|
HC S DRILL BIT OVER 3.5X122 AO
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
41603940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,232.24
|
| Rate for Payer: Aetna Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$838.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.98
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Centivo All Commercial |
$744.60
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Humana Medicare |
$744.60
|
| Rate for Payer: Lucent All Commercial |
$744.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$569.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,241.00
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
|
|
HC S DRILL GUIDE 90 DEG MICRO
|
Facility
OP
|
$2,981.95
|
|
| Hospital Charge Code |
41607932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,773.21 |
| Rate for Payer: Aetna Commercial |
$2,516.77
|
| Rate for Payer: Aetna Medicare |
$984.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$984.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,712.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,864.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,131.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,082.45
|
| Rate for Payer: Cash Price |
$1,848.81
|
| Rate for Payer: Cash Price |
$1,848.81
|
| Rate for Payer: Centivo All Commercial |
$1,520.79
|
| Rate for Payer: Cigna All Commercial |
$2,573.42
|
| Rate for Payer: CORVEL All Commercial |
$2,773.21
|
| Rate for Payer: Coventry All Commercial |
$2,624.12
|
| Rate for Payer: Encore All Commercial |
$2,744.88
|
| Rate for Payer: Frontpath All Commercial |
$2,743.39
|
| Rate for Payer: Humana ChoiceCare |
$2,575.51
|
| Rate for Payer: Humana Medicare |
$1,520.79
|
| Rate for Payer: Lucent All Commercial |
$1,520.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,683.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,236.46
|
| Rate for Payer: PHP All Commercial |
$2,261.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,162.96
|
| Rate for Payer: Sagamore Health Network All Products |
$2,302.07
|
| Rate for Payer: Signature Care EPO |
$2,475.02
|
| Rate for Payer: Signature Care PPO |
$2,624.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,534.66
|
| Rate for Payer: United Healthcare Commercial |
$2,349.78
|
| Rate for Payer: United Healthcare Medicare |
$984.04
|
|
|
HC S DRILL GUIDE 90 DEG MICRO
|
Facility
IP
|
$2,981.95
|
|
| Hospital Charge Code |
41607932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,236.46 |
| Max. Negotiated Rate |
$2,773.21 |
| Rate for Payer: Aetna Commercial |
$2,576.40
|
| Rate for Payer: Cash Price |
$1,848.81
|
| Rate for Payer: Cigna All Commercial |
$2,573.42
|
| Rate for Payer: CORVEL All Commercial |
$2,773.21
|
| Rate for Payer: Coventry All Commercial |
$2,624.12
|
| Rate for Payer: Encore All Commercial |
$2,744.88
|
| Rate for Payer: Frontpath All Commercial |
$2,743.39
|
| Rate for Payer: Humana ChoiceCare |
$2,575.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,683.76
|
| Rate for Payer: PHCS All Commercial |
$2,236.46
|
| Rate for Payer: PHP All Commercial |
$2,261.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,302.07
|
| Rate for Payer: Signature Care EPO |
$2,475.02
|
| Rate for Payer: Signature Care PPO |
$2,624.12
|
| Rate for Payer: United Healthcare Commercial |
$2,349.78
|
|
|
HC S DRILL ICONIX 2.3
|
Facility
OP
|
$1,042.15
|
|
| Hospital Charge Code |
41607525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$969.20 |
| Rate for Payer: Aetna Commercial |
$879.57
|
| Rate for Payer: Aetna Medicare |
$343.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$343.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$598.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$651.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$395.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$378.30
|
| Rate for Payer: Cash Price |
$646.13
|
| Rate for Payer: Cash Price |
$646.13
|
| Rate for Payer: Centivo All Commercial |
$531.50
|
| Rate for Payer: Cigna All Commercial |
$899.38
|
| Rate for Payer: CORVEL All Commercial |
$969.20
|
| Rate for Payer: Coventry All Commercial |
$917.09
|
| Rate for Payer: Encore All Commercial |
$959.30
|
| Rate for Payer: Frontpath All Commercial |
$958.78
|
| Rate for Payer: Humana ChoiceCare |
$900.10
|
| Rate for Payer: Humana Medicare |
$531.50
|
| Rate for Payer: Lucent All Commercial |
$531.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$937.94
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$781.61
|
| Rate for Payer: PHP All Commercial |
$790.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$406.44
|
| Rate for Payer: Sagamore Health Network All Products |
$804.54
|
| Rate for Payer: Signature Care EPO |
$864.98
|
| Rate for Payer: Signature Care PPO |
$917.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$885.83
|
| Rate for Payer: United Healthcare Commercial |
$821.21
|
| Rate for Payer: United Healthcare Medicare |
$343.91
|
|
|
HC S DRILL ICONIX 2.3
|
Facility
IP
|
$1,042.15
|
|
| Hospital Charge Code |
41607525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.61 |
| Max. Negotiated Rate |
$969.20 |
| Rate for Payer: Aetna Commercial |
$900.42
|
| Rate for Payer: Cash Price |
$646.13
|
| Rate for Payer: Cigna All Commercial |
$899.38
|
| Rate for Payer: CORVEL All Commercial |
$969.20
|
| Rate for Payer: Coventry All Commercial |
$917.09
|
| Rate for Payer: Encore All Commercial |
$959.30
|
| Rate for Payer: Frontpath All Commercial |
$958.78
|
| Rate for Payer: Humana ChoiceCare |
$900.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$937.94
|
| Rate for Payer: PHCS All Commercial |
$781.61
|
| Rate for Payer: PHP All Commercial |
$790.37
|
| Rate for Payer: Sagamore Health Network All Products |
$804.54
|
| Rate for Payer: Signature Care EPO |
$864.98
|
| Rate for Payer: Signature Care PPO |
$917.09
|
| Rate for Payer: United Healthcare Commercial |
$821.21
|
|
|
HC S DRILL MICRO OCD UNIV
|
Facility
OP
|
$1,996.06
|
|
| Hospital Charge Code |
41607931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,856.34 |
| Rate for Payer: Aetna Commercial |
$1,684.67
|
| Rate for Payer: Aetna Medicare |
$658.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$658.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,146.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,247.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$757.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$724.57
|
| Rate for Payer: Cash Price |
$1,237.56
|
| Rate for Payer: Cash Price |
$1,237.56
|
| Rate for Payer: Centivo All Commercial |
$1,017.99
|
| Rate for Payer: Cigna All Commercial |
$1,722.60
|
| Rate for Payer: CORVEL All Commercial |
$1,856.34
|
| Rate for Payer: Coventry All Commercial |
$1,756.53
|
| Rate for Payer: Encore All Commercial |
$1,837.37
|
| Rate for Payer: Frontpath All Commercial |
$1,836.38
|
| Rate for Payer: Humana ChoiceCare |
$1,724.00
|
| Rate for Payer: Humana Medicare |
$1,017.99
|
| Rate for Payer: Lucent All Commercial |
$1,017.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,796.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,497.04
|
| Rate for Payer: PHP All Commercial |
$1,513.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$778.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,540.96
|
| Rate for Payer: Signature Care EPO |
$1,656.73
|
| Rate for Payer: Signature Care PPO |
$1,756.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,696.65
|
| Rate for Payer: United Healthcare Commercial |
$1,572.90
|
| Rate for Payer: United Healthcare Medicare |
$658.70
|
|
|
HC S DRILL MICRO OCD UNIV
|
Facility
IP
|
$1,996.06
|
|
| Hospital Charge Code |
41607931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,497.04 |
| Max. Negotiated Rate |
$1,856.34 |
| Rate for Payer: Aetna Commercial |
$1,724.60
|
| Rate for Payer: Cash Price |
$1,237.56
|
| Rate for Payer: Cigna All Commercial |
$1,722.60
|
| Rate for Payer: CORVEL All Commercial |
$1,856.34
|
| Rate for Payer: Coventry All Commercial |
$1,756.53
|
| Rate for Payer: Encore All Commercial |
$1,837.37
|
| Rate for Payer: Frontpath All Commercial |
$1,836.38
|
| Rate for Payer: Humana ChoiceCare |
$1,724.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,796.45
|
| Rate for Payer: PHCS All Commercial |
$1,497.04
|
| Rate for Payer: PHP All Commercial |
$1,513.81
|
| Rate for Payer: Sagamore Health Network All Products |
$1,540.96
|
| Rate for Payer: Signature Care EPO |
$1,656.73
|
| Rate for Payer: Signature Care PPO |
$1,756.53
|
| Rate for Payer: United Healthcare Commercial |
$1,572.90
|
|
|
HC SEDIMENTATION RATE
|
Facility
IP
|
$53.55
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
63087809
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC SEDIMENTATION RATE
|
Facility
OP
|
$53.55
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
63087809
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC SED RATE MM/HR
|
Facility
OP
|
$146.75
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
63001243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Aetna Commercial |
$123.85
|
| Rate for Payer: Aetna Medicare |
$48.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.27
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Centivo All Commercial |
$74.84
|
| Rate for Payer: Cigna All Commercial |
$126.64
|
| Rate for Payer: CORVEL All Commercial |
$136.48
|
| Rate for Payer: Coventry All Commercial |
$129.14
|
| Rate for Payer: Encore All Commercial |
$135.08
|
| Rate for Payer: Frontpath All Commercial |
$135.01
|
| Rate for Payer: Humana ChoiceCare |
$126.75
|
| Rate for Payer: Humana Medicare |
$74.84
|
| Rate for Payer: Lucent All Commercial |
$74.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.07
|
| Rate for Payer: Managed Health Services Medicaid |
$2.70
|
| Rate for Payer: MDWise Medicaid |
$2.70
|
| Rate for Payer: PHCS All Commercial |
$110.06
|
| Rate for Payer: PHP All Commercial |
$111.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.23
|
| Rate for Payer: Sagamore Health Network All Products |
$113.29
|
| Rate for Payer: Signature Care EPO |
$121.80
|
| Rate for Payer: Signature Care PPO |
$129.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.74
|
| Rate for Payer: United Healthcare Commercial |
$115.64
|
| Rate for Payer: United Healthcare Medicare |
$48.43
|
|
|
HC SED RATE MM/HR
|
Facility
IP
|
$146.75
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
63001243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Aetna Commercial |
$126.79
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cigna All Commercial |
$126.64
|
| Rate for Payer: CORVEL All Commercial |
$136.48
|
| Rate for Payer: Coventry All Commercial |
$129.14
|
| Rate for Payer: Encore All Commercial |
$135.08
|
| Rate for Payer: Frontpath All Commercial |
$135.01
|
| Rate for Payer: Humana ChoiceCare |
$126.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.07
|
| Rate for Payer: PHCS All Commercial |
$110.06
|
| Rate for Payer: PHP All Commercial |
$111.29
|
| Rate for Payer: Sagamore Health Network All Products |
$113.29
|
| Rate for Payer: Signature Care EPO |
$121.80
|
| Rate for Payer: Signature Care PPO |
$129.14
|
| Rate for Payer: United Healthcare Commercial |
$115.64
|
|
|
HC S EGG RESUF 4.0
|
Facility
OP
|
$864.78
|
|
| Hospital Charge Code |
41606537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$804.25 |
| Rate for Payer: Aetna Commercial |
$729.87
|
| Rate for Payer: Aetna Medicare |
$285.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$496.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$540.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$313.92
|
| Rate for Payer: Cash Price |
$536.16
|
| Rate for Payer: Cash Price |
$536.16
|
| Rate for Payer: Centivo All Commercial |
$441.04
|
| Rate for Payer: Cigna All Commercial |
$746.31
|
| Rate for Payer: CORVEL All Commercial |
$804.25
|
| Rate for Payer: Coventry All Commercial |
$761.01
|
| Rate for Payer: Encore All Commercial |
$796.03
|
| Rate for Payer: Frontpath All Commercial |
$795.60
|
| Rate for Payer: Humana ChoiceCare |
$746.91
|
| Rate for Payer: Humana Medicare |
$441.04
|
| Rate for Payer: Lucent All Commercial |
$441.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$648.58
|
| Rate for Payer: PHP All Commercial |
$655.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.26
|
| Rate for Payer: Sagamore Health Network All Products |
$667.61
|
| Rate for Payer: Signature Care EPO |
$717.77
|
| Rate for Payer: Signature Care PPO |
$761.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$735.06
|
| Rate for Payer: United Healthcare Commercial |
$681.45
|
| Rate for Payer: United Healthcare Medicare |
$285.38
|
|
|
HC S EGG RESUF 4.0
|
Facility
IP
|
$864.78
|
|
| Hospital Charge Code |
41606537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$648.58 |
| Max. Negotiated Rate |
$804.25 |
| Rate for Payer: Aetna Commercial |
$747.17
|
| Rate for Payer: Cash Price |
$536.16
|
| Rate for Payer: Cigna All Commercial |
$746.31
|
| Rate for Payer: CORVEL All Commercial |
$804.25
|
| Rate for Payer: Coventry All Commercial |
$761.01
|
| Rate for Payer: Encore All Commercial |
$796.03
|
| Rate for Payer: Frontpath All Commercial |
$795.60
|
| Rate for Payer: Humana ChoiceCare |
$746.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.30
|
| Rate for Payer: PHCS All Commercial |
$648.58
|
| Rate for Payer: PHP All Commercial |
$655.85
|
| Rate for Payer: Sagamore Health Network All Products |
$667.61
|
| Rate for Payer: Signature Care EPO |
$717.77
|
| Rate for Payer: Signature Care PPO |
$761.01
|
| Rate for Payer: United Healthcare Commercial |
$681.45
|
|
|
HC SELECT SPIRIT FRAME BED /DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01892417
|
|
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 SELECT SPIRIT FRAME BED /DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01892417
|
|
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 SELENIUM
|
Facility
OP
|
$158.10
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
63001674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$147.03 |
| Rate for Payer: Aetna Commercial |
$133.44
|
| Rate for Payer: Aetna Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.39
|
| Rate for Payer: Cash Price |
$98.02
|
| Rate for Payer: Cash Price |
$98.02
|
| Rate for Payer: Centivo All Commercial |
$80.63
|
| Rate for Payer: Cigna All Commercial |
$136.44
|
| Rate for Payer: CORVEL All Commercial |
$147.03
|
| Rate for Payer: Coventry All Commercial |
$139.13
|
| Rate for Payer: Encore All Commercial |
$145.53
|
| Rate for Payer: Frontpath All Commercial |
$145.45
|
| Rate for Payer: Humana ChoiceCare |
$136.55
|
| Rate for Payer: Humana Medicare |
$80.63
|
| Rate for Payer: Lucent All Commercial |
$80.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.29
|
| Rate for Payer: Managed Health Services Medicaid |
$25.53
|
| Rate for Payer: MDWise Medicaid |
$25.53
|
| Rate for Payer: PHCS All Commercial |
$118.58
|
| Rate for Payer: PHP All Commercial |
$119.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.66
|
| Rate for Payer: Sagamore Health Network All Products |
$122.05
|
| Rate for Payer: Signature Care EPO |
$131.22
|
| Rate for Payer: Signature Care PPO |
$139.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134.38
|
| Rate for Payer: United Healthcare Commercial |
$124.58
|
| Rate for Payer: United Healthcare Medicare |
$52.17
|
|
|
HC SELENIUM
|
Facility
IP
|
$158.10
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
63001674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.58 |
| Max. Negotiated Rate |
$147.03 |
| Rate for Payer: Aetna Commercial |
$136.60
|
| Rate for Payer: Cash Price |
$98.02
|
| Rate for Payer: Cigna All Commercial |
$136.44
|
| Rate for Payer: CORVEL All Commercial |
$147.03
|
| Rate for Payer: Coventry All Commercial |
$139.13
|
| Rate for Payer: Encore All Commercial |
$145.53
|
| Rate for Payer: Frontpath All Commercial |
$145.45
|
| Rate for Payer: Humana ChoiceCare |
$136.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.29
|
| Rate for Payer: PHCS All Commercial |
$118.58
|
| Rate for Payer: PHP All Commercial |
$119.90
|
| Rate for Payer: Sagamore Health Network All Products |
$122.05
|
| Rate for Payer: Signature Care EPO |
$131.22
|
| Rate for Payer: Signature Care PPO |
$139.13
|
| Rate for Payer: United Healthcare Commercial |
$124.58
|
|
|
HC SEMEN ANALYSIS COMP
|
Facility
OP
|
$304.18
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
63001242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.38 |
| Max. Negotiated Rate |
$282.89 |
| Rate for Payer: Aetna Commercial |
$256.73
|
| Rate for Payer: Aetna Medicare |
$100.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$174.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.42
|
| Rate for Payer: Cash Price |
$188.59
|
| Rate for Payer: Centivo All Commercial |
$155.13
|
| Rate for Payer: Cigna All Commercial |
$262.51
|
| Rate for Payer: CORVEL All Commercial |
$282.89
|
| Rate for Payer: Coventry All Commercial |
$267.68
|
| Rate for Payer: Encore All Commercial |
$280.00
|
| Rate for Payer: Frontpath All Commercial |
$279.85
|
| Rate for Payer: Humana ChoiceCare |
$262.72
|
| Rate for Payer: Humana Medicare |
$155.13
|
| Rate for Payer: Lucent All Commercial |
$155.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.77
|
| Rate for Payer: PHCS All Commercial |
$228.14
|
| Rate for Payer: PHP All Commercial |
$230.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.63
|
| Rate for Payer: Sagamore Health Network All Products |
$234.83
|
| Rate for Payer: Signature Care EPO |
$252.47
|
| Rate for Payer: Signature Care PPO |
$267.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.56
|
| Rate for Payer: United Healthcare Commercial |
$239.70
|
| Rate for Payer: United Healthcare Medicare |
$100.38
|
|
|
HC SEMEN ANALYSIS COMP
|
Facility
IP
|
$304.18
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
63001242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.14 |
| Max. Negotiated Rate |
$282.89 |
| Rate for Payer: Aetna Commercial |
$262.82
|
| Rate for Payer: Cash Price |
$188.59
|
| Rate for Payer: Cigna All Commercial |
$262.51
|
| Rate for Payer: CORVEL All Commercial |
$282.89
|
| Rate for Payer: Coventry All Commercial |
$267.68
|
| Rate for Payer: Encore All Commercial |
$280.00
|
| Rate for Payer: Frontpath All Commercial |
$279.85
|
| Rate for Payer: Humana ChoiceCare |
$262.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.77
|
| Rate for Payer: PHCS All Commercial |
$228.14
|
| Rate for Payer: PHP All Commercial |
$230.69
|
| Rate for Payer: Sagamore Health Network All Products |
$234.83
|
| Rate for Payer: Signature Care EPO |
$252.47
|
| Rate for Payer: Signature Care PPO |
$267.68
|
| Rate for Payer: United Healthcare Commercial |
$239.70
|
|
|
HC SEMEN FRUCTOSE
|
Facility
OP
|
$74.22
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
63001544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$69.02 |
| Rate for Payer: Aetna Commercial |
$62.64
|
| Rate for Payer: Aetna Medicare |
$24.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.94
|
| Rate for Payer: Cash Price |
$46.01
|
| Rate for Payer: Cash Price |
$46.01
|
| Rate for Payer: Centivo All Commercial |
$37.85
|
| Rate for Payer: Cigna All Commercial |
$64.05
|
| Rate for Payer: CORVEL All Commercial |
$69.02
|
| Rate for Payer: Coventry All Commercial |
$65.31
|
| Rate for Payer: Encore All Commercial |
$68.32
|
| Rate for Payer: Frontpath All Commercial |
$68.28
|
| Rate for Payer: Humana ChoiceCare |
$64.10
|
| Rate for Payer: Humana Medicare |
$37.85
|
| Rate for Payer: Lucent All Commercial |
$37.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.79
|
| Rate for Payer: Managed Health Services Medicaid |
$17.34
|
| Rate for Payer: MDWise Medicaid |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$55.66
|
| Rate for Payer: PHP All Commercial |
$56.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.94
|
| Rate for Payer: Sagamore Health Network All Products |
$57.29
|
| Rate for Payer: Signature Care EPO |
$61.60
|
| Rate for Payer: Signature Care PPO |
$65.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.08
|
| Rate for Payer: United Healthcare Commercial |
$58.48
|
| Rate for Payer: United Healthcare Medicare |
$24.49
|
|
|
HC SEMEN FRUCTOSE
|
Facility
IP
|
$74.22
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
63001544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$69.02 |
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Cash Price |
$46.01
|
| Rate for Payer: Cigna All Commercial |
$64.05
|
| Rate for Payer: CORVEL All Commercial |
$69.02
|
| Rate for Payer: Coventry All Commercial |
$65.31
|
| Rate for Payer: Encore All Commercial |
$68.32
|
| Rate for Payer: Frontpath All Commercial |
$68.28
|
| Rate for Payer: Humana ChoiceCare |
$64.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.79
|
| Rate for Payer: PHCS All Commercial |
$55.66
|
| Rate for Payer: PHP All Commercial |
$56.28
|
| Rate for Payer: Sagamore Health Network All Products |
$57.29
|
| Rate for Payer: Signature Care EPO |
$61.60
|
| Rate for Payer: Signature Care PPO |
$65.31
|
| Rate for Payer: United Healthcare Commercial |
$58.48
|
|
|
HC S END CAP T2
|
Facility
OP
|
$1,330.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.08 |
| Max. Negotiated Rate |
$1,237.41 |
| Rate for Payer: Aetna Commercial |
$1,122.98
|
| Rate for Payer: Aetna Medicare |
$439.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$439.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$764.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$831.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$504.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$482.99
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Centivo All Commercial |
$678.58
|
| Rate for Payer: Cigna All Commercial |
$1,148.26
|
| Rate for Payer: CORVEL All Commercial |
$1,237.41
|
| Rate for Payer: Coventry All Commercial |
$1,170.88
|
| Rate for Payer: Encore All Commercial |
$1,224.77
|
| Rate for Payer: Frontpath All Commercial |
$1,224.11
|
| Rate for Payer: Humana ChoiceCare |
$1,149.20
|
| Rate for Payer: Humana Medicare |
$678.58
|
| Rate for Payer: Lucent All Commercial |
$678.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$997.91
|
| Rate for Payer: PHP All Commercial |
$1,009.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$518.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,027.18
|
| Rate for Payer: Signature Care EPO |
$1,104.36
|
| Rate for Payer: Signature Care PPO |
$1,170.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,130.97
|
| Rate for Payer: United Healthcare Commercial |
$1,048.47
|
| Rate for Payer: United Healthcare Medicare |
$439.08
|
|
|
HC S END CAP T2
|
Facility
IP
|
$1,330.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.91 |
| Max. Negotiated Rate |
$1,237.41 |
| Rate for Payer: Aetna Commercial |
$1,149.60
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cigna All Commercial |
$1,148.26
|
| Rate for Payer: CORVEL All Commercial |
$1,237.41
|
| Rate for Payer: Coventry All Commercial |
$1,170.88
|
| Rate for Payer: Encore All Commercial |
$1,224.77
|
| Rate for Payer: Frontpath All Commercial |
$1,224.11
|
| Rate for Payer: Humana ChoiceCare |
$1,149.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.50
|
| Rate for Payer: PHCS All Commercial |
$997.91
|
| Rate for Payer: PHP All Commercial |
$1,009.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,027.18
|
| Rate for Payer: Signature Care EPO |
$1,104.36
|
| Rate for Payer: Signature Care PPO |
$1,170.88
|
| Rate for Payer: United Healthcare Commercial |
$1,048.47
|
|
|
HC SENSITIVITY
|
Facility
OP
|
$114.92
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
63001065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$106.88 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: Aetna Medicare |
$37.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.72
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Centivo All Commercial |
$58.61
|
| Rate for Payer: Cigna All Commercial |
$99.18
|
| Rate for Payer: CORVEL All Commercial |
$106.88
|
| Rate for Payer: Coventry All Commercial |
$101.13
|
| Rate for Payer: Encore All Commercial |
$105.79
|
| Rate for Payer: Frontpath All Commercial |
$105.73
|
| Rate for Payer: Humana ChoiceCare |
$99.26
|
| Rate for Payer: Humana Medicare |
$58.61
|
| Rate for Payer: Lucent All Commercial |
$58.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.43
|
| Rate for Payer: Managed Health Services Medicaid |
$8.65
|
| Rate for Payer: MDWise Medicaid |
$8.65
|
| Rate for Payer: PHCS All Commercial |
$86.19
|
| Rate for Payer: PHP All Commercial |
$87.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.82
|
| Rate for Payer: Sagamore Health Network All Products |
$88.72
|
| Rate for Payer: Signature Care EPO |
$95.39
|
| Rate for Payer: Signature Care PPO |
$101.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97.68
|
| Rate for Payer: United Healthcare Commercial |
$90.56
|
| Rate for Payer: United Healthcare Medicare |
$37.92
|
|
|
HC SENSITIVITY
|
Facility
IP
|
$114.92
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
63001065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$106.88 |
| Rate for Payer: Aetna Commercial |
$99.29
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cigna All Commercial |
$99.18
|
| Rate for Payer: CORVEL All Commercial |
$106.88
|
| Rate for Payer: Coventry All Commercial |
$101.13
|
| Rate for Payer: Encore All Commercial |
$105.79
|
| Rate for Payer: Frontpath All Commercial |
$105.73
|
| Rate for Payer: Humana ChoiceCare |
$99.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.43
|
| Rate for Payer: PHCS All Commercial |
$86.19
|
| Rate for Payer: PHP All Commercial |
$87.16
|
| Rate for Payer: Sagamore Health Network All Products |
$88.72
|
| Rate for Payer: Signature Care EPO |
$95.39
|
| Rate for Payer: Signature Care PPO |
$101.13
|
| Rate for Payer: United Healthcare Commercial |
$90.56
|
|
