|
HC SPONGE FEMORAL W/SUCTION
|
Facility
IP
|
$249.04
|
|
| Hospital Charge Code |
41602412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.78 |
| Max. Negotiated Rate |
$231.61 |
| Rate for Payer: Aetna Commercial |
$215.17
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cigna All Commercial |
$214.92
|
| Rate for Payer: CORVEL All Commercial |
$231.61
|
| Rate for Payer: Coventry All Commercial |
$219.16
|
| Rate for Payer: Encore All Commercial |
$229.24
|
| Rate for Payer: Frontpath All Commercial |
$229.12
|
| Rate for Payer: Humana ChoiceCare |
$215.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$224.14
|
| Rate for Payer: PHCS All Commercial |
$186.78
|
| Rate for Payer: PHP All Commercial |
$188.87
|
| Rate for Payer: Sagamore Health Network All Products |
$192.26
|
| Rate for Payer: Signature Care EPO |
$206.70
|
| Rate for Payer: Signature Care PPO |
$219.16
|
| Rate for Payer: United Healthcare Commercial |
$196.24
|
|
|
HC SPONGE FEMORAL W/SUCTION
|
Facility
OP
|
$249.04
|
|
| Hospital Charge Code |
41602412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.18 |
| Max. Negotiated Rate |
$231.61 |
| Rate for Payer: Aetna Commercial |
$210.19
|
| Rate for Payer: Aetna Medicare |
$82.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$143.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$155.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.40
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Centivo All Commercial |
$127.01
|
| Rate for Payer: Cigna All Commercial |
$214.92
|
| Rate for Payer: CORVEL All Commercial |
$231.61
|
| Rate for Payer: Coventry All Commercial |
$219.16
|
| Rate for Payer: Encore All Commercial |
$229.24
|
| Rate for Payer: Frontpath All Commercial |
$229.12
|
| Rate for Payer: Humana ChoiceCare |
$215.10
|
| Rate for Payer: Humana Medicare |
$127.01
|
| Rate for Payer: Lucent All Commercial |
$127.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$224.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$186.78
|
| Rate for Payer: PHP All Commercial |
$188.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.13
|
| Rate for Payer: Sagamore Health Network All Products |
$192.26
|
| Rate for Payer: Signature Care EPO |
$206.70
|
| Rate for Payer: Signature Care PPO |
$219.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$211.68
|
| Rate for Payer: United Healthcare Commercial |
$196.24
|
| Rate for Payer: United Healthcare Medicare |
$82.18
|
|
|
HC SPRING GRIP 5MM-12MM
|
Facility
IP
|
$39.05
|
|
| Hospital Charge Code |
41601098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.29 |
| Max. Negotiated Rate |
$36.32 |
| Rate for Payer: Aetna Commercial |
$33.74
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Cigna All Commercial |
$33.70
|
| Rate for Payer: CORVEL All Commercial |
$36.32
|
| Rate for Payer: Coventry All Commercial |
$34.36
|
| Rate for Payer: Encore All Commercial |
$35.95
|
| Rate for Payer: Frontpath All Commercial |
$35.93
|
| Rate for Payer: Humana ChoiceCare |
$33.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.14
|
| Rate for Payer: PHCS All Commercial |
$29.29
|
| Rate for Payer: PHP All Commercial |
$29.62
|
| Rate for Payer: Sagamore Health Network All Products |
$30.15
|
| Rate for Payer: Signature Care EPO |
$32.41
|
| Rate for Payer: Signature Care PPO |
$34.36
|
| Rate for Payer: United Healthcare Commercial |
$30.77
|
|
|
HC SPRING GRIP 5MM-12MM
|
Facility
OP
|
$39.05
|
|
| Hospital Charge Code |
41601098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.18
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Centivo All Commercial |
$19.92
|
| Rate for Payer: Cigna All Commercial |
$33.70
|
| Rate for Payer: CORVEL All Commercial |
$36.32
|
| Rate for Payer: Coventry All Commercial |
$34.36
|
| Rate for Payer: Encore All Commercial |
$35.95
|
| Rate for Payer: Frontpath All Commercial |
$35.93
|
| Rate for Payer: Humana ChoiceCare |
$33.73
|
| Rate for Payer: Humana Medicare |
$19.92
|
| Rate for Payer: Lucent All Commercial |
$19.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.29
|
| Rate for Payer: PHP All Commercial |
$29.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.23
|
| Rate for Payer: Sagamore Health Network All Products |
$30.15
|
| Rate for Payer: Signature Care EPO |
$32.41
|
| Rate for Payer: Signature Care PPO |
$34.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.19
|
| Rate for Payer: United Healthcare Commercial |
$30.77
|
| Rate for Payer: United Healthcare Medicare |
$12.89
|
|
|
HC SPUTUM CULTURE
|
Facility
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
|
HC SPUTUM CULTURE
|
Facility
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC SPUTUM INDUCTION
|
Facility
IP
|
$190.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
01706000
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$177.31 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Cash Price |
$118.21
|
| Rate for Payer: Cigna All Commercial |
$164.54
|
| Rate for Payer: CORVEL All Commercial |
$177.31
|
| Rate for Payer: Coventry All Commercial |
$167.78
|
| Rate for Payer: Encore All Commercial |
$175.50
|
| Rate for Payer: Frontpath All Commercial |
$175.41
|
| Rate for Payer: Humana ChoiceCare |
$164.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.59
|
| Rate for Payer: PHCS All Commercial |
$142.99
|
| Rate for Payer: PHP All Commercial |
$144.60
|
| Rate for Payer: Sagamore Health Network All Products |
$147.19
|
| Rate for Payer: Signature Care EPO |
$158.25
|
| Rate for Payer: Signature Care PPO |
$167.78
|
| Rate for Payer: United Healthcare Commercial |
$150.24
|
|
|
HC SPUTUM INDUCTION
|
Facility
OP
|
$190.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
01706000
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$177.31 |
| Rate for Payer: Aetna Commercial |
$160.92
|
| Rate for Payer: Aetna Medicare |
$62.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.21
|
| Rate for Payer: Cash Price |
$118.21
|
| Rate for Payer: Cash Price |
$118.21
|
| Rate for Payer: Centivo All Commercial |
$97.24
|
| Rate for Payer: Cigna All Commercial |
$164.54
|
| Rate for Payer: CORVEL All Commercial |
$177.31
|
| Rate for Payer: Coventry All Commercial |
$167.78
|
| Rate for Payer: Encore All Commercial |
$175.50
|
| Rate for Payer: Frontpath All Commercial |
$175.41
|
| Rate for Payer: Humana ChoiceCare |
$164.67
|
| Rate for Payer: Humana Medicare |
$97.24
|
| Rate for Payer: Lucent All Commercial |
$97.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.59
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$142.99
|
| Rate for Payer: PHP All Commercial |
$144.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.36
|
| Rate for Payer: Sagamore Health Network All Products |
$147.19
|
| Rate for Payer: Signature Care EPO |
$158.25
|
| Rate for Payer: Signature Care PPO |
$167.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.06
|
| Rate for Payer: United Healthcare Commercial |
$150.24
|
| Rate for Payer: United Healthcare Medicare |
$62.92
|
|
|
HC SQ/IM INJECTION
|
Facility
OP
|
$106.08
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
01689113
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$73.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.51
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Centivo All Commercial |
$54.10
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$54.10
|
| Rate for Payer: Lucent All Commercial |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: Managed Health Services Medicaid |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$35.01
|
|
|
HC SQ/IM INJECTION
|
Facility
IP
|
$106.08
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
01291372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC SQ/IM INJECTION
|
Facility
OP
|
$106.08
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
01291372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$73.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.51
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Centivo All Commercial |
$54.10
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$54.10
|
| Rate for Payer: Lucent All Commercial |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: Managed Health Services Medicaid |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$35.01
|
|
|
HC SQ/IM INJECTION
|
Facility
IP
|
$106.08
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
01689113
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC SQ/IM INSULIN INJECTION
|
Facility
OP
|
$106.08
|
|
|
Service Code
|
CPT 96372 GZ
|
| Hospital Charge Code |
21689113
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.51
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Centivo All Commercial |
$54.10
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$54.10
|
| Rate for Payer: Lucent All Commercial |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$35.01
|
|
|
HC SQ/IM INSULIN INJECTION
|
Facility
IP
|
$106.08
|
|
|
Service Code
|
CPT 96372 GZ
|
| Hospital Charge Code |
21689113
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC S RASP LG 14X7
|
Facility
OP
|
$859.32
|
|
| Hospital Charge Code |
41606538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$799.17 |
| Rate for Payer: Aetna Commercial |
$725.27
|
| Rate for Payer: Aetna Medicare |
$283.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$283.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$493.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$537.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$311.93
|
| Rate for Payer: Cash Price |
$532.78
|
| Rate for Payer: Cash Price |
$532.78
|
| Rate for Payer: Centivo All Commercial |
$438.25
|
| Rate for Payer: Cigna All Commercial |
$741.59
|
| Rate for Payer: CORVEL All Commercial |
$799.17
|
| Rate for Payer: Coventry All Commercial |
$756.20
|
| Rate for Payer: Encore All Commercial |
$791.00
|
| Rate for Payer: Frontpath All Commercial |
$790.57
|
| Rate for Payer: Humana ChoiceCare |
$742.19
|
| Rate for Payer: Humana Medicare |
$438.25
|
| Rate for Payer: Lucent All Commercial |
$438.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$773.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$644.49
|
| Rate for Payer: PHP All Commercial |
$651.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.13
|
| Rate for Payer: Sagamore Health Network All Products |
$663.40
|
| Rate for Payer: Signature Care EPO |
$713.24
|
| Rate for Payer: Signature Care PPO |
$756.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$730.42
|
| Rate for Payer: United Healthcare Commercial |
$677.14
|
| Rate for Payer: United Healthcare Medicare |
$283.58
|
|
|
HC S RASP LG 14X7
|
Facility
IP
|
$859.32
|
|
| Hospital Charge Code |
41606538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.49 |
| Max. Negotiated Rate |
$799.17 |
| Rate for Payer: Aetna Commercial |
$742.45
|
| Rate for Payer: Cash Price |
$532.78
|
| Rate for Payer: Cigna All Commercial |
$741.59
|
| Rate for Payer: CORVEL All Commercial |
$799.17
|
| Rate for Payer: Coventry All Commercial |
$756.20
|
| Rate for Payer: Encore All Commercial |
$791.00
|
| Rate for Payer: Frontpath All Commercial |
$790.57
|
| Rate for Payer: Humana ChoiceCare |
$742.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$773.39
|
| Rate for Payer: PHCS All Commercial |
$644.49
|
| Rate for Payer: PHP All Commercial |
$651.71
|
| Rate for Payer: Sagamore Health Network All Products |
$663.40
|
| Rate for Payer: Signature Care EPO |
$713.24
|
| Rate for Payer: Signature Care PPO |
$756.20
|
| Rate for Payer: United Healthcare Commercial |
$677.14
|
|
|
HC S RASP SM 11X5
|
Facility
OP
|
$859.32
|
|
| Hospital Charge Code |
41606539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$799.17 |
| Rate for Payer: Aetna Commercial |
$725.27
|
| Rate for Payer: Aetna Medicare |
$283.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$283.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$493.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$537.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$311.93
|
| Rate for Payer: Cash Price |
$532.78
|
| Rate for Payer: Cash Price |
$532.78
|
| Rate for Payer: Centivo All Commercial |
$438.25
|
| Rate for Payer: Cigna All Commercial |
$741.59
|
| Rate for Payer: CORVEL All Commercial |
$799.17
|
| Rate for Payer: Coventry All Commercial |
$756.20
|
| Rate for Payer: Encore All Commercial |
$791.00
|
| Rate for Payer: Frontpath All Commercial |
$790.57
|
| Rate for Payer: Humana ChoiceCare |
$742.19
|
| Rate for Payer: Humana Medicare |
$438.25
|
| Rate for Payer: Lucent All Commercial |
$438.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$773.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$644.49
|
| Rate for Payer: PHP All Commercial |
$651.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.13
|
| Rate for Payer: Sagamore Health Network All Products |
$663.40
|
| Rate for Payer: Signature Care EPO |
$713.24
|
| Rate for Payer: Signature Care PPO |
$756.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$730.42
|
| Rate for Payer: United Healthcare Commercial |
$677.14
|
| Rate for Payer: United Healthcare Medicare |
$283.58
|
|
|
HC S RASP SM 11X5
|
Facility
IP
|
$859.32
|
|
| Hospital Charge Code |
41606539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.49 |
| Max. Negotiated Rate |
$799.17 |
| Rate for Payer: Aetna Commercial |
$742.45
|
| Rate for Payer: Cash Price |
$532.78
|
| Rate for Payer: Cigna All Commercial |
$741.59
|
| Rate for Payer: CORVEL All Commercial |
$799.17
|
| Rate for Payer: Coventry All Commercial |
$756.20
|
| Rate for Payer: Encore All Commercial |
$791.00
|
| Rate for Payer: Frontpath All Commercial |
$790.57
|
| Rate for Payer: Humana ChoiceCare |
$742.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$773.39
|
| Rate for Payer: PHCS All Commercial |
$644.49
|
| Rate for Payer: PHP All Commercial |
$651.71
|
| Rate for Payer: Sagamore Health Network All Products |
$663.40
|
| Rate for Payer: Signature Care EPO |
$713.24
|
| Rate for Payer: Signature Care PPO |
$756.20
|
| Rate for Payer: United Healthcare Commercial |
$677.14
|
|
|
HC S REAMER MTP CONE 20MM
|
Facility
IP
|
$1,413.90
|
|
| Hospital Charge Code |
41608348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,060.42 |
| Max. Negotiated Rate |
$1,314.93 |
| Rate for Payer: Aetna Commercial |
$1,221.61
|
| Rate for Payer: Cash Price |
$876.62
|
| Rate for Payer: Cigna All Commercial |
$1,220.20
|
| Rate for Payer: CORVEL All Commercial |
$1,314.93
|
| Rate for Payer: Coventry All Commercial |
$1,244.23
|
| Rate for Payer: Encore All Commercial |
$1,301.49
|
| Rate for Payer: Frontpath All Commercial |
$1,300.79
|
| Rate for Payer: Humana ChoiceCare |
$1,221.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,272.51
|
| Rate for Payer: PHCS All Commercial |
$1,060.42
|
| Rate for Payer: PHP All Commercial |
$1,072.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.53
|
| Rate for Payer: Signature Care EPO |
$1,173.54
|
| Rate for Payer: Signature Care PPO |
$1,244.23
|
| Rate for Payer: United Healthcare Commercial |
$1,114.15
|
|
|
HC S REAMER MTP CONE 20MM
|
Facility
OP
|
$1,413.90
|
|
| Hospital Charge Code |
41608348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,314.93 |
| Rate for Payer: Aetna Commercial |
$1,193.33
|
| Rate for Payer: Aetna Medicare |
$466.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$466.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$812.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$883.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$536.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.25
|
| Rate for Payer: Cash Price |
$876.62
|
| Rate for Payer: Cash Price |
$876.62
|
| Rate for Payer: Centivo All Commercial |
$721.09
|
| Rate for Payer: Cigna All Commercial |
$1,220.20
|
| Rate for Payer: CORVEL All Commercial |
$1,314.93
|
| Rate for Payer: Coventry All Commercial |
$1,244.23
|
| Rate for Payer: Encore All Commercial |
$1,301.49
|
| Rate for Payer: Frontpath All Commercial |
$1,300.79
|
| Rate for Payer: Humana ChoiceCare |
$1,221.19
|
| Rate for Payer: Humana Medicare |
$721.09
|
| Rate for Payer: Lucent All Commercial |
$721.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,272.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,060.42
|
| Rate for Payer: PHP All Commercial |
$1,072.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$551.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.53
|
| Rate for Payer: Signature Care EPO |
$1,173.54
|
| Rate for Payer: Signature Care PPO |
$1,244.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,201.82
|
| Rate for Payer: United Healthcare Commercial |
$1,114.15
|
| Rate for Payer: United Healthcare Medicare |
$466.59
|
|
|
HC S REAMER MTP CUP 20MM
|
Facility
IP
|
$1,413.90
|
|
| Hospital Charge Code |
41608347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,060.42 |
| Max. Negotiated Rate |
$1,314.93 |
| Rate for Payer: Aetna Commercial |
$1,221.61
|
| Rate for Payer: Cash Price |
$876.62
|
| Rate for Payer: Cigna All Commercial |
$1,220.20
|
| Rate for Payer: CORVEL All Commercial |
$1,314.93
|
| Rate for Payer: Coventry All Commercial |
$1,244.23
|
| Rate for Payer: Encore All Commercial |
$1,301.49
|
| Rate for Payer: Frontpath All Commercial |
$1,300.79
|
| Rate for Payer: Humana ChoiceCare |
$1,221.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,272.51
|
| Rate for Payer: PHCS All Commercial |
$1,060.42
|
| Rate for Payer: PHP All Commercial |
$1,072.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.53
|
| Rate for Payer: Signature Care EPO |
$1,173.54
|
| Rate for Payer: Signature Care PPO |
$1,244.23
|
| Rate for Payer: United Healthcare Commercial |
$1,114.15
|
|
|
HC S REAMER MTP CUP 20MM
|
Facility
OP
|
$1,413.90
|
|
| Hospital Charge Code |
41608347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,314.93 |
| Rate for Payer: Aetna Commercial |
$1,193.33
|
| Rate for Payer: Aetna Medicare |
$466.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$466.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$812.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$883.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$536.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.25
|
| Rate for Payer: Cash Price |
$876.62
|
| Rate for Payer: Cash Price |
$876.62
|
| Rate for Payer: Centivo All Commercial |
$721.09
|
| Rate for Payer: Cigna All Commercial |
$1,220.20
|
| Rate for Payer: CORVEL All Commercial |
$1,314.93
|
| Rate for Payer: Coventry All Commercial |
$1,244.23
|
| Rate for Payer: Encore All Commercial |
$1,301.49
|
| Rate for Payer: Frontpath All Commercial |
$1,300.79
|
| Rate for Payer: Humana ChoiceCare |
$1,221.19
|
| Rate for Payer: Humana Medicare |
$721.09
|
| Rate for Payer: Lucent All Commercial |
$721.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,272.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,060.42
|
| Rate for Payer: PHP All Commercial |
$1,072.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$551.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.53
|
| Rate for Payer: Signature Care EPO |
$1,173.54
|
| Rate for Payer: Signature Care PPO |
$1,244.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,201.82
|
| Rate for Payer: United Healthcare Commercial |
$1,114.15
|
| Rate for Payer: United Healthcare Medicare |
$466.59
|
|
|
HC SSA(RO) AB IGG
|
Facility
IP
|
$128.52
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$119.52 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cigna All Commercial |
$110.91
|
| Rate for Payer: CORVEL All Commercial |
$119.52
|
| Rate for Payer: Coventry All Commercial |
$113.10
|
| Rate for Payer: Encore All Commercial |
$118.30
|
| Rate for Payer: Frontpath All Commercial |
$118.24
|
| Rate for Payer: Humana ChoiceCare |
$111.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.67
|
| Rate for Payer: PHCS All Commercial |
$96.39
|
| Rate for Payer: PHP All Commercial |
$97.47
|
| Rate for Payer: Sagamore Health Network All Products |
$99.22
|
| Rate for Payer: Signature Care EPO |
$106.67
|
| Rate for Payer: Signature Care PPO |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$101.27
|
|
|
HC SSA(RO) AB IGG
|
Facility
OP
|
$128.52
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$119.52 |
| Rate for Payer: Aetna Commercial |
$108.47
|
| Rate for Payer: Aetna Medicare |
$42.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.65
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Centivo All Commercial |
$65.55
|
| Rate for Payer: Cigna All Commercial |
$110.91
|
| Rate for Payer: CORVEL All Commercial |
$119.52
|
| Rate for Payer: Coventry All Commercial |
$113.10
|
| Rate for Payer: Encore All Commercial |
$118.30
|
| Rate for Payer: Frontpath All Commercial |
$118.24
|
| Rate for Payer: Humana ChoiceCare |
$111.00
|
| Rate for Payer: Humana Medicare |
$65.55
|
| Rate for Payer: Lucent All Commercial |
$65.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.67
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$96.39
|
| Rate for Payer: PHP All Commercial |
$97.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.12
|
| Rate for Payer: Sagamore Health Network All Products |
$99.22
|
| Rate for Payer: Signature Care EPO |
$106.67
|
| Rate for Payer: Signature Care PPO |
$113.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.24
|
| Rate for Payer: United Healthcare Commercial |
$101.27
|
| Rate for Payer: United Healthcare Medicare |
$42.41
|
|
|
HC SSB(LA) AB IGG
|
Facility
IP
|
$128.52
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$119.52 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cigna All Commercial |
$110.91
|
| Rate for Payer: CORVEL All Commercial |
$119.52
|
| Rate for Payer: Coventry All Commercial |
$113.10
|
| Rate for Payer: Encore All Commercial |
$118.30
|
| Rate for Payer: Frontpath All Commercial |
$118.24
|
| Rate for Payer: Humana ChoiceCare |
$111.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.67
|
| Rate for Payer: PHCS All Commercial |
$96.39
|
| Rate for Payer: PHP All Commercial |
$97.47
|
| Rate for Payer: Sagamore Health Network All Products |
$99.22
|
| Rate for Payer: Signature Care EPO |
$106.67
|
| Rate for Payer: Signature Care PPO |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$101.27
|
|
