|
HC RELOAD PROX 60MM BLUE
|
Facility
IP
|
$297.69
|
|
| Hospital Charge Code |
41607893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.27 |
| Max. Negotiated Rate |
$276.85 |
| Rate for Payer: Aetna Commercial |
$257.20
|
| Rate for Payer: Cash Price |
$184.57
|
| Rate for Payer: Cigna All Commercial |
$256.91
|
| Rate for Payer: CORVEL All Commercial |
$276.85
|
| Rate for Payer: Coventry All Commercial |
$261.97
|
| Rate for Payer: Encore All Commercial |
$274.02
|
| Rate for Payer: Frontpath All Commercial |
$273.87
|
| Rate for Payer: Humana ChoiceCare |
$257.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.92
|
| Rate for Payer: PHCS All Commercial |
$223.27
|
| Rate for Payer: PHP All Commercial |
$225.77
|
| Rate for Payer: Sagamore Health Network All Products |
$229.82
|
| Rate for Payer: Signature Care EPO |
$247.08
|
| Rate for Payer: Signature Care PPO |
$261.97
|
| Rate for Payer: United Healthcare Commercial |
$234.58
|
|
|
HC RELOAD PROX 60MM BLUE
|
Facility
OP
|
$639.26
|
|
| Hospital Charge Code |
41607892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$594.51 |
| Rate for Payer: Aetna Commercial |
$539.54
|
| Rate for Payer: Aetna Medicare |
$210.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$210.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$367.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$399.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$242.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.05
|
| Rate for Payer: Cash Price |
$396.34
|
| Rate for Payer: Cash Price |
$396.34
|
| Rate for Payer: Centivo All Commercial |
$326.02
|
| Rate for Payer: Cigna All Commercial |
$551.68
|
| Rate for Payer: CORVEL All Commercial |
$594.51
|
| Rate for Payer: Coventry All Commercial |
$562.55
|
| Rate for Payer: Encore All Commercial |
$588.44
|
| Rate for Payer: Frontpath All Commercial |
$588.12
|
| Rate for Payer: Humana ChoiceCare |
$552.13
|
| Rate for Payer: Humana Medicare |
$326.02
|
| Rate for Payer: Lucent All Commercial |
$326.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$575.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$479.44
|
| Rate for Payer: PHP All Commercial |
$484.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.31
|
| Rate for Payer: Sagamore Health Network All Products |
$493.51
|
| Rate for Payer: Signature Care EPO |
$530.59
|
| Rate for Payer: Signature Care PPO |
$562.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$543.37
|
| Rate for Payer: United Healthcare Commercial |
$503.74
|
| Rate for Payer: United Healthcare Medicare |
$210.96
|
|
|
HC RELOAD PROX 60MM BLUE
|
Facility
IP
|
$639.26
|
|
| Hospital Charge Code |
41607892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.44 |
| Max. Negotiated Rate |
$594.51 |
| Rate for Payer: Aetna Commercial |
$552.32
|
| Rate for Payer: Cash Price |
$396.34
|
| Rate for Payer: Cigna All Commercial |
$551.68
|
| Rate for Payer: CORVEL All Commercial |
$594.51
|
| Rate for Payer: Coventry All Commercial |
$562.55
|
| Rate for Payer: Encore All Commercial |
$588.44
|
| Rate for Payer: Frontpath All Commercial |
$588.12
|
| Rate for Payer: Humana ChoiceCare |
$552.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$575.33
|
| Rate for Payer: PHCS All Commercial |
$479.44
|
| Rate for Payer: PHP All Commercial |
$484.81
|
| Rate for Payer: Sagamore Health Network All Products |
$493.51
|
| Rate for Payer: Signature Care EPO |
$530.59
|
| Rate for Payer: Signature Care PPO |
$562.55
|
| Rate for Payer: United Healthcare Commercial |
$503.74
|
|
|
HC RELOAD PROX CUTTER 55 BLUE
|
Facility
IP
|
$343.43
|
|
| Hospital Charge Code |
41607890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.57 |
| Max. Negotiated Rate |
$319.39 |
| Rate for Payer: Aetna Commercial |
$296.72
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cigna All Commercial |
$296.38
|
| Rate for Payer: CORVEL All Commercial |
$319.39
|
| Rate for Payer: Coventry All Commercial |
$302.22
|
| Rate for Payer: Encore All Commercial |
$316.13
|
| Rate for Payer: Frontpath All Commercial |
$315.96
|
| Rate for Payer: Humana ChoiceCare |
$296.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.09
|
| Rate for Payer: PHCS All Commercial |
$257.57
|
| Rate for Payer: PHP All Commercial |
$260.46
|
| Rate for Payer: Sagamore Health Network All Products |
$265.13
|
| Rate for Payer: Signature Care EPO |
$285.05
|
| Rate for Payer: Signature Care PPO |
$302.22
|
| Rate for Payer: United Healthcare Commercial |
$270.62
|
|
|
HC RELOAD PROX CUTTER 55 BLUE
|
Facility
OP
|
$343.43
|
|
| Hospital Charge Code |
41607890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.33 |
| Max. Negotiated Rate |
$319.39 |
| Rate for Payer: Aetna Commercial |
$289.85
|
| Rate for Payer: Aetna Medicare |
$113.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.67
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Centivo All Commercial |
$175.15
|
| Rate for Payer: Cigna All Commercial |
$296.38
|
| Rate for Payer: CORVEL All Commercial |
$319.39
|
| Rate for Payer: Coventry All Commercial |
$302.22
|
| Rate for Payer: Encore All Commercial |
$316.13
|
| Rate for Payer: Frontpath All Commercial |
$315.96
|
| Rate for Payer: Humana ChoiceCare |
$296.62
|
| Rate for Payer: Humana Medicare |
$175.15
|
| Rate for Payer: Lucent All Commercial |
$175.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$257.57
|
| Rate for Payer: PHP All Commercial |
$260.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$133.94
|
| Rate for Payer: Sagamore Health Network All Products |
$265.13
|
| Rate for Payer: Signature Care EPO |
$285.05
|
| Rate for Payer: Signature Care PPO |
$302.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$291.92
|
| Rate for Payer: United Healthcare Commercial |
$270.62
|
| Rate for Payer: United Healthcare Medicare |
$113.33
|
|
|
HC RELOAD PROX CUTTER 75 BLUE
|
Facility
OP
|
$509.96
|
|
| Hospital Charge Code |
41607891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$474.26 |
| Rate for Payer: Aetna Commercial |
$430.41
|
| Rate for Payer: Aetna Medicare |
$168.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$292.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$318.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$193.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.12
|
| Rate for Payer: Cash Price |
$316.18
|
| Rate for Payer: Cash Price |
$316.18
|
| Rate for Payer: Centivo All Commercial |
$260.08
|
| Rate for Payer: Cigna All Commercial |
$440.10
|
| Rate for Payer: CORVEL All Commercial |
$474.26
|
| Rate for Payer: Coventry All Commercial |
$448.76
|
| Rate for Payer: Encore All Commercial |
$469.42
|
| Rate for Payer: Frontpath All Commercial |
$469.16
|
| Rate for Payer: Humana ChoiceCare |
$440.45
|
| Rate for Payer: Humana Medicare |
$260.08
|
| Rate for Payer: Lucent All Commercial |
$260.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$458.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$382.47
|
| Rate for Payer: PHP All Commercial |
$386.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.88
|
| Rate for Payer: Sagamore Health Network All Products |
$393.69
|
| Rate for Payer: Signature Care EPO |
$423.27
|
| Rate for Payer: Signature Care PPO |
$448.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$433.47
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
| Rate for Payer: United Healthcare Medicare |
$168.29
|
|
|
HC RELOAD PROX CUTTER 75 BLUE
|
Facility
IP
|
$509.96
|
|
| Hospital Charge Code |
41607891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.47 |
| Max. Negotiated Rate |
$474.26 |
| Rate for Payer: Aetna Commercial |
$440.61
|
| Rate for Payer: Cash Price |
$316.18
|
| Rate for Payer: Cigna All Commercial |
$440.10
|
| Rate for Payer: CORVEL All Commercial |
$474.26
|
| Rate for Payer: Coventry All Commercial |
$448.76
|
| Rate for Payer: Encore All Commercial |
$469.42
|
| Rate for Payer: Frontpath All Commercial |
$469.16
|
| Rate for Payer: Humana ChoiceCare |
$440.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$458.96
|
| Rate for Payer: PHCS All Commercial |
$382.47
|
| Rate for Payer: PHP All Commercial |
$386.75
|
| Rate for Payer: Sagamore Health Network All Products |
$393.69
|
| Rate for Payer: Signature Care EPO |
$423.27
|
| Rate for Payer: Signature Care PPO |
$448.76
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
|
|
HC RELOAD TA 45-3.5
|
Facility
OP
|
$356.67
|
|
| Hospital Charge Code |
41601981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.70 |
| Max. Negotiated Rate |
$331.70 |
| Rate for Payer: Aetna Commercial |
$301.03
|
| Rate for Payer: Aetna Medicare |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.47
|
| Rate for Payer: Cash Price |
$221.14
|
| Rate for Payer: Cash Price |
$221.14
|
| Rate for Payer: Centivo All Commercial |
$181.90
|
| Rate for Payer: Cigna All Commercial |
$307.81
|
| Rate for Payer: CORVEL All Commercial |
$331.70
|
| Rate for Payer: Coventry All Commercial |
$313.87
|
| Rate for Payer: Encore All Commercial |
$328.31
|
| Rate for Payer: Frontpath All Commercial |
$328.14
|
| Rate for Payer: Humana ChoiceCare |
$308.06
|
| Rate for Payer: Humana Medicare |
$181.90
|
| Rate for Payer: Lucent All Commercial |
$181.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$267.50
|
| Rate for Payer: PHP All Commercial |
$270.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.10
|
| Rate for Payer: Sagamore Health Network All Products |
$275.35
|
| Rate for Payer: Signature Care EPO |
$296.04
|
| Rate for Payer: Signature Care PPO |
$313.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$303.17
|
| Rate for Payer: United Healthcare Commercial |
$281.06
|
| Rate for Payer: United Healthcare Medicare |
$117.70
|
|
|
HC RELOAD TA 45-3.5
|
Facility
IP
|
$356.67
|
|
| Hospital Charge Code |
41601981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.50 |
| Max. Negotiated Rate |
$331.70 |
| Rate for Payer: Aetna Commercial |
$308.16
|
| Rate for Payer: Cash Price |
$221.14
|
| Rate for Payer: Cigna All Commercial |
$307.81
|
| Rate for Payer: CORVEL All Commercial |
$331.70
|
| Rate for Payer: Coventry All Commercial |
$313.87
|
| Rate for Payer: Encore All Commercial |
$328.31
|
| Rate for Payer: Frontpath All Commercial |
$328.14
|
| Rate for Payer: Humana ChoiceCare |
$308.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.00
|
| Rate for Payer: PHCS All Commercial |
$267.50
|
| Rate for Payer: PHP All Commercial |
$270.50
|
| Rate for Payer: Sagamore Health Network All Products |
$275.35
|
| Rate for Payer: Signature Care EPO |
$296.04
|
| Rate for Payer: Signature Care PPO |
$313.87
|
| Rate for Payer: United Healthcare Commercial |
$281.06
|
|
|
HC RELOAD TA 60-3.5
|
Facility
IP
|
$288.88
|
|
| Hospital Charge Code |
41601982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.66 |
| Max. Negotiated Rate |
$268.66 |
| Rate for Payer: Aetna Commercial |
$249.59
|
| Rate for Payer: Cash Price |
$179.11
|
| Rate for Payer: Cigna All Commercial |
$249.30
|
| Rate for Payer: CORVEL All Commercial |
$268.66
|
| Rate for Payer: Coventry All Commercial |
$254.21
|
| Rate for Payer: Encore All Commercial |
$265.91
|
| Rate for Payer: Frontpath All Commercial |
$265.77
|
| Rate for Payer: Humana ChoiceCare |
$249.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.99
|
| Rate for Payer: PHCS All Commercial |
$216.66
|
| Rate for Payer: PHP All Commercial |
$219.09
|
| Rate for Payer: Sagamore Health Network All Products |
$223.02
|
| Rate for Payer: Signature Care EPO |
$239.77
|
| Rate for Payer: Signature Care PPO |
$254.21
|
| Rate for Payer: United Healthcare Commercial |
$227.64
|
|
|
HC RELOAD TA 60-3.5
|
Facility
OP
|
$288.88
|
|
| Hospital Charge Code |
41601982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$268.66 |
| Rate for Payer: Aetna Commercial |
$243.81
|
| Rate for Payer: Aetna Medicare |
$95.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$109.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$104.86
|
| Rate for Payer: Cash Price |
$179.11
|
| Rate for Payer: Cash Price |
$179.11
|
| Rate for Payer: Centivo All Commercial |
$147.33
|
| Rate for Payer: Cigna All Commercial |
$249.30
|
| Rate for Payer: CORVEL All Commercial |
$268.66
|
| Rate for Payer: Coventry All Commercial |
$254.21
|
| Rate for Payer: Encore All Commercial |
$265.91
|
| Rate for Payer: Frontpath All Commercial |
$265.77
|
| Rate for Payer: Humana ChoiceCare |
$249.51
|
| Rate for Payer: Humana Medicare |
$147.33
|
| Rate for Payer: Lucent All Commercial |
$147.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.99
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$216.66
|
| Rate for Payer: PHP All Commercial |
$219.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.66
|
| Rate for Payer: Sagamore Health Network All Products |
$223.02
|
| Rate for Payer: Signature Care EPO |
$239.77
|
| Rate for Payer: Signature Care PPO |
$254.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$245.55
|
| Rate for Payer: United Healthcare Commercial |
$227.64
|
| Rate for Payer: United Healthcare Medicare |
$95.33
|
|
|
HC REMOVER STAPLE SKIN
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
41607721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.80
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Centivo All Commercial |
$2.53
|
| Rate for Payer: Cigna All Commercial |
$4.29
|
| Rate for Payer: CORVEL All Commercial |
$4.62
|
| Rate for Payer: Coventry All Commercial |
$4.37
|
| Rate for Payer: Encore All Commercial |
$4.57
|
| Rate for Payer: Frontpath All Commercial |
$4.57
|
| Rate for Payer: Humana ChoiceCare |
$4.29
|
| Rate for Payer: Humana Medicare |
$2.53
|
| Rate for Payer: Lucent All Commercial |
$2.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3.73
|
| Rate for Payer: PHP All Commercial |
$3.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.94
|
| Rate for Payer: Sagamore Health Network All Products |
$3.84
|
| Rate for Payer: Signature Care EPO |
$4.13
|
| Rate for Payer: Signature Care PPO |
$4.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$3.92
|
| Rate for Payer: United Healthcare Medicare |
$1.64
|
|
|
HC REMOVER STAPLE SKIN
|
Facility
IP
|
$4.97
|
|
| Hospital Charge Code |
41607721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$4.29
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cigna All Commercial |
$4.29
|
| Rate for Payer: CORVEL All Commercial |
$4.62
|
| Rate for Payer: Coventry All Commercial |
$4.37
|
| Rate for Payer: Encore All Commercial |
$4.57
|
| Rate for Payer: Frontpath All Commercial |
$4.57
|
| Rate for Payer: Humana ChoiceCare |
$4.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.47
|
| Rate for Payer: PHCS All Commercial |
$3.73
|
| Rate for Payer: PHP All Commercial |
$3.77
|
| Rate for Payer: Sagamore Health Network All Products |
$3.84
|
| Rate for Payer: Signature Care EPO |
$4.13
|
| Rate for Payer: Signature Care PPO |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$3.92
|
|
|
HC RENAL FLOW WITH INTERVENTION
|
Facility
IP
|
$2,358.77
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
01638463
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,769.08 |
| Max. Negotiated Rate |
$2,193.66 |
| Rate for Payer: Aetna Commercial |
$2,037.98
|
| Rate for Payer: Cash Price |
$1,462.44
|
| Rate for Payer: Cigna All Commercial |
$2,035.62
|
| Rate for Payer: CORVEL All Commercial |
$2,193.66
|
| Rate for Payer: Coventry All Commercial |
$2,075.72
|
| Rate for Payer: Encore All Commercial |
$2,171.25
|
| Rate for Payer: Frontpath All Commercial |
$2,170.07
|
| Rate for Payer: Humana ChoiceCare |
$2,037.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,122.89
|
| Rate for Payer: PHCS All Commercial |
$1,769.08
|
| Rate for Payer: PHP All Commercial |
$1,788.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,820.97
|
| Rate for Payer: Signature Care EPO |
$1,957.78
|
| Rate for Payer: Signature Care PPO |
$2,075.72
|
| Rate for Payer: United Healthcare Commercial |
$1,858.71
|
|
|
HC RENAL FLOW WITH INTERVENTION
|
Facility
OP
|
$2,358.77
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
01638463
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$313.99 |
| Max. Negotiated Rate |
$2,193.66 |
| Rate for Payer: Aetna Commercial |
$1,990.80
|
| Rate for Payer: Aetna Medicare |
$778.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$778.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,354.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,474.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$313.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$895.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$856.23
|
| Rate for Payer: Cash Price |
$1,462.44
|
| Rate for Payer: Cash Price |
$1,462.44
|
| Rate for Payer: Centivo All Commercial |
$1,202.97
|
| Rate for Payer: Cigna All Commercial |
$2,035.62
|
| Rate for Payer: CORVEL All Commercial |
$2,193.66
|
| Rate for Payer: Coventry All Commercial |
$2,075.72
|
| Rate for Payer: Encore All Commercial |
$2,171.25
|
| Rate for Payer: Frontpath All Commercial |
$2,170.07
|
| Rate for Payer: Humana ChoiceCare |
$2,037.27
|
| Rate for Payer: Humana Medicare |
$1,202.97
|
| Rate for Payer: Lucent All Commercial |
$1,202.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,122.89
|
| Rate for Payer: Managed Health Services Medicaid |
$313.99
|
| Rate for Payer: MDWise Medicaid |
$313.99
|
| Rate for Payer: PHCS All Commercial |
$1,769.08
|
| Rate for Payer: PHP All Commercial |
$1,788.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$919.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,820.97
|
| Rate for Payer: Signature Care EPO |
$1,957.78
|
| Rate for Payer: Signature Care PPO |
$2,075.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,004.95
|
| Rate for Payer: United Healthcare Commercial |
$1,858.71
|
| Rate for Payer: United Healthcare Medicare |
$778.39
|
|
|
HC RENAL PANEL
|
Facility
OP
|
$115.57
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
63001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$107.48 |
| Rate for Payer: Aetna Commercial |
$97.54
|
| Rate for Payer: Aetna Medicare |
$38.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.95
|
| Rate for Payer: Cash Price |
$71.65
|
| Rate for Payer: Cash Price |
$71.65
|
| Rate for Payer: Centivo All Commercial |
$58.94
|
| Rate for Payer: Cigna All Commercial |
$99.73
|
| Rate for Payer: CORVEL All Commercial |
$107.48
|
| Rate for Payer: Coventry All Commercial |
$101.70
|
| Rate for Payer: Encore All Commercial |
$106.38
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.81
|
| Rate for Payer: Humana Medicare |
$58.94
|
| Rate for Payer: Lucent All Commercial |
$58.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.68
|
| Rate for Payer: MDWise Medicaid |
$8.68
|
| Rate for Payer: PHCS All Commercial |
$86.67
|
| Rate for Payer: PHP All Commercial |
$87.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.07
|
| Rate for Payer: Sagamore Health Network All Products |
$89.22
|
| Rate for Payer: Signature Care EPO |
$95.92
|
| Rate for Payer: Signature Care PPO |
$101.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.23
|
| Rate for Payer: United Healthcare Commercial |
$91.07
|
| Rate for Payer: United Healthcare Medicare |
$38.14
|
|
|
HC RENAL PANEL
|
Facility
IP
|
$115.57
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
63001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.67 |
| Max. Negotiated Rate |
$107.48 |
| Rate for Payer: Aetna Commercial |
$99.85
|
| Rate for Payer: Cash Price |
$71.65
|
| Rate for Payer: Cigna All Commercial |
$99.73
|
| Rate for Payer: CORVEL All Commercial |
$107.48
|
| Rate for Payer: Coventry All Commercial |
$101.70
|
| Rate for Payer: Encore All Commercial |
$106.38
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.01
|
| Rate for Payer: PHCS All Commercial |
$86.67
|
| Rate for Payer: PHP All Commercial |
$87.65
|
| Rate for Payer: Sagamore Health Network All Products |
$89.22
|
| Rate for Payer: Signature Care EPO |
$95.92
|
| Rate for Payer: Signature Care PPO |
$101.70
|
| Rate for Payer: United Healthcare Commercial |
$91.07
|
|
|
HC RENAL SCAN
|
Facility
OP
|
$1,975.95
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
01638345
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$509.15 |
| Max. Negotiated Rate |
$1,837.64 |
| Rate for Payer: Aetna Commercial |
$1,667.71
|
| Rate for Payer: Aetna Medicare |
$652.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$652.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,134.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,235.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$509.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$749.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.27
|
| Rate for Payer: Cash Price |
$1,225.09
|
| Rate for Payer: Cash Price |
$1,225.09
|
| Rate for Payer: Centivo All Commercial |
$1,007.74
|
| Rate for Payer: Cigna All Commercial |
$1,705.25
|
| Rate for Payer: CORVEL All Commercial |
$1,837.64
|
| Rate for Payer: Coventry All Commercial |
$1,738.84
|
| Rate for Payer: Encore All Commercial |
$1,818.87
|
| Rate for Payer: Frontpath All Commercial |
$1,817.88
|
| Rate for Payer: Humana ChoiceCare |
$1,706.63
|
| Rate for Payer: Humana Medicare |
$1,007.74
|
| Rate for Payer: Lucent All Commercial |
$1,007.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,778.36
|
| Rate for Payer: Managed Health Services Medicaid |
$509.15
|
| Rate for Payer: MDWise Medicaid |
$509.15
|
| Rate for Payer: PHCS All Commercial |
$1,481.97
|
| Rate for Payer: PHP All Commercial |
$1,498.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$770.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,525.44
|
| Rate for Payer: Signature Care EPO |
$1,640.04
|
| Rate for Payer: Signature Care PPO |
$1,738.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,679.56
|
| Rate for Payer: United Healthcare Commercial |
$1,557.05
|
| Rate for Payer: United Healthcare Medicare |
$652.06
|
|
|
HC RENAL SCAN
|
Facility
IP
|
$1,975.95
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
01638345
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,481.97 |
| Max. Negotiated Rate |
$1,837.64 |
| Rate for Payer: Aetna Commercial |
$1,707.22
|
| Rate for Payer: Cash Price |
$1,225.09
|
| Rate for Payer: Cigna All Commercial |
$1,705.25
|
| Rate for Payer: CORVEL All Commercial |
$1,837.64
|
| Rate for Payer: Coventry All Commercial |
$1,738.84
|
| Rate for Payer: Encore All Commercial |
$1,818.87
|
| Rate for Payer: Frontpath All Commercial |
$1,817.88
|
| Rate for Payer: Humana ChoiceCare |
$1,706.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,778.36
|
| Rate for Payer: PHCS All Commercial |
$1,481.97
|
| Rate for Payer: PHP All Commercial |
$1,498.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,525.44
|
| Rate for Payer: Signature Care EPO |
$1,640.04
|
| Rate for Payer: Signature Care PPO |
$1,738.84
|
| Rate for Payer: United Healthcare Commercial |
$1,557.05
|
|
|
HC RENAL SCAN (STATIC)
|
Facility
OP
|
$997.92
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
01639001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$329.31 |
| Max. Negotiated Rate |
$928.06 |
| Rate for Payer: Aetna Commercial |
$842.24
|
| Rate for Payer: Aetna Medicare |
$329.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$329.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$573.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$417.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$378.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.24
|
| Rate for Payer: Cash Price |
$618.71
|
| Rate for Payer: Cash Price |
$618.71
|
| Rate for Payer: Centivo All Commercial |
$508.94
|
| Rate for Payer: Cigna All Commercial |
$861.20
|
| Rate for Payer: CORVEL All Commercial |
$928.06
|
| Rate for Payer: Coventry All Commercial |
$878.17
|
| Rate for Payer: Encore All Commercial |
$918.58
|
| Rate for Payer: Frontpath All Commercial |
$918.08
|
| Rate for Payer: Humana ChoiceCare |
$861.90
|
| Rate for Payer: Humana Medicare |
$508.94
|
| Rate for Payer: Lucent All Commercial |
$508.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.13
|
| Rate for Payer: Managed Health Services Medicaid |
$417.34
|
| Rate for Payer: MDWise Medicaid |
$417.34
|
| Rate for Payer: PHCS All Commercial |
$748.44
|
| Rate for Payer: PHP All Commercial |
$756.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.19
|
| Rate for Payer: Sagamore Health Network All Products |
$770.39
|
| Rate for Payer: Signature Care EPO |
$828.27
|
| Rate for Payer: Signature Care PPO |
$878.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$848.23
|
| Rate for Payer: United Healthcare Commercial |
$786.36
|
| Rate for Payer: United Healthcare Medicare |
$329.31
|
|
|
HC RENAL SCAN (STATIC)
|
Facility
IP
|
$997.92
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
01639001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$748.44 |
| Max. Negotiated Rate |
$928.06 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Cash Price |
$618.71
|
| Rate for Payer: Cigna All Commercial |
$861.20
|
| Rate for Payer: CORVEL All Commercial |
$928.06
|
| Rate for Payer: Coventry All Commercial |
$878.17
|
| Rate for Payer: Encore All Commercial |
$918.58
|
| Rate for Payer: Frontpath All Commercial |
$918.08
|
| Rate for Payer: Humana ChoiceCare |
$861.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.13
|
| Rate for Payer: PHCS All Commercial |
$748.44
|
| Rate for Payer: PHP All Commercial |
$756.82
|
| Rate for Payer: Sagamore Health Network All Products |
$770.39
|
| Rate for Payer: Signature Care EPO |
$828.27
|
| Rate for Payer: Signature Care PPO |
$878.17
|
| Rate for Payer: United Healthcare Commercial |
$786.36
|
|
|
HC RENIN
|
Facility
OP
|
$398.31
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
63001673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$370.43 |
| Rate for Payer: Aetna Commercial |
$336.17
|
| Rate for Payer: Aetna Medicare |
$131.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.59
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Centivo All Commercial |
$203.14
|
| Rate for Payer: Cigna All Commercial |
$343.74
|
| Rate for Payer: CORVEL All Commercial |
$370.43
|
| Rate for Payer: Coventry All Commercial |
$350.51
|
| Rate for Payer: Encore All Commercial |
$366.64
|
| Rate for Payer: Frontpath All Commercial |
$366.45
|
| Rate for Payer: Humana ChoiceCare |
$344.02
|
| Rate for Payer: Humana Medicare |
$203.14
|
| Rate for Payer: Lucent All Commercial |
$203.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.48
|
| Rate for Payer: Managed Health Services Medicaid |
$21.99
|
| Rate for Payer: MDWise Medicaid |
$21.99
|
| Rate for Payer: PHCS All Commercial |
$298.73
|
| Rate for Payer: PHP All Commercial |
$302.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.34
|
| Rate for Payer: Sagamore Health Network All Products |
$307.50
|
| Rate for Payer: Signature Care EPO |
$330.60
|
| Rate for Payer: Signature Care PPO |
$350.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.56
|
| Rate for Payer: United Healthcare Commercial |
$313.87
|
| Rate for Payer: United Healthcare Medicare |
$131.44
|
|
|
HC RENIN
|
Facility
IP
|
$398.31
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
63001673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$370.43 |
| Rate for Payer: Aetna Commercial |
$344.14
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna All Commercial |
$343.74
|
| Rate for Payer: CORVEL All Commercial |
$370.43
|
| Rate for Payer: Coventry All Commercial |
$350.51
|
| Rate for Payer: Encore All Commercial |
$366.64
|
| Rate for Payer: Frontpath All Commercial |
$366.45
|
| Rate for Payer: Humana ChoiceCare |
$344.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.48
|
| Rate for Payer: PHCS All Commercial |
$298.73
|
| Rate for Payer: PHP All Commercial |
$302.08
|
| Rate for Payer: Sagamore Health Network All Products |
$307.50
|
| Rate for Payer: Signature Care EPO |
$330.60
|
| Rate for Payer: Signature Care PPO |
$350.51
|
| Rate for Payer: United Healthcare Commercial |
$313.87
|
|
|
HC RESOLUTION CLIP
|
Facility
OP
|
$560.00
|
|
| Hospital Charge Code |
41601201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$472.64
|
| Rate for Payer: Aetna Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$350.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.28
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Centivo All Commercial |
$285.60
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Humana Medicare |
$285.60
|
| Rate for Payer: Lucent All Commercial |
$285.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.40
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$476.00
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
|
|
HC RESOLUTION CLIP
|
Facility
IP
|
$560.00
|
|
| Hospital Charge Code |
41601201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$483.84
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
|
