|
HC ROTH NET PLATINUM
|
Facility
IP
|
$700.00
|
|
| Hospital Charge Code |
41601221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$434.00
|
| 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: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| 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: United Healthcare Commercial |
$551.60
|
|
|
HC ROTH NET POLYP RET
|
Facility
OP
|
$623.00
|
|
| Hospital Charge Code |
41601984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$579.39 |
| Rate for Payer: Aetna Commercial |
$525.81
|
| Rate for Payer: Aetna Medicare |
$205.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$357.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$389.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$226.15
|
| Rate for Payer: Cash Price |
$386.26
|
| Rate for Payer: Cash Price |
$386.26
|
| Rate for Payer: Centivo All Commercial |
$317.73
|
| Rate for Payer: Cigna All Commercial |
$537.65
|
| Rate for Payer: CORVEL All Commercial |
$579.39
|
| Rate for Payer: Coventry All Commercial |
$548.24
|
| Rate for Payer: Encore All Commercial |
$573.47
|
| Rate for Payer: Frontpath All Commercial |
$573.16
|
| Rate for Payer: Humana ChoiceCare |
$538.09
|
| Rate for Payer: Humana Medicare |
$317.73
|
| Rate for Payer: Lucent All Commercial |
$317.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$560.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$467.25
|
| Rate for Payer: PHP All Commercial |
$472.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.97
|
| Rate for Payer: Sagamore Health Network All Products |
$480.96
|
| Rate for Payer: Signature Care EPO |
$517.09
|
| Rate for Payer: Signature Care PPO |
$548.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$529.55
|
| Rate for Payer: United Healthcare Commercial |
$490.92
|
| Rate for Payer: United Healthcare Medicare |
$205.59
|
|
|
HC ROTH NET POLYP RET
|
Facility
IP
|
$623.00
|
|
| Hospital Charge Code |
41601984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.25 |
| Max. Negotiated Rate |
$579.39 |
| Rate for Payer: Aetna Commercial |
$538.27
|
| Rate for Payer: Cash Price |
$386.26
|
| Rate for Payer: Cigna All Commercial |
$537.65
|
| Rate for Payer: CORVEL All Commercial |
$579.39
|
| Rate for Payer: Coventry All Commercial |
$548.24
|
| Rate for Payer: Encore All Commercial |
$573.47
|
| Rate for Payer: Frontpath All Commercial |
$573.16
|
| Rate for Payer: Humana ChoiceCare |
$538.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$560.70
|
| Rate for Payer: PHCS All Commercial |
$467.25
|
| Rate for Payer: PHP All Commercial |
$472.48
|
| Rate for Payer: Sagamore Health Network All Products |
$480.96
|
| Rate for Payer: Signature Care EPO |
$517.09
|
| Rate for Payer: Signature Care PPO |
$548.24
|
| Rate for Payer: United Healthcare Commercial |
$490.92
|
|
|
HC ROTICULATOR 55 3.5
|
Facility
IP
|
$1,010.80
|
|
| Hospital Charge Code |
41602238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$758.10 |
| Max. Negotiated Rate |
$940.04 |
| Rate for Payer: Aetna Commercial |
$873.33
|
| Rate for Payer: Cash Price |
$626.70
|
| Rate for Payer: Cigna All Commercial |
$872.32
|
| Rate for Payer: CORVEL All Commercial |
$940.04
|
| Rate for Payer: Coventry All Commercial |
$889.50
|
| Rate for Payer: Encore All Commercial |
$930.44
|
| Rate for Payer: Frontpath All Commercial |
$929.94
|
| Rate for Payer: Humana ChoiceCare |
$873.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$909.72
|
| Rate for Payer: PHCS All Commercial |
$758.10
|
| Rate for Payer: PHP All Commercial |
$766.59
|
| Rate for Payer: Sagamore Health Network All Products |
$780.34
|
| Rate for Payer: Signature Care EPO |
$838.96
|
| Rate for Payer: Signature Care PPO |
$889.50
|
| Rate for Payer: United Healthcare Commercial |
$796.51
|
|
|
HC ROTICULATOR 55 3.5
|
Facility
OP
|
$1,010.80
|
|
| Hospital Charge Code |
41602238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$940.04 |
| Rate for Payer: Aetna Commercial |
$853.12
|
| Rate for Payer: Aetna Medicare |
$333.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$333.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$580.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$631.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$383.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$366.92
|
| Rate for Payer: Cash Price |
$626.70
|
| Rate for Payer: Cash Price |
$626.70
|
| Rate for Payer: Centivo All Commercial |
$515.51
|
| Rate for Payer: Cigna All Commercial |
$872.32
|
| Rate for Payer: CORVEL All Commercial |
$940.04
|
| Rate for Payer: Coventry All Commercial |
$889.50
|
| Rate for Payer: Encore All Commercial |
$930.44
|
| Rate for Payer: Frontpath All Commercial |
$929.94
|
| Rate for Payer: Humana ChoiceCare |
$873.03
|
| Rate for Payer: Humana Medicare |
$515.51
|
| Rate for Payer: Lucent All Commercial |
$515.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$909.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$758.10
|
| Rate for Payer: PHP All Commercial |
$766.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$394.21
|
| Rate for Payer: Sagamore Health Network All Products |
$780.34
|
| Rate for Payer: Signature Care EPO |
$838.96
|
| Rate for Payer: Signature Care PPO |
$889.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$859.18
|
| Rate for Payer: United Healthcare Commercial |
$796.51
|
| Rate for Payer: United Healthcare Medicare |
$333.56
|
|
|
HC ROTICULATOR ENDO MINI
|
Facility
OP
|
$652.28
|
|
| Hospital Charge Code |
41601863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$606.62 |
| Rate for Payer: Aetna Commercial |
$550.52
|
| Rate for Payer: Aetna Medicare |
$215.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$215.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$374.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$407.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$247.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$236.78
|
| Rate for Payer: Cash Price |
$404.41
|
| Rate for Payer: Cash Price |
$404.41
|
| Rate for Payer: Centivo All Commercial |
$332.66
|
| Rate for Payer: Cigna All Commercial |
$562.92
|
| Rate for Payer: CORVEL All Commercial |
$606.62
|
| Rate for Payer: Coventry All Commercial |
$574.01
|
| Rate for Payer: Encore All Commercial |
$600.42
|
| Rate for Payer: Frontpath All Commercial |
$600.10
|
| Rate for Payer: Humana ChoiceCare |
$563.37
|
| Rate for Payer: Humana Medicare |
$332.66
|
| Rate for Payer: Lucent All Commercial |
$332.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$587.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$489.21
|
| Rate for Payer: PHP All Commercial |
$494.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$254.39
|
| Rate for Payer: Sagamore Health Network All Products |
$503.56
|
| Rate for Payer: Signature Care EPO |
$541.39
|
| Rate for Payer: Signature Care PPO |
$574.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$554.44
|
| Rate for Payer: United Healthcare Commercial |
$514.00
|
| Rate for Payer: United Healthcare Medicare |
$215.25
|
|
|
HC ROTICULATOR ENDO MINI
|
Facility
IP
|
$652.28
|
|
| Hospital Charge Code |
41601863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.21 |
| Max. Negotiated Rate |
$606.62 |
| Rate for Payer: Aetna Commercial |
$563.57
|
| Rate for Payer: Cash Price |
$404.41
|
| Rate for Payer: Cigna All Commercial |
$562.92
|
| Rate for Payer: CORVEL All Commercial |
$606.62
|
| Rate for Payer: Coventry All Commercial |
$574.01
|
| Rate for Payer: Encore All Commercial |
$600.42
|
| Rate for Payer: Frontpath All Commercial |
$600.10
|
| Rate for Payer: Humana ChoiceCare |
$563.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$587.05
|
| Rate for Payer: PHCS All Commercial |
$489.21
|
| Rate for Payer: PHP All Commercial |
$494.69
|
| Rate for Payer: Sagamore Health Network All Products |
$503.56
|
| Rate for Payer: Signature Care EPO |
$541.39
|
| Rate for Payer: Signature Care PPO |
$574.01
|
| Rate for Payer: United Healthcare Commercial |
$514.00
|
|
|
HC ROTOPRONE BED /DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01892418
|
|
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 ROTOPRONE BED /DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01892418
|
|
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 ROTO-REST DELTA TX TABLE /DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01339738
|
|
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 ROTO-REST DELTA TX TABLE /DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01339738
|
|
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 ROUTINE FOLLOW UP
|
Facility
IP
|
$112.46
|
|
|
Service Code
|
CPT G0463 25
|
| Hospital Charge Code |
00410102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.34 |
| Max. Negotiated Rate |
$104.58 |
| Rate for Payer: Aetna Commercial |
$97.16
|
| Rate for Payer: Cash Price |
$69.72
|
| Rate for Payer: Cigna All Commercial |
$97.05
|
| Rate for Payer: CORVEL All Commercial |
$104.58
|
| Rate for Payer: Coventry All Commercial |
$98.96
|
| Rate for Payer: Encore All Commercial |
$103.51
|
| Rate for Payer: Frontpath All Commercial |
$103.46
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.21
|
| Rate for Payer: PHCS All Commercial |
$84.34
|
| Rate for Payer: PHP All Commercial |
$85.29
|
| Rate for Payer: Sagamore Health Network All Products |
$86.82
|
| Rate for Payer: Signature Care EPO |
$93.34
|
| Rate for Payer: Signature Care PPO |
$98.96
|
| Rate for Payer: United Healthcare Commercial |
$88.61
|
|
|
HC ROUTINE FOLLOW UP
|
Facility
OP
|
$112.46
|
|
|
Service Code
|
CPT G0463 25
|
| Hospital Charge Code |
00410102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$104.58 |
| Rate for Payer: Aetna Commercial |
$94.91
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.82
|
| Rate for Payer: Cash Price |
$69.72
|
| Rate for Payer: Centivo All Commercial |
$57.35
|
| Rate for Payer: Cigna All Commercial |
$97.05
|
| Rate for Payer: CORVEL All Commercial |
$104.58
|
| Rate for Payer: Coventry All Commercial |
$98.96
|
| Rate for Payer: Encore All Commercial |
$103.51
|
| Rate for Payer: Frontpath All Commercial |
$103.46
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Lucent All Commercial |
$57.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.21
|
| Rate for Payer: PHCS All Commercial |
$84.34
|
| Rate for Payer: PHP All Commercial |
$85.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.86
|
| Rate for Payer: Sagamore Health Network All Products |
$86.82
|
| Rate for Payer: Signature Care EPO |
$93.34
|
| Rate for Payer: Signature Care PPO |
$98.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.59
|
| Rate for Payer: United Healthcare Commercial |
$88.61
|
| Rate for Payer: United Healthcare Medicare |
$37.11
|
|
|
HC RP LOCLZJ TUM WHBDY 1 D IMG
|
Facility
OP
|
$3,547.05
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
01638802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$771.89 |
| Max. Negotiated Rate |
$3,298.76 |
| Rate for Payer: Aetna Commercial |
$2,993.71
|
| Rate for Payer: Aetna Medicare |
$1,170.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,170.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,037.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,217.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$771.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,346.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,287.58
|
| Rate for Payer: Cash Price |
$2,199.17
|
| Rate for Payer: Cash Price |
$2,199.17
|
| Rate for Payer: Centivo All Commercial |
$1,809.00
|
| Rate for Payer: Cigna All Commercial |
$3,061.10
|
| Rate for Payer: CORVEL All Commercial |
$3,298.76
|
| Rate for Payer: Coventry All Commercial |
$3,121.40
|
| Rate for Payer: Encore All Commercial |
$3,265.06
|
| Rate for Payer: Frontpath All Commercial |
$3,263.29
|
| Rate for Payer: Humana ChoiceCare |
$3,063.59
|
| Rate for Payer: Humana Medicare |
$1,809.00
|
| Rate for Payer: Lucent All Commercial |
$1,809.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,192.34
|
| Rate for Payer: Managed Health Services Medicaid |
$771.89
|
| Rate for Payer: MDWise Medicaid |
$771.89
|
| Rate for Payer: PHCS All Commercial |
$2,660.29
|
| Rate for Payer: PHP All Commercial |
$2,690.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,383.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,738.32
|
| Rate for Payer: Signature Care EPO |
$2,944.05
|
| Rate for Payer: Signature Care PPO |
$3,121.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,014.99
|
| Rate for Payer: United Healthcare Commercial |
$2,795.08
|
| Rate for Payer: United Healthcare Medicare |
$1,170.53
|
|
|
HC RP LOCLZJ TUM WHBDY 1 D IMG
|
Facility
IP
|
$3,547.05
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
01638802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,660.29 |
| Max. Negotiated Rate |
$3,298.76 |
| Rate for Payer: Aetna Commercial |
$3,064.65
|
| Rate for Payer: Cash Price |
$2,199.17
|
| Rate for Payer: Cigna All Commercial |
$3,061.10
|
| Rate for Payer: CORVEL All Commercial |
$3,298.76
|
| Rate for Payer: Coventry All Commercial |
$3,121.40
|
| Rate for Payer: Encore All Commercial |
$3,265.06
|
| Rate for Payer: Frontpath All Commercial |
$3,263.29
|
| Rate for Payer: Humana ChoiceCare |
$3,063.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,192.34
|
| Rate for Payer: PHCS All Commercial |
$2,660.29
|
| Rate for Payer: PHP All Commercial |
$2,690.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2,738.32
|
| Rate for Payer: Signature Care EPO |
$2,944.05
|
| Rate for Payer: Signature Care PPO |
$3,121.40
|
| Rate for Payer: United Healthcare Commercial |
$2,795.08
|
|
|
HC RPR SCREEN WTITER
|
Facility
IP
|
$53.88
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
63001211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Cash Price |
$33.40
|
| Rate for Payer: Cigna All Commercial |
$46.50
|
| Rate for Payer: CORVEL All Commercial |
$50.11
|
| Rate for Payer: Coventry All Commercial |
$47.41
|
| Rate for Payer: Encore All Commercial |
$49.59
|
| Rate for Payer: Frontpath All Commercial |
$49.57
|
| Rate for Payer: Humana ChoiceCare |
$46.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.49
|
| Rate for Payer: PHCS All Commercial |
$40.41
|
| Rate for Payer: PHP All Commercial |
$40.86
|
| Rate for Payer: Sagamore Health Network All Products |
$41.59
|
| Rate for Payer: Signature Care EPO |
$44.72
|
| Rate for Payer: Signature Care PPO |
$47.41
|
| Rate for Payer: United Healthcare Commercial |
$42.45
|
|
|
HC RPR SCREEN WTITER
|
Facility
OP
|
$53.88
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
63001211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Aetna Commercial |
$45.47
|
| Rate for Payer: Aetna Medicare |
$17.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.56
|
| Rate for Payer: Cash Price |
$33.40
|
| Rate for Payer: Cash Price |
$33.40
|
| Rate for Payer: Centivo All Commercial |
$27.48
|
| Rate for Payer: Cigna All Commercial |
$46.50
|
| Rate for Payer: CORVEL All Commercial |
$50.11
|
| Rate for Payer: Coventry All Commercial |
$47.41
|
| Rate for Payer: Encore All Commercial |
$49.59
|
| Rate for Payer: Frontpath All Commercial |
$49.57
|
| Rate for Payer: Humana ChoiceCare |
$46.53
|
| Rate for Payer: Humana Medicare |
$27.48
|
| Rate for Payer: Lucent All Commercial |
$27.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.49
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$40.41
|
| Rate for Payer: PHP All Commercial |
$40.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.01
|
| Rate for Payer: Sagamore Health Network All Products |
$41.59
|
| Rate for Payer: Signature Care EPO |
$44.72
|
| Rate for Payer: Signature Care PPO |
$47.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.79
|
| Rate for Payer: United Healthcare Commercial |
$42.45
|
| Rate for Payer: United Healthcare Medicare |
$17.78
|
|
|
HC RSV
|
Facility
IP
|
$253.20
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
63087801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.90 |
| Max. Negotiated Rate |
$235.48 |
| Rate for Payer: Aetna Commercial |
$218.77
|
| Rate for Payer: Cash Price |
$156.99
|
| Rate for Payer: Cigna All Commercial |
$218.52
|
| Rate for Payer: CORVEL All Commercial |
$235.48
|
| Rate for Payer: Coventry All Commercial |
$222.82
|
| Rate for Payer: Encore All Commercial |
$233.08
|
| Rate for Payer: Frontpath All Commercial |
$232.95
|
| Rate for Payer: Humana ChoiceCare |
$218.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.88
|
| Rate for Payer: PHCS All Commercial |
$189.90
|
| Rate for Payer: PHP All Commercial |
$192.03
|
| Rate for Payer: Sagamore Health Network All Products |
$195.47
|
| Rate for Payer: Signature Care EPO |
$210.16
|
| Rate for Payer: Signature Care PPO |
$222.82
|
| Rate for Payer: United Healthcare Commercial |
$199.53
|
|
|
HC RSV
|
Facility
OP
|
$253.20
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
63087801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$235.48 |
| Rate for Payer: Aetna Commercial |
$213.70
|
| Rate for Payer: Aetna Medicare |
$83.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$145.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$158.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$70.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.91
|
| Rate for Payer: Cash Price |
$156.99
|
| Rate for Payer: Cash Price |
$156.99
|
| Rate for Payer: Centivo All Commercial |
$129.13
|
| Rate for Payer: Cigna All Commercial |
$218.52
|
| Rate for Payer: CORVEL All Commercial |
$235.48
|
| Rate for Payer: Coventry All Commercial |
$222.82
|
| Rate for Payer: Encore All Commercial |
$233.08
|
| Rate for Payer: Frontpath All Commercial |
$232.95
|
| Rate for Payer: Humana ChoiceCare |
$218.69
|
| Rate for Payer: Humana Medicare |
$129.13
|
| Rate for Payer: Lucent All Commercial |
$129.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.88
|
| Rate for Payer: Managed Health Services Medicaid |
$70.20
|
| Rate for Payer: MDWise Medicaid |
$70.20
|
| Rate for Payer: PHCS All Commercial |
$189.90
|
| Rate for Payer: PHP All Commercial |
$192.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.75
|
| Rate for Payer: Sagamore Health Network All Products |
$195.47
|
| Rate for Payer: Signature Care EPO |
$210.16
|
| Rate for Payer: Signature Care PPO |
$222.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.22
|
| Rate for Payer: United Healthcare Commercial |
$199.53
|
| Rate for Payer: United Healthcare Medicare |
$83.56
|
|
|
HC RSV
|
Facility
OP
|
$147.47
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
63001210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Aetna Commercial |
$124.47
|
| Rate for Payer: Aetna Medicare |
$48.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.53
|
| Rate for Payer: Cash Price |
$91.43
|
| Rate for Payer: Cash Price |
$91.43
|
| Rate for Payer: Centivo All Commercial |
$75.21
|
| Rate for Payer: Cigna All Commercial |
$127.27
|
| Rate for Payer: CORVEL All Commercial |
$137.15
|
| Rate for Payer: Coventry All Commercial |
$129.78
|
| Rate for Payer: Encore All Commercial |
$135.75
|
| Rate for Payer: Frontpath All Commercial |
$135.67
|
| Rate for Payer: Humana ChoiceCare |
$127.37
|
| Rate for Payer: Humana Medicare |
$75.21
|
| Rate for Payer: Lucent All Commercial |
$75.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.72
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$110.60
|
| Rate for Payer: PHP All Commercial |
$111.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.51
|
| Rate for Payer: Sagamore Health Network All Products |
$113.85
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$129.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.35
|
| Rate for Payer: United Healthcare Commercial |
$116.21
|
| Rate for Payer: United Healthcare Medicare |
$48.67
|
|
|
HC RSV
|
Facility
IP
|
$147.47
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
63001210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Aetna Commercial |
$127.42
|
| Rate for Payer: Cash Price |
$91.43
|
| Rate for Payer: Cigna All Commercial |
$127.27
|
| Rate for Payer: CORVEL All Commercial |
$137.15
|
| Rate for Payer: Coventry All Commercial |
$129.78
|
| Rate for Payer: Encore All Commercial |
$135.75
|
| Rate for Payer: Frontpath All Commercial |
$135.67
|
| Rate for Payer: Humana ChoiceCare |
$127.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.72
|
| Rate for Payer: PHCS All Commercial |
$110.60
|
| Rate for Payer: PHP All Commercial |
$111.84
|
| Rate for Payer: Sagamore Health Network All Products |
$113.85
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$129.78
|
| Rate for Payer: United Healthcare Commercial |
$116.21
|
|
|
HC RUBELLA ANTIBODY (IGM)
|
Facility
OP
|
$111.08
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$103.30 |
| Rate for Payer: Aetna Commercial |
$93.75
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.32
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Centivo All Commercial |
$56.65
|
| Rate for Payer: Cigna All Commercial |
$95.86
|
| Rate for Payer: CORVEL All Commercial |
$103.30
|
| Rate for Payer: Coventry All Commercial |
$97.75
|
| Rate for Payer: Encore All Commercial |
$102.25
|
| Rate for Payer: Frontpath All Commercial |
$102.19
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Humana Medicare |
$56.65
|
| Rate for Payer: Lucent All Commercial |
$56.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.97
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$83.31
|
| Rate for Payer: PHP All Commercial |
$84.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.32
|
| Rate for Payer: Sagamore Health Network All Products |
$85.75
|
| Rate for Payer: Signature Care EPO |
$92.19
|
| Rate for Payer: Signature Care PPO |
$97.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.42
|
| Rate for Payer: United Healthcare Commercial |
$87.53
|
| Rate for Payer: United Healthcare Medicare |
$36.66
|
|
|
HC RUBELLA ANTIBODY (IGM)
|
Facility
IP
|
$111.08
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$103.30 |
| Rate for Payer: Aetna Commercial |
$95.97
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cigna All Commercial |
$95.86
|
| Rate for Payer: CORVEL All Commercial |
$103.30
|
| Rate for Payer: Coventry All Commercial |
$97.75
|
| Rate for Payer: Encore All Commercial |
$102.25
|
| Rate for Payer: Frontpath All Commercial |
$102.19
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.97
|
| Rate for Payer: PHCS All Commercial |
$83.31
|
| Rate for Payer: PHP All Commercial |
$84.24
|
| Rate for Payer: Sagamore Health Network All Products |
$85.75
|
| Rate for Payer: Signature Care EPO |
$92.19
|
| Rate for Payer: Signature Care PPO |
$97.75
|
| Rate for Payer: United Healthcare Commercial |
$87.53
|
|
|
HC RUBELLA IGG
|
Facility
OP
|
$111.08
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$103.30 |
| Rate for Payer: Aetna Commercial |
$93.75
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.32
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Centivo All Commercial |
$56.65
|
| Rate for Payer: Cigna All Commercial |
$95.86
|
| Rate for Payer: CORVEL All Commercial |
$103.30
|
| Rate for Payer: Coventry All Commercial |
$97.75
|
| Rate for Payer: Encore All Commercial |
$102.25
|
| Rate for Payer: Frontpath All Commercial |
$102.19
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Humana Medicare |
$56.65
|
| Rate for Payer: Lucent All Commercial |
$56.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.97
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$83.31
|
| Rate for Payer: PHP All Commercial |
$84.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.32
|
| Rate for Payer: Sagamore Health Network All Products |
$85.75
|
| Rate for Payer: Signature Care EPO |
$92.19
|
| Rate for Payer: Signature Care PPO |
$97.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.42
|
| Rate for Payer: United Healthcare Commercial |
$87.53
|
| Rate for Payer: United Healthcare Medicare |
$36.66
|
|
|
HC RUBELLA IGG
|
Facility
IP
|
$111.08
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$103.30 |
| Rate for Payer: Aetna Commercial |
$95.97
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cigna All Commercial |
$95.86
|
| Rate for Payer: CORVEL All Commercial |
$103.30
|
| Rate for Payer: Coventry All Commercial |
$97.75
|
| Rate for Payer: Encore All Commercial |
$102.25
|
| Rate for Payer: Frontpath All Commercial |
$102.19
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.97
|
| Rate for Payer: PHCS All Commercial |
$83.31
|
| Rate for Payer: PHP All Commercial |
$84.24
|
| Rate for Payer: Sagamore Health Network All Products |
$85.75
|
| Rate for Payer: Signature Care EPO |
$92.19
|
| Rate for Payer: Signature Care PPO |
$97.75
|
| Rate for Payer: United Healthcare Commercial |
$87.53
|
|
