|
HC PYRUVIC ACID-BLOOD
|
Facility
IP
|
$99.07
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
63001671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$85.60
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cigna All Commercial |
$85.50
|
| Rate for Payer: CORVEL All Commercial |
$92.14
|
| Rate for Payer: Coventry All Commercial |
$87.18
|
| Rate for Payer: Encore All Commercial |
$91.20
|
| Rate for Payer: Frontpath All Commercial |
$91.15
|
| Rate for Payer: Humana ChoiceCare |
$85.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.17
|
| Rate for Payer: PHCS All Commercial |
$74.30
|
| Rate for Payer: PHP All Commercial |
$75.14
|
| Rate for Payer: Sagamore Health Network All Products |
$76.48
|
| Rate for Payer: Signature Care EPO |
$82.23
|
| Rate for Payer: Signature Care PPO |
$87.18
|
| Rate for Payer: United Healthcare Commercial |
$78.07
|
|
|
HC QUANTIFERRON GOLD-TB
|
Facility
IP
|
$304.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
63001917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.05 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$262.71
|
| Rate for Payer: Cash Price |
$188.52
|
| Rate for Payer: Cigna All Commercial |
$262.41
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.66
|
| Rate for Payer: PHCS All Commercial |
$228.05
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Sagamore Health Network All Products |
$234.74
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
|
|
HC QUANTIFERRON GOLD-TB
|
Facility
OP
|
$304.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
63001917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$100.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$61.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.37
|
| Rate for Payer: Cash Price |
$188.52
|
| Rate for Payer: Cash Price |
$188.52
|
| Rate for Payer: Centivo All Commercial |
$155.07
|
| Rate for Payer: Cigna All Commercial |
$262.41
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Humana Medicare |
$155.07
|
| Rate for Payer: Lucent All Commercial |
$155.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.66
|
| Rate for Payer: Managed Health Services Medicaid |
$61.98
|
| Rate for Payer: MDWise Medicaid |
$61.98
|
| Rate for Payer: PHCS All Commercial |
$228.05
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.58
|
| Rate for Payer: Sagamore Health Network All Products |
$234.74
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.45
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
| Rate for Payer: United Healthcare Medicare |
$100.34
|
|
|
HC QUICKCLIP PRO 230 CM
|
Facility
OP
|
$804.36
|
|
| Hospital Charge Code |
41602176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$748.05 |
| Rate for Payer: Aetna Commercial |
$678.88
|
| Rate for Payer: Aetna Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$461.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$502.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$305.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$291.98
|
| Rate for Payer: Cash Price |
$498.70
|
| Rate for Payer: Cash Price |
$498.70
|
| Rate for Payer: Centivo All Commercial |
$410.22
|
| Rate for Payer: Cigna All Commercial |
$694.16
|
| Rate for Payer: CORVEL All Commercial |
$748.05
|
| Rate for Payer: Coventry All Commercial |
$707.84
|
| Rate for Payer: Encore All Commercial |
$740.41
|
| Rate for Payer: Frontpath All Commercial |
$740.01
|
| Rate for Payer: Humana ChoiceCare |
$694.73
|
| Rate for Payer: Humana Medicare |
$410.22
|
| Rate for Payer: Lucent All Commercial |
$410.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$723.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$603.27
|
| Rate for Payer: PHP All Commercial |
$610.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$313.70
|
| Rate for Payer: Sagamore Health Network All Products |
$620.97
|
| Rate for Payer: Signature Care EPO |
$667.62
|
| Rate for Payer: Signature Care PPO |
$707.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$683.71
|
| Rate for Payer: United Healthcare Commercial |
$633.84
|
| Rate for Payer: United Healthcare Medicare |
$265.44
|
|
|
HC QUICKCLIP PRO 230 CM
|
Facility
IP
|
$804.36
|
|
| Hospital Charge Code |
41602176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$603.27 |
| Max. Negotiated Rate |
$748.05 |
| Rate for Payer: Aetna Commercial |
$694.97
|
| Rate for Payer: Cash Price |
$498.70
|
| Rate for Payer: Cigna All Commercial |
$694.16
|
| Rate for Payer: CORVEL All Commercial |
$748.05
|
| Rate for Payer: Coventry All Commercial |
$707.84
|
| Rate for Payer: Encore All Commercial |
$740.41
|
| Rate for Payer: Frontpath All Commercial |
$740.01
|
| Rate for Payer: Humana ChoiceCare |
$694.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$723.92
|
| Rate for Payer: PHCS All Commercial |
$603.27
|
| Rate for Payer: PHP All Commercial |
$610.03
|
| Rate for Payer: Sagamore Health Network All Products |
$620.97
|
| Rate for Payer: Signature Care EPO |
$667.62
|
| Rate for Payer: Signature Care PPO |
$707.84
|
| Rate for Payer: United Healthcare Commercial |
$633.84
|
|
|
HC QUICK PRESSURE MONITOR SET
|
Facility
OP
|
$1,013.54
|
|
| Hospital Charge Code |
41601244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$942.59 |
| Rate for Payer: Aetna Commercial |
$855.43
|
| Rate for Payer: Aetna Medicare |
$334.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$334.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$582.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$633.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$384.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$367.92
|
| Rate for Payer: Cash Price |
$628.40
|
| Rate for Payer: Cash Price |
$628.40
|
| Rate for Payer: Centivo All Commercial |
$516.91
|
| Rate for Payer: Cigna All Commercial |
$874.69
|
| Rate for Payer: CORVEL All Commercial |
$942.59
|
| Rate for Payer: Coventry All Commercial |
$891.92
|
| Rate for Payer: Encore All Commercial |
$932.96
|
| Rate for Payer: Frontpath All Commercial |
$932.46
|
| Rate for Payer: Humana ChoiceCare |
$875.39
|
| Rate for Payer: Humana Medicare |
$516.91
|
| Rate for Payer: Lucent All Commercial |
$516.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$912.19
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$760.16
|
| Rate for Payer: PHP All Commercial |
$768.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$395.28
|
| Rate for Payer: Sagamore Health Network All Products |
$782.45
|
| Rate for Payer: Signature Care EPO |
$841.24
|
| Rate for Payer: Signature Care PPO |
$891.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$861.51
|
| Rate for Payer: United Healthcare Commercial |
$798.67
|
| Rate for Payer: United Healthcare Medicare |
$334.47
|
|
|
HC QUICK PRESSURE MONITOR SET
|
Facility
IP
|
$1,013.54
|
|
| Hospital Charge Code |
41601244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$760.16 |
| Max. Negotiated Rate |
$942.59 |
| Rate for Payer: Aetna Commercial |
$875.70
|
| Rate for Payer: Cash Price |
$628.40
|
| Rate for Payer: Cigna All Commercial |
$874.69
|
| Rate for Payer: CORVEL All Commercial |
$942.59
|
| Rate for Payer: Coventry All Commercial |
$891.92
|
| Rate for Payer: Encore All Commercial |
$932.96
|
| Rate for Payer: Frontpath All Commercial |
$932.46
|
| Rate for Payer: Humana ChoiceCare |
$875.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$912.19
|
| Rate for Payer: PHCS All Commercial |
$760.16
|
| Rate for Payer: PHP All Commercial |
$768.67
|
| Rate for Payer: Sagamore Health Network All Products |
$782.45
|
| Rate for Payer: Signature Care EPO |
$841.24
|
| Rate for Payer: Signature Care PPO |
$891.92
|
| Rate for Payer: United Healthcare Commercial |
$798.67
|
|
|
HC RA
|
Facility
IP
|
$127.83
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
63001281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.87 |
| Max. Negotiated Rate |
$118.88 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Cash Price |
$79.25
|
| Rate for Payer: Cigna All Commercial |
$110.31
|
| Rate for Payer: CORVEL All Commercial |
$118.88
|
| Rate for Payer: Coventry All Commercial |
$112.49
|
| Rate for Payer: Encore All Commercial |
$117.66
|
| Rate for Payer: Frontpath All Commercial |
$117.60
|
| Rate for Payer: Humana ChoiceCare |
$110.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.04
|
| Rate for Payer: PHCS All Commercial |
$95.87
|
| Rate for Payer: PHP All Commercial |
$96.94
|
| Rate for Payer: Sagamore Health Network All Products |
$98.68
|
| Rate for Payer: Signature Care EPO |
$106.10
|
| Rate for Payer: Signature Care PPO |
$112.49
|
| Rate for Payer: United Healthcare Commercial |
$100.73
|
|
|
HC RA
|
Facility
OP
|
$127.83
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
63001281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$118.88 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: Aetna Medicare |
$42.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.40
|
| Rate for Payer: Cash Price |
$79.25
|
| Rate for Payer: Cash Price |
$79.25
|
| Rate for Payer: Centivo All Commercial |
$65.19
|
| Rate for Payer: Cigna All Commercial |
$110.31
|
| Rate for Payer: CORVEL All Commercial |
$118.88
|
| Rate for Payer: Coventry All Commercial |
$112.49
|
| Rate for Payer: Encore All Commercial |
$117.66
|
| Rate for Payer: Frontpath All Commercial |
$117.60
|
| Rate for Payer: Humana ChoiceCare |
$110.40
|
| Rate for Payer: Humana Medicare |
$65.19
|
| Rate for Payer: Lucent All Commercial |
$65.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.14
|
| Rate for Payer: MDWise Medicaid |
$6.14
|
| Rate for Payer: PHCS All Commercial |
$95.87
|
| Rate for Payer: PHP All Commercial |
$96.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.85
|
| Rate for Payer: Sagamore Health Network All Products |
$98.68
|
| Rate for Payer: Signature Care EPO |
$106.10
|
| Rate for Payer: Signature Care PPO |
$112.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.65
|
| Rate for Payer: United Healthcare Commercial |
$100.73
|
| Rate for Payer: United Healthcare Medicare |
$42.18
|
|
|
HC RADIAL JAW 4 JUMBO
|
Facility
OP
|
$134.15
|
|
| Hospital Charge Code |
41608237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$124.76 |
| Rate for Payer: Aetna Commercial |
$113.22
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.70
|
| Rate for Payer: Cash Price |
$83.17
|
| Rate for Payer: Cash Price |
$83.17
|
| Rate for Payer: Centivo All Commercial |
$68.42
|
| Rate for Payer: Cigna All Commercial |
$115.77
|
| Rate for Payer: CORVEL All Commercial |
$124.76
|
| Rate for Payer: Coventry All Commercial |
$118.05
|
| Rate for Payer: Encore All Commercial |
$123.49
|
| Rate for Payer: Frontpath All Commercial |
$123.42
|
| Rate for Payer: Humana ChoiceCare |
$115.87
|
| Rate for Payer: Humana Medicare |
$68.42
|
| Rate for Payer: Lucent All Commercial |
$68.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$100.61
|
| Rate for Payer: PHP All Commercial |
$101.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.32
|
| Rate for Payer: Sagamore Health Network All Products |
$103.56
|
| Rate for Payer: Signature Care EPO |
$111.34
|
| Rate for Payer: Signature Care PPO |
$118.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.03
|
| Rate for Payer: United Healthcare Commercial |
$105.71
|
| Rate for Payer: United Healthcare Medicare |
$44.27
|
|
|
HC RADIAL JAW 4 JUMBO
|
Facility
IP
|
$134.15
|
|
| Hospital Charge Code |
41608237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.61 |
| Max. Negotiated Rate |
$124.76 |
| Rate for Payer: Aetna Commercial |
$115.91
|
| Rate for Payer: Cash Price |
$83.17
|
| Rate for Payer: Cigna All Commercial |
$115.77
|
| Rate for Payer: CORVEL All Commercial |
$124.76
|
| Rate for Payer: Coventry All Commercial |
$118.05
|
| Rate for Payer: Encore All Commercial |
$123.49
|
| Rate for Payer: Frontpath All Commercial |
$123.42
|
| Rate for Payer: Humana ChoiceCare |
$115.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.74
|
| Rate for Payer: PHCS All Commercial |
$100.61
|
| Rate for Payer: PHP All Commercial |
$101.74
|
| Rate for Payer: Sagamore Health Network All Products |
$103.56
|
| Rate for Payer: Signature Care EPO |
$111.34
|
| Rate for Payer: Signature Care PPO |
$118.05
|
| Rate for Payer: United Healthcare Commercial |
$105.71
|
|
|
HC RADIATION TREATMENT DELIVERY, >1MEV; COMPLEX
|
Facility
OP
|
$1,166.88
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
01547412
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.07 |
| Max. Negotiated Rate |
$1,085.20 |
| Rate for Payer: Aetna Commercial |
$984.85
|
| Rate for Payer: Aetna Medicare |
$385.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$385.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$670.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$729.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$753.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$423.58
|
| Rate for Payer: Cash Price |
$723.47
|
| Rate for Payer: Cash Price |
$723.47
|
| Rate for Payer: Centivo All Commercial |
$595.11
|
| Rate for Payer: Cigna All Commercial |
$1,007.02
|
| Rate for Payer: CORVEL All Commercial |
$1,085.20
|
| Rate for Payer: Coventry All Commercial |
$1,026.85
|
| Rate for Payer: Encore All Commercial |
$1,074.11
|
| Rate for Payer: Frontpath All Commercial |
$1,073.53
|
| Rate for Payer: Humana ChoiceCare |
$1,007.83
|
| Rate for Payer: Humana Medicare |
$595.11
|
| Rate for Payer: Lucent All Commercial |
$595.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.19
|
| Rate for Payer: Managed Health Services Medicaid |
$753.36
|
| Rate for Payer: MDWise Medicaid |
$753.36
|
| Rate for Payer: PHCS All Commercial |
$875.16
|
| Rate for Payer: PHP All Commercial |
$884.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$455.08
|
| Rate for Payer: Sagamore Health Network All Products |
$900.83
|
| Rate for Payer: Signature Care EPO |
$968.51
|
| Rate for Payer: Signature Care PPO |
$1,026.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$991.85
|
| Rate for Payer: United Healthcare Commercial |
$919.50
|
| Rate for Payer: United Healthcare Medicare |
$385.07
|
|
|
HC RADIATION TREATMENT DELIVERY, >1MEV; COMPLEX
|
Facility
IP
|
$1,166.88
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
01547412
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$875.16 |
| Max. Negotiated Rate |
$1,085.20 |
| Rate for Payer: Aetna Commercial |
$1,008.18
|
| Rate for Payer: Cash Price |
$723.47
|
| Rate for Payer: Cigna All Commercial |
$1,007.02
|
| Rate for Payer: CORVEL All Commercial |
$1,085.20
|
| Rate for Payer: Coventry All Commercial |
$1,026.85
|
| Rate for Payer: Encore All Commercial |
$1,074.11
|
| Rate for Payer: Frontpath All Commercial |
$1,073.53
|
| Rate for Payer: Humana ChoiceCare |
$1,007.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.19
|
| Rate for Payer: PHCS All Commercial |
$875.16
|
| Rate for Payer: PHP All Commercial |
$884.96
|
| Rate for Payer: Sagamore Health Network All Products |
$900.83
|
| Rate for Payer: Signature Care EPO |
$968.51
|
| Rate for Payer: Signature Care PPO |
$1,026.85
|
| Rate for Payer: United Healthcare Commercial |
$919.50
|
|
|
HC RADIATION TREATMENT DELIVERY, >1MEV; INTERMEDIATE
|
Facility
IP
|
$954.72
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
01547407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$716.04 |
| Max. Negotiated Rate |
$887.89 |
| Rate for Payer: Aetna Commercial |
$824.88
|
| Rate for Payer: Cash Price |
$591.93
|
| Rate for Payer: Cigna All Commercial |
$823.92
|
| Rate for Payer: CORVEL All Commercial |
$887.89
|
| Rate for Payer: Coventry All Commercial |
$840.15
|
| Rate for Payer: Encore All Commercial |
$878.82
|
| Rate for Payer: Frontpath All Commercial |
$878.34
|
| Rate for Payer: Humana ChoiceCare |
$824.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$859.25
|
| Rate for Payer: PHCS All Commercial |
$716.04
|
| Rate for Payer: PHP All Commercial |
$724.06
|
| Rate for Payer: Sagamore Health Network All Products |
$737.04
|
| Rate for Payer: Signature Care EPO |
$792.42
|
| Rate for Payer: Signature Care PPO |
$840.15
|
| Rate for Payer: United Healthcare Commercial |
$752.32
|
|
|
HC RADIATION TREATMENT DELIVERY, >1MEV; INTERMEDIATE
|
Facility
OP
|
$954.72
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
01547407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$315.06 |
| Max. Negotiated Rate |
$887.89 |
| Rate for Payer: Aetna Commercial |
$805.78
|
| Rate for Payer: Aetna Medicare |
$315.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$315.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$548.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$596.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$390.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$362.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$346.56
|
| Rate for Payer: Cash Price |
$591.93
|
| Rate for Payer: Cash Price |
$591.93
|
| Rate for Payer: Centivo All Commercial |
$486.91
|
| Rate for Payer: Cigna All Commercial |
$823.92
|
| Rate for Payer: CORVEL All Commercial |
$887.89
|
| Rate for Payer: Coventry All Commercial |
$840.15
|
| Rate for Payer: Encore All Commercial |
$878.82
|
| Rate for Payer: Frontpath All Commercial |
$878.34
|
| Rate for Payer: Humana ChoiceCare |
$824.59
|
| Rate for Payer: Humana Medicare |
$486.91
|
| Rate for Payer: Lucent All Commercial |
$486.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$859.25
|
| Rate for Payer: Managed Health Services Medicaid |
$390.35
|
| Rate for Payer: MDWise Medicaid |
$390.35
|
| Rate for Payer: PHCS All Commercial |
$716.04
|
| Rate for Payer: PHP All Commercial |
$724.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$372.34
|
| Rate for Payer: Sagamore Health Network All Products |
$737.04
|
| Rate for Payer: Signature Care EPO |
$792.42
|
| Rate for Payer: Signature Care PPO |
$840.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$811.51
|
| Rate for Payer: United Healthcare Commercial |
$752.32
|
| Rate for Payer: United Healthcare Medicare |
$315.06
|
|
|
HC RADIATION TREATMENT DELIVERY, >1MEV; SIMPLE
|
Facility
OP
|
$742.56
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
01547402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$245.04 |
| Max. Negotiated Rate |
$690.58 |
| Rate for Payer: Aetna Commercial |
$626.72
|
| Rate for Payer: Aetna Medicare |
$245.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$245.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$426.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$464.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$390.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.55
|
| Rate for Payer: Cash Price |
$460.39
|
| Rate for Payer: Cash Price |
$460.39
|
| Rate for Payer: Centivo All Commercial |
$378.71
|
| Rate for Payer: Cigna All Commercial |
$640.83
|
| Rate for Payer: CORVEL All Commercial |
$690.58
|
| Rate for Payer: Coventry All Commercial |
$653.45
|
| Rate for Payer: Encore All Commercial |
$683.53
|
| Rate for Payer: Frontpath All Commercial |
$683.16
|
| Rate for Payer: Humana ChoiceCare |
$641.35
|
| Rate for Payer: Humana Medicare |
$378.71
|
| Rate for Payer: Lucent All Commercial |
$378.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$668.30
|
| Rate for Payer: Managed Health Services Medicaid |
$390.35
|
| Rate for Payer: MDWise Medicaid |
$390.35
|
| Rate for Payer: PHCS All Commercial |
$556.92
|
| Rate for Payer: PHP All Commercial |
$563.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.60
|
| Rate for Payer: Sagamore Health Network All Products |
$573.26
|
| Rate for Payer: Signature Care EPO |
$616.32
|
| Rate for Payer: Signature Care PPO |
$653.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$631.18
|
| Rate for Payer: United Healthcare Commercial |
$585.14
|
| Rate for Payer: United Healthcare Medicare |
$245.04
|
|
|
HC RADIATION TREATMENT DELIVERY, >1MEV; SIMPLE
|
Facility
IP
|
$742.56
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
01547402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$556.92 |
| Max. Negotiated Rate |
$690.58 |
| Rate for Payer: Aetna Commercial |
$641.57
|
| Rate for Payer: Cash Price |
$460.39
|
| Rate for Payer: Cigna All Commercial |
$640.83
|
| Rate for Payer: CORVEL All Commercial |
$690.58
|
| Rate for Payer: Coventry All Commercial |
$653.45
|
| Rate for Payer: Encore All Commercial |
$683.53
|
| Rate for Payer: Frontpath All Commercial |
$683.16
|
| Rate for Payer: Humana ChoiceCare |
$641.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$668.30
|
| Rate for Payer: PHCS All Commercial |
$556.92
|
| Rate for Payer: PHP All Commercial |
$563.16
|
| Rate for Payer: Sagamore Health Network All Products |
$573.26
|
| Rate for Payer: Signature Care EPO |
$616.32
|
| Rate for Payer: Signature Care PPO |
$653.45
|
| Rate for Payer: United Healthcare Commercial |
$585.14
|
|
|
HC RAD JAW 4 LG/NEEDLE
|
Facility
OP
|
$65.25
|
|
| Hospital Charge Code |
41608208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.53 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$55.07
|
| Rate for Payer: Aetna Medicare |
$21.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.69
|
| Rate for Payer: Cash Price |
$40.46
|
| Rate for Payer: Cash Price |
$40.46
|
| Rate for Payer: Centivo All Commercial |
$33.28
|
| Rate for Payer: Cigna All Commercial |
$56.31
|
| Rate for Payer: CORVEL All Commercial |
$60.68
|
| Rate for Payer: Coventry All Commercial |
$57.42
|
| Rate for Payer: Encore All Commercial |
$60.06
|
| Rate for Payer: Frontpath All Commercial |
$60.03
|
| Rate for Payer: Humana ChoiceCare |
$56.36
|
| Rate for Payer: Humana Medicare |
$33.28
|
| Rate for Payer: Lucent All Commercial |
$33.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$48.94
|
| Rate for Payer: PHP All Commercial |
$49.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.45
|
| Rate for Payer: Sagamore Health Network All Products |
$50.37
|
| Rate for Payer: Signature Care EPO |
$54.16
|
| Rate for Payer: Signature Care PPO |
$57.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.46
|
| Rate for Payer: United Healthcare Commercial |
$51.42
|
| Rate for Payer: United Healthcare Medicare |
$21.53
|
|
|
HC RAD JAW 4 LG/NEEDLE
|
Facility
IP
|
$65.25
|
|
| Hospital Charge Code |
41608208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$60.68 |
| Rate for Payer: Aetna Commercial |
$56.38
|
| Rate for Payer: Cash Price |
$40.46
|
| Rate for Payer: Cigna All Commercial |
$56.31
|
| Rate for Payer: CORVEL All Commercial |
$60.68
|
| Rate for Payer: Coventry All Commercial |
$57.42
|
| Rate for Payer: Encore All Commercial |
$60.06
|
| Rate for Payer: Frontpath All Commercial |
$60.03
|
| Rate for Payer: Humana ChoiceCare |
$56.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.72
|
| Rate for Payer: PHCS All Commercial |
$48.94
|
| Rate for Payer: PHP All Commercial |
$49.49
|
| Rate for Payer: Sagamore Health Network All Products |
$50.37
|
| Rate for Payer: Signature Care EPO |
$54.16
|
| Rate for Payer: Signature Care PPO |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$51.42
|
|
|
HC RAPTOR GRASPING DEVICE
|
Facility
IP
|
$910.00
|
|
| Hospital Charge Code |
41601220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$846.30 |
| Rate for Payer: Aetna Commercial |
$786.24
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cigna All Commercial |
$785.33
|
| Rate for Payer: CORVEL All Commercial |
$846.30
|
| Rate for Payer: Coventry All Commercial |
$800.80
|
| Rate for Payer: Encore All Commercial |
$837.66
|
| Rate for Payer: Frontpath All Commercial |
$837.20
|
| Rate for Payer: Humana ChoiceCare |
$785.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$819.00
|
| Rate for Payer: PHCS All Commercial |
$682.50
|
| Rate for Payer: PHP All Commercial |
$690.14
|
| Rate for Payer: Sagamore Health Network All Products |
$702.52
|
| Rate for Payer: Signature Care EPO |
$755.30
|
| Rate for Payer: Signature Care PPO |
$800.80
|
| Rate for Payer: United Healthcare Commercial |
$717.08
|
|
|
HC RAPTOR GRASPING DEVICE
|
Facility
OP
|
$910.00
|
|
| Hospital Charge Code |
41601220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$846.30 |
| Rate for Payer: Aetna Commercial |
$768.04
|
| Rate for Payer: Aetna Medicare |
$300.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$522.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$345.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$330.33
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Centivo All Commercial |
$464.10
|
| Rate for Payer: Cigna All Commercial |
$785.33
|
| Rate for Payer: CORVEL All Commercial |
$846.30
|
| Rate for Payer: Coventry All Commercial |
$800.80
|
| Rate for Payer: Encore All Commercial |
$837.66
|
| Rate for Payer: Frontpath All Commercial |
$837.20
|
| Rate for Payer: Humana ChoiceCare |
$785.97
|
| Rate for Payer: Humana Medicare |
$464.10
|
| Rate for Payer: Lucent All Commercial |
$464.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$819.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$682.50
|
| Rate for Payer: PHP All Commercial |
$690.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$354.90
|
| Rate for Payer: Sagamore Health Network All Products |
$702.52
|
| Rate for Payer: Signature Care EPO |
$755.30
|
| Rate for Payer: Signature Care PPO |
$800.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$773.50
|
| Rate for Payer: United Healthcare Commercial |
$717.08
|
| Rate for Payer: United Healthcare Medicare |
$300.30
|
|
|
HC RA QUANT
|
Facility
OP
|
$61.04
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
63001915
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$51.52
|
| Rate for Payer: Aetna Medicare |
$20.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.16
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Centivo All Commercial |
$31.13
|
| Rate for Payer: Cigna All Commercial |
$52.67
|
| Rate for Payer: CORVEL All Commercial |
$56.76
|
| Rate for Payer: Coventry All Commercial |
$53.71
|
| Rate for Payer: Encore All Commercial |
$56.18
|
| Rate for Payer: Frontpath All Commercial |
$56.15
|
| Rate for Payer: Humana ChoiceCare |
$52.72
|
| Rate for Payer: Humana Medicare |
$31.13
|
| Rate for Payer: Lucent All Commercial |
$31.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.93
|
| Rate for Payer: Managed Health Services Medicaid |
$5.67
|
| Rate for Payer: MDWise Medicaid |
$5.67
|
| Rate for Payer: PHCS All Commercial |
$45.78
|
| Rate for Payer: PHP All Commercial |
$46.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.80
|
| Rate for Payer: Sagamore Health Network All Products |
$47.12
|
| Rate for Payer: Signature Care EPO |
$50.66
|
| Rate for Payer: Signature Care PPO |
$53.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.88
|
| Rate for Payer: United Healthcare Commercial |
$48.10
|
| Rate for Payer: United Healthcare Medicare |
$20.14
|
|
|
HC RA QUANT
|
Facility
IP
|
$61.04
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
63001915
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$52.74
|
| Rate for Payer: Cash Price |
$37.84
|
| Rate for Payer: Cigna All Commercial |
$52.67
|
| Rate for Payer: CORVEL All Commercial |
$56.76
|
| Rate for Payer: Coventry All Commercial |
$53.71
|
| Rate for Payer: Encore All Commercial |
$56.18
|
| Rate for Payer: Frontpath All Commercial |
$56.15
|
| Rate for Payer: Humana ChoiceCare |
$52.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.93
|
| Rate for Payer: PHCS All Commercial |
$45.78
|
| Rate for Payer: PHP All Commercial |
$46.29
|
| Rate for Payer: Sagamore Health Network All Products |
$47.12
|
| Rate for Payer: Signature Care EPO |
$50.66
|
| Rate for Payer: Signature Care PPO |
$53.71
|
| Rate for Payer: United Healthcare Commercial |
$48.10
|
|
|
HC RA TITER
|
Facility
OP
|
$69.56
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
63001288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$58.71
|
| Rate for Payer: Aetna Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.25
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Centivo All Commercial |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.22
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Humana Medicare |
$35.48
|
| Rate for Payer: Lucent All Commercial |
$35.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.61
|
| Rate for Payer: Managed Health Services Medicaid |
$5.67
|
| Rate for Payer: MDWise Medicaid |
$5.67
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.13
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.74
|
| Rate for Payer: Signature Care PPO |
$61.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.13
|
| Rate for Payer: United Healthcare Commercial |
$54.82
|
| Rate for Payer: United Healthcare Medicare |
$22.96
|
|
|
HC RA TITER
|
Facility
IP
|
$69.56
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
63001288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.22
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.61
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.76
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.74
|
| Rate for Payer: Signature Care PPO |
$61.22
|
| Rate for Payer: United Healthcare Commercial |
$54.82
|
|
