|
HC SN ULTRABUTTON ADJUST FIXATION
|
Facility
OP
|
$3,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,364.74 |
| Rate for Payer: Aetna Commercial |
$3,053.59
|
| Rate for Payer: Aetna Medicare |
$1,193.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,193.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,077.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,261.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,373.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,313.33
|
| Rate for Payer: Cash Price |
$2,243.16
|
| Rate for Payer: Cash Price |
$2,243.16
|
| Rate for Payer: Centivo All Commercial |
$1,845.18
|
| Rate for Payer: Cigna All Commercial |
$3,122.33
|
| Rate for Payer: CORVEL All Commercial |
$3,364.74
|
| Rate for Payer: Coventry All Commercial |
$3,183.84
|
| Rate for Payer: Encore All Commercial |
$3,330.37
|
| Rate for Payer: Frontpath All Commercial |
$3,328.56
|
| Rate for Payer: Humana ChoiceCare |
$3,124.87
|
| Rate for Payer: Humana Medicare |
$1,845.18
|
| Rate for Payer: Lucent All Commercial |
$1,845.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,256.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,713.50
|
| Rate for Payer: PHP All Commercial |
$2,743.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,411.02
|
| Rate for Payer: Sagamore Health Network All Products |
$2,793.10
|
| Rate for Payer: Signature Care EPO |
$3,002.94
|
| Rate for Payer: Signature Care PPO |
$3,183.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,075.30
|
| Rate for Payer: United Healthcare Commercial |
$2,850.98
|
| Rate for Payer: United Healthcare Medicare |
$1,193.94
|
|
|
HC SN ULTRABUTTON ADJUST FIXATION
|
Facility
IP
|
$3,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,713.50 |
| Max. Negotiated Rate |
$3,364.74 |
| Rate for Payer: Aetna Commercial |
$3,125.95
|
| Rate for Payer: Cash Price |
$2,243.16
|
| Rate for Payer: Cigna All Commercial |
$3,122.33
|
| Rate for Payer: CORVEL All Commercial |
$3,364.74
|
| Rate for Payer: Coventry All Commercial |
$3,183.84
|
| Rate for Payer: Encore All Commercial |
$3,330.37
|
| Rate for Payer: Frontpath All Commercial |
$3,328.56
|
| Rate for Payer: Humana ChoiceCare |
$3,124.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,256.20
|
| Rate for Payer: PHCS All Commercial |
$2,713.50
|
| Rate for Payer: PHP All Commercial |
$2,743.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,793.10
|
| Rate for Payer: Signature Care EPO |
$3,002.94
|
| Rate for Payer: Signature Care PPO |
$3,183.84
|
| Rate for Payer: United Healthcare Commercial |
$2,850.98
|
|
|
HC SODIUM
|
Facility
OP
|
$78.54
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
63001109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$73.04 |
| 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 |
$4.81
|
| 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 |
$4.81
|
| Rate for Payer: MDWise Medicaid |
$4.81
|
| 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 SODIUM
|
Facility
IP
|
$78.54
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
63001109
|
|
Hospital Revenue Code
|
300
|
| 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 SODIUM FECES
|
Facility
IP
|
$75.38
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
63001679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$70.10 |
| Rate for Payer: Cigna All Commercial |
$65.05
|
| Rate for Payer: Aetna Commercial |
$65.13
|
| Rate for Payer: Cash Price |
$46.73
|
| Rate for Payer: CORVEL All Commercial |
$70.10
|
| Rate for Payer: Coventry All Commercial |
$66.33
|
| Rate for Payer: Encore All Commercial |
$69.39
|
| Rate for Payer: Frontpath All Commercial |
$69.35
|
| Rate for Payer: Humana ChoiceCare |
$65.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.84
|
| Rate for Payer: PHCS All Commercial |
$56.53
|
| Rate for Payer: PHP All Commercial |
$57.17
|
| Rate for Payer: Sagamore Health Network All Products |
$58.19
|
| Rate for Payer: Signature Care EPO |
$62.56
|
| Rate for Payer: Signature Care PPO |
$66.33
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
HC SODIUM FECES
|
Facility
OP
|
$75.38
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
63001679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$70.10 |
| Rate for Payer: Aetna Commercial |
$63.62
|
| Rate for Payer: Aetna Medicare |
$24.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.36
|
| Rate for Payer: Cash Price |
$46.73
|
| Rate for Payer: Cash Price |
$46.73
|
| Rate for Payer: Centivo All Commercial |
$38.44
|
| Rate for Payer: Cigna All Commercial |
$65.05
|
| Rate for Payer: CORVEL All Commercial |
$70.10
|
| Rate for Payer: Coventry All Commercial |
$66.33
|
| Rate for Payer: Encore All Commercial |
$69.39
|
| Rate for Payer: Frontpath All Commercial |
$69.35
|
| Rate for Payer: Humana ChoiceCare |
$65.10
|
| Rate for Payer: Humana Medicare |
$38.44
|
| Rate for Payer: Lucent All Commercial |
$38.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.84
|
| Rate for Payer: Managed Health Services Medicaid |
$4.70
|
| Rate for Payer: MDWise Medicaid |
$4.70
|
| Rate for Payer: PHCS All Commercial |
$56.53
|
| Rate for Payer: PHP All Commercial |
$57.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.40
|
| Rate for Payer: Sagamore Health Network All Products |
$58.19
|
| Rate for Payer: Signature Care EPO |
$62.56
|
| Rate for Payer: Signature Care PPO |
$66.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.07
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Medicare |
$24.87
|
|
|
HC SODIUM URINE
|
Facility
OP
|
$99.86
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
63001151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$32.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.25
|
| Rate for Payer: Cash Price |
$61.91
|
| Rate for Payer: Cash Price |
$61.91
|
| Rate for Payer: Centivo All Commercial |
$50.93
|
| Rate for Payer: Cigna All Commercial |
$86.18
|
| Rate for Payer: CORVEL All Commercial |
$92.87
|
| Rate for Payer: Coventry All Commercial |
$87.88
|
| Rate for Payer: Encore All Commercial |
$91.92
|
| Rate for Payer: Frontpath All Commercial |
$91.87
|
| Rate for Payer: Humana ChoiceCare |
$86.25
|
| Rate for Payer: Humana Medicare |
$50.93
|
| Rate for Payer: Lucent All Commercial |
$50.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.87
|
| Rate for Payer: Managed Health Services Medicaid |
$4.70
|
| Rate for Payer: MDWise Medicaid |
$4.70
|
| Rate for Payer: PHCS All Commercial |
$74.89
|
| Rate for Payer: PHP All Commercial |
$75.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.94
|
| Rate for Payer: Sagamore Health Network All Products |
$77.09
|
| Rate for Payer: Signature Care EPO |
$82.88
|
| Rate for Payer: Signature Care PPO |
$87.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.88
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
| Rate for Payer: United Healthcare Medicare |
$32.95
|
|
|
HC SODIUM URINE
|
Facility
IP
|
$99.86
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
63001151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.89 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$61.91
|
| Rate for Payer: Cigna All Commercial |
$86.18
|
| Rate for Payer: CORVEL All Commercial |
$92.87
|
| Rate for Payer: Coventry All Commercial |
$87.88
|
| Rate for Payer: Encore All Commercial |
$91.92
|
| Rate for Payer: Frontpath All Commercial |
$91.87
|
| Rate for Payer: Humana ChoiceCare |
$86.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.87
|
| Rate for Payer: PHCS All Commercial |
$74.89
|
| Rate for Payer: PHP All Commercial |
$75.73
|
| Rate for Payer: Sagamore Health Network All Products |
$77.09
|
| Rate for Payer: Signature Care EPO |
$82.88
|
| Rate for Payer: Signature Care PPO |
$87.88
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
|
|
HC SOLUBLE TRANSFERRIN
|
Facility
IP
|
$419.63
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
63001672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$314.72 |
| Max. Negotiated Rate |
$390.25 |
| Rate for Payer: Aetna Commercial |
$362.56
|
| Rate for Payer: Cash Price |
$260.17
|
| Rate for Payer: Cigna All Commercial |
$362.14
|
| Rate for Payer: CORVEL All Commercial |
$390.25
|
| Rate for Payer: Coventry All Commercial |
$369.27
|
| Rate for Payer: Encore All Commercial |
$386.27
|
| Rate for Payer: Frontpath All Commercial |
$386.06
|
| Rate for Payer: Humana ChoiceCare |
$362.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$377.67
|
| Rate for Payer: PHCS All Commercial |
$314.72
|
| Rate for Payer: PHP All Commercial |
$318.25
|
| Rate for Payer: Sagamore Health Network All Products |
$323.95
|
| Rate for Payer: Signature Care EPO |
$348.29
|
| Rate for Payer: Signature Care PPO |
$369.27
|
| Rate for Payer: United Healthcare Commercial |
$330.67
|
|
|
HC SOLUBLE TRANSFERRIN
|
Facility
OP
|
$419.63
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
63001672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$390.25 |
| Rate for Payer: Aetna Commercial |
$354.17
|
| Rate for Payer: Aetna Medicare |
$138.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$240.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$36.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.32
|
| Rate for Payer: Cash Price |
$260.17
|
| Rate for Payer: Cash Price |
$260.17
|
| Rate for Payer: Centivo All Commercial |
$214.01
|
| Rate for Payer: Cigna All Commercial |
$362.14
|
| Rate for Payer: CORVEL All Commercial |
$390.25
|
| Rate for Payer: Coventry All Commercial |
$369.27
|
| Rate for Payer: Encore All Commercial |
$386.27
|
| Rate for Payer: Frontpath All Commercial |
$386.06
|
| Rate for Payer: Humana ChoiceCare |
$362.43
|
| Rate for Payer: Humana Medicare |
$214.01
|
| Rate for Payer: Lucent All Commercial |
$214.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$377.67
|
| Rate for Payer: Managed Health Services Medicaid |
$36.57
|
| Rate for Payer: MDWise Medicaid |
$36.57
|
| Rate for Payer: PHCS All Commercial |
$314.72
|
| Rate for Payer: PHP All Commercial |
$318.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.65
|
| Rate for Payer: Sagamore Health Network All Products |
$323.95
|
| Rate for Payer: Signature Care EPO |
$348.29
|
| Rate for Payer: Signature Care PPO |
$369.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$356.68
|
| Rate for Payer: United Healthcare Commercial |
$330.67
|
| Rate for Payer: United Healthcare Medicare |
$138.48
|
|
|
HC SOLUTION LUGOL'S 8ML
|
Facility
IP
|
$58.18
|
|
| Hospital Charge Code |
41602148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.64 |
| Max. Negotiated Rate |
$54.11 |
| Rate for Payer: Aetna Commercial |
$50.27
|
| Rate for Payer: Cash Price |
$36.07
|
| Rate for Payer: Cigna All Commercial |
$50.21
|
| Rate for Payer: CORVEL All Commercial |
$54.11
|
| Rate for Payer: Coventry All Commercial |
$51.20
|
| Rate for Payer: Encore All Commercial |
$53.55
|
| Rate for Payer: Frontpath All Commercial |
$53.53
|
| Rate for Payer: Humana ChoiceCare |
$50.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.36
|
| Rate for Payer: PHCS All Commercial |
$43.64
|
| Rate for Payer: PHP All Commercial |
$44.12
|
| Rate for Payer: Sagamore Health Network All Products |
$44.91
|
| Rate for Payer: Signature Care EPO |
$48.29
|
| Rate for Payer: Signature Care PPO |
$51.20
|
| Rate for Payer: United Healthcare Commercial |
$45.85
|
|
|
HC SOLUTION LUGOL'S 8ML
|
Facility
OP
|
$58.18
|
|
| Hospital Charge Code |
41602148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$49.10
|
| Rate for Payer: Aetna Medicare |
$19.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.12
|
| Rate for Payer: Cash Price |
$36.07
|
| Rate for Payer: Cash Price |
$36.07
|
| Rate for Payer: Centivo All Commercial |
$29.67
|
| Rate for Payer: Cigna All Commercial |
$50.21
|
| Rate for Payer: CORVEL All Commercial |
$54.11
|
| Rate for Payer: Coventry All Commercial |
$51.20
|
| Rate for Payer: Encore All Commercial |
$53.55
|
| Rate for Payer: Frontpath All Commercial |
$53.53
|
| Rate for Payer: Humana ChoiceCare |
$50.25
|
| Rate for Payer: Humana Medicare |
$29.67
|
| Rate for Payer: Lucent All Commercial |
$29.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.36
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$43.64
|
| Rate for Payer: PHP All Commercial |
$44.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.69
|
| Rate for Payer: Sagamore Health Network All Products |
$44.91
|
| Rate for Payer: Signature Care EPO |
$48.29
|
| Rate for Payer: Signature Care PPO |
$51.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.45
|
| Rate for Payer: United Healthcare Commercial |
$45.85
|
| Rate for Payer: United Healthcare Medicare |
$19.20
|
|
|
HC SOLUTION MONSEL'S 8ML
|
Facility
IP
|
$101.35
|
|
| Hospital Charge Code |
41602149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.01 |
| Max. Negotiated Rate |
$94.26 |
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Cigna All Commercial |
$87.47
|
| Rate for Payer: CORVEL All Commercial |
$94.26
|
| Rate for Payer: Coventry All Commercial |
$89.19
|
| Rate for Payer: Encore All Commercial |
$93.29
|
| Rate for Payer: Frontpath All Commercial |
$93.24
|
| Rate for Payer: Humana ChoiceCare |
$87.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.22
|
| Rate for Payer: PHCS All Commercial |
$76.01
|
| Rate for Payer: PHP All Commercial |
$76.86
|
| Rate for Payer: Sagamore Health Network All Products |
$78.24
|
| Rate for Payer: Signature Care EPO |
$84.12
|
| Rate for Payer: Signature Care PPO |
$89.19
|
| Rate for Payer: United Healthcare Commercial |
$79.86
|
|
|
HC SOLUTION MONSEL'S 8ML
|
Facility
OP
|
$101.35
|
|
| Hospital Charge Code |
41602149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.45 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$85.54
|
| Rate for Payer: Aetna Medicare |
$33.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.79
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Centivo All Commercial |
$51.69
|
| Rate for Payer: Cigna All Commercial |
$87.47
|
| Rate for Payer: CORVEL All Commercial |
$94.26
|
| Rate for Payer: Coventry All Commercial |
$89.19
|
| Rate for Payer: Encore All Commercial |
$93.29
|
| Rate for Payer: Frontpath All Commercial |
$93.24
|
| Rate for Payer: Humana ChoiceCare |
$87.54
|
| Rate for Payer: Humana Medicare |
$51.69
|
| Rate for Payer: Lucent All Commercial |
$51.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$76.01
|
| Rate for Payer: PHP All Commercial |
$76.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.53
|
| Rate for Payer: Sagamore Health Network All Products |
$78.24
|
| Rate for Payer: Signature Care EPO |
$84.12
|
| Rate for Payer: Signature Care PPO |
$89.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.15
|
| Rate for Payer: United Healthcare Commercial |
$79.86
|
| Rate for Payer: United Healthcare Medicare |
$33.45
|
|
|
HC SOMA BED /DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
02341153
|
|
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 SOMA BED /DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
02341153
|
|
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 S ONE-THIRD TUB PLATE 83 7-H
|
Facility
OP
|
$1,962.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,824.66 |
| Rate for Payer: Aetna Commercial |
$1,655.93
|
| Rate for Payer: Aetna Medicare |
$647.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$647.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,126.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,226.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$744.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$712.21
|
| Rate for Payer: Cash Price |
$1,216.44
|
| Rate for Payer: Cash Price |
$1,216.44
|
| Rate for Payer: Centivo All Commercial |
$1,000.62
|
| Rate for Payer: Cigna All Commercial |
$1,693.21
|
| Rate for Payer: CORVEL All Commercial |
$1,824.66
|
| Rate for Payer: Coventry All Commercial |
$1,726.56
|
| Rate for Payer: Encore All Commercial |
$1,806.02
|
| Rate for Payer: Frontpath All Commercial |
$1,805.04
|
| Rate for Payer: Humana ChoiceCare |
$1,694.58
|
| Rate for Payer: Humana Medicare |
$1,000.62
|
| Rate for Payer: Lucent All Commercial |
$1,000.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,765.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,471.50
|
| Rate for Payer: PHP All Commercial |
$1,487.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$765.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,514.66
|
| Rate for Payer: Signature Care EPO |
$1,628.46
|
| Rate for Payer: Signature Care PPO |
$1,726.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,667.70
|
| Rate for Payer: United Healthcare Commercial |
$1,546.06
|
| Rate for Payer: United Healthcare Medicare |
$647.46
|
|
|
HC S ONE-THIRD TUB PLATE 83 7-H
|
Facility
IP
|
$1,962.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.50 |
| Max. Negotiated Rate |
$1,824.66 |
| Rate for Payer: Aetna Commercial |
$1,695.17
|
| Rate for Payer: Cash Price |
$1,216.44
|
| Rate for Payer: Cigna All Commercial |
$1,693.21
|
| Rate for Payer: CORVEL All Commercial |
$1,824.66
|
| Rate for Payer: Coventry All Commercial |
$1,726.56
|
| Rate for Payer: Encore All Commercial |
$1,806.02
|
| Rate for Payer: Frontpath All Commercial |
$1,805.04
|
| Rate for Payer: Humana ChoiceCare |
$1,694.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,765.80
|
| Rate for Payer: PHCS All Commercial |
$1,471.50
|
| Rate for Payer: PHP All Commercial |
$1,487.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,514.66
|
| Rate for Payer: Signature Care EPO |
$1,628.46
|
| Rate for Payer: Signature Care PPO |
$1,726.56
|
| Rate for Payer: United Healthcare Commercial |
$1,546.06
|
|
|
HC SOTROVIMAB INFUSION
|
Facility
IP
|
$583.44
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
00521247
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$542.60 |
| Rate for Payer: Aetna Commercial |
$504.09
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cigna All Commercial |
$503.51
|
| Rate for Payer: CORVEL All Commercial |
$542.60
|
| Rate for Payer: Coventry All Commercial |
$513.43
|
| Rate for Payer: Encore All Commercial |
$537.06
|
| Rate for Payer: Frontpath All Commercial |
$536.76
|
| Rate for Payer: Humana ChoiceCare |
$503.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$525.10
|
| Rate for Payer: PHCS All Commercial |
$437.58
|
| Rate for Payer: PHP All Commercial |
$442.48
|
| Rate for Payer: Sagamore Health Network All Products |
$450.42
|
| Rate for Payer: Signature Care EPO |
$484.26
|
| Rate for Payer: Signature Care PPO |
$513.43
|
| Rate for Payer: United Healthcare Commercial |
$459.75
|
|
|
HC SOTROVIMAB INFUSION
|
Facility
OP
|
$583.44
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
00521247
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$192.54 |
| Max. Negotiated Rate |
$542.60 |
| Rate for Payer: Aetna Commercial |
$492.42
|
| Rate for Payer: Aetna Medicare |
$192.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$335.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$364.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.79
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Centivo All Commercial |
$297.55
|
| Rate for Payer: Cigna All Commercial |
$503.51
|
| Rate for Payer: CORVEL All Commercial |
$542.60
|
| Rate for Payer: Coventry All Commercial |
$513.43
|
| Rate for Payer: Encore All Commercial |
$537.06
|
| Rate for Payer: Frontpath All Commercial |
$536.76
|
| Rate for Payer: Humana ChoiceCare |
$503.92
|
| Rate for Payer: Humana Medicare |
$297.55
|
| Rate for Payer: Lucent All Commercial |
$297.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$525.10
|
| Rate for Payer: PHCS All Commercial |
$437.58
|
| Rate for Payer: PHP All Commercial |
$442.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.54
|
| Rate for Payer: Sagamore Health Network All Products |
$450.42
|
| Rate for Payer: Signature Care EPO |
$484.26
|
| Rate for Payer: Signature Care PPO |
$513.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$495.92
|
| Rate for Payer: United Healthcare Commercial |
$459.75
|
| Rate for Payer: United Healthcare Medicare |
$192.54
|
|
|
HC S PATELLA S29X8 SYM TRI E
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S29X8 SYM TRI E
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S31X9 TRI
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S31X9 TRI
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S33X9 SYM TRI
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
