|
HC TRANSCUTANEOUS BILIRUBIN
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
1028400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC TRANSESOPHAGEAL ECHO
|
Facility
|
OP
|
$2,378.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
1643312
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$443.28 |
| Max. Negotiated Rate |
$2,211.54 |
| Rate for Payer: Aetna Commercial |
$2,007.03
|
| Rate for Payer: Aetna Medicare |
$760.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$443.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$737.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,365.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,486.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$443.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$875.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$837.06
|
| Rate for Payer: Cash Price |
$1,426.80
|
| Rate for Payer: Cash Price |
$1,426.80
|
| Rate for Payer: Centivo All Commercial |
$1,293.63
|
| Rate for Payer: Cigna All Commercial |
$2,052.21
|
| Rate for Payer: CORVEL All Commercial |
$2,211.54
|
| Rate for Payer: Coventry All Commercial |
$2,092.64
|
| Rate for Payer: Encore All Commercial |
$2,188.95
|
| Rate for Payer: Frontpath All Commercial |
$2,187.76
|
| Rate for Payer: Humana ChoiceCare |
$2,053.88
|
| Rate for Payer: Humana Medicare |
$760.96
|
| Rate for Payer: Lucent All Commercial |
$1,293.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,140.20
|
| Rate for Payer: Managed Health Services Medicaid |
$443.28
|
| Rate for Payer: MDWise Medicaid |
$443.28
|
| Rate for Payer: PHCS All Commercial |
$1,783.50
|
| Rate for Payer: PHP All Commercial |
$1,803.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$927.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,835.82
|
| Rate for Payer: Signature Care EPO |
$1,973.74
|
| Rate for Payer: Signature Care PPO |
$2,092.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,021.30
|
| Rate for Payer: United Healthcare Commercial |
$1,873.86
|
| Rate for Payer: United Healthcare Medicare |
$760.96
|
|
|
HC TRANSESOPHAGEAL ECHO
|
Facility
|
IP
|
$2,378.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
1643312
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,783.50 |
| Max. Negotiated Rate |
$2,211.54 |
| Rate for Payer: Aetna Commercial |
$2,054.59
|
| Rate for Payer: Cash Price |
$1,426.80
|
| Rate for Payer: Cigna All Commercial |
$2,052.21
|
| Rate for Payer: CORVEL All Commercial |
$2,211.54
|
| Rate for Payer: Coventry All Commercial |
$2,092.64
|
| Rate for Payer: Encore All Commercial |
$2,188.95
|
| Rate for Payer: Frontpath All Commercial |
$2,187.76
|
| Rate for Payer: Humana ChoiceCare |
$2,053.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,140.20
|
| Rate for Payer: PHCS All Commercial |
$1,783.50
|
| Rate for Payer: PHP All Commercial |
$1,803.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,835.82
|
| Rate for Payer: Signature Care EPO |
$1,973.74
|
| Rate for Payer: Signature Care PPO |
$2,092.64
|
| Rate for Payer: United Healthcare Commercial |
$1,873.86
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$211.97
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
63001162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$178.90
|
| Rate for Payer: Aetna Medicare |
$67.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.61
|
| Rate for Payer: Cash Price |
$127.18
|
| Rate for Payer: Cash Price |
$127.18
|
| Rate for Payer: Centivo All Commercial |
$115.31
|
| Rate for Payer: Cigna All Commercial |
$182.93
|
| Rate for Payer: CORVEL All Commercial |
$197.13
|
| Rate for Payer: Coventry All Commercial |
$186.53
|
| Rate for Payer: Encore All Commercial |
$195.12
|
| Rate for Payer: Frontpath All Commercial |
$195.01
|
| Rate for Payer: Humana ChoiceCare |
$183.08
|
| Rate for Payer: Humana Medicare |
$67.83
|
| Rate for Payer: Lucent All Commercial |
$115.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.77
|
| Rate for Payer: Managed Health Services Medicaid |
$12.76
|
| Rate for Payer: MDWise Medicaid |
$12.76
|
| Rate for Payer: PHCS All Commercial |
$158.98
|
| Rate for Payer: PHP All Commercial |
$160.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.67
|
| Rate for Payer: Sagamore Health Network All Products |
$163.64
|
| Rate for Payer: Signature Care EPO |
$175.94
|
| Rate for Payer: Signature Care PPO |
$186.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.17
|
| Rate for Payer: United Healthcare Commercial |
$167.03
|
| Rate for Payer: United Healthcare Medicare |
$67.83
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$211.97
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
63001162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.98 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$183.14
|
| Rate for Payer: Cash Price |
$127.18
|
| Rate for Payer: Cigna All Commercial |
$182.93
|
| Rate for Payer: CORVEL All Commercial |
$197.13
|
| Rate for Payer: Coventry All Commercial |
$186.53
|
| Rate for Payer: Encore All Commercial |
$195.12
|
| Rate for Payer: Frontpath All Commercial |
$195.01
|
| Rate for Payer: Humana ChoiceCare |
$183.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.77
|
| Rate for Payer: PHCS All Commercial |
$158.98
|
| Rate for Payer: PHP All Commercial |
$160.76
|
| Rate for Payer: Sagamore Health Network All Products |
$163.64
|
| Rate for Payer: Signature Care EPO |
$175.94
|
| Rate for Payer: Signature Care PPO |
$186.53
|
| Rate for Payer: United Healthcare Commercial |
$167.03
|
|
|
HC TRANSTIBIAL ACL DISP. KIT
|
Facility
|
IP
|
$1,237.50
|
|
| Hospital Charge Code |
41602389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.12 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
|
|
HC TRANSTIBIAL ACL DISP. KIT
|
Facility
|
OP
|
$1,237.50
|
|
| Hospital Charge Code |
41602389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,044.45
|
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$383.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$710.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$773.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.60
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Centivo All Commercial |
$673.20
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Humana Medicare |
$396.00
|
| Rate for Payer: Lucent All Commercial |
$673.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$482.62
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,051.88
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
|
|
HC TRAP POLYP
|
Facility
|
IP
|
$63.45
|
|
| Hospital Charge Code |
41602060
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$59.01 |
| Rate for Payer: Aetna Commercial |
$54.82
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cigna All Commercial |
$54.76
|
| Rate for Payer: CORVEL All Commercial |
$59.01
|
| Rate for Payer: Coventry All Commercial |
$55.84
|
| Rate for Payer: Encore All Commercial |
$58.41
|
| Rate for Payer: Frontpath All Commercial |
$58.37
|
| Rate for Payer: Humana ChoiceCare |
$54.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.10
|
| Rate for Payer: PHCS All Commercial |
$47.59
|
| Rate for Payer: PHP All Commercial |
$48.12
|
| Rate for Payer: Sagamore Health Network All Products |
$48.98
|
| Rate for Payer: Signature Care EPO |
$52.66
|
| Rate for Payer: Signature Care PPO |
$55.84
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
HC TRAP POLYP
|
Facility
|
OP
|
$63.45
|
|
| Hospital Charge Code |
41602060
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$59.01 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.33
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Centivo All Commercial |
$34.52
|
| Rate for Payer: Cigna All Commercial |
$54.76
|
| Rate for Payer: CORVEL All Commercial |
$59.01
|
| Rate for Payer: Coventry All Commercial |
$55.84
|
| Rate for Payer: Encore All Commercial |
$58.41
|
| Rate for Payer: Frontpath All Commercial |
$58.37
|
| Rate for Payer: Humana ChoiceCare |
$54.80
|
| Rate for Payer: Humana Medicare |
$20.30
|
| Rate for Payer: Lucent All Commercial |
$34.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.10
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$47.59
|
| Rate for Payer: PHP All Commercial |
$48.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.75
|
| Rate for Payer: Sagamore Health Network All Products |
$48.98
|
| Rate for Payer: Signature Care EPO |
$52.66
|
| Rate for Payer: Signature Care PPO |
$55.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.93
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
|
|
HC TRAY ADULT LUMBAR PUNCTURE
|
Facility
|
IP
|
$143.99
|
|
| Hospital Charge Code |
41607852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$133.91 |
| Rate for Payer: Aetna Commercial |
$124.41
|
| Rate for Payer: Cash Price |
$86.39
|
| Rate for Payer: Cigna All Commercial |
$124.26
|
| Rate for Payer: CORVEL All Commercial |
$133.91
|
| Rate for Payer: Coventry All Commercial |
$126.71
|
| Rate for Payer: Encore All Commercial |
$132.54
|
| Rate for Payer: Frontpath All Commercial |
$132.47
|
| Rate for Payer: Humana ChoiceCare |
$124.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.59
|
| Rate for Payer: PHCS All Commercial |
$107.99
|
| Rate for Payer: PHP All Commercial |
$109.20
|
| Rate for Payer: Sagamore Health Network All Products |
$111.16
|
| Rate for Payer: Signature Care EPO |
$119.51
|
| Rate for Payer: Signature Care PPO |
$126.71
|
| Rate for Payer: United Healthcare Commercial |
$113.46
|
|
|
HC TRAY ADULT LUMBAR PUNCTURE
|
Facility
|
OP
|
$143.99
|
|
| Hospital Charge Code |
41607852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$133.91 |
| Rate for Payer: Aetna Commercial |
$121.53
|
| Rate for Payer: Aetna Medicare |
$46.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.68
|
| Rate for Payer: Cash Price |
$86.39
|
| Rate for Payer: Cash Price |
$86.39
|
| Rate for Payer: Centivo All Commercial |
$78.33
|
| Rate for Payer: Cigna All Commercial |
$124.26
|
| Rate for Payer: CORVEL All Commercial |
$133.91
|
| Rate for Payer: Coventry All Commercial |
$126.71
|
| Rate for Payer: Encore All Commercial |
$132.54
|
| Rate for Payer: Frontpath All Commercial |
$132.47
|
| Rate for Payer: Humana ChoiceCare |
$124.36
|
| Rate for Payer: Humana Medicare |
$46.08
|
| Rate for Payer: Lucent All Commercial |
$78.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.59
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$107.99
|
| Rate for Payer: PHP All Commercial |
$109.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.16
|
| Rate for Payer: Sagamore Health Network All Products |
$111.16
|
| Rate for Payer: Signature Care EPO |
$119.51
|
| Rate for Payer: Signature Care PPO |
$126.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.39
|
| Rate for Payer: United Healthcare Commercial |
$113.46
|
| Rate for Payer: United Healthcare Medicare |
$46.08
|
|
|
HC TRAY DRESSING CHANGE CENTRAL L
|
Facility
|
OP
|
$117.72
|
|
| Hospital Charge Code |
41607590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna Medicare |
$37.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.44
|
| Rate for Payer: Cash Price |
$70.63
|
| Rate for Payer: Cash Price |
$70.63
|
| Rate for Payer: Centivo All Commercial |
$64.04
|
| Rate for Payer: Cigna All Commercial |
$101.59
|
| Rate for Payer: CORVEL All Commercial |
$109.48
|
| Rate for Payer: Coventry All Commercial |
$103.59
|
| Rate for Payer: Encore All Commercial |
$108.36
|
| Rate for Payer: Frontpath All Commercial |
$108.30
|
| Rate for Payer: Humana ChoiceCare |
$101.67
|
| Rate for Payer: Humana Medicare |
$37.67
|
| Rate for Payer: Lucent All Commercial |
$64.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.95
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$88.29
|
| Rate for Payer: PHP All Commercial |
$89.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.91
|
| Rate for Payer: Sagamore Health Network All Products |
$90.88
|
| Rate for Payer: Signature Care EPO |
$97.71
|
| Rate for Payer: Signature Care PPO |
$103.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.06
|
| Rate for Payer: United Healthcare Commercial |
$92.76
|
| Rate for Payer: United Healthcare Medicare |
$37.67
|
|
|
HC TRAY DRESSING CHANGE CENTRAL L
|
Facility
|
IP
|
$117.72
|
|
| Hospital Charge Code |
41607590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.29 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$101.71
|
| Rate for Payer: Cash Price |
$70.63
|
| Rate for Payer: Cigna All Commercial |
$101.59
|
| Rate for Payer: CORVEL All Commercial |
$109.48
|
| Rate for Payer: Coventry All Commercial |
$103.59
|
| Rate for Payer: Encore All Commercial |
$108.36
|
| Rate for Payer: Frontpath All Commercial |
$108.30
|
| Rate for Payer: Humana ChoiceCare |
$101.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.95
|
| Rate for Payer: PHCS All Commercial |
$88.29
|
| Rate for Payer: PHP All Commercial |
$89.28
|
| Rate for Payer: Sagamore Health Network All Products |
$90.88
|
| Rate for Payer: Signature Care EPO |
$97.71
|
| Rate for Payer: Signature Care PPO |
$103.59
|
| Rate for Payer: United Healthcare Commercial |
$92.76
|
|
|
HC TRAY PORT ACCESSING
|
Facility
|
IP
|
$194.22
|
|
| Hospital Charge Code |
41607683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.66 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: United Healthcare Commercial |
$153.05
|
|
|
HC TRAY PORT ACCESSING
|
Facility
|
OP
|
$194.22
|
|
| Hospital Charge Code |
41607683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$62.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.37
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Centivo All Commercial |
$105.66
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Humana Medicare |
$62.15
|
| Rate for Payer: Lucent All Commercial |
$105.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.09
|
| Rate for Payer: United Healthcare Commercial |
$153.05
|
| Rate for Payer: United Healthcare Medicare |
$62.15
|
|
|
HC TRAY SPINAL PENCAN
|
Facility
|
IP
|
$117.92
|
|
| Hospital Charge Code |
41601184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$101.88
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna All Commercial |
$101.76
|
| Rate for Payer: CORVEL All Commercial |
$109.67
|
| Rate for Payer: Coventry All Commercial |
$103.77
|
| Rate for Payer: Encore All Commercial |
$108.55
|
| Rate for Payer: Frontpath All Commercial |
$108.49
|
| Rate for Payer: Humana ChoiceCare |
$101.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.13
|
| Rate for Payer: PHCS All Commercial |
$88.44
|
| Rate for Payer: PHP All Commercial |
$89.43
|
| Rate for Payer: Sagamore Health Network All Products |
$91.03
|
| Rate for Payer: Signature Care EPO |
$97.87
|
| Rate for Payer: Signature Care PPO |
$103.77
|
| Rate for Payer: United Healthcare Commercial |
$92.92
|
|
|
HC TRAY SPINAL PENCAN
|
Facility
|
OP
|
$117.92
|
|
| Hospital Charge Code |
41601184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.51
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Centivo All Commercial |
$64.15
|
| Rate for Payer: Cigna All Commercial |
$101.76
|
| Rate for Payer: CORVEL All Commercial |
$109.67
|
| Rate for Payer: Coventry All Commercial |
$103.77
|
| Rate for Payer: Encore All Commercial |
$108.55
|
| Rate for Payer: Frontpath All Commercial |
$108.49
|
| Rate for Payer: Humana ChoiceCare |
$101.85
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Lucent All Commercial |
$64.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.13
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$88.44
|
| Rate for Payer: PHP All Commercial |
$89.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.99
|
| Rate for Payer: Sagamore Health Network All Products |
$91.03
|
| Rate for Payer: Signature Care EPO |
$97.87
|
| Rate for Payer: Signature Care PPO |
$103.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.23
|
| Rate for Payer: United Healthcare Commercial |
$92.92
|
| Rate for Payer: United Healthcare Medicare |
$37.73
|
|
|
HC TRAY THORA/PARACENTESIS
|
Facility
|
IP
|
$301.00
|
|
| Hospital Charge Code |
41606345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$279.93 |
| Rate for Payer: Aetna Commercial |
$260.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna All Commercial |
$259.76
|
| Rate for Payer: CORVEL All Commercial |
$279.93
|
| Rate for Payer: Coventry All Commercial |
$264.88
|
| Rate for Payer: Encore All Commercial |
$277.07
|
| Rate for Payer: Frontpath All Commercial |
$276.92
|
| Rate for Payer: Humana ChoiceCare |
$259.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.90
|
| Rate for Payer: PHCS All Commercial |
$225.75
|
| Rate for Payer: PHP All Commercial |
$228.28
|
| Rate for Payer: Sagamore Health Network All Products |
$232.37
|
| Rate for Payer: Signature Care EPO |
$249.83
|
| Rate for Payer: Signature Care PPO |
$264.88
|
| Rate for Payer: United Healthcare Commercial |
$237.19
|
|
|
HC TRAY THORA/PARACENTESIS
|
Facility
|
OP
|
$301.00
|
|
| Hospital Charge Code |
41606345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$279.93 |
| Rate for Payer: Aetna Commercial |
$254.04
|
| Rate for Payer: Aetna Medicare |
$96.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$172.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$188.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.95
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Centivo All Commercial |
$163.74
|
| Rate for Payer: Cigna All Commercial |
$259.76
|
| Rate for Payer: CORVEL All Commercial |
$279.93
|
| Rate for Payer: Coventry All Commercial |
$264.88
|
| Rate for Payer: Encore All Commercial |
$277.07
|
| Rate for Payer: Frontpath All Commercial |
$276.92
|
| Rate for Payer: Humana ChoiceCare |
$259.97
|
| Rate for Payer: Humana Medicare |
$96.32
|
| Rate for Payer: Lucent All Commercial |
$163.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$225.75
|
| Rate for Payer: PHP All Commercial |
$228.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.39
|
| Rate for Payer: Sagamore Health Network All Products |
$232.37
|
| Rate for Payer: Signature Care EPO |
$249.83
|
| Rate for Payer: Signature Care PPO |
$264.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$255.85
|
| Rate for Payer: United Healthcare Commercial |
$237.19
|
| Rate for Payer: United Healthcare Medicare |
$96.32
|
|
|
HC TREPONEMA PALLIDUM IGG AB
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.62 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
|
|
HC TREPONEMA PALLIDUM IGG AB
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$50.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.78
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Centivo All Commercial |
$59.93
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Humana Medicare |
$35.25
|
| Rate for Payer: Lucent All Commercial |
$59.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.96
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.64
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
|
|
HC TRIGLYCERIDES
|
Facility
|
OP
|
$103.07
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
63001300
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$95.86 |
| Rate for Payer: Aetna Commercial |
$86.99
|
| Rate for Payer: Aetna Medicare |
$32.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.28
|
| Rate for Payer: Cash Price |
$61.84
|
| Rate for Payer: Cash Price |
$61.84
|
| Rate for Payer: Centivo All Commercial |
$56.07
|
| Rate for Payer: Cigna All Commercial |
$88.95
|
| Rate for Payer: CORVEL All Commercial |
$95.86
|
| Rate for Payer: Coventry All Commercial |
$90.70
|
| Rate for Payer: Encore All Commercial |
$94.88
|
| Rate for Payer: Frontpath All Commercial |
$94.82
|
| Rate for Payer: Humana ChoiceCare |
$89.02
|
| Rate for Payer: Humana Medicare |
$32.98
|
| Rate for Payer: Lucent All Commercial |
$56.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.76
|
| Rate for Payer: Managed Health Services Medicaid |
$5.74
|
| Rate for Payer: MDWise Medicaid |
$5.74
|
| Rate for Payer: PHCS All Commercial |
$77.30
|
| Rate for Payer: PHP All Commercial |
$78.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.20
|
| Rate for Payer: Sagamore Health Network All Products |
$79.57
|
| Rate for Payer: Signature Care EPO |
$85.55
|
| Rate for Payer: Signature Care PPO |
$90.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.61
|
| Rate for Payer: United Healthcare Commercial |
$81.22
|
| Rate for Payer: United Healthcare Medicare |
$32.98
|
|
|
HC TRIGLYCERIDES
|
Facility
|
IP
|
$103.07
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
63001300
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.30 |
| Max. Negotiated Rate |
$95.86 |
| Rate for Payer: Aetna Commercial |
$89.05
|
| Rate for Payer: Cash Price |
$61.84
|
| Rate for Payer: Cigna All Commercial |
$88.95
|
| Rate for Payer: CORVEL All Commercial |
$95.86
|
| Rate for Payer: Coventry All Commercial |
$90.70
|
| Rate for Payer: Encore All Commercial |
$94.88
|
| Rate for Payer: Frontpath All Commercial |
$94.82
|
| Rate for Payer: Humana ChoiceCare |
$89.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.76
|
| Rate for Payer: PHCS All Commercial |
$77.30
|
| Rate for Payer: PHP All Commercial |
$78.17
|
| Rate for Payer: Sagamore Health Network All Products |
$79.57
|
| Rate for Payer: Signature Care EPO |
$85.55
|
| Rate for Payer: Signature Care PPO |
$90.70
|
| Rate for Payer: United Healthcare Commercial |
$81.22
|
|
|
HC TRIPLE LUMEN GARD PLUS KIT CVC
|
Facility
|
IP
|
$1,017.80
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41601264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$763.35 |
| Max. Negotiated Rate |
$946.55 |
| Rate for Payer: Aetna Commercial |
$879.38
|
| Rate for Payer: Cash Price |
$610.68
|
| Rate for Payer: Cigna All Commercial |
$878.36
|
| Rate for Payer: CORVEL All Commercial |
$946.55
|
| Rate for Payer: Coventry All Commercial |
$895.66
|
| Rate for Payer: Encore All Commercial |
$936.88
|
| Rate for Payer: Frontpath All Commercial |
$936.38
|
| Rate for Payer: Humana ChoiceCare |
$879.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$916.02
|
| Rate for Payer: PHCS All Commercial |
$763.35
|
| Rate for Payer: PHP All Commercial |
$771.90
|
| Rate for Payer: Sagamore Health Network All Products |
$785.74
|
| Rate for Payer: Signature Care EPO |
$844.77
|
| Rate for Payer: Signature Care PPO |
$895.66
|
| Rate for Payer: United Healthcare Commercial |
$802.03
|
|
|
HC TRIPLE LUMEN GARD PLUS KIT CVC
|
Facility
|
OP
|
$1,017.80
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41601264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$946.55 |
| Rate for Payer: Aetna Commercial |
$859.02
|
| Rate for Payer: Aetna Medicare |
$325.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$315.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$374.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$358.27
|
| Rate for Payer: Cash Price |
$610.68
|
| Rate for Payer: Cash Price |
$610.68
|
| Rate for Payer: Centivo All Commercial |
$553.68
|
| Rate for Payer: Cigna All Commercial |
$878.36
|
| Rate for Payer: CORVEL All Commercial |
$946.55
|
| Rate for Payer: Coventry All Commercial |
$895.66
|
| Rate for Payer: Encore All Commercial |
$936.88
|
| Rate for Payer: Frontpath All Commercial |
$936.38
|
| Rate for Payer: Humana ChoiceCare |
$879.07
|
| Rate for Payer: Humana Medicare |
$325.70
|
| Rate for Payer: Lucent All Commercial |
$553.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$916.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$763.35
|
| Rate for Payer: PHP All Commercial |
$771.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$396.94
|
| Rate for Payer: Sagamore Health Network All Products |
$785.74
|
| Rate for Payer: Signature Care EPO |
$844.77
|
| Rate for Payer: Signature Care PPO |
$895.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$865.13
|
| Rate for Payer: United Healthcare Commercial |
$802.03
|
| Rate for Payer: United Healthcare Medicare |
$325.70
|
|
