|
HC TROCAR XCEL 11MM
|
Facility
|
IP
|
$734.69
|
|
| Hospital Charge Code |
41602080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.02 |
| Max. Negotiated Rate |
$683.26 |
| Rate for Payer: Aetna Commercial |
$634.77
|
| Rate for Payer: Cash Price |
$440.81
|
| Rate for Payer: Cigna All Commercial |
$634.04
|
| Rate for Payer: CORVEL All Commercial |
$683.26
|
| Rate for Payer: Coventry All Commercial |
$646.53
|
| Rate for Payer: Encore All Commercial |
$676.28
|
| Rate for Payer: Frontpath All Commercial |
$675.91
|
| Rate for Payer: Humana ChoiceCare |
$634.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.22
|
| Rate for Payer: PHCS All Commercial |
$551.02
|
| Rate for Payer: PHP All Commercial |
$557.19
|
| Rate for Payer: Sagamore Health Network All Products |
$567.18
|
| Rate for Payer: Signature Care EPO |
$609.79
|
| Rate for Payer: Signature Care PPO |
$646.53
|
| Rate for Payer: United Healthcare Commercial |
$578.94
|
|
|
HC TROPONIN T
|
Facility
|
OP
|
$259.17
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
63001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$241.03 |
| Rate for Payer: Aetna Commercial |
$218.74
|
| Rate for Payer: Aetna Medicare |
$82.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$119.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.23
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Centivo All Commercial |
$140.99
|
| Rate for Payer: Cigna All Commercial |
$223.66
|
| Rate for Payer: CORVEL All Commercial |
$241.03
|
| Rate for Payer: Coventry All Commercial |
$228.07
|
| Rate for Payer: Encore All Commercial |
$238.57
|
| Rate for Payer: Frontpath All Commercial |
$238.44
|
| Rate for Payer: Humana ChoiceCare |
$223.85
|
| Rate for Payer: Humana Medicare |
$82.93
|
| Rate for Payer: Lucent All Commercial |
$140.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.25
|
| Rate for Payer: Managed Health Services Medicaid |
$12.47
|
| Rate for Payer: MDWise Medicaid |
$12.47
|
| Rate for Payer: PHCS All Commercial |
$194.38
|
| Rate for Payer: PHP All Commercial |
$196.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.08
|
| Rate for Payer: Sagamore Health Network All Products |
$200.08
|
| Rate for Payer: Signature Care EPO |
$215.11
|
| Rate for Payer: Signature Care PPO |
$228.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.29
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
| Rate for Payer: United Healthcare Medicare |
$82.93
|
|
|
HC TROPONIN T
|
Facility
|
IP
|
$259.17
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
63001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.38 |
| Max. Negotiated Rate |
$241.03 |
| Rate for Payer: Aetna Commercial |
$223.92
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna All Commercial |
$223.66
|
| Rate for Payer: CORVEL All Commercial |
$241.03
|
| Rate for Payer: Coventry All Commercial |
$228.07
|
| Rate for Payer: Encore All Commercial |
$238.57
|
| Rate for Payer: Frontpath All Commercial |
$238.44
|
| Rate for Payer: Humana ChoiceCare |
$223.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.25
|
| Rate for Payer: PHCS All Commercial |
$194.38
|
| Rate for Payer: PHP All Commercial |
$196.55
|
| Rate for Payer: Sagamore Health Network All Products |
$200.08
|
| Rate for Payer: Signature Care EPO |
$215.11
|
| Rate for Payer: Signature Care PPO |
$228.07
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
|
|
HC TRYPTASE-SERUM/PLASM
|
Facility
|
OP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$178.65
|
| Rate for Payer: Aetna Medicare |
$67.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.51
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Centivo All Commercial |
$115.15
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Humana Medicare |
$67.73
|
| Rate for Payer: Lucent All Commercial |
$115.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.55
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.92
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
| Rate for Payer: United Healthcare Medicare |
$67.73
|
|
|
HC TRYPTASE-SERUM/PLASM
|
Facility
|
IP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$182.88
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
|
|
HC TSH
|
Facility
|
IP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$132.06
|
| Rate for Payer: Cash Price |
$91.71
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.87
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: United Healthcare Commercial |
$120.45
|
|
|
HC TSH
|
Facility
|
OP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: Aetna Medicare |
$48.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.80
|
| Rate for Payer: Cash Price |
$91.71
|
| Rate for Payer: Cash Price |
$91.71
|
| Rate for Payer: Centivo All Commercial |
$83.15
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.02
|
| Rate for Payer: Humana Medicare |
$48.91
|
| Rate for Payer: Lucent All Commercial |
$83.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: Managed Health Services Medicaid |
$16.80
|
| Rate for Payer: MDWise Medicaid |
$16.80
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.61
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.87
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.92
|
| Rate for Payer: United Healthcare Commercial |
$120.45
|
| Rate for Payer: United Healthcare Medicare |
$48.91
|
|
|
HC TSH RECEPTOR ANTIBODY
|
Facility
|
IP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$182.88
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
|
|
HC TSH RECEPTOR ANTIBODY
|
Facility
|
OP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$178.65
|
| Rate for Payer: Aetna Medicare |
$67.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.51
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Centivo All Commercial |
$115.15
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Humana Medicare |
$67.73
|
| Rate for Payer: Lucent All Commercial |
$115.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.55
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.92
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
| Rate for Payer: United Healthcare Medicare |
$67.73
|
|
|
HC TSH REFLEX FREE T4
|
Facility
|
IP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$132.06
|
| Rate for Payer: Cash Price |
$91.71
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.87
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: United Healthcare Commercial |
$120.45
|
|
|
HC TSH REFLEX FREE T4
|
Facility
|
OP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: Aetna Medicare |
$48.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.80
|
| Rate for Payer: Cash Price |
$91.71
|
| Rate for Payer: Cash Price |
$91.71
|
| Rate for Payer: Centivo All Commercial |
$83.15
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.02
|
| Rate for Payer: Humana Medicare |
$48.91
|
| Rate for Payer: Lucent All Commercial |
$83.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: Managed Health Services Medicaid |
$16.80
|
| Rate for Payer: MDWise Medicaid |
$16.80
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.61
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.87
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.92
|
| Rate for Payer: United Healthcare Commercial |
$120.45
|
| Rate for Payer: United Healthcare Medicare |
$48.91
|
|
|
HC TT ECHO CONG ABN; COMPLETE
|
Facility
|
IP
|
$1,090.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
863303
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$818.10 |
| Max. Negotiated Rate |
$1,014.44 |
| Rate for Payer: Aetna Commercial |
$942.45
|
| Rate for Payer: Cash Price |
$654.48
|
| Rate for Payer: Cigna All Commercial |
$941.36
|
| Rate for Payer: CORVEL All Commercial |
$1,014.44
|
| Rate for Payer: Coventry All Commercial |
$959.90
|
| Rate for Payer: Encore All Commercial |
$1,004.08
|
| Rate for Payer: Frontpath All Commercial |
$1,003.54
|
| Rate for Payer: Humana ChoiceCare |
$942.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.72
|
| Rate for Payer: PHCS All Commercial |
$818.10
|
| Rate for Payer: PHP All Commercial |
$827.26
|
| Rate for Payer: Sagamore Health Network All Products |
$842.10
|
| Rate for Payer: Signature Care EPO |
$905.36
|
| Rate for Payer: Signature Care PPO |
$959.90
|
| Rate for Payer: United Healthcare Commercial |
$859.55
|
|
|
HC TT ECHO CONG ABN; COMPLETE
|
Facility
|
OP
|
$1,090.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
863303
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$202.23 |
| Max. Negotiated Rate |
$1,014.44 |
| Rate for Payer: Aetna Commercial |
$920.64
|
| Rate for Payer: Aetna Medicare |
$349.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$626.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$681.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$401.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.96
|
| Rate for Payer: Cash Price |
$654.48
|
| Rate for Payer: Cash Price |
$654.48
|
| Rate for Payer: Centivo All Commercial |
$593.40
|
| Rate for Payer: Cigna All Commercial |
$941.36
|
| Rate for Payer: CORVEL All Commercial |
$1,014.44
|
| Rate for Payer: Coventry All Commercial |
$959.90
|
| Rate for Payer: Encore All Commercial |
$1,004.08
|
| Rate for Payer: Frontpath All Commercial |
$1,003.54
|
| Rate for Payer: Humana ChoiceCare |
$942.12
|
| Rate for Payer: Humana Medicare |
$349.06
|
| Rate for Payer: Lucent All Commercial |
$593.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.72
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$818.10
|
| Rate for Payer: PHP All Commercial |
$827.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.41
|
| Rate for Payer: Sagamore Health Network All Products |
$842.10
|
| Rate for Payer: Signature Care EPO |
$905.36
|
| Rate for Payer: Signature Care PPO |
$959.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$927.18
|
| Rate for Payer: United Healthcare Commercial |
$859.55
|
| Rate for Payer: United Healthcare Medicare |
$349.06
|
|
|
HC TTE CONG ABN; LIMITED/F-UP
|
Facility
|
OP
|
$963.90
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
863304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$202.23 |
| Max. Negotiated Rate |
$896.43 |
| Rate for Payer: Aetna Commercial |
$813.53
|
| Rate for Payer: Aetna Medicare |
$308.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$553.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$602.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.29
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Centivo All Commercial |
$524.36
|
| Rate for Payer: Cigna All Commercial |
$831.85
|
| Rate for Payer: CORVEL All Commercial |
$896.43
|
| Rate for Payer: Coventry All Commercial |
$848.23
|
| Rate for Payer: Encore All Commercial |
$887.27
|
| Rate for Payer: Frontpath All Commercial |
$886.79
|
| Rate for Payer: Humana ChoiceCare |
$832.52
|
| Rate for Payer: Humana Medicare |
$308.45
|
| Rate for Payer: Lucent All Commercial |
$524.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.51
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$722.92
|
| Rate for Payer: PHP All Commercial |
$731.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.92
|
| Rate for Payer: Sagamore Health Network All Products |
$744.13
|
| Rate for Payer: Signature Care EPO |
$800.04
|
| Rate for Payer: Signature Care PPO |
$848.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$819.32
|
| Rate for Payer: United Healthcare Commercial |
$759.55
|
| Rate for Payer: United Healthcare Medicare |
$308.45
|
|
|
HC TTE CONG ABN; LIMITED/F-UP
|
Facility
|
IP
|
$963.90
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
863304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$722.92 |
| Max. Negotiated Rate |
$896.43 |
| Rate for Payer: Aetna Commercial |
$832.81
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cigna All Commercial |
$831.85
|
| Rate for Payer: CORVEL All Commercial |
$896.43
|
| Rate for Payer: Coventry All Commercial |
$848.23
|
| Rate for Payer: Encore All Commercial |
$887.27
|
| Rate for Payer: Frontpath All Commercial |
$886.79
|
| Rate for Payer: Humana ChoiceCare |
$832.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.51
|
| Rate for Payer: PHCS All Commercial |
$722.92
|
| Rate for Payer: PHP All Commercial |
$731.02
|
| Rate for Payer: Sagamore Health Network All Products |
$744.13
|
| Rate for Payer: Signature Care EPO |
$800.04
|
| Rate for Payer: Signature Care PPO |
$848.23
|
| Rate for Payer: United Healthcare Commercial |
$759.55
|
|
|
HC TUBE CONNECTING 14FR X 30CM
|
Facility
|
IP
|
$123.97
|
|
| Hospital Charge Code |
41607839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.98 |
| Max. Negotiated Rate |
$115.29 |
| Rate for Payer: Aetna Commercial |
$107.11
|
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: Cigna All Commercial |
$106.99
|
| Rate for Payer: CORVEL All Commercial |
$115.29
|
| Rate for Payer: Coventry All Commercial |
$109.09
|
| Rate for Payer: Encore All Commercial |
$114.11
|
| Rate for Payer: Frontpath All Commercial |
$114.05
|
| Rate for Payer: Humana ChoiceCare |
$107.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.57
|
| Rate for Payer: PHCS All Commercial |
$92.98
|
| Rate for Payer: PHP All Commercial |
$94.02
|
| Rate for Payer: Sagamore Health Network All Products |
$95.70
|
| Rate for Payer: Signature Care EPO |
$102.90
|
| Rate for Payer: Signature Care PPO |
$109.09
|
| Rate for Payer: United Healthcare Commercial |
$97.69
|
|
|
HC TUBE CONNECTING 14FR X 30CM
|
Facility
|
OP
|
$123.97
|
|
| Hospital Charge Code |
41607839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$115.29 |
| Rate for Payer: Aetna Commercial |
$104.63
|
| Rate for Payer: Aetna Medicare |
$39.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.64
|
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: Centivo All Commercial |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$106.99
|
| Rate for Payer: CORVEL All Commercial |
$115.29
|
| Rate for Payer: Coventry All Commercial |
$109.09
|
| Rate for Payer: Encore All Commercial |
$114.11
|
| Rate for Payer: Frontpath All Commercial |
$114.05
|
| Rate for Payer: Humana ChoiceCare |
$107.07
|
| Rate for Payer: Humana Medicare |
$39.67
|
| Rate for Payer: Lucent All Commercial |
$67.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$92.98
|
| Rate for Payer: PHP All Commercial |
$94.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.35
|
| Rate for Payer: Sagamore Health Network All Products |
$95.70
|
| Rate for Payer: Signature Care EPO |
$102.90
|
| Rate for Payer: Signature Care PPO |
$109.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.37
|
| Rate for Payer: United Healthcare Commercial |
$97.69
|
| Rate for Payer: United Healthcare Medicare |
$39.67
|
|
|
HC TUBE ENDO CUFF 3.5
|
Facility
|
OP
|
$10.09
|
|
| Hospital Charge Code |
41603474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.52
|
| Rate for Payer: Aetna Medicare |
$3.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.55
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Centivo All Commercial |
$5.49
|
| Rate for Payer: Cigna All Commercial |
$8.71
|
| Rate for Payer: CORVEL All Commercial |
$9.38
|
| Rate for Payer: Coventry All Commercial |
$8.88
|
| Rate for Payer: Encore All Commercial |
$9.29
|
| Rate for Payer: Frontpath All Commercial |
$9.28
|
| Rate for Payer: Humana ChoiceCare |
$8.71
|
| Rate for Payer: Humana Medicare |
$3.23
|
| Rate for Payer: Lucent All Commercial |
$5.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.08
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.57
|
| Rate for Payer: PHP All Commercial |
$7.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.94
|
| Rate for Payer: Sagamore Health Network All Products |
$7.79
|
| Rate for Payer: Signature Care EPO |
$8.37
|
| Rate for Payer: Signature Care PPO |
$8.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.58
|
| Rate for Payer: United Healthcare Commercial |
$7.95
|
| Rate for Payer: United Healthcare Medicare |
$3.23
|
|
|
HC TUBE ENDO CUFF 3.5
|
Facility
|
IP
|
$10.09
|
|
| Hospital Charge Code |
41603474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$9.38 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Cigna All Commercial |
$8.71
|
| Rate for Payer: CORVEL All Commercial |
$9.38
|
| Rate for Payer: Coventry All Commercial |
$8.88
|
| Rate for Payer: Encore All Commercial |
$9.29
|
| Rate for Payer: Frontpath All Commercial |
$9.28
|
| Rate for Payer: Humana ChoiceCare |
$8.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.08
|
| Rate for Payer: PHCS All Commercial |
$7.57
|
| Rate for Payer: PHP All Commercial |
$7.65
|
| Rate for Payer: Sagamore Health Network All Products |
$7.79
|
| Rate for Payer: Signature Care EPO |
$8.37
|
| Rate for Payer: Signature Care PPO |
$8.88
|
| Rate for Payer: United Healthcare Commercial |
$7.95
|
|
|
HC TUBE SALEM SUMP NG 16FR
|
Facility
|
OP
|
$8.61
|
|
| Hospital Charge Code |
41601190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$7.27
|
| Rate for Payer: Aetna Medicare |
$2.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.03
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Centivo All Commercial |
$4.68
|
| Rate for Payer: Cigna All Commercial |
$7.43
|
| Rate for Payer: CORVEL All Commercial |
$8.01
|
| Rate for Payer: Coventry All Commercial |
$7.58
|
| Rate for Payer: Encore All Commercial |
$7.93
|
| Rate for Payer: Frontpath All Commercial |
$7.92
|
| Rate for Payer: Humana ChoiceCare |
$7.44
|
| Rate for Payer: Humana Medicare |
$2.76
|
| Rate for Payer: Lucent All Commercial |
$4.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6.46
|
| Rate for Payer: PHP All Commercial |
$6.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.36
|
| Rate for Payer: Sagamore Health Network All Products |
$6.65
|
| Rate for Payer: Signature Care EPO |
$7.15
|
| Rate for Payer: Signature Care PPO |
$7.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.32
|
| Rate for Payer: United Healthcare Commercial |
$6.78
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
|
|
HC TUBE SALEM SUMP NG 16FR
|
Facility
|
IP
|
$8.61
|
|
| Hospital Charge Code |
41601190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$7.44
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cigna All Commercial |
$7.43
|
| Rate for Payer: CORVEL All Commercial |
$8.01
|
| Rate for Payer: Coventry All Commercial |
$7.58
|
| Rate for Payer: Encore All Commercial |
$7.93
|
| Rate for Payer: Frontpath All Commercial |
$7.92
|
| Rate for Payer: Humana ChoiceCare |
$7.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.75
|
| Rate for Payer: PHCS All Commercial |
$6.46
|
| Rate for Payer: PHP All Commercial |
$6.53
|
| Rate for Payer: Sagamore Health Network All Products |
$6.65
|
| Rate for Payer: Signature Care EPO |
$7.15
|
| Rate for Payer: Signature Care PPO |
$7.58
|
| Rate for Payer: United Healthcare Commercial |
$6.78
|
|
|
HC TUBE SALEM SUMP NG 18FR
|
Facility
|
IP
|
$7.28
|
|
| Hospital Charge Code |
41601191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$6.77 |
| Rate for Payer: Aetna Commercial |
$6.29
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cigna All Commercial |
$6.28
|
| Rate for Payer: CORVEL All Commercial |
$6.77
|
| Rate for Payer: Coventry All Commercial |
$6.41
|
| Rate for Payer: Encore All Commercial |
$6.70
|
| Rate for Payer: Frontpath All Commercial |
$6.70
|
| Rate for Payer: Humana ChoiceCare |
$6.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.55
|
| Rate for Payer: PHCS All Commercial |
$5.46
|
| Rate for Payer: PHP All Commercial |
$5.52
|
| Rate for Payer: Sagamore Health Network All Products |
$5.62
|
| Rate for Payer: Signature Care EPO |
$6.04
|
| Rate for Payer: Signature Care PPO |
$6.41
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
|
|
HC TUBE SALEM SUMP NG 18FR
|
Facility
|
OP
|
$7.28
|
|
| Hospital Charge Code |
41601191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$6.14
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.56
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Centivo All Commercial |
$3.96
|
| Rate for Payer: Cigna All Commercial |
$6.28
|
| Rate for Payer: CORVEL All Commercial |
$6.77
|
| Rate for Payer: Coventry All Commercial |
$6.41
|
| Rate for Payer: Encore All Commercial |
$6.70
|
| Rate for Payer: Frontpath All Commercial |
$6.70
|
| Rate for Payer: Humana ChoiceCare |
$6.29
|
| Rate for Payer: Humana Medicare |
$2.33
|
| Rate for Payer: Lucent All Commercial |
$3.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.55
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$5.46
|
| Rate for Payer: PHP All Commercial |
$5.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.84
|
| Rate for Payer: Sagamore Health Network All Products |
$5.62
|
| Rate for Payer: Signature Care EPO |
$6.04
|
| Rate for Payer: Signature Care PPO |
$6.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.19
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
| Rate for Payer: United Healthcare Medicare |
$2.33
|
|
|
HC TUBESET ARTHROSCOPY PUMP
|
Facility
|
OP
|
$306.77
|
|
| Hospital Charge Code |
41601203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$258.91
|
| Rate for Payer: Aetna Medicare |
$98.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$176.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.98
|
| Rate for Payer: Cash Price |
$184.06
|
| Rate for Payer: Cash Price |
$184.06
|
| Rate for Payer: Centivo All Commercial |
$166.88
|
| Rate for Payer: Cigna All Commercial |
$264.74
|
| Rate for Payer: CORVEL All Commercial |
$285.30
|
| Rate for Payer: Coventry All Commercial |
$269.96
|
| Rate for Payer: Encore All Commercial |
$282.38
|
| Rate for Payer: Frontpath All Commercial |
$282.23
|
| Rate for Payer: Humana ChoiceCare |
$264.96
|
| Rate for Payer: Humana Medicare |
$98.17
|
| Rate for Payer: Lucent All Commercial |
$166.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.09
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$230.08
|
| Rate for Payer: PHP All Commercial |
$232.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.64
|
| Rate for Payer: Sagamore Health Network All Products |
$236.83
|
| Rate for Payer: Signature Care EPO |
$254.62
|
| Rate for Payer: Signature Care PPO |
$269.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.75
|
| Rate for Payer: United Healthcare Commercial |
$241.73
|
| Rate for Payer: United Healthcare Medicare |
$98.17
|
|
|
HC TUBESET ARTHROSCOPY PUMP
|
Facility
|
IP
|
$306.77
|
|
| Hospital Charge Code |
41601203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.08 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Cash Price |
$184.06
|
| Rate for Payer: Cigna All Commercial |
$264.74
|
| Rate for Payer: CORVEL All Commercial |
$285.30
|
| Rate for Payer: Coventry All Commercial |
$269.96
|
| Rate for Payer: Encore All Commercial |
$282.38
|
| Rate for Payer: Frontpath All Commercial |
$282.23
|
| Rate for Payer: Humana ChoiceCare |
$264.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.09
|
| Rate for Payer: PHCS All Commercial |
$230.08
|
| Rate for Payer: PHP All Commercial |
$232.65
|
| Rate for Payer: Sagamore Health Network All Products |
$236.83
|
| Rate for Payer: Signature Care EPO |
$254.62
|
| Rate for Payer: Signature Care PPO |
$269.96
|
| Rate for Payer: United Healthcare Commercial |
$241.73
|
|
