|
HC SIMULATION-SIMPLE
|
Facility
IP
|
$1,785.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
01547280
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,338.75 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna All Commercial |
$1,540.46
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
|
|
HC SIMULATION-SIMPLE
|
Facility
OP
|
$1,785.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
01547280
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$589.05 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,506.54
|
| Rate for Payer: Aetna Medicare |
$589.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$589.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,025.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,115.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$634.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$677.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$647.96
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Centivo All Commercial |
$910.35
|
| Rate for Payer: Cigna All Commercial |
$1,540.46
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Humana Medicare |
$910.35
|
| Rate for Payer: Lucent All Commercial |
$910.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: Managed Health Services Medicaid |
$634.41
|
| Rate for Payer: MDWise Medicaid |
$634.41
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$696.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,517.25
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
| Rate for Payer: United Healthcare Medicare |
$589.05
|
|
|
HC SIROLIMUS
|
Facility
OP
|
$284.29
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
63001379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$264.39 |
| Rate for Payer: Aetna Commercial |
$239.94
|
| Rate for Payer: Aetna Medicare |
$93.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$163.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$177.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.20
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Centivo All Commercial |
$144.99
|
| Rate for Payer: Cigna All Commercial |
$245.35
|
| Rate for Payer: CORVEL All Commercial |
$264.39
|
| Rate for Payer: Coventry All Commercial |
$250.18
|
| Rate for Payer: Encore All Commercial |
$261.69
|
| Rate for Payer: Frontpath All Commercial |
$261.55
|
| Rate for Payer: Humana ChoiceCare |
$245.55
|
| Rate for Payer: Humana Medicare |
$144.99
|
| Rate for Payer: Lucent All Commercial |
$144.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$255.86
|
| Rate for Payer: Managed Health Services Medicaid |
$13.73
|
| Rate for Payer: MDWise Medicaid |
$13.73
|
| Rate for Payer: PHCS All Commercial |
$213.22
|
| Rate for Payer: PHP All Commercial |
$215.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.87
|
| Rate for Payer: Sagamore Health Network All Products |
$219.48
|
| Rate for Payer: Signature Care EPO |
$235.96
|
| Rate for Payer: Signature Care PPO |
$250.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$241.65
|
| Rate for Payer: United Healthcare Commercial |
$224.02
|
| Rate for Payer: United Healthcare Medicare |
$93.82
|
|
|
HC SIROLIMUS
|
Facility
IP
|
$284.29
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
63001379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$264.39 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cigna All Commercial |
$245.35
|
| Rate for Payer: CORVEL All Commercial |
$264.39
|
| Rate for Payer: Coventry All Commercial |
$250.18
|
| Rate for Payer: Encore All Commercial |
$261.69
|
| Rate for Payer: Frontpath All Commercial |
$261.55
|
| Rate for Payer: Humana ChoiceCare |
$245.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$255.86
|
| Rate for Payer: PHCS All Commercial |
$213.22
|
| Rate for Payer: PHP All Commercial |
$215.61
|
| Rate for Payer: Sagamore Health Network All Products |
$219.48
|
| Rate for Payer: Signature Care EPO |
$235.96
|
| Rate for Payer: Signature Care PPO |
$250.18
|
| Rate for Payer: United Healthcare Commercial |
$224.02
|
|
|
HC SJORGRENS ANTI
|
Facility
OP
|
$78.03
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63002197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$72.57 |
| Rate for Payer: Frontpath All Commercial |
$71.79
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Medicare |
$25.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.32
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Centivo All Commercial |
$39.80
|
| Rate for Payer: Cigna All Commercial |
$67.34
|
| Rate for Payer: CORVEL All Commercial |
$72.57
|
| Rate for Payer: Coventry All Commercial |
$68.67
|
| Rate for Payer: Encore All Commercial |
$71.83
|
| Rate for Payer: Humana ChoiceCare |
$67.39
|
| Rate for Payer: Humana Medicare |
$39.80
|
| Rate for Payer: Lucent All Commercial |
$39.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.23
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$58.52
|
| Rate for Payer: PHP All Commercial |
$59.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.43
|
| Rate for Payer: Sagamore Health Network All Products |
$60.24
|
| Rate for Payer: Signature Care EPO |
$64.76
|
| Rate for Payer: Signature Care PPO |
$68.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.33
|
| Rate for Payer: United Healthcare Commercial |
$61.49
|
| Rate for Payer: United Healthcare Medicare |
$25.75
|
|
|
HC SJORGRENS ANTI
|
Facility
IP
|
$78.03
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63002197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.52 |
| Max. Negotiated Rate |
$72.57 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cigna All Commercial |
$67.34
|
| Rate for Payer: CORVEL All Commercial |
$72.57
|
| Rate for Payer: Coventry All Commercial |
$68.67
|
| Rate for Payer: Encore All Commercial |
$71.83
|
| Rate for Payer: Frontpath All Commercial |
$71.79
|
| Rate for Payer: Humana ChoiceCare |
$67.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.23
|
| Rate for Payer: PHCS All Commercial |
$58.52
|
| Rate for Payer: PHP All Commercial |
$59.18
|
| Rate for Payer: Sagamore Health Network All Products |
$60.24
|
| Rate for Payer: Signature Care EPO |
$64.76
|
| Rate for Payer: Signature Care PPO |
$68.67
|
| Rate for Payer: United Healthcare Commercial |
$61.49
|
|
|
HC SK ALLOGRAFT AMNIOTIC
|
Facility
IP
|
$10,080.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,560.00 |
| Max. Negotiated Rate |
$9,374.40 |
| Rate for Payer: Aetna Commercial |
$8,709.12
|
| Rate for Payer: Cash Price |
$6,249.60
|
| Rate for Payer: Cigna All Commercial |
$8,699.04
|
| Rate for Payer: CORVEL All Commercial |
$9,374.40
|
| Rate for Payer: Coventry All Commercial |
$8,870.40
|
| Rate for Payer: Encore All Commercial |
$9,278.64
|
| Rate for Payer: Frontpath All Commercial |
$9,273.60
|
| Rate for Payer: Humana ChoiceCare |
$8,706.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,072.00
|
| Rate for Payer: PHCS All Commercial |
$7,560.00
|
| Rate for Payer: PHP All Commercial |
$7,644.67
|
| Rate for Payer: Sagamore Health Network All Products |
$7,781.76
|
| Rate for Payer: Signature Care EPO |
$8,366.40
|
| Rate for Payer: Signature Care PPO |
$8,870.40
|
| Rate for Payer: United Healthcare Commercial |
$7,943.04
|
|
|
HC SK ALLOGRAFT AMNIOTIC
|
Facility
OP
|
$10,080.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,374.40 |
| Rate for Payer: Aetna Commercial |
$8,507.52
|
| Rate for Payer: Aetna Medicare |
$3,326.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,326.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,788.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,301.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,825.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,659.04
|
| Rate for Payer: Cash Price |
$6,249.60
|
| Rate for Payer: Cash Price |
$6,249.60
|
| Rate for Payer: Centivo All Commercial |
$5,140.80
|
| Rate for Payer: Cigna All Commercial |
$8,699.04
|
| Rate for Payer: CORVEL All Commercial |
$9,374.40
|
| Rate for Payer: Coventry All Commercial |
$8,870.40
|
| Rate for Payer: Encore All Commercial |
$9,278.64
|
| Rate for Payer: Frontpath All Commercial |
$9,273.60
|
| Rate for Payer: Humana ChoiceCare |
$8,706.10
|
| Rate for Payer: Humana Medicare |
$5,140.80
|
| Rate for Payer: Lucent All Commercial |
$5,140.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,072.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,560.00
|
| Rate for Payer: PHP All Commercial |
$7,644.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,931.20
|
| Rate for Payer: Sagamore Health Network All Products |
$7,781.76
|
| Rate for Payer: Signature Care EPO |
$8,366.40
|
| Rate for Payer: Signature Care PPO |
$8,870.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,568.00
|
| Rate for Payer: United Healthcare Commercial |
$7,943.04
|
| Rate for Payer: United Healthcare Medicare |
$3,326.40
|
|
|
HC SKIN AFFIX SURG ADHESIVE
|
Facility
IP
|
$89.38
|
|
| Hospital Charge Code |
41601200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.04 |
| Max. Negotiated Rate |
$83.12 |
| Rate for Payer: Aetna Commercial |
$77.22
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cigna All Commercial |
$77.13
|
| Rate for Payer: CORVEL All Commercial |
$83.12
|
| Rate for Payer: Coventry All Commercial |
$78.65
|
| Rate for Payer: Encore All Commercial |
$82.27
|
| Rate for Payer: Frontpath All Commercial |
$82.23
|
| Rate for Payer: Humana ChoiceCare |
$77.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.44
|
| Rate for Payer: PHCS All Commercial |
$67.04
|
| Rate for Payer: PHP All Commercial |
$67.79
|
| Rate for Payer: Sagamore Health Network All Products |
$69.00
|
| Rate for Payer: Signature Care EPO |
$74.19
|
| Rate for Payer: Signature Care PPO |
$78.65
|
| Rate for Payer: United Healthcare Commercial |
$70.43
|
|
|
HC SKIN AFFIX SURG ADHESIVE
|
Facility
OP
|
$89.38
|
|
| Hospital Charge Code |
41601200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$75.44
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.44
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Centivo All Commercial |
$45.58
|
| Rate for Payer: Cigna All Commercial |
$77.13
|
| Rate for Payer: CORVEL All Commercial |
$83.12
|
| Rate for Payer: Coventry All Commercial |
$78.65
|
| Rate for Payer: Encore All Commercial |
$82.27
|
| Rate for Payer: Frontpath All Commercial |
$82.23
|
| Rate for Payer: Humana ChoiceCare |
$77.20
|
| Rate for Payer: Humana Medicare |
$45.58
|
| Rate for Payer: Lucent All Commercial |
$45.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.44
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$67.04
|
| Rate for Payer: PHP All Commercial |
$67.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.86
|
| Rate for Payer: Sagamore Health Network All Products |
$69.00
|
| Rate for Payer: Signature Care EPO |
$74.19
|
| Rate for Payer: Signature Care PPO |
$78.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.97
|
| Rate for Payer: United Healthcare Commercial |
$70.43
|
| Rate for Payer: United Healthcare Medicare |
$29.50
|
|
|
HC SKIN STAPLER 35W
|
Facility
OP
|
$123.95
|
|
| Hospital Charge Code |
41601099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.90 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$104.61
|
| Rate for Payer: Aetna Medicare |
$40.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.99
|
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Centivo All Commercial |
$63.21
|
| Rate for Payer: Cigna All Commercial |
$106.97
|
| Rate for Payer: CORVEL All Commercial |
$115.27
|
| Rate for Payer: Coventry All Commercial |
$109.08
|
| Rate for Payer: Encore All Commercial |
$114.10
|
| Rate for Payer: Frontpath All Commercial |
$114.03
|
| Rate for Payer: Humana ChoiceCare |
$107.06
|
| Rate for Payer: Humana Medicare |
$63.21
|
| Rate for Payer: Lucent All Commercial |
$63.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$92.96
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.34
|
| Rate for Payer: Sagamore Health Network All Products |
$95.69
|
| Rate for Payer: Signature Care EPO |
$102.88
|
| Rate for Payer: Signature Care PPO |
$109.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.36
|
| Rate for Payer: United Healthcare Commercial |
$97.67
|
| Rate for Payer: United Healthcare Medicare |
$40.90
|
|
|
HC SKIN STAPLER 35W
|
Facility
IP
|
$123.95
|
|
| Hospital Charge Code |
41601099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.96 |
| Max. Negotiated Rate |
$115.27 |
| Rate for Payer: Aetna Commercial |
$107.09
|
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Cigna All Commercial |
$106.97
|
| Rate for Payer: CORVEL All Commercial |
$115.27
|
| Rate for Payer: Coventry All Commercial |
$109.08
|
| Rate for Payer: Encore All Commercial |
$114.10
|
| Rate for Payer: Frontpath All Commercial |
$114.03
|
| Rate for Payer: Humana ChoiceCare |
$107.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.56
|
| Rate for Payer: PHCS All Commercial |
$92.96
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Sagamore Health Network All Products |
$95.69
|
| Rate for Payer: Signature Care EPO |
$102.88
|
| Rate for Payer: Signature Care PPO |
$109.08
|
| Rate for Payer: United Healthcare Commercial |
$97.67
|
|
|
HC S K-WIRE .045
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$286.44 |
| Rate for Payer: Aetna Commercial |
$266.11
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cigna All Commercial |
$265.80
|
| Rate for Payer: CORVEL All Commercial |
$286.44
|
| Rate for Payer: Coventry All Commercial |
$271.04
|
| Rate for Payer: Encore All Commercial |
$283.51
|
| Rate for Payer: Frontpath All Commercial |
$283.36
|
| Rate for Payer: Humana ChoiceCare |
$266.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.20
|
| Rate for Payer: PHCS All Commercial |
$231.00
|
| Rate for Payer: PHP All Commercial |
$233.59
|
| Rate for Payer: Sagamore Health Network All Products |
$237.78
|
| Rate for Payer: Signature Care EPO |
$255.64
|
| Rate for Payer: Signature Care PPO |
$271.04
|
| Rate for Payer: United Healthcare Commercial |
$242.70
|
|
|
HC S K-WIRE .045
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$259.95
|
| Rate for Payer: Aetna Medicare |
$101.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.80
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Centivo All Commercial |
$157.08
|
| Rate for Payer: Cigna All Commercial |
$265.80
|
| Rate for Payer: CORVEL All Commercial |
$286.44
|
| Rate for Payer: Coventry All Commercial |
$271.04
|
| Rate for Payer: Encore All Commercial |
$283.51
|
| Rate for Payer: Frontpath All Commercial |
$283.36
|
| Rate for Payer: Humana ChoiceCare |
$266.02
|
| Rate for Payer: Humana Medicare |
$157.08
|
| Rate for Payer: Lucent All Commercial |
$157.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$231.00
|
| Rate for Payer: PHP All Commercial |
$233.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.12
|
| Rate for Payer: Sagamore Health Network All Products |
$237.78
|
| Rate for Payer: Signature Care EPO |
$255.64
|
| Rate for Payer: Signature Care PPO |
$271.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.80
|
| Rate for Payer: United Healthcare Commercial |
$242.70
|
| Rate for Payer: United Healthcare Medicare |
$101.64
|
|
|
HC S K-WIRE 1.6 150 SS
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$100.44
|
| Rate for Payer: Aetna Medicare |
$39.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$73.78
|
| Rate for Payer: Cash Price |
$73.78
|
| Rate for Payer: Centivo All Commercial |
$60.69
|
| Rate for Payer: Cigna All Commercial |
$102.70
|
| Rate for Payer: CORVEL All Commercial |
$110.67
|
| Rate for Payer: Coventry All Commercial |
$104.72
|
| Rate for Payer: Encore All Commercial |
$109.54
|
| Rate for Payer: Frontpath All Commercial |
$109.48
|
| Rate for Payer: Humana ChoiceCare |
$102.78
|
| Rate for Payer: Humana Medicare |
$60.69
|
| Rate for Payer: Lucent All Commercial |
$60.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$89.25
|
| Rate for Payer: PHP All Commercial |
$90.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.41
|
| Rate for Payer: Sagamore Health Network All Products |
$91.87
|
| Rate for Payer: Signature Care EPO |
$98.77
|
| Rate for Payer: Signature Care PPO |
$104.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.15
|
| Rate for Payer: United Healthcare Commercial |
$93.77
|
| Rate for Payer: United Healthcare Medicare |
$39.27
|
|
|
HC S K-WIRE 1.6 150 SS
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$110.67 |
| Rate for Payer: Aetna Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$73.78
|
| Rate for Payer: Cigna All Commercial |
$102.70
|
| Rate for Payer: CORVEL All Commercial |
$110.67
|
| Rate for Payer: Coventry All Commercial |
$104.72
|
| Rate for Payer: Encore All Commercial |
$109.54
|
| Rate for Payer: Frontpath All Commercial |
$109.48
|
| Rate for Payer: Humana ChoiceCare |
$102.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.10
|
| Rate for Payer: PHCS All Commercial |
$89.25
|
| Rate for Payer: PHP All Commercial |
$90.25
|
| Rate for Payer: Sagamore Health Network All Products |
$91.87
|
| Rate for Payer: Signature Care EPO |
$98.77
|
| Rate for Payer: Signature Care PPO |
$104.72
|
| Rate for Payer: United Healthcare Commercial |
$93.77
|
|
|
HC S KWIRE 3X285
|
Facility
OP
|
$883.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.69 |
| Max. Negotiated Rate |
$822.03 |
| Rate for Payer: Aetna Commercial |
$746.01
|
| Rate for Payer: Aetna Medicare |
$291.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$507.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$552.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$335.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.86
|
| Rate for Payer: Cash Price |
$548.02
|
| Rate for Payer: Cash Price |
$548.02
|
| Rate for Payer: Centivo All Commercial |
$450.79
|
| Rate for Payer: Cigna All Commercial |
$762.81
|
| Rate for Payer: CORVEL All Commercial |
$822.03
|
| Rate for Payer: Coventry All Commercial |
$777.83
|
| Rate for Payer: Encore All Commercial |
$813.63
|
| Rate for Payer: Frontpath All Commercial |
$813.19
|
| Rate for Payer: Humana ChoiceCare |
$763.42
|
| Rate for Payer: Humana Medicare |
$450.79
|
| Rate for Payer: Lucent All Commercial |
$450.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$795.51
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$662.92
|
| Rate for Payer: PHP All Commercial |
$670.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$344.72
|
| Rate for Payer: Sagamore Health Network All Products |
$682.37
|
| Rate for Payer: Signature Care EPO |
$733.64
|
| Rate for Payer: Signature Care PPO |
$777.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$751.32
|
| Rate for Payer: United Healthcare Commercial |
$696.51
|
| Rate for Payer: United Healthcare Medicare |
$291.69
|
|
|
HC S KWIRE 3X285
|
Facility
IP
|
$883.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.92 |
| Max. Negotiated Rate |
$822.03 |
| Rate for Payer: Aetna Commercial |
$763.69
|
| Rate for Payer: Cash Price |
$548.02
|
| Rate for Payer: Cigna All Commercial |
$762.81
|
| Rate for Payer: CORVEL All Commercial |
$822.03
|
| Rate for Payer: Coventry All Commercial |
$777.83
|
| Rate for Payer: Encore All Commercial |
$813.63
|
| Rate for Payer: Frontpath All Commercial |
$813.19
|
| Rate for Payer: Humana ChoiceCare |
$763.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$795.51
|
| Rate for Payer: PHCS All Commercial |
$662.92
|
| Rate for Payer: PHP All Commercial |
$670.35
|
| Rate for Payer: Sagamore Health Network All Products |
$682.37
|
| Rate for Payer: Signature Care EPO |
$733.64
|
| Rate for Payer: Signature Care PPO |
$777.83
|
| Rate for Payer: United Healthcare Commercial |
$696.51
|
|
|
HC S KWIRE BALL TIP 3X1000
|
Facility
OP
|
$1,414.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.69 |
| Max. Negotiated Rate |
$1,315.21 |
| Rate for Payer: Aetna Commercial |
$1,193.58
|
| Rate for Payer: Aetna Medicare |
$466.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$466.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$812.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$884.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$536.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.35
|
| Rate for Payer: Cash Price |
$876.80
|
| Rate for Payer: Cash Price |
$876.80
|
| Rate for Payer: Centivo All Commercial |
$721.24
|
| Rate for Payer: Cigna All Commercial |
$1,220.45
|
| Rate for Payer: CORVEL All Commercial |
$1,315.21
|
| Rate for Payer: Coventry All Commercial |
$1,244.50
|
| Rate for Payer: Encore All Commercial |
$1,301.77
|
| Rate for Payer: Frontpath All Commercial |
$1,301.06
|
| Rate for Payer: Humana ChoiceCare |
$1,221.44
|
| Rate for Payer: Humana Medicare |
$721.24
|
| Rate for Payer: Lucent All Commercial |
$721.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,272.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,060.65
|
| Rate for Payer: PHP All Commercial |
$1,072.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$551.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.76
|
| Rate for Payer: Signature Care EPO |
$1,173.79
|
| Rate for Payer: Signature Care PPO |
$1,244.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,202.07
|
| Rate for Payer: United Healthcare Commercial |
$1,114.39
|
| Rate for Payer: United Healthcare Medicare |
$466.69
|
|
|
HC S KWIRE BALL TIP 3X1000
|
Facility
IP
|
$1,414.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.65 |
| Max. Negotiated Rate |
$1,315.21 |
| Rate for Payer: Aetna Commercial |
$1,221.87
|
| Rate for Payer: Cash Price |
$876.80
|
| Rate for Payer: Cigna All Commercial |
$1,220.45
|
| Rate for Payer: CORVEL All Commercial |
$1,315.21
|
| Rate for Payer: Coventry All Commercial |
$1,244.50
|
| Rate for Payer: Encore All Commercial |
$1,301.77
|
| Rate for Payer: Frontpath All Commercial |
$1,301.06
|
| Rate for Payer: Humana ChoiceCare |
$1,221.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,272.78
|
| Rate for Payer: PHCS All Commercial |
$1,060.65
|
| Rate for Payer: PHP All Commercial |
$1,072.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.76
|
| Rate for Payer: Signature Care EPO |
$1,173.79
|
| Rate for Payer: Signature Care PPO |
$1,244.50
|
| Rate for Payer: United Healthcare Commercial |
$1,114.39
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM <6 HRS RECORDING
|
Facility
OP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810 52
|
| Hospital Charge Code |
01369810
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,955.17 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,000.51
|
| Rate for Payer: Aetna Medicare |
$1,955.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,955.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,402.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,703.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,248.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,150.69
|
| Rate for Payer: Cash Price |
$3,673.36
|
| Rate for Payer: Centivo All Commercial |
$3,021.63
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.23
|
| Rate for Payer: Humana Medicare |
$3,021.63
|
| Rate for Payer: Lucent All Commercial |
$3,021.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,310.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,036.06
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
| Rate for Payer: United Healthcare Medicare |
$1,955.17
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM <6 HRS RECORDING
|
Facility
IP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810 52
|
| Hospital Charge Code |
01369810
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,443.58 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,119.00
|
| Rate for Payer: Cash Price |
$3,673.36
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM 6+ HRS RECORDING
|
Facility
OP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
01520010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$780.39 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,000.51
|
| Rate for Payer: Aetna Medicare |
$1,955.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,955.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,402.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,703.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$780.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,248.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,150.69
|
| Rate for Payer: Cash Price |
$3,673.36
|
| Rate for Payer: Cash Price |
$3,673.36
|
| Rate for Payer: Centivo All Commercial |
$3,021.63
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.23
|
| Rate for Payer: Humana Medicare |
$3,021.63
|
| Rate for Payer: Lucent All Commercial |
$3,021.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: Managed Health Services Medicaid |
$780.39
|
| Rate for Payer: MDWise Medicaid |
$780.39
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,310.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,036.06
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
| Rate for Payer: United Healthcare Medicare |
$1,955.17
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM 6+ HRS RECORDING
|
Facility
IP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
01520010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,443.58 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,119.00
|
| Rate for Payer: Cash Price |
$3,673.36
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
|
|
HC SLEEVE ICED KNEE LARGE
|
Facility
OP
|
$259.14
|
|
| Hospital Charge Code |
41602162
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna Commercial |
$218.71
|
| Rate for Payer: Aetna Medicare |
$85.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.07
|
| Rate for Payer: Cash Price |
$160.67
|
| Rate for Payer: Cash Price |
$160.67
|
| Rate for Payer: Centivo All Commercial |
$132.16
|
| Rate for Payer: Cigna All Commercial |
$223.64
|
| Rate for Payer: CORVEL All Commercial |
$241.00
|
| Rate for Payer: Coventry All Commercial |
$228.04
|
| Rate for Payer: Encore All Commercial |
$238.54
|
| Rate for Payer: Frontpath All Commercial |
$238.41
|
| Rate for Payer: Humana ChoiceCare |
$223.82
|
| Rate for Payer: Humana Medicare |
$132.16
|
| Rate for Payer: Lucent All Commercial |
$132.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.23
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$194.36
|
| Rate for Payer: PHP All Commercial |
$196.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.06
|
| Rate for Payer: Sagamore Health Network All Products |
$200.06
|
| Rate for Payer: Signature Care EPO |
$215.09
|
| Rate for Payer: Signature Care PPO |
$228.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.27
|
| Rate for Payer: United Healthcare Commercial |
$204.20
|
| Rate for Payer: United Healthcare Medicare |
$85.52
|
|
