|
HC RHOGAM INJECTION MINI DOSE
|
Facility
IP
|
$232.09
|
|
| Hospital Charge Code |
63002242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.07 |
| Max. Negotiated Rate |
$215.84 |
| Rate for Payer: Aetna Commercial |
$200.53
|
| Rate for Payer: Cash Price |
$143.90
|
| Rate for Payer: Cigna All Commercial |
$200.29
|
| Rate for Payer: CORVEL All Commercial |
$215.84
|
| Rate for Payer: Coventry All Commercial |
$204.24
|
| Rate for Payer: Encore All Commercial |
$213.64
|
| Rate for Payer: Frontpath All Commercial |
$213.52
|
| Rate for Payer: Humana ChoiceCare |
$200.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.88
|
| Rate for Payer: PHCS All Commercial |
$174.07
|
| Rate for Payer: PHP All Commercial |
$176.02
|
| Rate for Payer: Sagamore Health Network All Products |
$179.17
|
| Rate for Payer: Signature Care EPO |
$192.64
|
| Rate for Payer: Signature Care PPO |
$204.24
|
| Rate for Payer: United Healthcare Commercial |
$182.89
|
|
|
HC RHOGAM INJECTION MINI DOSE
|
Facility
OP
|
$232.09
|
|
| Hospital Charge Code |
63002242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$215.84 |
| Rate for Payer: Aetna Commercial |
$195.88
|
| Rate for Payer: Aetna Medicare |
$76.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$133.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.25
|
| Rate for Payer: Cash Price |
$143.90
|
| Rate for Payer: Centivo All Commercial |
$118.37
|
| Rate for Payer: Cigna All Commercial |
$200.29
|
| Rate for Payer: CORVEL All Commercial |
$215.84
|
| Rate for Payer: Coventry All Commercial |
$204.24
|
| Rate for Payer: Encore All Commercial |
$213.64
|
| Rate for Payer: Frontpath All Commercial |
$213.52
|
| Rate for Payer: Humana ChoiceCare |
$200.46
|
| Rate for Payer: Humana Medicare |
$118.37
|
| Rate for Payer: Lucent All Commercial |
$118.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.88
|
| Rate for Payer: PHCS All Commercial |
$174.07
|
| Rate for Payer: PHP All Commercial |
$176.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.52
|
| Rate for Payer: Sagamore Health Network All Products |
$179.17
|
| Rate for Payer: Signature Care EPO |
$192.64
|
| Rate for Payer: Signature Care PPO |
$204.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$197.28
|
| Rate for Payer: United Healthcare Commercial |
$182.89
|
| Rate for Payer: United Healthcare Medicare |
$76.59
|
|
|
HC RHOGAM WORKUP
|
Facility
OP
|
$191.45
|
|
| Hospital Charge Code |
63002243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$178.05 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna Medicare |
$63.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.50
|
| Rate for Payer: Cash Price |
$118.70
|
| Rate for Payer: Centivo All Commercial |
$97.64
|
| Rate for Payer: Cigna All Commercial |
$165.22
|
| Rate for Payer: CORVEL All Commercial |
$178.05
|
| Rate for Payer: Coventry All Commercial |
$168.48
|
| Rate for Payer: Encore All Commercial |
$176.23
|
| Rate for Payer: Frontpath All Commercial |
$176.14
|
| Rate for Payer: Humana ChoiceCare |
$165.36
|
| Rate for Payer: Humana Medicare |
$97.64
|
| Rate for Payer: Lucent All Commercial |
$97.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.31
|
| Rate for Payer: PHCS All Commercial |
$143.59
|
| Rate for Payer: PHP All Commercial |
$145.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.67
|
| Rate for Payer: Sagamore Health Network All Products |
$147.80
|
| Rate for Payer: Signature Care EPO |
$158.91
|
| Rate for Payer: Signature Care PPO |
$168.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.74
|
| Rate for Payer: United Healthcare Commercial |
$150.87
|
| Rate for Payer: United Healthcare Medicare |
$63.18
|
|
|
HC RHOGAM WORKUP
|
Facility
IP
|
$191.45
|
|
| Hospital Charge Code |
63002243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.59 |
| Max. Negotiated Rate |
$178.05 |
| Rate for Payer: Aetna Commercial |
$165.42
|
| Rate for Payer: Cash Price |
$118.70
|
| Rate for Payer: Cigna All Commercial |
$165.22
|
| Rate for Payer: CORVEL All Commercial |
$178.05
|
| Rate for Payer: Coventry All Commercial |
$168.48
|
| Rate for Payer: Encore All Commercial |
$176.23
|
| Rate for Payer: Frontpath All Commercial |
$176.14
|
| Rate for Payer: Humana ChoiceCare |
$165.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.31
|
| Rate for Payer: PHCS All Commercial |
$143.59
|
| Rate for Payer: PHP All Commercial |
$145.20
|
| Rate for Payer: Sagamore Health Network All Products |
$147.80
|
| Rate for Payer: Signature Care EPO |
$158.91
|
| Rate for Payer: Signature Care PPO |
$168.48
|
| Rate for Payer: United Healthcare Commercial |
$150.87
|
|
|
HC RH TYPE
|
Facility
OP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$31.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.99
|
| 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 |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| 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 RH TYPE
|
Facility
IP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001355
|
|
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
|
|
|
HC RIBOSOMAL P PROT AB
|
Facility
OP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$80.88
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.79
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Centivo All Commercial |
$48.87
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Humana Medicare |
$48.87
|
| Rate for Payer: Lucent All Commercial |
$48.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.37
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.45
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
| Rate for Payer: United Healthcare Medicare |
$31.62
|
|
|
HC RIBOSOMAL P PROT AB
|
Facility
IP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
|
|
HC RING BARRIER ADAPT 4.5MM
|
Facility
IP
|
$8.01
|
|
| Hospital Charge Code |
41607532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cigna All Commercial |
$6.91
|
| Rate for Payer: CORVEL All Commercial |
$7.45
|
| Rate for Payer: Coventry All Commercial |
$7.05
|
| Rate for Payer: Encore All Commercial |
$7.37
|
| Rate for Payer: Frontpath All Commercial |
$7.37
|
| Rate for Payer: Humana ChoiceCare |
$6.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.21
|
| Rate for Payer: PHCS All Commercial |
$6.01
|
| Rate for Payer: PHP All Commercial |
$6.07
|
| Rate for Payer: Sagamore Health Network All Products |
$6.18
|
| Rate for Payer: Signature Care EPO |
$6.65
|
| Rate for Payer: Signature Care PPO |
$7.05
|
| Rate for Payer: United Healthcare Commercial |
$6.31
|
|
|
HC RING BARRIER ADAPT 4.5MM
|
Facility
OP
|
$8.01
|
|
| Hospital Charge Code |
41607532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$6.76
|
| Rate for Payer: Aetna Medicare |
$2.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.91
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Centivo All Commercial |
$4.09
|
| Rate for Payer: Cigna All Commercial |
$6.91
|
| Rate for Payer: CORVEL All Commercial |
$7.45
|
| Rate for Payer: Coventry All Commercial |
$7.05
|
| Rate for Payer: Encore All Commercial |
$7.37
|
| Rate for Payer: Frontpath All Commercial |
$7.37
|
| Rate for Payer: Humana ChoiceCare |
$6.92
|
| Rate for Payer: Humana Medicare |
$4.09
|
| Rate for Payer: Lucent All Commercial |
$4.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.21
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$6.01
|
| Rate for Payer: PHP All Commercial |
$6.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.12
|
| Rate for Payer: Sagamore Health Network All Products |
$6.18
|
| Rate for Payer: Signature Care EPO |
$6.65
|
| Rate for Payer: Signature Care PPO |
$7.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.81
|
| Rate for Payer: United Healthcare Commercial |
$6.31
|
| Rate for Payer: United Healthcare Medicare |
$2.64
|
|
|
HC RISTOCETIN COFACTOR ASSAY
|
Facility
IP
|
$188.63
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
63001736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$175.42 |
| Rate for Payer: Aetna Commercial |
$162.98
|
| Rate for Payer: Cash Price |
$116.95
|
| Rate for Payer: Cigna All Commercial |
$162.79
|
| Rate for Payer: CORVEL All Commercial |
$175.42
|
| Rate for Payer: Coventry All Commercial |
$165.99
|
| Rate for Payer: Encore All Commercial |
$173.63
|
| Rate for Payer: Frontpath All Commercial |
$173.54
|
| Rate for Payer: Humana ChoiceCare |
$162.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.77
|
| Rate for Payer: PHCS All Commercial |
$141.47
|
| Rate for Payer: PHP All Commercial |
$143.06
|
| Rate for Payer: Sagamore Health Network All Products |
$145.62
|
| Rate for Payer: Signature Care EPO |
$156.56
|
| Rate for Payer: Signature Care PPO |
$165.99
|
| Rate for Payer: United Healthcare Commercial |
$148.64
|
|
|
HC RISTOCETIN COFACTOR ASSAY
|
Facility
OP
|
$188.63
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
63001736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$175.42 |
| Rate for Payer: Aetna Commercial |
$159.20
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.47
|
| Rate for Payer: Cash Price |
$116.95
|
| Rate for Payer: Cash Price |
$116.95
|
| Rate for Payer: Centivo All Commercial |
$96.20
|
| Rate for Payer: Cigna All Commercial |
$162.79
|
| Rate for Payer: CORVEL All Commercial |
$175.42
|
| Rate for Payer: Coventry All Commercial |
$165.99
|
| Rate for Payer: Encore All Commercial |
$173.63
|
| Rate for Payer: Frontpath All Commercial |
$173.54
|
| Rate for Payer: Humana ChoiceCare |
$162.92
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Lucent All Commercial |
$96.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.77
|
| Rate for Payer: Managed Health Services Medicaid |
$22.94
|
| Rate for Payer: MDWise Medicaid |
$22.94
|
| Rate for Payer: PHCS All Commercial |
$141.47
|
| Rate for Payer: PHP All Commercial |
$143.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.57
|
| Rate for Payer: Sagamore Health Network All Products |
$145.62
|
| Rate for Payer: Signature Care EPO |
$156.56
|
| Rate for Payer: Signature Care PPO |
$165.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.33
|
| Rate for Payer: United Healthcare Commercial |
$148.64
|
| Rate for Payer: United Healthcare Medicare |
$62.25
|
|
|
HC RITE HITE / ENVELLA BED /DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
02330054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.23
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Centivo All Commercial |
$156.27
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Humana Medicare |
$156.27
|
| Rate for Payer: Lucent All Commercial |
$156.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$101.11
|
|
|
HC RITE HITE / ENVELLA BED /DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
02330054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC ROBOTIC SRS INITIAL FRACTION
|
Facility
OP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
01540339
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,224.79 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,247.64
|
| Rate for Payer: Aetna Medicare |
$3,224.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,224.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,612.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,108.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3,898.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,708.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,547.27
|
| Rate for Payer: Cash Price |
$6,058.70
|
| Rate for Payer: Cash Price |
$6,058.70
|
| Rate for Payer: Centivo All Commercial |
$4,983.77
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Humana Medicare |
$4,983.77
|
| Rate for Payer: Lucent All Commercial |
$4,983.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: Managed Health Services Medicaid |
$3,898.64
|
| Rate for Payer: MDWise Medicaid |
$3,898.64
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,811.11
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,306.28
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
| Rate for Payer: United Healthcare Medicare |
$3,224.79
|
|
|
HC ROBOTIC SRS INITIAL FRACTION
|
Facility
IP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
01540339
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$7,329.07 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,443.09
|
| Rate for Payer: Cash Price |
$6,058.70
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
|
|
HC ROBOTIC SRS SUBSEQUENT FRACT
|
Facility
OP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
01540340
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,224.79 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,247.64
|
| Rate for Payer: Aetna Medicare |
$3,224.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,224.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,612.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,108.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3,898.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,708.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,547.27
|
| Rate for Payer: Cash Price |
$6,058.70
|
| Rate for Payer: Cash Price |
$6,058.70
|
| Rate for Payer: Centivo All Commercial |
$4,983.77
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Humana Medicare |
$4,983.77
|
| Rate for Payer: Lucent All Commercial |
$4,983.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: Managed Health Services Medicaid |
$3,898.64
|
| Rate for Payer: MDWise Medicaid |
$3,898.64
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,811.11
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,306.28
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
| Rate for Payer: United Healthcare Medicare |
$3,224.79
|
|
|
HC ROBOTIC SRS SUBSEQUENT FRACT
|
Facility
IP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
01540340
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$7,329.07 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,443.09
|
| Rate for Payer: Cash Price |
$6,058.70
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
|
|
HC ROM RUPTURE OF MEMBRANE
|
Facility
OP
|
$468.44
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
63001660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$435.64 |
| Rate for Payer: Aetna Commercial |
$395.36
|
| Rate for Payer: Aetna Medicare |
$154.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$215.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$87.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$177.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.04
|
| Rate for Payer: Cash Price |
$290.43
|
| Rate for Payer: Cash Price |
$290.43
|
| Rate for Payer: Centivo All Commercial |
$238.90
|
| Rate for Payer: Cigna All Commercial |
$404.26
|
| Rate for Payer: CORVEL All Commercial |
$435.64
|
| Rate for Payer: Coventry All Commercial |
$412.22
|
| Rate for Payer: Encore All Commercial |
$431.19
|
| Rate for Payer: Frontpath All Commercial |
$430.96
|
| Rate for Payer: Humana ChoiceCare |
$404.59
|
| Rate for Payer: Humana Medicare |
$238.90
|
| Rate for Payer: Lucent All Commercial |
$238.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.59
|
| Rate for Payer: Managed Health Services Medicaid |
$87.65
|
| Rate for Payer: MDWise Medicaid |
$87.65
|
| Rate for Payer: PHCS All Commercial |
$351.33
|
| Rate for Payer: PHP All Commercial |
$355.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.69
|
| Rate for Payer: Sagamore Health Network All Products |
$361.63
|
| Rate for Payer: Signature Care EPO |
$388.80
|
| Rate for Payer: Signature Care PPO |
$412.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.17
|
| Rate for Payer: United Healthcare Commercial |
$369.13
|
| Rate for Payer: United Healthcare Medicare |
$154.58
|
|
|
HC ROM RUPTURE OF MEMBRANE
|
Facility
IP
|
$468.44
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
63001660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$351.33 |
| Max. Negotiated Rate |
$435.64 |
| Rate for Payer: Aetna Commercial |
$404.73
|
| Rate for Payer: Cash Price |
$290.43
|
| Rate for Payer: Cigna All Commercial |
$404.26
|
| Rate for Payer: CORVEL All Commercial |
$435.64
|
| Rate for Payer: Coventry All Commercial |
$412.22
|
| Rate for Payer: Encore All Commercial |
$431.19
|
| Rate for Payer: Frontpath All Commercial |
$430.96
|
| Rate for Payer: Humana ChoiceCare |
$404.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.59
|
| Rate for Payer: PHCS All Commercial |
$351.33
|
| Rate for Payer: PHP All Commercial |
$355.26
|
| Rate for Payer: Sagamore Health Network All Products |
$361.63
|
| Rate for Payer: Signature Care EPO |
$388.80
|
| Rate for Payer: Signature Care PPO |
$412.22
|
| Rate for Payer: United Healthcare Commercial |
$369.13
|
|
|
HC ROTAVIRUS
|
Facility
OP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63001085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$144.41
|
| Rate for Payer: Aetna Medicare |
$56.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.11
|
| Rate for Payer: Cash Price |
$106.09
|
| Rate for Payer: Cash Price |
$106.09
|
| Rate for Payer: Centivo All Commercial |
$87.26
|
| Rate for Payer: Cigna All Commercial |
$147.66
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.57
|
| Rate for Payer: Encore All Commercial |
$157.50
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.78
|
| Rate for Payer: Humana Medicare |
$87.26
|
| Rate for Payer: Lucent All Commercial |
$87.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.99
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.73
|
| Rate for Payer: Sagamore Health Network All Products |
$132.09
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.44
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
|
|
HC ROTAVIRUS
|
Facility
IP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63001085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$147.83
|
| Rate for Payer: Cash Price |
$106.09
|
| Rate for Payer: Cigna All Commercial |
$147.66
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.57
|
| Rate for Payer: Encore All Commercial |
$157.50
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.99
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Sagamore Health Network All Products |
$132.09
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.57
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
|
|
HC ROTH NET MINI FB
|
Facility
IP
|
$840.00
|
|
| Hospital Charge Code |
41608230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$781.20 |
| Rate for Payer: Aetna Commercial |
$725.76
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna All Commercial |
$724.92
|
| Rate for Payer: CORVEL All Commercial |
$781.20
|
| Rate for Payer: Coventry All Commercial |
$739.20
|
| Rate for Payer: Encore All Commercial |
$773.22
|
| Rate for Payer: Frontpath All Commercial |
$772.80
|
| Rate for Payer: Humana ChoiceCare |
$725.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.00
|
| Rate for Payer: PHCS All Commercial |
$630.00
|
| Rate for Payer: PHP All Commercial |
$637.06
|
| Rate for Payer: Sagamore Health Network All Products |
$648.48
|
| Rate for Payer: Signature Care EPO |
$697.20
|
| Rate for Payer: Signature Care PPO |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$661.92
|
|
|
HC ROTH NET MINI FB
|
Facility
OP
|
$840.00
|
|
| Hospital Charge Code |
41608230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$781.20 |
| Rate for Payer: Aetna Commercial |
$708.96
|
| Rate for Payer: Aetna Medicare |
$277.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$277.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$482.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$525.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.92
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Centivo All Commercial |
$428.40
|
| Rate for Payer: Cigna All Commercial |
$724.92
|
| Rate for Payer: CORVEL All Commercial |
$781.20
|
| Rate for Payer: Coventry All Commercial |
$739.20
|
| Rate for Payer: Encore All Commercial |
$773.22
|
| Rate for Payer: Frontpath All Commercial |
$772.80
|
| Rate for Payer: Humana ChoiceCare |
$725.51
|
| Rate for Payer: Humana Medicare |
$428.40
|
| Rate for Payer: Lucent All Commercial |
$428.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$630.00
|
| Rate for Payer: PHP All Commercial |
$637.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.60
|
| Rate for Payer: Sagamore Health Network All Products |
$648.48
|
| Rate for Payer: Signature Care EPO |
$697.20
|
| Rate for Payer: Signature Care PPO |
$739.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$714.00
|
| Rate for Payer: United Healthcare Commercial |
$661.92
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
|
|
HC ROTH NET PLATINUM
|
Facility
OP
|
$700.00
|
|
| Hospital Charge Code |
41601221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$590.80
|
| Rate for Payer: Aetna Medicare |
$231.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$402.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.10
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Centivo All Commercial |
$357.00
|
| Rate for Payer: Cigna All Commercial |
$604.10
|
| Rate for Payer: CORVEL All Commercial |
$651.00
|
| Rate for Payer: Coventry All Commercial |
$616.00
|
| Rate for Payer: Encore All Commercial |
$644.35
|
| Rate for Payer: Frontpath All Commercial |
$644.00
|
| Rate for Payer: Humana ChoiceCare |
$604.59
|
| Rate for Payer: Humana Medicare |
$357.00
|
| Rate for Payer: Lucent All Commercial |
$357.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.00
|
| Rate for Payer: Sagamore Health Network All Products |
$540.40
|
| Rate for Payer: Signature Care EPO |
$581.00
|
| Rate for Payer: Signature Care PPO |
$616.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$595.00
|
| Rate for Payer: United Healthcare Commercial |
$551.60
|
| Rate for Payer: United Healthcare Medicare |
$231.00
|
|
