChoiceCare |
$253.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.56
|
| Rate for Payer: PHCS All Commercial |
$220.47
|
| Rate for Payer: PHP All Commercial |
$222.94
|
| Rate for Payer: Sagamore Health Network All Products |
$226.94
|
| Rate for Payer: Signature Care EPO |
$243.99
|
| Rate for Payer: Signature Care PPO |
$258.68
|
| Rate for Payer: United Healthcare Commercial |
$231.64
|
|
|
HC TALON GRASPING DEVICE
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
41601223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$885.36 |
| Rate for Payer: Aetna Commercial |
$803.49
|
| Rate for Payer: Aetna Medicare |
$304.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$295.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$546.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$595.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.10
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Centivo All Commercial |
$517.89
|
| Rate for Payer: Cigna All Commercial |
$821.58
|
| Rate for Payer: CORVEL All Commercial |
$885.36
|
| Rate for Payer: Coventry All Commercial |
$837.76
|
| Rate for Payer: Encore All Commercial |
$876.32
|
| Rate for Payer: Frontpath All Commercial |
$875.84
|
| Rate for Payer: Humana ChoiceCare |
$822.24
|
| Rate for Payer: Humana Medicare |
$304.64
|
| Rate for Payer: Lucent All Commercial |
$517.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$856.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$714.00
|
| Rate for Payer: PHP All Commercial |
$722.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$371.28
|
| Rate for Payer: Sagamore Health Network All Products |
$734.94
|
| Rate for Payer: Signature Care EPO |
$790.16
|
| Rate for Payer: Signature Care PPO |
$837.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$809.20
|
| Rate for Payer: United Healthcare Commercial |
$750.18
|
| Rate for Payer: United Healthcare Medicare |
$304.64
|
|
|
HC TALON GRASPING DEVICE
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
41601223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$885.36 |
| Rate for Payer: Aetna Commercial |
$822.53
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna All Commercial |
$821.58
|
| Rate for Payer: CORVEL All Commercial |
$885.36
|
| Rate for Payer: Coventry All Commercial |
$837.76
|
| Rate for Payer: Encore All Commercial |
$876.32
|
| Rate for Payer: Frontpath All Commercial |
$875.84
|
| Rate for Payer: Humana ChoiceCare |
$822.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$856.80
|
| Rate for Payer: PHCS All Commercial |
$714.00
|
| Rate for Payer: PHP All Commercial |
$722.00
|
| Rate for Payer: Sagamore Health Network All Products |
$734.94
|
| Rate for Payer: Signature Care EPO |
$790.16
|
| Rate for Payer: Signature Care PPO |
$837.76
|
| Rate for Payer: United Healthcare Commercial |
$750.18
|
|
|
HC T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
OP
|
$53.55
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
63087812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$46.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$46.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.85
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Centivo All Commercial |
$29.13
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Lucent All Commercial |
$29.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$46.98
|
| Rate for Payer: MDWise Medicaid |
$46.98
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.14
|
|
|
HC T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
IP
|
$53.55
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
63087812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC T CELLS TOTAL COUNT
|
Facility
|
OP
|
$53.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
63087811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$37.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.85
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Centivo All Commercial |
$29.13
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Lucent All Commercial |
$29.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$37.73
|
| Rate for Payer: MDWise Medicaid |
$37.73
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.14
|
|
|
HC T CELLS TOTAL COUNT
|
Facility
|
IP
|
$53.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
63087811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC TEGRETOL
|
Facility
|
IP
|
$259.18
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
63001314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$223.93
|
| Rate for Payer: Cash Price |
$155.51
|
| Rate for Payer: Cigna All Commercial |
$223.67
|
| Rate for Payer: CORVEL All Commercial |
$241.04
|
| Rate for Payer: Coventry All Commercial |
$228.08
|
| Rate for Payer: Encore All Commercial |
$238.58
|
| Rate for Payer: Frontpath All Commercial |
$238.45
|
| Rate for Payer: Humana ChoiceCare |
$223.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.26
|
| Rate for Payer: PHCS All Commercial |
$194.38
|
| Rate for Payer: PHP All Commercial |
$196.56
|
| Rate for Payer: Sagamore Health Network All Products |
$200.09
|
| Rate for Payer: Signature Care EPO |
$215.12
|
| Rate for Payer: Signature Care PPO |
$228.08
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
|
|
HC TEGRETOL
|
Facility
|
OP
|
$259.18
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
63001314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$218.75
|
| Rate for Payer: Aetna Medicare |
$82.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$119.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.23
|
| Rate for Payer: Cash Price |
$155.51
|
| Rate for Payer: Cash Price |
$155.51
|
| Rate for Payer: Centivo All Commercial |
$140.99
|
| Rate for Payer: Cigna All Commercial |
$223.67
|
| Rate for Payer: CORVEL All Commercial |
$241.04
|
| Rate for Payer: Coventry All Commercial |
$228.08
|
| Rate for Payer: Encore All Commercial |
$238.58
|
| Rate for Payer: Frontpath All Commercial |
$238.45
|
| Rate for Payer: Humana ChoiceCare |
$223.85
|
| Rate for Payer: Humana Medicare |
$82.94
|
| Rate for Payer: Lucent All Commercial |
$140.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.26
|
| Rate for Payer: Managed Health Services Medicaid |
$14.57
|
| Rate for Payer: MDWise Medicaid |
$14.57
|
| Rate for Payer: PHCS All Commercial |
$194.38
|
| Rate for Payer: PHP All Commercial |
$196.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.08
|
| Rate for Payer: Sagamore Health Network All Products |
$200.09
|
| Rate for Payer: Signature Care EPO |
$215.12
|
| Rate for Payer: Signature Care PPO |
$228.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.30
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
| Rate for Payer: United Healthcare Medicare |
$82.94
|
|
|
HC TELEMETRY MONITORING PER DAY
|
Facility
|
IP
|
$254.59
|
|
| Hospital Charge Code |
1950195
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$190.94 |
| Max. Negotiated Rate |
$236.77 |
| Rate for Payer: Aetna Commercial |
$219.97
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Cigna All Commercial |
$219.71
|
| Rate for Payer: CORVEL All Commercial |
$236.77
|
| Rate for Payer: Coventry All Commercial |
$224.04
|
| Rate for Payer: Encore All Commercial |
$234.35
|
| Rate for Payer: Frontpath All Commercial |
$234.22
|
| Rate for Payer: Humana ChoiceCare |
$219.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.13
|
| Rate for Payer: PHCS All Commercial |
$190.94
|
| Rate for Payer: PHP All Commercial |
$193.08
|
| Rate for Payer: Sagamore Health Network All Products |
$196.54
|
| Rate for Payer: Signature Care EPO |
$211.31
|
| Rate for Payer: Signature Care PPO |
$224.04
|
| Rate for Payer: United Healthcare Commercial |
$200.62
|
|
