|
HC SENSOR BIS QUARTRO XP
|
Facility
OP
|
$129.64
|
|
| Hospital Charge Code |
41603475
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$120.57 |
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: Aetna Medicare |
$42.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.06
|
| Rate for Payer: Cash Price |
$80.38
|
| Rate for Payer: Cash Price |
$80.38
|
| Rate for Payer: Centivo All Commercial |
$66.12
|
| Rate for Payer: Cigna All Commercial |
$111.88
|
| Rate for Payer: CORVEL All Commercial |
$120.57
|
| Rate for Payer: Coventry All Commercial |
$114.08
|
| Rate for Payer: Encore All Commercial |
$119.33
|
| Rate for Payer: Frontpath All Commercial |
$119.27
|
| Rate for Payer: Humana ChoiceCare |
$111.97
|
| Rate for Payer: Humana Medicare |
$66.12
|
| Rate for Payer: Lucent All Commercial |
$66.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.68
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$97.23
|
| Rate for Payer: PHP All Commercial |
$98.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.56
|
| Rate for Payer: Sagamore Health Network All Products |
$100.08
|
| Rate for Payer: Signature Care EPO |
$107.60
|
| Rate for Payer: Signature Care PPO |
$114.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.19
|
| Rate for Payer: United Healthcare Commercial |
$102.16
|
| Rate for Payer: United Healthcare Medicare |
$42.78
|
|
|
HC SENSOR BIS QUARTRO XP
|
Facility
IP
|
$129.64
|
|
| Hospital Charge Code |
41603475
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$120.57 |
| Rate for Payer: Aetna Commercial |
$112.01
|
| Rate for Payer: Cash Price |
$80.38
|
| Rate for Payer: Cigna All Commercial |
$111.88
|
| Rate for Payer: CORVEL All Commercial |
$120.57
|
| Rate for Payer: Coventry All Commercial |
$114.08
|
| Rate for Payer: Encore All Commercial |
$119.33
|
| Rate for Payer: Frontpath All Commercial |
$119.27
|
| Rate for Payer: Humana ChoiceCare |
$111.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.68
|
| Rate for Payer: PHCS All Commercial |
$97.23
|
| Rate for Payer: PHP All Commercial |
$98.32
|
| Rate for Payer: Sagamore Health Network All Products |
$100.08
|
| Rate for Payer: Signature Care EPO |
$107.60
|
| Rate for Payer: Signature Care PPO |
$114.08
|
| Rate for Payer: United Healthcare Commercial |
$102.16
|
|
|
HC SENSORY INTEGRATION/15 MIN-OT
|
Facility
OP
|
$143.02
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
01738067
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.92
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Centivo All Commercial |
$72.94
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$72.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
|
|
HC SENSORY INTEGRATION/15 MIN-OT
|
Facility
IP
|
$143.02
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
01738067
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC SENTINEL NODE INJECTION
|
Facility
OP
|
$1,088.69
|
|
| Hospital Charge Code |
01638792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.27 |
| Max. Negotiated Rate |
$1,012.48 |
| Rate for Payer: Aetna Commercial |
$918.85
|
| Rate for Payer: Aetna Medicare |
$359.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$359.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$625.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$680.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$413.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$395.19
|
| Rate for Payer: Cash Price |
$674.99
|
| Rate for Payer: Centivo All Commercial |
$555.23
|
| Rate for Payer: Cigna All Commercial |
$939.54
|
| Rate for Payer: CORVEL All Commercial |
$1,012.48
|
| Rate for Payer: Coventry All Commercial |
$958.04
|
| Rate for Payer: Encore All Commercial |
$1,002.14
|
| Rate for Payer: Frontpath All Commercial |
$1,001.59
|
| Rate for Payer: Humana ChoiceCare |
$940.30
|
| Rate for Payer: Humana Medicare |
$555.23
|
| Rate for Payer: Lucent All Commercial |
$555.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$979.82
|
| Rate for Payer: PHCS All Commercial |
$816.52
|
| Rate for Payer: PHP All Commercial |
$825.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$424.59
|
| Rate for Payer: Sagamore Health Network All Products |
$840.47
|
| Rate for Payer: Signature Care EPO |
$903.61
|
| Rate for Payer: Signature Care PPO |
$958.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$925.38
|
| Rate for Payer: United Healthcare Commercial |
$857.89
|
| Rate for Payer: United Healthcare Medicare |
$359.27
|
|
|
HC SENTINEL NODE INJECTION
|
Facility
IP
|
$1,088.69
|
|
| Hospital Charge Code |
01638792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.52 |
| Max. Negotiated Rate |
$1,012.48 |
| Rate for Payer: Aetna Commercial |
$940.63
|
| Rate for Payer: Cash Price |
$674.99
|
| Rate for Payer: Cigna All Commercial |
$939.54
|
| Rate for Payer: CORVEL All Commercial |
$1,012.48
|
| Rate for Payer: Coventry All Commercial |
$958.04
|
| Rate for Payer: Encore All Commercial |
$1,002.14
|
| Rate for Payer: Frontpath All Commercial |
$1,001.59
|
| Rate for Payer: Humana ChoiceCare |
$940.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$979.82
|
| Rate for Payer: PHCS All Commercial |
$816.52
|
| Rate for Payer: PHP All Commercial |
$825.66
|
| Rate for Payer: Sagamore Health Network All Products |
$840.47
|
| Rate for Payer: Signature Care EPO |
$903.61
|
| Rate for Payer: Signature Care PPO |
$958.04
|
| Rate for Payer: United Healthcare Commercial |
$857.89
|
|
|
HC SEPRAFILM
|
Facility
OP
|
$1,124.71
|
|
| Hospital Charge Code |
41608190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,045.98 |
| Rate for Payer: Aetna Commercial |
$949.26
|
| Rate for Payer: Aetna Medicare |
$371.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$645.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$703.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$426.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$408.27
|
| Rate for Payer: Cash Price |
$697.32
|
| Rate for Payer: Cash Price |
$697.32
|
| Rate for Payer: Centivo All Commercial |
$573.60
|
| Rate for Payer: Cigna All Commercial |
$970.62
|
| Rate for Payer: CORVEL All Commercial |
$1,045.98
|
| Rate for Payer: Coventry All Commercial |
$989.74
|
| Rate for Payer: Encore All Commercial |
$1,035.30
|
| Rate for Payer: Frontpath All Commercial |
$1,034.73
|
| Rate for Payer: Humana ChoiceCare |
$971.41
|
| Rate for Payer: Humana Medicare |
$573.60
|
| Rate for Payer: Lucent All Commercial |
$573.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,012.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$843.53
|
| Rate for Payer: PHP All Commercial |
$852.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$438.64
|
| Rate for Payer: Sagamore Health Network All Products |
$868.28
|
| Rate for Payer: Signature Care EPO |
$933.51
|
| Rate for Payer: Signature Care PPO |
$989.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$956.00
|
| Rate for Payer: United Healthcare Commercial |
$886.27
|
| Rate for Payer: United Healthcare Medicare |
$371.15
|
|
|
HC SEPRAFILM
|
Facility
IP
|
$1,124.71
|
|
| Hospital Charge Code |
41608190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$843.53 |
| Max. Negotiated Rate |
$1,045.98 |
| Rate for Payer: Aetna Commercial |
$971.75
|
| Rate for Payer: Cash Price |
$697.32
|
| Rate for Payer: Cigna All Commercial |
$970.62
|
| Rate for Payer: CORVEL All Commercial |
$1,045.98
|
| Rate for Payer: Coventry All Commercial |
$989.74
|
| Rate for Payer: Encore All Commercial |
$1,035.30
|
| Rate for Payer: Frontpath All Commercial |
$1,034.73
|
| Rate for Payer: Humana ChoiceCare |
$971.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,012.24
|
| Rate for Payer: PHCS All Commercial |
$843.53
|
| Rate for Payer: PHP All Commercial |
$852.98
|
| Rate for Payer: Sagamore Health Network All Products |
$868.28
|
| Rate for Payer: Signature Care EPO |
$933.51
|
| Rate for Payer: Signature Care PPO |
$989.74
|
| Rate for Payer: United Healthcare Commercial |
$886.27
|
|
|
HC SEPRAFILM 5X6
|
Facility
OP
|
$1,777.30
|
|
| Hospital Charge Code |
41601402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$1,652.89 |
| Rate for Payer: Aetna Commercial |
$1,500.04
|
| Rate for Payer: Aetna Medicare |
$586.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$586.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,020.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,110.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$674.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$645.16
|
| Rate for Payer: Cash Price |
$1,101.93
|
| Rate for Payer: Cash Price |
$1,101.93
|
| Rate for Payer: Centivo All Commercial |
$906.42
|
| Rate for Payer: Cigna All Commercial |
$1,533.81
|
| Rate for Payer: CORVEL All Commercial |
$1,652.89
|
| Rate for Payer: Coventry All Commercial |
$1,564.02
|
| Rate for Payer: Encore All Commercial |
$1,636.00
|
| Rate for Payer: Frontpath All Commercial |
$1,635.12
|
| Rate for Payer: Humana ChoiceCare |
$1,535.05
|
| Rate for Payer: Humana Medicare |
$906.42
|
| Rate for Payer: Lucent All Commercial |
$906.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,599.57
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$1,332.98
|
| Rate for Payer: PHP All Commercial |
$1,347.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$693.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,372.08
|
| Rate for Payer: Signature Care EPO |
$1,475.16
|
| Rate for Payer: Signature Care PPO |
$1,564.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,510.70
|
| Rate for Payer: United Healthcare Commercial |
$1,400.51
|
| Rate for Payer: United Healthcare Medicare |
$586.51
|
|
|
HC SEPRAFILM 5X6
|
Facility
IP
|
$1,777.30
|
|
| Hospital Charge Code |
41601402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,332.98 |
| Max. Negotiated Rate |
$1,652.89 |
| Rate for Payer: Aetna Commercial |
$1,535.59
|
| Rate for Payer: Cash Price |
$1,101.93
|
| Rate for Payer: Cigna All Commercial |
$1,533.81
|
| Rate for Payer: CORVEL All Commercial |
$1,652.89
|
| Rate for Payer: Coventry All Commercial |
$1,564.02
|
| Rate for Payer: Encore All Commercial |
$1,636.00
|
| Rate for Payer: Frontpath All Commercial |
$1,635.12
|
| Rate for Payer: Humana ChoiceCare |
$1,535.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,599.57
|
| Rate for Payer: PHCS All Commercial |
$1,332.98
|
| Rate for Payer: PHP All Commercial |
$1,347.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,372.08
|
| Rate for Payer: Signature Care EPO |
$1,475.16
|
| Rate for Payer: Signature Care PPO |
$1,564.02
|
| Rate for Payer: United Healthcare Commercial |
$1,400.51
|
|
|
HC SEROTONIN - SERUM
|
Facility
IP
|
$213.18
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
63001675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$198.26 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Cash Price |
$132.17
|
| Rate for Payer: Cigna All Commercial |
$183.97
|
| Rate for Payer: CORVEL All Commercial |
$198.26
|
| Rate for Payer: Coventry All Commercial |
$187.60
|
| Rate for Payer: Encore All Commercial |
$196.23
|
| Rate for Payer: Frontpath All Commercial |
$196.13
|
| Rate for Payer: Humana ChoiceCare |
$184.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.86
|
| Rate for Payer: PHCS All Commercial |
$159.88
|
| Rate for Payer: PHP All Commercial |
$161.68
|
| Rate for Payer: Sagamore Health Network All Products |
$164.57
|
| Rate for Payer: Signature Care EPO |
$176.94
|
| Rate for Payer: Signature Care PPO |
$187.60
|
| Rate for Payer: United Healthcare Commercial |
$167.99
|
|
|
HC SEROTONIN - SERUM
|
Facility
OP
|
$213.18
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
63001675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$198.26 |
| Rate for Payer: Aetna Commercial |
$179.92
|
| Rate for Payer: Aetna Medicare |
$70.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$30.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.38
|
| Rate for Payer: Cash Price |
$132.17
|
| Rate for Payer: Cash Price |
$132.17
|
| Rate for Payer: Centivo All Commercial |
$108.72
|
| Rate for Payer: Cigna All Commercial |
$183.97
|
| Rate for Payer: CORVEL All Commercial |
$198.26
|
| Rate for Payer: Coventry All Commercial |
$187.60
|
| Rate for Payer: Encore All Commercial |
$196.23
|
| Rate for Payer: Frontpath All Commercial |
$196.13
|
| Rate for Payer: Humana ChoiceCare |
$184.12
|
| Rate for Payer: Humana Medicare |
$108.72
|
| Rate for Payer: Lucent All Commercial |
$108.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.86
|
| Rate for Payer: Managed Health Services Medicaid |
$30.98
|
| Rate for Payer: MDWise Medicaid |
$30.98
|
| Rate for Payer: PHCS All Commercial |
$159.88
|
| Rate for Payer: PHP All Commercial |
$161.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.14
|
| Rate for Payer: Sagamore Health Network All Products |
$164.57
|
| Rate for Payer: Signature Care EPO |
$176.94
|
| Rate for Payer: Signature Care PPO |
$187.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$181.20
|
| Rate for Payer: United Healthcare Commercial |
$167.99
|
| Rate for Payer: United Healthcare Medicare |
$70.35
|
|
|
HC SEROTONIN - WHOLE BLOOD
|
Facility
OP
|
$329.87
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
63001676
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$306.78 |
| Rate for Payer: Aetna Commercial |
$278.41
|
| Rate for Payer: Aetna Medicare |
$108.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$30.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.74
|
| Rate for Payer: Cash Price |
$204.52
|
| Rate for Payer: Cash Price |
$204.52
|
| Rate for Payer: Centivo All Commercial |
$168.23
|
| Rate for Payer: Cigna All Commercial |
$284.68
|
| Rate for Payer: CORVEL All Commercial |
$306.78
|
| Rate for Payer: Coventry All Commercial |
$290.28
|
| Rate for Payer: Encore All Commercial |
$303.64
|
| Rate for Payer: Frontpath All Commercial |
$303.48
|
| Rate for Payer: Humana ChoiceCare |
$284.91
|
| Rate for Payer: Humana Medicare |
$168.23
|
| Rate for Payer: Lucent All Commercial |
$168.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.88
|
| Rate for Payer: Managed Health Services Medicaid |
$30.98
|
| Rate for Payer: MDWise Medicaid |
$30.98
|
| Rate for Payer: PHCS All Commercial |
$247.40
|
| Rate for Payer: PHP All Commercial |
$250.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.65
|
| Rate for Payer: Sagamore Health Network All Products |
$254.66
|
| Rate for Payer: Signature Care EPO |
$273.79
|
| Rate for Payer: Signature Care PPO |
$290.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$280.39
|
| Rate for Payer: United Healthcare Commercial |
$259.94
|
| Rate for Payer: United Healthcare Medicare |
$108.86
|
|
|
HC SEROTONIN - WHOLE BLOOD
|
Facility
IP
|
$329.87
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
63001676
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$247.40 |
| Max. Negotiated Rate |
$306.78 |
| Rate for Payer: Aetna Commercial |
$285.01
|
| Rate for Payer: Cash Price |
$204.52
|
| Rate for Payer: Cigna All Commercial |
$284.68
|
| Rate for Payer: CORVEL All Commercial |
$306.78
|
| Rate for Payer: Coventry All Commercial |
$290.28
|
| Rate for Payer: Encore All Commercial |
$303.64
|
| Rate for Payer: Frontpath All Commercial |
$303.48
|
| Rate for Payer: Humana ChoiceCare |
$284.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.88
|
| Rate for Payer: PHCS All Commercial |
$247.40
|
| Rate for Payer: PHP All Commercial |
$250.17
|
| Rate for Payer: Sagamore Health Network All Products |
$254.66
|
| Rate for Payer: Signature Care EPO |
$273.79
|
| Rate for Payer: Signature Care PPO |
$290.28
|
| Rate for Payer: United Healthcare Commercial |
$259.94
|
|
|
HC SET CRYCOTHYROTOMY MELKER
|
Facility
IP
|
$2,404.08
|
|
| Hospital Charge Code |
41601359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,803.06 |
| Max. Negotiated Rate |
$2,235.79 |
| Rate for Payer: Aetna Commercial |
$2,077.13
|
| Rate for Payer: Cash Price |
$1,490.53
|
| Rate for Payer: Cigna All Commercial |
$2,074.72
|
| Rate for Payer: CORVEL All Commercial |
$2,235.79
|
| Rate for Payer: Coventry All Commercial |
$2,115.59
|
| Rate for Payer: Encore All Commercial |
$2,212.96
|
| Rate for Payer: Frontpath All Commercial |
$2,211.75
|
| Rate for Payer: Humana ChoiceCare |
$2,076.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,163.67
|
| Rate for Payer: PHCS All Commercial |
$1,803.06
|
| Rate for Payer: PHP All Commercial |
$1,823.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,855.95
|
| Rate for Payer: Signature Care EPO |
$1,995.39
|
| Rate for Payer: Signature Care PPO |
$2,115.59
|
| Rate for Payer: United Healthcare Commercial |
$1,894.42
|
|
|
HC SET CRYCOTHYROTOMY MELKER
|
Facility
OP
|
$2,404.08
|
|
| Hospital Charge Code |
41601359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,235.79 |
| Rate for Payer: Aetna Commercial |
$2,029.04
|
| Rate for Payer: Aetna Medicare |
$793.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$793.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,380.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,502.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$912.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$872.68
|
| Rate for Payer: Cash Price |
$1,490.53
|
| Rate for Payer: Cash Price |
$1,490.53
|
| Rate for Payer: Centivo All Commercial |
$1,226.08
|
| Rate for Payer: Cigna All Commercial |
$2,074.72
|
| Rate for Payer: CORVEL All Commercial |
$2,235.79
|
| Rate for Payer: Coventry All Commercial |
$2,115.59
|
| Rate for Payer: Encore All Commercial |
$2,212.96
|
| Rate for Payer: Frontpath All Commercial |
$2,211.75
|
| Rate for Payer: Humana ChoiceCare |
$2,076.40
|
| Rate for Payer: Humana Medicare |
$1,226.08
|
| Rate for Payer: Lucent All Commercial |
$1,226.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,163.67
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,803.06
|
| Rate for Payer: PHP All Commercial |
$1,823.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$937.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,855.95
|
| Rate for Payer: Signature Care EPO |
$1,995.39
|
| Rate for Payer: Signature Care PPO |
$2,115.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,043.47
|
| Rate for Payer: United Healthcare Commercial |
$1,894.42
|
| Rate for Payer: United Healthcare Medicare |
$793.35
|
|
|
HC SET FEEDING FLUSH EPUMP KANG
|
Facility
OP
|
$78.54
|
|
| Hospital Charge Code |
41607867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Aetna Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.51
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Centivo All Commercial |
$40.06
|
| Rate for Payer: Cigna All Commercial |
$67.78
|
| Rate for Payer: CORVEL All Commercial |
$73.04
|
| Rate for Payer: Coventry All Commercial |
$69.12
|
| Rate for Payer: Encore All Commercial |
$72.30
|
| Rate for Payer: Frontpath All Commercial |
$72.26
|
| Rate for Payer: Humana ChoiceCare |
$67.83
|
| Rate for Payer: Humana Medicare |
$40.06
|
| Rate for Payer: Lucent All Commercial |
$40.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.69
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$58.90
|
| Rate for Payer: PHP All Commercial |
$59.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.63
|
| Rate for Payer: Sagamore Health Network All Products |
$60.63
|
| Rate for Payer: Signature Care EPO |
$65.19
|
| Rate for Payer: Signature Care PPO |
$69.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.76
|
| Rate for Payer: United Healthcare Commercial |
$61.89
|
| Rate for Payer: United Healthcare Medicare |
$25.92
|
|
|
HC SET FEEDING FLUSH EPUMP KANG
|
Facility
IP
|
$78.54
|
|
| Hospital Charge Code |
41607867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cigna All Commercial |
$67.78
|
| Rate for Payer: CORVEL All Commercial |
$73.04
|
| Rate for Payer: Coventry All Commercial |
$69.12
|
| Rate for Payer: Encore All Commercial |
$72.30
|
| Rate for Payer: Frontpath All Commercial |
$72.26
|
| Rate for Payer: Humana ChoiceCare |
$67.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.69
|
| Rate for Payer: PHCS All Commercial |
$58.90
|
| Rate for Payer: PHP All Commercial |
$59.56
|
| Rate for Payer: Sagamore Health Network All Products |
$60.63
|
| Rate for Payer: Signature Care EPO |
$65.19
|
| Rate for Payer: Signature Care PPO |
$69.12
|
| Rate for Payer: United Healthcare Commercial |
$61.89
|
|
|
HC SET RADIATION THERAPY FIELD 3D
|
Facility
IP
|
$7,531.68
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
01547295
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,648.76 |
| Max. Negotiated Rate |
$7,004.46 |
| Rate for Payer: Aetna Commercial |
$6,507.37
|
| Rate for Payer: Cash Price |
$4,669.64
|
| Rate for Payer: Cigna All Commercial |
$6,499.84
|
| Rate for Payer: CORVEL All Commercial |
$7,004.46
|
| Rate for Payer: Coventry All Commercial |
$6,627.88
|
| Rate for Payer: Encore All Commercial |
$6,932.91
|
| Rate for Payer: Frontpath All Commercial |
$6,929.15
|
| Rate for Payer: Humana ChoiceCare |
$6,505.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,778.51
|
| Rate for Payer: PHCS All Commercial |
$5,648.76
|
| Rate for Payer: PHP All Commercial |
$5,712.03
|
| Rate for Payer: Sagamore Health Network All Products |
$5,814.46
|
| Rate for Payer: Signature Care EPO |
$6,251.29
|
| Rate for Payer: Signature Care PPO |
$6,627.88
|
| Rate for Payer: United Healthcare Commercial |
$5,934.96
|
|
|
HC SET RADIATION THERAPY FIELD 3D
|
Facility
OP
|
$7,531.68
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
01547295
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$7,004.46 |
| Rate for Payer: Aetna Commercial |
$6,356.74
|
| Rate for Payer: Aetna Medicare |
$2,485.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,485.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,325.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,708.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$705.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,858.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,734.00
|
| Rate for Payer: Cash Price |
$4,669.64
|
| Rate for Payer: Cash Price |
$4,669.64
|
| Rate for Payer: Centivo All Commercial |
$3,841.16
|
| Rate for Payer: Cigna All Commercial |
$6,499.84
|
| Rate for Payer: CORVEL All Commercial |
$7,004.46
|
| Rate for Payer: Coventry All Commercial |
$6,627.88
|
| Rate for Payer: Encore All Commercial |
$6,932.91
|
| Rate for Payer: Frontpath All Commercial |
$6,929.15
|
| Rate for Payer: Humana ChoiceCare |
$6,505.11
|
| Rate for Payer: Humana Medicare |
$3,841.16
|
| Rate for Payer: Lucent All Commercial |
$3,841.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,778.51
|
| Rate for Payer: Managed Health Services Medicaid |
$705.90
|
| Rate for Payer: MDWise Medicaid |
$705.90
|
| Rate for Payer: PHCS All Commercial |
$5,648.76
|
| Rate for Payer: PHP All Commercial |
$5,712.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,937.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,814.46
|
| Rate for Payer: Signature Care EPO |
$6,251.29
|
| Rate for Payer: Signature Care PPO |
$6,627.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,401.93
|
| Rate for Payer: United Healthcare Commercial |
$5,934.96
|
| Rate for Payer: United Healthcare Medicare |
$2,485.45
|
|
|
HC SEVOFLURANE (ULTANE) LIQD CMCH
|
Facility
OP
|
$34.75
|
|
| Hospital Charge Code |
61301001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$29.33
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.61
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Centivo All Commercial |
$17.72
|
| Rate for Payer: Cigna All Commercial |
$29.99
|
| Rate for Payer: CORVEL All Commercial |
$32.32
|
| Rate for Payer: Coventry All Commercial |
$30.58
|
| Rate for Payer: Encore All Commercial |
$31.99
|
| Rate for Payer: Frontpath All Commercial |
$31.97
|
| Rate for Payer: Humana ChoiceCare |
$30.01
|
| Rate for Payer: Humana Medicare |
$17.72
|
| Rate for Payer: Lucent All Commercial |
$17.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.28
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$26.06
|
| Rate for Payer: PHP All Commercial |
$26.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.55
|
| Rate for Payer: Sagamore Health Network All Products |
$26.83
|
| Rate for Payer: Signature Care EPO |
$28.84
|
| Rate for Payer: Signature Care PPO |
$30.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.54
|
| Rate for Payer: United Healthcare Commercial |
$27.38
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
|
|
HC SEVOFLURANE (ULTANE) LIQD CMCH
|
Facility
IP
|
$34.75
|
|
| Hospital Charge Code |
61301001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cigna All Commercial |
$29.99
|
| Rate for Payer: CORVEL All Commercial |
$32.32
|
| Rate for Payer: Coventry All Commercial |
$30.58
|
| Rate for Payer: Encore All Commercial |
$31.99
|
| Rate for Payer: Frontpath All Commercial |
$31.97
|
| Rate for Payer: Humana ChoiceCare |
$30.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.28
|
| Rate for Payer: PHCS All Commercial |
$26.06
|
| Rate for Payer: PHP All Commercial |
$26.36
|
| Rate for Payer: Sagamore Health Network All Products |
$26.83
|
| Rate for Payer: Signature Care EPO |
$28.84
|
| Rate for Payer: Signature Care PPO |
$30.58
|
| Rate for Payer: United Healthcare Commercial |
$27.38
|
|
|
HC SEX HORMONE BINDING GLOB
|
Facility
OP
|
$94.86
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
63001677
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$88.22 |
| Rate for Payer: Aetna Commercial |
$80.06
|
| Rate for Payer: Aetna Medicare |
$31.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.43
|
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Centivo All Commercial |
$48.38
|
| Rate for Payer: Cigna All Commercial |
$81.86
|
| Rate for Payer: CORVEL All Commercial |
$88.22
|
| Rate for Payer: Coventry All Commercial |
$83.48
|
| Rate for Payer: Encore All Commercial |
$87.32
|
| Rate for Payer: Frontpath All Commercial |
$87.27
|
| Rate for Payer: Humana ChoiceCare |
$81.93
|
| Rate for Payer: Humana Medicare |
$48.38
|
| Rate for Payer: Lucent All Commercial |
$48.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.37
|
| Rate for Payer: Managed Health Services Medicaid |
$21.73
|
| Rate for Payer: MDWise Medicaid |
$21.73
|
| Rate for Payer: PHCS All Commercial |
$71.14
|
| Rate for Payer: PHP All Commercial |
$71.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.00
|
| Rate for Payer: Sagamore Health Network All Products |
$73.23
|
| Rate for Payer: Signature Care EPO |
$78.73
|
| Rate for Payer: Signature Care PPO |
$83.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.63
|
| Rate for Payer: United Healthcare Commercial |
$74.75
|
| Rate for Payer: United Healthcare Medicare |
$31.30
|
|
|
HC SEX HORMONE BINDING GLOB
|
Facility
IP
|
$94.86
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
63001677
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$88.22 |
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cigna All Commercial |
$81.86
|
| Rate for Payer: CORVEL All Commercial |
$88.22
|
| Rate for Payer: Coventry All Commercial |
$83.48
|
| Rate for Payer: Encore All Commercial |
$87.32
|
| Rate for Payer: Frontpath All Commercial |
$87.27
|
| Rate for Payer: Humana ChoiceCare |
$81.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.37
|
| Rate for Payer: PHCS All Commercial |
$71.14
|
| Rate for Payer: PHP All Commercial |
$71.94
|
| Rate for Payer: Sagamore Health Network All Products |
$73.23
|
| Rate for Payer: Signature Care EPO |
$78.73
|
| Rate for Payer: Signature Care PPO |
$83.48
|
| Rate for Payer: United Healthcare Commercial |
$74.75
|
|
|
HC S FEM COMP 2 CR TRI L
|
Facility
OP
|
$7,784.71
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$7,239.78 |
| Rate for Payer: Aetna Commercial |
$6,570.30
|
| Rate for Payer: Aetna Medicare |
$2,568.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,568.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,470.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,866.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,954.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,825.85
|
| Rate for Payer: Cash Price |
$4,826.52
|
| Rate for Payer: Cash Price |
$4,826.52
|
| Rate for Payer: Centivo All Commercial |
$3,970.20
|
| Rate for Payer: Cigna All Commercial |
$6,718.20
|
| Rate for Payer: CORVEL All Commercial |
$7,239.78
|
| Rate for Payer: Coventry All Commercial |
$6,850.54
|
| Rate for Payer: Encore All Commercial |
$7,165.83
|
| Rate for Payer: Frontpath All Commercial |
$7,161.93
|
| Rate for Payer: Humana ChoiceCare |
$6,723.65
|
| Rate for Payer: Humana Medicare |
$3,970.20
|
| Rate for Payer: Lucent All Commercial |
$3,970.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,006.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$5,838.53
|
| Rate for Payer: PHP All Commercial |
$5,903.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,036.04
|
| Rate for Payer: Sagamore Health Network All Products |
$6,009.80
|
| Rate for Payer: Signature Care EPO |
$6,461.31
|
| Rate for Payer: Signature Care PPO |
$6,850.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,617.00
|
| Rate for Payer: United Healthcare Commercial |
$6,134.35
|
| Rate for Payer: United Healthcare Medicare |
$2,568.95
|
|
