|
HC SYSTEM REVEAL LINQ
|
Facility
|
OP
|
$18,168.75
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
41607379
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$16,896.94 |
| Rate for Payer: Aetna Commercial |
$15,334.42
|
| Rate for Payer: Aetna Medicare |
$5,995.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,995.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10,434.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,357.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,895.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,595.26
|
| Rate for Payer: Cash Price |
$11,264.63
|
| Rate for Payer: Cash Price |
$11,264.63
|
| Rate for Payer: Centivo All Commercial |
$9,266.06
|
| Rate for Payer: Cigna All Commercial |
$15,679.63
|
| Rate for Payer: CORVEL All Commercial |
$16,896.94
|
| Rate for Payer: Coventry All Commercial |
$15,988.50
|
| Rate for Payer: Encore All Commercial |
$16,724.33
|
| Rate for Payer: Frontpath All Commercial |
$16,715.25
|
| Rate for Payer: Humana ChoiceCare |
$15,692.35
|
| Rate for Payer: Humana Medicare |
$9,266.06
|
| Rate for Payer: Lucent All Commercial |
$9,266.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,351.88
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$13,626.56
|
| Rate for Payer: PHP All Commercial |
$13,779.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,085.81
|
| Rate for Payer: Sagamore Health Network All Products |
$14,026.28
|
| Rate for Payer: Signature Care EPO |
$15,080.06
|
| Rate for Payer: Signature Care PPO |
$15,988.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,443.44
|
| Rate for Payer: United Healthcare Commercial |
$14,316.98
|
| Rate for Payer: United Healthcare Medicare |
$5,995.69
|
|
|
HC SYSTEM REVEAL LINQ
|
Facility
|
IP
|
$18,168.75
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
41607379
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,626.56 |
| Max. Negotiated Rate |
$16,896.94 |
| Rate for Payer: Aetna Commercial |
$15,697.80
|
| Rate for Payer: Cash Price |
$11,264.63
|
| Rate for Payer: Cigna All Commercial |
$15,679.63
|
| Rate for Payer: CORVEL All Commercial |
$16,896.94
|
| Rate for Payer: Coventry All Commercial |
$15,988.50
|
| Rate for Payer: Encore All Commercial |
$16,724.33
|
| Rate for Payer: Frontpath All Commercial |
$16,715.25
|
| Rate for Payer: Humana ChoiceCare |
$15,692.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,351.88
|
| Rate for Payer: PHCS All Commercial |
$13,626.56
|
| Rate for Payer: PHP All Commercial |
$13,779.18
|
| Rate for Payer: Sagamore Health Network All Products |
$14,026.28
|
| Rate for Payer: Signature Care EPO |
$15,080.06
|
| Rate for Payer: Signature Care PPO |
$15,988.50
|
| Rate for Payer: United Healthcare Commercial |
$14,316.98
|
|
|
HC SYSTEM REVEAL LINQ II
|
Facility
|
OP
|
$17,982.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$16,723.26 |
| Rate for Payer: Aetna Commercial |
$15,176.81
|
| Rate for Payer: Aetna Medicare |
$5,934.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,934.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10,327.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,240.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,824.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,527.47
|
| Rate for Payer: Cash Price |
$11,148.84
|
| Rate for Payer: Cash Price |
$11,148.84
|
| Rate for Payer: Centivo All Commercial |
$9,170.82
|
| Rate for Payer: Cigna All Commercial |
$15,518.47
|
| Rate for Payer: CORVEL All Commercial |
$16,723.26
|
| Rate for Payer: Coventry All Commercial |
$15,824.16
|
| Rate for Payer: Encore All Commercial |
$16,552.43
|
| Rate for Payer: Frontpath All Commercial |
$16,543.44
|
| Rate for Payer: Humana ChoiceCare |
$15,531.05
|
| Rate for Payer: Humana Medicare |
$9,170.82
|
| Rate for Payer: Lucent All Commercial |
$9,170.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,183.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$13,486.50
|
| Rate for Payer: PHP All Commercial |
$13,637.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,012.98
|
| Rate for Payer: Sagamore Health Network All Products |
$13,882.10
|
| Rate for Payer: Signature Care EPO |
$14,925.06
|
| Rate for Payer: Signature Care PPO |
$15,824.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,284.70
|
| Rate for Payer: United Healthcare Commercial |
$14,169.82
|
| Rate for Payer: United Healthcare Medicare |
$5,934.06
|
|
|
HC SYSTEM REVEAL LINQ II
|
Facility
|
IP
|
$17,982.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,486.50 |
| Max. Negotiated Rate |
$16,723.26 |
| Rate for Payer: Aetna Commercial |
$15,536.45
|
| Rate for Payer: Cash Price |
$11,148.84
|
| Rate for Payer: Cigna All Commercial |
$15,518.47
|
| Rate for Payer: CORVEL All Commercial |
$16,723.26
|
| Rate for Payer: Coventry All Commercial |
$15,824.16
|
| Rate for Payer: Encore All Commercial |
$16,552.43
|
| Rate for Payer: Frontpath All Commercial |
$16,543.44
|
| Rate for Payer: Humana ChoiceCare |
$15,531.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,183.80
|
| Rate for Payer: PHCS All Commercial |
$13,486.50
|
| Rate for Payer: PHP All Commercial |
$13,637.55
|
| Rate for Payer: Sagamore Health Network All Products |
$13,882.10
|
| Rate for Payer: Signature Care EPO |
$14,925.06
|
| Rate for Payer: Signature Care PPO |
$15,824.16
|
| Rate for Payer: United Healthcare Commercial |
$14,169.82
|
|
|
HC SYSTEM SUCTION DRAINAGE 500ML
|
Facility
|
OP
|
$261.07
|
|
| Hospital Charge Code |
41607735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.15 |
| Max. Negotiated Rate |
$242.80 |
| Rate for Payer: Aetna Commercial |
$220.34
|
| Rate for Payer: Aetna Medicare |
$86.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.77
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Centivo All Commercial |
$133.15
|
| Rate for Payer: Cigna All Commercial |
$225.30
|
| Rate for Payer: CORVEL All Commercial |
$242.80
|
| Rate for Payer: Coventry All Commercial |
$229.74
|
| Rate for Payer: Encore All Commercial |
$240.31
|
| Rate for Payer: Frontpath All Commercial |
$240.18
|
| Rate for Payer: Humana ChoiceCare |
$225.49
|
| Rate for Payer: Humana Medicare |
$133.15
|
| Rate for Payer: Lucent All Commercial |
$133.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$195.80
|
| Rate for Payer: PHP All Commercial |
$198.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.82
|
| Rate for Payer: Sagamore Health Network All Products |
$201.55
|
| Rate for Payer: Signature Care EPO |
$216.69
|
| Rate for Payer: Signature Care PPO |
$229.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.91
|
| Rate for Payer: United Healthcare Commercial |
$205.72
|
| Rate for Payer: United Healthcare Medicare |
$86.15
|
|
|
HC SYSTEM SUCTION DRAINAGE 500ML
|
Facility
|
IP
|
$261.07
|
|
| Hospital Charge Code |
41607735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$242.80 |
| Rate for Payer: Aetna Commercial |
$225.56
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Cigna All Commercial |
$225.30
|
| Rate for Payer: CORVEL All Commercial |
$242.80
|
| Rate for Payer: Coventry All Commercial |
$229.74
|
| Rate for Payer: Encore All Commercial |
$240.31
|
| Rate for Payer: Frontpath All Commercial |
$240.18
|
| Rate for Payer: Humana ChoiceCare |
$225.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.96
|
| Rate for Payer: PHCS All Commercial |
$195.80
|
| Rate for Payer: PHP All Commercial |
$198.00
|
| Rate for Payer: Sagamore Health Network All Products |
$201.55
|
| Rate for Payer: Signature Care EPO |
$216.69
|
| Rate for Payer: Signature Care PPO |
$229.74
|
| Rate for Payer: United Healthcare Commercial |
$205.72
|
|
|
HC SYSTEM SUTURE CLOSESURE XL
|
Facility
|
IP
|
$950.40
|
|
| Hospital Charge Code |
41601612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$712.80 |
| Max. Negotiated Rate |
$883.87 |
| Rate for Payer: Aetna Commercial |
$821.15
|
| Rate for Payer: Cash Price |
$589.25
|
| Rate for Payer: Cigna All Commercial |
$820.20
|
| Rate for Payer: CORVEL All Commercial |
$883.87
|
| Rate for Payer: Coventry All Commercial |
$836.35
|
| Rate for Payer: Encore All Commercial |
$874.84
|
| Rate for Payer: Frontpath All Commercial |
$874.37
|
| Rate for Payer: Humana ChoiceCare |
$820.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.36
|
| Rate for Payer: PHCS All Commercial |
$712.80
|
| Rate for Payer: PHP All Commercial |
$720.78
|
| Rate for Payer: Sagamore Health Network All Products |
$733.71
|
| Rate for Payer: Signature Care EPO |
$788.83
|
| Rate for Payer: Signature Care PPO |
$836.35
|
| Rate for Payer: United Healthcare Commercial |
$748.92
|
|
|
HC SYSTEM SUTURE CLOSESURE XL
|
Facility
|
OP
|
$950.40
|
|
| Hospital Charge Code |
41601612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$883.87 |
| Rate for Payer: Aetna Commercial |
$802.14
|
| Rate for Payer: Aetna Medicare |
$313.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$313.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$545.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$594.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$345.00
|
| Rate for Payer: Cash Price |
$589.25
|
| Rate for Payer: Cash Price |
$589.25
|
| Rate for Payer: Centivo All Commercial |
$484.70
|
| Rate for Payer: Cigna All Commercial |
$820.20
|
| Rate for Payer: CORVEL All Commercial |
$883.87
|
| Rate for Payer: Coventry All Commercial |
$836.35
|
| Rate for Payer: Encore All Commercial |
$874.84
|
| Rate for Payer: Frontpath All Commercial |
$874.37
|
| Rate for Payer: Humana ChoiceCare |
$820.86
|
| Rate for Payer: Humana Medicare |
$484.70
|
| Rate for Payer: Lucent All Commercial |
$484.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.36
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$712.80
|
| Rate for Payer: PHP All Commercial |
$720.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.66
|
| Rate for Payer: Sagamore Health Network All Products |
$733.71
|
| Rate for Payer: Signature Care EPO |
$788.83
|
| Rate for Payer: Signature Care PPO |
$836.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$807.84
|
| Rate for Payer: United Healthcare Commercial |
$748.92
|
| Rate for Payer: United Healthcare Medicare |
$313.63
|
|
|
HC S ZIP 16 SKIN CLOSURE
|
Facility
|
OP
|
$648.40
|
|
| Hospital Charge Code |
41606999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$603.01 |
| Rate for Payer: Aetna Commercial |
$547.25
|
| Rate for Payer: Aetna Medicare |
$213.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$372.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.37
|
| Rate for Payer: Cash Price |
$402.01
|
| Rate for Payer: Cash Price |
$402.01
|
| Rate for Payer: Centivo All Commercial |
$330.68
|
| Rate for Payer: Cigna All Commercial |
$559.57
|
| Rate for Payer: CORVEL All Commercial |
$603.01
|
| Rate for Payer: Coventry All Commercial |
$570.59
|
| Rate for Payer: Encore All Commercial |
$596.85
|
| Rate for Payer: Frontpath All Commercial |
$596.53
|
| Rate for Payer: Humana ChoiceCare |
$560.02
|
| Rate for Payer: Humana Medicare |
$330.68
|
| Rate for Payer: Lucent All Commercial |
$330.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$583.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$486.30
|
| Rate for Payer: PHP All Commercial |
$491.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$252.88
|
| Rate for Payer: Sagamore Health Network All Products |
$500.56
|
| Rate for Payer: Signature Care EPO |
$538.17
|
| Rate for Payer: Signature Care PPO |
$570.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$551.14
|
| Rate for Payer: United Healthcare Commercial |
$510.94
|
| Rate for Payer: United Healthcare Medicare |
$213.97
|
|
|
HC S ZIP 16 SKIN CLOSURE
|
Facility
|
IP
|
$648.40
|
|
| Hospital Charge Code |
41606999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.30 |
| Max. Negotiated Rate |
$603.01 |
| Rate for Payer: Aetna Commercial |
$560.22
|
| Rate for Payer: Cash Price |
$402.01
|
| Rate for Payer: Cigna All Commercial |
$559.57
|
| Rate for Payer: CORVEL All Commercial |
$603.01
|
| Rate for Payer: Coventry All Commercial |
$570.59
|
| Rate for Payer: Encore All Commercial |
$596.85
|
| Rate for Payer: Frontpath All Commercial |
$596.53
|
| Rate for Payer: Humana ChoiceCare |
$560.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$583.56
|
| Rate for Payer: PHCS All Commercial |
$486.30
|
| Rate for Payer: PHP All Commercial |
$491.75
|
| Rate for Payer: Sagamore Health Network All Products |
$500.56
|
| Rate for Payer: Signature Care EPO |
$538.17
|
| Rate for Payer: Signature Care PPO |
$570.59
|
| Rate for Payer: United Healthcare Commercial |
$510.94
|
|
|
HC S ZIP 8 SKIN CLOSURE
|
Facility
|
OP
|
$570.87
|
|
| Hospital Charge Code |
41606998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$530.91 |
| Rate for Payer: Aetna Commercial |
$481.81
|
| Rate for Payer: Aetna Medicare |
$188.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$188.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$327.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$356.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$216.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$207.23
|
| Rate for Payer: Cash Price |
$353.94
|
| Rate for Payer: Cash Price |
$353.94
|
| Rate for Payer: Centivo All Commercial |
$291.14
|
| Rate for Payer: Cigna All Commercial |
$492.66
|
| Rate for Payer: CORVEL All Commercial |
$530.91
|
| Rate for Payer: Coventry All Commercial |
$502.37
|
| Rate for Payer: Encore All Commercial |
$525.49
|
| Rate for Payer: Frontpath All Commercial |
$525.20
|
| Rate for Payer: Humana ChoiceCare |
$493.06
|
| Rate for Payer: Humana Medicare |
$291.14
|
| Rate for Payer: Lucent All Commercial |
$291.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$513.78
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$428.15
|
| Rate for Payer: PHP All Commercial |
$432.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$222.64
|
| Rate for Payer: Sagamore Health Network All Products |
$440.71
|
| Rate for Payer: Signature Care EPO |
$473.82
|
| Rate for Payer: Signature Care PPO |
$502.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$485.24
|
| Rate for Payer: United Healthcare Commercial |
$449.85
|
| Rate for Payer: United Healthcare Medicare |
$188.39
|
|
|
HC S ZIP 8 SKIN CLOSURE
|
Facility
|
IP
|
$570.87
|
|
| Hospital Charge Code |
41606998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.15 |
| Max. Negotiated Rate |
$530.91 |
| Rate for Payer: Aetna Commercial |
$493.23
|
| Rate for Payer: Cash Price |
$353.94
|
| Rate for Payer: Cigna All Commercial |
$492.66
|
| Rate for Payer: CORVEL All Commercial |
$530.91
|
| Rate for Payer: Coventry All Commercial |
$502.37
|
| Rate for Payer: Encore All Commercial |
$525.49
|
| Rate for Payer: Frontpath All Commercial |
$525.20
|
| Rate for Payer: Humana ChoiceCare |
$493.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$513.78
|
| Rate for Payer: PHCS All Commercial |
$428.15
|
| Rate for Payer: PHP All Commercial |
$432.95
|
| Rate for Payer: Sagamore Health Network All Products |
$440.71
|
| Rate for Payer: Signature Care EPO |
$473.82
|
| Rate for Payer: Signature Care PPO |
$502.37
|
| Rate for Payer: United Healthcare Commercial |
$449.85
|
|
|
HC T3 FREE
|
Facility
|
OP
|
$180.62
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
63001701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$152.44
|
| Rate for Payer: Aetna Medicare |
$59.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.57
|
| Rate for Payer: Cash Price |
$111.99
|
| Rate for Payer: Cash Price |
$111.99
|
| Rate for Payer: Centivo All Commercial |
$92.12
|
| Rate for Payer: Cigna All Commercial |
$155.88
|
| Rate for Payer: CORVEL All Commercial |
$167.98
|
| Rate for Payer: Coventry All Commercial |
$158.95
|
| Rate for Payer: Encore All Commercial |
$166.26
|
| Rate for Payer: Frontpath All Commercial |
$166.17
|
| Rate for Payer: Humana ChoiceCare |
$156.00
|
| Rate for Payer: Humana Medicare |
$92.12
|
| Rate for Payer: Lucent All Commercial |
$92.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.56
|
| Rate for Payer: Managed Health Services Medicaid |
$16.94
|
| Rate for Payer: MDWise Medicaid |
$16.94
|
| Rate for Payer: PHCS All Commercial |
$135.47
|
| Rate for Payer: PHP All Commercial |
$136.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.44
|
| Rate for Payer: Sagamore Health Network All Products |
$139.44
|
| Rate for Payer: Signature Care EPO |
$149.92
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153.53
|
| Rate for Payer: United Healthcare Commercial |
$142.33
|
| Rate for Payer: United Healthcare Medicare |
$59.61
|
|
|
HC T3 FREE
|
Facility
|
IP
|
$180.62
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
63001701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.47 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Cash Price |
$111.99
|
| Rate for Payer: Cigna All Commercial |
$155.88
|
| Rate for Payer: CORVEL All Commercial |
$167.98
|
| Rate for Payer: Coventry All Commercial |
$158.95
|
| Rate for Payer: Encore All Commercial |
$166.26
|
| Rate for Payer: Frontpath All Commercial |
$166.17
|
| Rate for Payer: Humana ChoiceCare |
$156.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.56
|
| Rate for Payer: PHCS All Commercial |
$135.47
|
| Rate for Payer: PHP All Commercial |
$136.98
|
| Rate for Payer: Sagamore Health Network All Products |
$139.44
|
| Rate for Payer: Signature Care EPO |
$149.92
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: United Healthcare Commercial |
$142.33
|
|
|
HC T3 RESIN UPTAKE
|
Facility
|
IP
|
$105.90
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
63001700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$98.48 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cigna All Commercial |
$91.39
|
| Rate for Payer: CORVEL All Commercial |
$98.48
|
| Rate for Payer: Coventry All Commercial |
$93.19
|
| Rate for Payer: Encore All Commercial |
$97.48
|
| Rate for Payer: Frontpath All Commercial |
$97.42
|
| Rate for Payer: Humana ChoiceCare |
$91.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.31
|
| Rate for Payer: PHCS All Commercial |
$79.42
|
| Rate for Payer: PHP All Commercial |
$80.31
|
| Rate for Payer: Sagamore Health Network All Products |
$81.75
|
| Rate for Payer: Signature Care EPO |
$87.89
|
| Rate for Payer: Signature Care PPO |
$93.19
|
| Rate for Payer: United Healthcare Commercial |
$83.45
|
|
|
HC T3 RESIN UPTAKE
|
Facility
|
OP
|
$105.90
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
63001700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$98.48 |
| Rate for Payer: Aetna Commercial |
$89.38
|
| Rate for Payer: Aetna Medicare |
$34.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.44
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Centivo All Commercial |
$54.01
|
| Rate for Payer: Cigna All Commercial |
$91.39
|
| Rate for Payer: CORVEL All Commercial |
$98.48
|
| Rate for Payer: Coventry All Commercial |
$93.19
|
| Rate for Payer: Encore All Commercial |
$97.48
|
| Rate for Payer: Frontpath All Commercial |
$97.42
|
| Rate for Payer: Humana ChoiceCare |
$91.46
|
| Rate for Payer: Humana Medicare |
$54.01
|
| Rate for Payer: Lucent All Commercial |
$54.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.31
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$79.42
|
| Rate for Payer: PHP All Commercial |
$80.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.30
|
| Rate for Payer: Sagamore Health Network All Products |
$81.75
|
| Rate for Payer: Signature Care EPO |
$87.89
|
| Rate for Payer: Signature Care PPO |
$93.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.01
|
| Rate for Payer: United Healthcare Commercial |
$83.45
|
| Rate for Payer: United Healthcare Medicare |
$34.95
|
|
|
HC T3 REVERSE
|
Facility
|
OP
|
$216.74
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
63001702
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$201.57 |
| Rate for Payer: Aetna Commercial |
$182.93
|
| Rate for Payer: Aetna Medicare |
$71.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.68
|
| Rate for Payer: Cash Price |
$134.38
|
| Rate for Payer: Cash Price |
$134.38
|
| Rate for Payer: Centivo All Commercial |
$110.54
|
| Rate for Payer: Cigna All Commercial |
$187.05
|
| Rate for Payer: CORVEL All Commercial |
$201.57
|
| Rate for Payer: Coventry All Commercial |
$190.73
|
| Rate for Payer: Encore All Commercial |
$199.51
|
| Rate for Payer: Frontpath All Commercial |
$199.40
|
| Rate for Payer: Humana ChoiceCare |
$187.20
|
| Rate for Payer: Humana Medicare |
$110.54
|
| Rate for Payer: Lucent All Commercial |
$110.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.07
|
| Rate for Payer: Managed Health Services Medicaid |
$15.76
|
| Rate for Payer: MDWise Medicaid |
$15.76
|
| Rate for Payer: PHCS All Commercial |
$162.55
|
| Rate for Payer: PHP All Commercial |
$164.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.53
|
| Rate for Payer: Sagamore Health Network All Products |
$167.32
|
| Rate for Payer: Signature Care EPO |
$179.89
|
| Rate for Payer: Signature Care PPO |
$190.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$184.23
|
| Rate for Payer: United Healthcare Commercial |
$170.79
|
| Rate for Payer: United Healthcare Medicare |
$71.52
|
|
|
HC T3 REVERSE
|
Facility
|
IP
|
$216.74
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
63001702
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$201.57 |
| Rate for Payer: Aetna Commercial |
$187.26
|
| Rate for Payer: Cash Price |
$134.38
|
| Rate for Payer: Cigna All Commercial |
$187.05
|
| Rate for Payer: CORVEL All Commercial |
$201.57
|
| Rate for Payer: Coventry All Commercial |
$190.73
|
| Rate for Payer: Encore All Commercial |
$199.51
|
| Rate for Payer: Frontpath All Commercial |
$199.40
|
| Rate for Payer: Humana ChoiceCare |
$187.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.07
|
| Rate for Payer: PHCS All Commercial |
$162.55
|
| Rate for Payer: PHP All Commercial |
$164.38
|
| Rate for Payer: Sagamore Health Network All Products |
$167.32
|
| Rate for Payer: Signature Care EPO |
$179.89
|
| Rate for Payer: Signature Care PPO |
$190.73
|
| Rate for Payer: United Healthcare Commercial |
$170.79
|
|
|
HC T3 TOTAL(TT3)
|
Facility
|
IP
|
$204.50
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
63001324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$190.18 |
| Rate for Payer: Aetna Commercial |
$176.69
|
| Rate for Payer: Cash Price |
$126.79
|
| Rate for Payer: Cigna All Commercial |
$176.48
|
| Rate for Payer: CORVEL All Commercial |
$190.18
|
| Rate for Payer: Coventry All Commercial |
$179.96
|
| Rate for Payer: Encore All Commercial |
$188.24
|
| Rate for Payer: Frontpath All Commercial |
$188.14
|
| Rate for Payer: Humana ChoiceCare |
$176.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.05
|
| Rate for Payer: PHCS All Commercial |
$153.37
|
| Rate for Payer: PHP All Commercial |
$155.09
|
| Rate for Payer: Sagamore Health Network All Products |
$157.87
|
| Rate for Payer: Signature Care EPO |
$169.73
|
| Rate for Payer: Signature Care PPO |
$179.96
|
| Rate for Payer: United Healthcare Commercial |
$161.15
|
|
|
HC T3 TOTAL(TT3)
|
Facility
|
OP
|
$204.50
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
63001324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$190.18 |
| Rate for Payer: Aetna Commercial |
$172.60
|
| Rate for Payer: Aetna Medicare |
$67.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.23
|
| Rate for Payer: Cash Price |
$126.79
|
| Rate for Payer: Cash Price |
$126.79
|
| Rate for Payer: Centivo All Commercial |
$104.29
|
| Rate for Payer: Cigna All Commercial |
$176.48
|
| Rate for Payer: CORVEL All Commercial |
$190.18
|
| Rate for Payer: Coventry All Commercial |
$179.96
|
| Rate for Payer: Encore All Commercial |
$188.24
|
| Rate for Payer: Frontpath All Commercial |
$188.14
|
| Rate for Payer: Humana ChoiceCare |
$176.63
|
| Rate for Payer: Humana Medicare |
$104.29
|
| Rate for Payer: Lucent All Commercial |
$104.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.05
|
| Rate for Payer: Managed Health Services Medicaid |
$13.43
|
| Rate for Payer: MDWise Medicaid |
$13.43
|
| Rate for Payer: PHCS All Commercial |
$153.37
|
| Rate for Payer: PHP All Commercial |
$155.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.75
|
| Rate for Payer: Sagamore Health Network All Products |
$157.87
|
| Rate for Payer: Signature Care EPO |
$169.73
|
| Rate for Payer: Signature Care PPO |
$179.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.82
|
| Rate for Payer: United Healthcare Commercial |
$161.15
|
| Rate for Payer: United Healthcare Medicare |
$67.48
|
|
|
HC T3 UPTAKE
|
Facility
|
IP
|
$254.69
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
63001299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.02 |
| Max. Negotiated Rate |
$236.87 |
| Rate for Payer: Aetna Commercial |
$220.06
|
| Rate for Payer: Cash Price |
$157.91
|
| Rate for Payer: Cigna All Commercial |
$219.80
|
| Rate for Payer: CORVEL All Commercial |
$236.87
|
| Rate for Payer: Coventry All Commercial |
$224.13
|
| Rate for Payer: Encore All Commercial |
$234.45
|
| Rate for Payer: Frontpath All Commercial |
$234.32
|
| Rate for Payer: Humana ChoiceCare |
$219.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.22
|
| Rate for Payer: PHCS All Commercial |
$191.02
|
| Rate for Payer: PHP All Commercial |
$193.16
|
| Rate for Payer: Sagamore Health Network All Products |
$196.62
|
| Rate for Payer: Signature Care EPO |
$211.40
|
| Rate for Payer: Signature Care PPO |
$224.13
|
| Rate for Payer: United Healthcare Commercial |
$200.70
|
|
|
HC T3 UPTAKE
|
Facility
|
OP
|
$254.69
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
63001299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$236.87 |
| Rate for Payer: Aetna Commercial |
$214.96
|
| Rate for Payer: Aetna Medicare |
$84.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.45
|
| Rate for Payer: Cash Price |
$157.91
|
| Rate for Payer: Cash Price |
$157.91
|
| Rate for Payer: Centivo All Commercial |
$129.89
|
| Rate for Payer: Cigna All Commercial |
$219.80
|
| Rate for Payer: CORVEL All Commercial |
$236.87
|
| Rate for Payer: Coventry All Commercial |
$224.13
|
| Rate for Payer: Encore All Commercial |
$234.45
|
| Rate for Payer: Frontpath All Commercial |
$234.32
|
| Rate for Payer: Humana ChoiceCare |
$219.98
|
| Rate for Payer: Humana Medicare |
$129.89
|
| Rate for Payer: Lucent All Commercial |
$129.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.22
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$191.02
|
| Rate for Payer: PHP All Commercial |
$193.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.33
|
| Rate for Payer: Sagamore Health Network All Products |
$196.62
|
| Rate for Payer: Signature Care EPO |
$211.40
|
| Rate for Payer: Signature Care PPO |
$224.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.49
|
| Rate for Payer: United Healthcare Commercial |
$200.70
|
| Rate for Payer: United Healthcare Medicare |
$84.05
|
|
|
HC T4
|
Facility
|
IP
|
$79.76
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
63001311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Aetna Commercial |
$68.92
|
| Rate for Payer: Cash Price |
$49.45
|
| Rate for Payer: Cigna All Commercial |
$68.84
|
| Rate for Payer: CORVEL All Commercial |
$74.18
|
| Rate for Payer: Coventry All Commercial |
$70.19
|
| Rate for Payer: Encore All Commercial |
$73.42
|
| Rate for Payer: Frontpath All Commercial |
$73.38
|
| Rate for Payer: Humana ChoiceCare |
$68.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.79
|
| Rate for Payer: PHCS All Commercial |
$59.82
|
| Rate for Payer: PHP All Commercial |
$60.49
|
| Rate for Payer: Sagamore Health Network All Products |
$61.58
|
| Rate for Payer: Signature Care EPO |
$66.20
|
| Rate for Payer: Signature Care PPO |
$70.19
|
| Rate for Payer: United Healthcare Commercial |
$62.85
|
|
|
HC T4
|
Facility
|
OP
|
$79.76
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
63001311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Aetna Commercial |
$67.32
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.95
|
| Rate for Payer: Cash Price |
$49.45
|
| Rate for Payer: Cash Price |
$49.45
|
| Rate for Payer: Centivo All Commercial |
$40.68
|
| Rate for Payer: Cigna All Commercial |
$68.84
|
| Rate for Payer: CORVEL All Commercial |
$74.18
|
| Rate for Payer: Coventry All Commercial |
$70.19
|
| Rate for Payer: Encore All Commercial |
$73.42
|
| Rate for Payer: Frontpath All Commercial |
$73.38
|
| Rate for Payer: Humana ChoiceCare |
$68.89
|
| Rate for Payer: Humana Medicare |
$40.68
|
| Rate for Payer: Lucent All Commercial |
$40.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.79
|
| Rate for Payer: Managed Health Services Medicaid |
$6.87
|
| Rate for Payer: MDWise Medicaid |
$6.87
|
| Rate for Payer: PHCS All Commercial |
$59.82
|
| Rate for Payer: PHP All Commercial |
$60.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.11
|
| Rate for Payer: Sagamore Health Network All Products |
$61.58
|
| Rate for Payer: Signature Care EPO |
$66.20
|
| Rate for Payer: Signature Care PPO |
$70.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.80
|
| Rate for Payer: United Healthcare Commercial |
$62.85
|
| Rate for Payer: United Healthcare Medicare |
$26.32
|
|
|
HC T4, FREE, ED/HPLC
|
Facility
|
OP
|
$123.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$114.63 |
| Rate for Payer: Aetna Commercial |
$104.03
|
| Rate for Payer: Aetna Medicare |
$40.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.74
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Centivo All Commercial |
$62.86
|
| Rate for Payer: Cigna All Commercial |
$106.37
|
| Rate for Payer: CORVEL All Commercial |
$114.63
|
| Rate for Payer: Coventry All Commercial |
$108.47
|
| Rate for Payer: Encore All Commercial |
$113.46
|
| Rate for Payer: Frontpath All Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$106.46
|
| Rate for Payer: Humana Medicare |
$62.86
|
| Rate for Payer: Lucent All Commercial |
$62.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.93
|
| Rate for Payer: Managed Health Services Medicaid |
$9.02
|
| Rate for Payer: MDWise Medicaid |
$9.02
|
| Rate for Payer: PHCS All Commercial |
$92.44
|
| Rate for Payer: PHP All Commercial |
$93.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.07
|
| Rate for Payer: Sagamore Health Network All Products |
$95.15
|
| Rate for Payer: Signature Care EPO |
$102.30
|
| Rate for Payer: Signature Care PPO |
$108.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.77
|
| Rate for Payer: United Healthcare Commercial |
$97.13
|
| Rate for Payer: United Healthcare Medicare |
$40.67
|
|
