|
HC WAND SERFAS ENERGY 90-S
|
Facility
|
OP
|
$870.45
|
|
| Hospital Charge Code |
41602567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$809.52 |
| Rate for Payer: Aetna Commercial |
$734.66
|
| Rate for Payer: Aetna Medicare |
$278.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$499.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$544.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$320.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$522.27
|
| Rate for Payer: Cash Price |
$522.27
|
| Rate for Payer: Centivo All Commercial |
$473.52
|
| Rate for Payer: Cigna All Commercial |
$751.20
|
| Rate for Payer: CORVEL All Commercial |
$809.52
|
| Rate for Payer: Coventry All Commercial |
$766.00
|
| Rate for Payer: Encore All Commercial |
$801.25
|
| Rate for Payer: Frontpath All Commercial |
$800.81
|
| Rate for Payer: Humana ChoiceCare |
$751.81
|
| Rate for Payer: Humana Medicare |
$278.54
|
| Rate for Payer: Lucent All Commercial |
$473.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$783.40
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$652.84
|
| Rate for Payer: PHP All Commercial |
$660.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$339.48
|
| Rate for Payer: Sagamore Health Network All Products |
$671.99
|
| Rate for Payer: Signature Care EPO |
$722.47
|
| Rate for Payer: Signature Care PPO |
$766.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$739.88
|
| Rate for Payer: United Healthcare Commercial |
$685.91
|
| Rate for Payer: United Healthcare Medicare |
$278.54
|
|
|
HC WAND SERFAS ENERGY 90-S
|
Facility
|
IP
|
$870.45
|
|
| Hospital Charge Code |
41602567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.84 |
| Max. Negotiated Rate |
$809.52 |
| Rate for Payer: Aetna Commercial |
$752.07
|
| Rate for Payer: Cash Price |
$522.27
|
| Rate for Payer: Cigna All Commercial |
$751.20
|
| Rate for Payer: CORVEL All Commercial |
$809.52
|
| Rate for Payer: Coventry All Commercial |
$766.00
|
| Rate for Payer: Encore All Commercial |
$801.25
|
| Rate for Payer: Frontpath All Commercial |
$800.81
|
| Rate for Payer: Humana ChoiceCare |
$751.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$783.40
|
| Rate for Payer: PHCS All Commercial |
$652.84
|
| Rate for Payer: PHP All Commercial |
$660.15
|
| Rate for Payer: Sagamore Health Network All Products |
$671.99
|
| Rate for Payer: Signature Care EPO |
$722.47
|
| Rate for Payer: Signature Care PPO |
$766.00
|
| Rate for Payer: United Healthcare Commercial |
$685.91
|
|
|
HC W AUGMENT 1.5ML
|
Facility
|
IP
|
$7,448.40
|
|
|
Service Code
|
CPT C1734
|
| Hospital Charge Code |
41606135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.30 |
| Max. Negotiated Rate |
$6,927.01 |
| Rate for Payer: Aetna Commercial |
$6,435.42
|
| Rate for Payer: Cash Price |
$4,469.04
|
| Rate for Payer: Cigna All Commercial |
$6,427.97
|
| Rate for Payer: CORVEL All Commercial |
$6,927.01
|
| Rate for Payer: Coventry All Commercial |
$6,554.59
|
| Rate for Payer: Encore All Commercial |
$6,856.25
|
| Rate for Payer: Frontpath All Commercial |
$6,852.53
|
| Rate for Payer: Humana ChoiceCare |
$6,433.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,703.56
|
| Rate for Payer: PHCS All Commercial |
$5,586.30
|
| Rate for Payer: PHP All Commercial |
$5,648.87
|
| Rate for Payer: Sagamore Health Network All Products |
$5,750.16
|
| Rate for Payer: Signature Care EPO |
$6,182.17
|
| Rate for Payer: Signature Care PPO |
$6,554.59
|
| Rate for Payer: United Healthcare Commercial |
$5,869.34
|
|
|
HC W AUGMENT 1.5ML
|
Facility
|
OP
|
$7,448.40
|
|
|
Service Code
|
CPT C1734
|
| Hospital Charge Code |
41606135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,927.01 |
| Rate for Payer: Aetna Commercial |
$6,286.45
|
| Rate for Payer: Aetna Medicare |
$2,383.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,309.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,277.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,655.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,741.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,621.84
|
| Rate for Payer: Cash Price |
$4,469.04
|
| Rate for Payer: Cash Price |
$4,469.04
|
| Rate for Payer: Centivo All Commercial |
$4,051.93
|
| Rate for Payer: Cigna All Commercial |
$6,427.97
|
| Rate for Payer: CORVEL All Commercial |
$6,927.01
|
| Rate for Payer: Coventry All Commercial |
$6,554.59
|
| Rate for Payer: Encore All Commercial |
$6,856.25
|
| Rate for Payer: Frontpath All Commercial |
$6,852.53
|
| Rate for Payer: Humana ChoiceCare |
$6,433.18
|
| Rate for Payer: Humana Medicare |
$2,383.49
|
| Rate for Payer: Lucent All Commercial |
$4,051.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,703.56
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,586.30
|
| Rate for Payer: PHP All Commercial |
$5,648.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,904.88
|
| Rate for Payer: Sagamore Health Network All Products |
$5,750.16
|
| Rate for Payer: Signature Care EPO |
$6,182.17
|
| Rate for Payer: Signature Care PPO |
$6,554.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,331.14
|
| Rate for Payer: United Healthcare Commercial |
$5,869.34
|
| Rate for Payer: United Healthcare Medicare |
$2,383.49
|
|
|
HC WBC STOOL
|
Facility
|
OP
|
$101.46
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63001295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$94.36 |
| Rate for Payer: Aetna Commercial |
$85.63
|
| Rate for Payer: Aetna Medicare |
$32.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$46.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.71
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Centivo All Commercial |
$55.19
|
| Rate for Payer: Cigna All Commercial |
$87.56
|
| Rate for Payer: CORVEL All Commercial |
$94.36
|
| Rate for Payer: Coventry All Commercial |
$89.28
|
| Rate for Payer: Encore All Commercial |
$93.39
|
| Rate for Payer: Frontpath All Commercial |
$93.34
|
| Rate for Payer: Humana ChoiceCare |
$87.63
|
| Rate for Payer: Humana Medicare |
$32.47
|
| Rate for Payer: Lucent All Commercial |
$55.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.31
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$76.09
|
| Rate for Payer: PHP All Commercial |
$76.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.57
|
| Rate for Payer: Sagamore Health Network All Products |
$78.33
|
| Rate for Payer: Signature Care EPO |
$84.21
|
| Rate for Payer: Signature Care PPO |
$89.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.24
|
| Rate for Payer: United Healthcare Commercial |
$79.95
|
| Rate for Payer: United Healthcare Medicare |
$32.47
|
|
|
HC WBC STOOL
|
Facility
|
IP
|
$101.46
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63001295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$94.36 |
| Rate for Payer: Aetna Commercial |
$87.66
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cigna All Commercial |
$87.56
|
| Rate for Payer: CORVEL All Commercial |
$94.36
|
| Rate for Payer: Coventry All Commercial |
$89.28
|
| Rate for Payer: Encore All Commercial |
$93.39
|
| Rate for Payer: Frontpath All Commercial |
$93.34
|
| Rate for Payer: Humana ChoiceCare |
$87.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.31
|
| Rate for Payer: PHCS All Commercial |
$76.09
|
| Rate for Payer: PHP All Commercial |
$76.95
|
| Rate for Payer: Sagamore Health Network All Products |
$78.33
|
| Rate for Payer: Signature Care EPO |
$84.21
|
| Rate for Payer: Signature Care PPO |
$89.28
|
| Rate for Payer: United Healthcare Commercial |
$79.95
|
|
|
HC W DRILL BIT 1.6 1630
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
41606318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$888.15 |
| Rate for Payer: Aetna Commercial |
$806.02
|
| Rate for Payer: Aetna Medicare |
$305.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$296.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$548.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$596.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$351.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$336.16
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Centivo All Commercial |
$519.52
|
| Rate for Payer: Cigna All Commercial |
$824.16
|
| Rate for Payer: CORVEL All Commercial |
$888.15
|
| Rate for Payer: Coventry All Commercial |
$840.40
|
| Rate for Payer: Encore All Commercial |
$879.08
|
| Rate for Payer: Frontpath All Commercial |
$878.60
|
| Rate for Payer: Humana ChoiceCare |
$824.83
|
| Rate for Payer: Humana Medicare |
$305.60
|
| Rate for Payer: Lucent All Commercial |
$519.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$859.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$716.25
|
| Rate for Payer: PHP All Commercial |
$724.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$372.45
|
| Rate for Payer: Sagamore Health Network All Products |
$737.26
|
| Rate for Payer: Signature Care EPO |
$792.65
|
| Rate for Payer: Signature Care PPO |
$840.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$811.75
|
| Rate for Payer: United Healthcare Commercial |
$752.54
|
| Rate for Payer: United Healthcare Medicare |
$305.60
|
|
|
HC W DRILL BIT 1.6 1630
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
41606318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.25 |
| Max. Negotiated Rate |
$888.15 |
| Rate for Payer: Aetna Commercial |
$825.12
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna All Commercial |
$824.16
|
| Rate for Payer: CORVEL All Commercial |
$888.15
|
| Rate for Payer: Coventry All Commercial |
$840.40
|
| Rate for Payer: Encore All Commercial |
$879.08
|
| Rate for Payer: Frontpath All Commercial |
$878.60
|
| Rate for Payer: Humana ChoiceCare |
$824.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$859.50
|
| Rate for Payer: PHCS All Commercial |
$716.25
|
| Rate for Payer: PHP All Commercial |
$724.27
|
| Rate for Payer: Sagamore Health Network All Products |
$737.26
|
| Rate for Payer: Signature Care EPO |
$792.65
|
| Rate for Payer: Signature Care PPO |
$840.40
|
| Rate for Payer: United Healthcare Commercial |
$752.54
|
|
|
HC W DRILL BIT 2.0 CANN 0020
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41604362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC W DRILL BIT 2.0 CANN 0020
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41604362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$603.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Centivo All Commercial |
$571.20
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$336.00
|
| Rate for Payer: Lucent All Commercial |
$571.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$336.00
|
|
|
HC W DRILL BIT 2.0X30
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41603577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$897.45 |
| Rate for Payer: Aetna Commercial |
$833.76
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna All Commercial |
$832.79
|
| Rate for Payer: CORVEL All Commercial |
$897.45
|
| Rate for Payer: Coventry All Commercial |
$849.20
|
| Rate for Payer: Encore All Commercial |
$888.28
|
| Rate for Payer: Frontpath All Commercial |
$887.80
|
| Rate for Payer: Humana ChoiceCare |
$833.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.50
|
| Rate for Payer: PHCS All Commercial |
$723.75
|
| Rate for Payer: PHP All Commercial |
$731.86
|
| Rate for Payer: Sagamore Health Network All Products |
$744.98
|
| Rate for Payer: Signature Care EPO |
$800.95
|
| Rate for Payer: Signature Care PPO |
$849.20
|
| Rate for Payer: United Healthcare Commercial |
$760.42
|
|
|
HC W DRILL BIT 2.0X30
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41603577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$897.45 |
| Rate for Payer: Aetna Commercial |
$814.46
|
| Rate for Payer: Aetna Medicare |
$308.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$554.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.68
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Centivo All Commercial |
$524.96
|
| Rate for Payer: Cigna All Commercial |
$832.79
|
| Rate for Payer: CORVEL All Commercial |
$897.45
|
| Rate for Payer: Coventry All Commercial |
$849.20
|
| Rate for Payer: Encore All Commercial |
$888.28
|
| Rate for Payer: Frontpath All Commercial |
$887.80
|
| Rate for Payer: Humana ChoiceCare |
$833.47
|
| Rate for Payer: Humana Medicare |
$308.80
|
| Rate for Payer: Lucent All Commercial |
$524.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$723.75
|
| Rate for Payer: PHP All Commercial |
$731.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.35
|
| Rate for Payer: Sagamore Health Network All Products |
$744.98
|
| Rate for Payer: Signature Care EPO |
$800.95
|
| Rate for Payer: Signature Care PPO |
$849.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.25
|
| Rate for Payer: United Healthcare Commercial |
$760.42
|
| Rate for Payer: United Healthcare Medicare |
$308.80
|
|
|
HC W DRILL BIT 2.55 CANN 45303055
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC W DRILL BIT 2.55 CANN 45303055
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$603.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Centivo All Commercial |
$571.20
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$336.00
|
| Rate for Payer: Lucent All Commercial |
$571.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$336.00
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
63044084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$50.23
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
63044084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: Aetna Medicare |
$18.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.47
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Centivo All Commercial |
$31.63
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Lucent All Commercial |
$31.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: Managed Health Services Medicaid |
$16.85
|
| Rate for Payer: MDWise Medicaid |
$16.85
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.67
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.42
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
| Rate for Payer: United Healthcare Medicare |
$18.60
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY-B
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63044085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: Aetna Medicare |
$18.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.47
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Centivo All Commercial |
$31.63
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Lucent All Commercial |
$31.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.67
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.42
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
| Rate for Payer: United Healthcare Medicare |
$18.60
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY-B
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63044085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$50.23
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
|
|
HC WET PREP
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
63001062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$95.99 |
| Rate for Payer: Aetna Commercial |
$89.18
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cigna All Commercial |
$89.08
|
| Rate for Payer: CORVEL All Commercial |
$95.99
|
| Rate for Payer: Coventry All Commercial |
$90.83
|
| Rate for Payer: Encore All Commercial |
$95.01
|
| Rate for Payer: Frontpath All Commercial |
$94.96
|
| Rate for Payer: Humana ChoiceCare |
$89.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.90
|
| Rate for Payer: PHCS All Commercial |
$77.42
|
| Rate for Payer: PHP All Commercial |
$78.28
|
| Rate for Payer: Sagamore Health Network All Products |
$79.69
|
| Rate for Payer: Signature Care EPO |
$85.67
|
| Rate for Payer: Signature Care PPO |
$90.83
|
| Rate for Payer: United Healthcare Commercial |
$81.34
|
|
|
HC WET PREP
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
63001062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$95.99 |
| Rate for Payer: Aetna Commercial |
$87.12
|
| Rate for Payer: Aetna Medicare |
$33.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.33
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Centivo All Commercial |
$56.15
|
| Rate for Payer: Cigna All Commercial |
$89.08
|
| Rate for Payer: CORVEL All Commercial |
$95.99
|
| Rate for Payer: Coventry All Commercial |
$90.83
|
| Rate for Payer: Encore All Commercial |
$95.01
|
| Rate for Payer: Frontpath All Commercial |
$94.96
|
| Rate for Payer: Humana ChoiceCare |
$89.15
|
| Rate for Payer: Humana Medicare |
$33.03
|
| Rate for Payer: Lucent All Commercial |
$56.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.90
|
| Rate for Payer: Managed Health Services Medicaid |
$5.82
|
| Rate for Payer: MDWise Medicaid |
$5.82
|
| Rate for Payer: PHCS All Commercial |
$77.42
|
| Rate for Payer: PHP All Commercial |
$78.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.26
|
| Rate for Payer: Sagamore Health Network All Products |
$79.69
|
| Rate for Payer: Signature Care EPO |
$85.67
|
| Rate for Payer: Signature Care PPO |
$90.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.74
|
| Rate for Payer: United Healthcare Commercial |
$81.34
|
| Rate for Payer: United Healthcare Medicare |
$33.03
|
|
|
HC WHEELCHAIR MGMT/TRN/15 MIN-PT
|
Facility
|
IP
|
$209.75
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
1728089
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$157.31 |
| Max. Negotiated Rate |
$195.07 |
| Rate for Payer: Aetna Commercial |
$181.22
|
| Rate for Payer: Cash Price |
$125.85
|
| Rate for Payer: Cigna All Commercial |
$181.01
|
| Rate for Payer: CORVEL All Commercial |
$195.07
|
| Rate for Payer: Coventry All Commercial |
$184.58
|
| Rate for Payer: Encore All Commercial |
$193.07
|
| Rate for Payer: Frontpath All Commercial |
$192.97
|
| Rate for Payer: Humana ChoiceCare |
$181.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.78
|
| Rate for Payer: PHCS All Commercial |
$157.31
|
| Rate for Payer: PHP All Commercial |
$159.07
|
| Rate for Payer: Sagamore Health Network All Products |
$161.93
|
| Rate for Payer: Signature Care EPO |
$174.09
|
| Rate for Payer: Signature Care PPO |
$184.58
|
| Rate for Payer: United Healthcare Commercial |
$165.28
|
|
|
HC WHEELCHAIR MGMT/TRN/15 MIN-PT
|
Facility
|
OP
|
$209.75
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
1728089
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$195.07 |
| Rate for Payer: Aetna Commercial |
$177.03
|
| Rate for Payer: Aetna Medicare |
$67.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.83
|
| Rate for Payer: Cash Price |
$125.85
|
| Rate for Payer: Cash Price |
$125.85
|
| Rate for Payer: Centivo All Commercial |
$114.10
|
| Rate for Payer: Cigna All Commercial |
$181.01
|
| Rate for Payer: CORVEL All Commercial |
$195.07
|
| Rate for Payer: Coventry All Commercial |
$184.58
|
| Rate for Payer: Encore All Commercial |
$193.07
|
| Rate for Payer: Frontpath All Commercial |
$192.97
|
| Rate for Payer: Humana ChoiceCare |
$181.16
|
| Rate for Payer: Humana Medicare |
$67.12
|
| Rate for Payer: Lucent All Commercial |
$114.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$157.31
|
| Rate for Payer: PHP All Commercial |
$159.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.80
|
| Rate for Payer: Sagamore Health Network All Products |
$161.93
|
| Rate for Payer: Signature Care EPO |
$174.09
|
| Rate for Payer: Signature Care PPO |
$184.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.29
|
| Rate for Payer: United Healthcare Commercial |
$165.28
|
| Rate for Payer: United Healthcare Medicare |
$67.12
|
|
|
HC WHITE FOAM LG
|
Facility
|
IP
|
$81.53
|
|
| Hospital Charge Code |
41606588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$75.82 |
| Rate for Payer: Aetna Commercial |
$70.44
|
| Rate for Payer: Cash Price |
$48.92
|
| Rate for Payer: Cigna All Commercial |
$70.36
|
| Rate for Payer: CORVEL All Commercial |
$75.82
|
| Rate for Payer: Coventry All Commercial |
$71.75
|
| Rate for Payer: Encore All Commercial |
$75.05
|
| Rate for Payer: Frontpath All Commercial |
$75.01
|
| Rate for Payer: Humana ChoiceCare |
$70.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.38
|
| Rate for Payer: PHCS All Commercial |
$61.15
|
| Rate for Payer: PHP All Commercial |
$61.83
|
| Rate for Payer: Sagamore Health Network All Products |
$62.94
|
| Rate for Payer: Signature Care EPO |
$67.67
|
| Rate for Payer: Signature Care PPO |
$71.75
|
| Rate for Payer: United Healthcare Commercial |
$64.25
|
|
|
HC WHITE FOAM LG
|
Facility
|
OP
|
$81.53
|
|
| Hospital Charge Code |
41606588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$75.82 |
| Rate for Payer: Aetna Commercial |
$68.81
|
| Rate for Payer: Aetna Medicare |
$26.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$46.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.70
|
| Rate for Payer: Cash Price |
$48.92
|
| Rate for Payer: Cash Price |
$48.92
|
| Rate for Payer: Centivo All Commercial |
$44.35
|
| Rate for Payer: Cigna All Commercial |
$70.36
|
| Rate for Payer: CORVEL All Commercial |
$75.82
|
| Rate for Payer: Coventry All Commercial |
$71.75
|
| Rate for Payer: Encore All Commercial |
$75.05
|
| Rate for Payer: Frontpath All Commercial |
$75.01
|
| Rate for Payer: Humana ChoiceCare |
$70.42
|
| Rate for Payer: Humana Medicare |
$26.09
|
| Rate for Payer: Lucent All Commercial |
$44.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.38
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$61.15
|
| Rate for Payer: PHP All Commercial |
$61.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.80
|
| Rate for Payer: Sagamore Health Network All Products |
$62.94
|
| Rate for Payer: Signature Care EPO |
$67.67
|
| Rate for Payer: Signature Care PPO |
$71.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$64.25
|
| Rate for Payer: United Healthcare Medicare |
$26.09
|
|
|
HC WHOLE BODY TUMOR LOC
|
Facility
|
IP
|
$4,333.98
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
1638430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,250.49 |
| Max. Negotiated Rate |
$4,030.60 |
| Rate for Payer: Aetna Commercial |
$3,744.56
|
| Rate for Payer: Cash Price |
$2,600.39
|
| Rate for Payer: Cigna All Commercial |
$3,740.22
|
| Rate for Payer: CORVEL All Commercial |
$4,030.60
|
| Rate for Payer: Coventry All Commercial |
$3,813.90
|
| Rate for Payer: Encore All Commercial |
$3,989.43
|
| Rate for Payer: Frontpath All Commercial |
$3,987.26
|
| Rate for Payer: Humana ChoiceCare |
$3,743.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,900.58
|
| Rate for Payer: PHCS All Commercial |
$3,250.49
|
| Rate for Payer: PHP All Commercial |
$3,286.89
|
| Rate for Payer: Sagamore Health Network All Products |
$3,345.83
|
| Rate for Payer: Signature Care EPO |
$3,597.20
|
| Rate for Payer: Signature Care PPO |
$3,813.90
|
| Rate for Payer: United Healthcare Commercial |
$3,415.18
|
|
