|
HC THIN PREP-NON-GYN +INTERP
|
Facility
|
IP
|
$197.15
|
|
|
Service Code
|
CPT 88112 59
|
| Hospital Charge Code |
63002154
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna Commercial |
$170.33
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cigna All Commercial |
$170.14
|
| Rate for Payer: CORVEL All Commercial |
$183.35
|
| Rate for Payer: Coventry All Commercial |
$173.49
|
| Rate for Payer: Encore All Commercial |
$181.47
|
| Rate for Payer: Frontpath All Commercial |
$181.37
|
| Rate for Payer: Humana ChoiceCare |
$170.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.43
|
| Rate for Payer: PHCS All Commercial |
$147.86
|
| Rate for Payer: PHP All Commercial |
$149.52
|
| Rate for Payer: Sagamore Health Network All Products |
$152.20
|
| Rate for Payer: Signature Care EPO |
$163.63
|
| Rate for Payer: Signature Care PPO |
$173.49
|
| Rate for Payer: United Healthcare Commercial |
$155.35
|
|
|
HC THIN PREP-NON-GYN +INTERP
|
Facility
|
OP
|
$197.15
|
|
|
Service Code
|
CPT 88112 59
|
| Hospital Charge Code |
63002154
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.06 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna Commercial |
$166.39
|
| Rate for Payer: Aetna Medicare |
$65.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$113.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.56
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Centivo All Commercial |
$100.54
|
| Rate for Payer: Cigna All Commercial |
$170.14
|
| Rate for Payer: CORVEL All Commercial |
$183.35
|
| Rate for Payer: Coventry All Commercial |
$173.49
|
| Rate for Payer: Encore All Commercial |
$181.47
|
| Rate for Payer: Frontpath All Commercial |
$181.37
|
| Rate for Payer: Humana ChoiceCare |
$170.27
|
| Rate for Payer: Humana Medicare |
$100.54
|
| Rate for Payer: Lucent All Commercial |
$100.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.43
|
| Rate for Payer: PHCS All Commercial |
$147.86
|
| Rate for Payer: PHP All Commercial |
$149.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.89
|
| Rate for Payer: Sagamore Health Network All Products |
$152.20
|
| Rate for Payer: Signature Care EPO |
$163.63
|
| Rate for Payer: Signature Care PPO |
$173.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.57
|
| Rate for Payer: United Healthcare Commercial |
$155.35
|
| Rate for Payer: United Healthcare Medicare |
$65.06
|
|
|
HC THIN PREP-NON-GYN PATH +INTERP
|
Facility
|
OP
|
$197.15
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
63002060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.06 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna Commercial |
$166.39
|
| Rate for Payer: Aetna Medicare |
$65.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$113.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$151.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.56
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Centivo All Commercial |
$100.54
|
| Rate for Payer: Cigna All Commercial |
$170.14
|
| Rate for Payer: CORVEL All Commercial |
$183.35
|
| Rate for Payer: Coventry All Commercial |
$173.49
|
| Rate for Payer: Encore All Commercial |
$181.47
|
| Rate for Payer: Frontpath All Commercial |
$181.37
|
| Rate for Payer: Humana ChoiceCare |
$170.27
|
| Rate for Payer: Humana Medicare |
$100.54
|
| Rate for Payer: Lucent All Commercial |
$100.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.43
|
| Rate for Payer: Managed Health Services Medicaid |
$151.59
|
| Rate for Payer: MDWise Medicaid |
$151.59
|
| Rate for Payer: PHCS All Commercial |
$147.86
|
| Rate for Payer: PHP All Commercial |
$149.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.89
|
| Rate for Payer: Sagamore Health Network All Products |
$152.20
|
| Rate for Payer: Signature Care EPO |
$163.63
|
| Rate for Payer: Signature Care PPO |
$173.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.57
|
| Rate for Payer: United Healthcare Commercial |
$155.35
|
| Rate for Payer: United Healthcare Medicare |
$65.06
|
|
|
HC THIN PREP-NON-GYN PATH +INTERP
|
Facility
|
IP
|
$197.15
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
63002060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna Commercial |
$170.33
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cigna All Commercial |
$170.14
|
| Rate for Payer: CORVEL All Commercial |
$183.35
|
| Rate for Payer: Coventry All Commercial |
$173.49
|
| Rate for Payer: Encore All Commercial |
$181.47
|
| Rate for Payer: Frontpath All Commercial |
$181.37
|
| Rate for Payer: Humana ChoiceCare |
$170.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.43
|
| Rate for Payer: PHCS All Commercial |
$147.86
|
| Rate for Payer: PHP All Commercial |
$149.52
|
| Rate for Payer: Sagamore Health Network All Products |
$152.20
|
| Rate for Payer: Signature Care EPO |
$163.63
|
| Rate for Payer: Signature Care PPO |
$173.49
|
| Rate for Payer: United Healthcare Commercial |
$155.35
|
|
|
HC THIN PREP-NON-GYN PATH +INTERP - O/P
|
Facility
|
IP
|
$193.29
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
63002061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$144.97 |
| Max. Negotiated Rate |
$179.76 |
| Rate for Payer: Aetna Commercial |
$167.00
|
| Rate for Payer: Cash Price |
$119.84
|
| Rate for Payer: Cigna All Commercial |
$166.81
|
| Rate for Payer: CORVEL All Commercial |
$179.76
|
| Rate for Payer: Coventry All Commercial |
$170.10
|
| Rate for Payer: Encore All Commercial |
$177.92
|
| Rate for Payer: Frontpath All Commercial |
$177.83
|
| Rate for Payer: Humana ChoiceCare |
$166.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.96
|
| Rate for Payer: PHCS All Commercial |
$144.97
|
| Rate for Payer: PHP All Commercial |
$146.59
|
| Rate for Payer: Sagamore Health Network All Products |
$149.22
|
| Rate for Payer: Signature Care EPO |
$160.43
|
| Rate for Payer: Signature Care PPO |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$152.31
|
|
|
HC THIN PREP-NON-GYN PATH +INTERP - O/P
|
Facility
|
OP
|
$193.29
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
63002061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$179.76 |
| Rate for Payer: Aetna Commercial |
$163.14
|
| Rate for Payer: Aetna Medicare |
$63.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$151.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.16
|
| Rate for Payer: Cash Price |
$119.84
|
| Rate for Payer: Cash Price |
$119.84
|
| Rate for Payer: Centivo All Commercial |
$98.58
|
| Rate for Payer: Cigna All Commercial |
$166.81
|
| Rate for Payer: CORVEL All Commercial |
$179.76
|
| Rate for Payer: Coventry All Commercial |
$170.10
|
| Rate for Payer: Encore All Commercial |
$177.92
|
| Rate for Payer: Frontpath All Commercial |
$177.83
|
| Rate for Payer: Humana ChoiceCare |
$166.94
|
| Rate for Payer: Humana Medicare |
$98.58
|
| Rate for Payer: Lucent All Commercial |
$98.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.96
|
| Rate for Payer: Managed Health Services Medicaid |
$151.59
|
| Rate for Payer: MDWise Medicaid |
$151.59
|
| Rate for Payer: PHCS All Commercial |
$144.97
|
| Rate for Payer: PHP All Commercial |
$146.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.38
|
| Rate for Payer: Sagamore Health Network All Products |
$149.22
|
| Rate for Payer: Signature Care EPO |
$160.43
|
| Rate for Payer: Signature Care PPO |
$170.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$164.30
|
| Rate for Payer: United Healthcare Commercial |
$152.31
|
| Rate for Payer: United Healthcare Medicare |
$63.79
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
OP
|
$1,912.50
|
|
| Hospital Charge Code |
01662555
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$1,778.62 |
| Rate for Payer: Aetna Commercial |
$1,614.15
|
| Rate for Payer: Aetna Medicare |
$631.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$631.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,098.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,195.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$725.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$694.24
|
| Rate for Payer: Cash Price |
$1,185.75
|
| Rate for Payer: Centivo All Commercial |
$975.38
|
| Rate for Payer: Cigna All Commercial |
$1,650.49
|
| Rate for Payer: CORVEL All Commercial |
$1,778.62
|
| Rate for Payer: Coventry All Commercial |
$1,683.00
|
| Rate for Payer: Encore All Commercial |
$1,760.46
|
| Rate for Payer: Frontpath All Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$1,651.83
|
| Rate for Payer: Humana Medicare |
$975.38
|
| Rate for Payer: Lucent All Commercial |
$975.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,721.25
|
| Rate for Payer: PHCS All Commercial |
$1,434.38
|
| Rate for Payer: PHP All Commercial |
$1,450.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$745.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,476.45
|
| Rate for Payer: Signature Care EPO |
$1,587.38
|
| Rate for Payer: Signature Care PPO |
$1,683.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,625.62
|
| Rate for Payer: United Healthcare Commercial |
$1,507.05
|
| Rate for Payer: United Healthcare Medicare |
$631.12
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
IP
|
$1,912.50
|
|
| Hospital Charge Code |
01662555
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,434.38 |
| Max. Negotiated Rate |
$1,778.62 |
| Rate for Payer: Aetna Commercial |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,185.75
|
| Rate for Payer: Cigna All Commercial |
$1,650.49
|
| Rate for Payer: CORVEL All Commercial |
$1,778.62
|
| Rate for Payer: Coventry All Commercial |
$1,683.00
|
| Rate for Payer: Encore All Commercial |
$1,760.46
|
| Rate for Payer: Frontpath All Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$1,651.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,721.25
|
| Rate for Payer: PHCS All Commercial |
$1,434.38
|
| Rate for Payer: PHP All Commercial |
$1,450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,476.45
|
| Rate for Payer: Signature Care EPO |
$1,587.38
|
| Rate for Payer: Signature Care PPO |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,507.05
|
|
|
HC THORACENTESIS W/ IMAGING
|
Facility
|
IP
|
$1,562.05
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
01642555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,171.54 |
| Max. Negotiated Rate |
$1,452.71 |
| Rate for Payer: Aetna Commercial |
$1,349.61
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Cigna All Commercial |
$1,348.05
|
| Rate for Payer: CORVEL All Commercial |
$1,452.71
|
| Rate for Payer: Coventry All Commercial |
$1,374.60
|
| Rate for Payer: Encore All Commercial |
$1,437.87
|
| Rate for Payer: Frontpath All Commercial |
$1,437.08
|
| Rate for Payer: Humana ChoiceCare |
$1,349.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,405.84
|
| Rate for Payer: PHCS All Commercial |
$1,171.54
|
| Rate for Payer: PHP All Commercial |
$1,184.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,205.90
|
| Rate for Payer: Signature Care EPO |
$1,296.50
|
| Rate for Payer: Signature Care PPO |
$1,374.60
|
| Rate for Payer: United Healthcare Commercial |
$1,230.89
|
|
|
HC THORACENTESIS W/ IMAGING
|
Facility
|
OP
|
$1,562.05
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
01642555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.48 |
| Max. Negotiated Rate |
$1,452.71 |
| Rate for Payer: Aetna Commercial |
$1,318.37
|
| Rate for Payer: Aetna Medicare |
$515.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$515.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$897.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$976.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,283.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$592.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$567.02
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Centivo All Commercial |
$796.64
|
| Rate for Payer: Cigna All Commercial |
$1,348.05
|
| Rate for Payer: CORVEL All Commercial |
$1,452.71
|
| Rate for Payer: Coventry All Commercial |
$1,374.60
|
| Rate for Payer: Encore All Commercial |
$1,437.87
|
| Rate for Payer: Frontpath All Commercial |
$1,437.08
|
| Rate for Payer: Humana ChoiceCare |
$1,349.14
|
| Rate for Payer: Humana Medicare |
$796.64
|
| Rate for Payer: Lucent All Commercial |
$796.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,405.84
|
| Rate for Payer: Managed Health Services Medicaid |
$1,283.57
|
| Rate for Payer: MDWise Medicaid |
$1,283.57
|
| Rate for Payer: PHCS All Commercial |
$1,171.54
|
| Rate for Payer: PHP All Commercial |
$1,184.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$609.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,205.90
|
| Rate for Payer: Signature Care EPO |
$1,296.50
|
| Rate for Payer: Signature Care PPO |
$1,374.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,327.74
|
| Rate for Payer: United Healthcare Commercial |
$1,230.89
|
| Rate for Payer: United Healthcare Medicare |
$515.48
|
|
|
HC THORACENTESIS W/IMAGING BS
|
Facility
|
OP
|
$1,680.04
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
01684005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.41 |
| Max. Negotiated Rate |
$1,562.44 |
| Rate for Payer: Aetna Commercial |
$1,417.96
|
| Rate for Payer: Aetna Medicare |
$554.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$554.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$964.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,050.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,283.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$637.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$609.86
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Centivo All Commercial |
$856.82
|
| Rate for Payer: Cigna All Commercial |
$1,449.88
|
| Rate for Payer: CORVEL All Commercial |
$1,562.44
|
| Rate for Payer: Coventry All Commercial |
$1,478.44
|
| Rate for Payer: Encore All Commercial |
$1,546.48
|
| Rate for Payer: Frontpath All Commercial |
$1,545.64
|
| Rate for Payer: Humana ChoiceCare |
$1,451.05
|
| Rate for Payer: Humana Medicare |
$856.82
|
| Rate for Payer: Lucent All Commercial |
$856.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,512.04
|
| Rate for Payer: Managed Health Services Medicaid |
$1,283.57
|
| Rate for Payer: MDWise Medicaid |
$1,283.57
|
| Rate for Payer: PHCS All Commercial |
$1,260.03
|
| Rate for Payer: PHP All Commercial |
$1,274.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$655.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,296.99
|
| Rate for Payer: Signature Care EPO |
$1,394.43
|
| Rate for Payer: Signature Care PPO |
$1,478.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,428.04
|
| Rate for Payer: United Healthcare Commercial |
$1,323.87
|
| Rate for Payer: United Healthcare Medicare |
$554.41
|
|
|
HC THORACENTESIS W/IMAGING BS
|
Facility
|
IP
|
$1,680.04
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
01684005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.03 |
| Max. Negotiated Rate |
$1,562.44 |
| Rate for Payer: Aetna Commercial |
$1,451.56
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cigna All Commercial |
$1,449.88
|
| Rate for Payer: CORVEL All Commercial |
$1,562.44
|
| Rate for Payer: Coventry All Commercial |
$1,478.44
|
| Rate for Payer: Encore All Commercial |
$1,546.48
|
| Rate for Payer: Frontpath All Commercial |
$1,545.64
|
| Rate for Payer: Humana ChoiceCare |
$1,451.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,512.04
|
| Rate for Payer: PHCS All Commercial |
$1,260.03
|
| Rate for Payer: PHP All Commercial |
$1,274.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,296.99
|
| Rate for Payer: Signature Care EPO |
$1,394.43
|
| Rate for Payer: Signature Care PPO |
$1,478.44
|
| Rate for Payer: United Healthcare Commercial |
$1,323.87
|
|
|
HC THORACENTESIS W/O IMAGING
|
Facility
|
OP
|
$1,157.33
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
01682554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.92 |
| Max. Negotiated Rate |
$1,283.57 |
| Rate for Payer: Aetna Commercial |
$976.79
|
| Rate for Payer: Aetna Medicare |
$381.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$381.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$664.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$723.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,283.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$439.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$420.11
|
| Rate for Payer: Cash Price |
$717.55
|
| Rate for Payer: Cash Price |
$717.55
|
| Rate for Payer: Centivo All Commercial |
$590.24
|
| Rate for Payer: Cigna All Commercial |
$998.78
|
| Rate for Payer: CORVEL All Commercial |
$1,076.32
|
| Rate for Payer: Coventry All Commercial |
$1,018.45
|
| Rate for Payer: Encore All Commercial |
$1,065.32
|
| Rate for Payer: Frontpath All Commercial |
$1,064.75
|
| Rate for Payer: Humana ChoiceCare |
$999.59
|
| Rate for Payer: Humana Medicare |
$590.24
|
| Rate for Payer: Lucent All Commercial |
$590.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,041.60
|
| Rate for Payer: Managed Health Services Medicaid |
$1,283.57
|
| Rate for Payer: MDWise Medicaid |
$1,283.57
|
| Rate for Payer: PHCS All Commercial |
$868.00
|
| Rate for Payer: PHP All Commercial |
$877.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$451.36
|
| Rate for Payer: Sagamore Health Network All Products |
$893.46
|
| Rate for Payer: Signature Care EPO |
$960.59
|
| Rate for Payer: Signature Care PPO |
$1,018.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$983.73
|
| Rate for Payer: United Healthcare Commercial |
$911.98
|
| Rate for Payer: United Healthcare Medicare |
$381.92
|
|
|
HC THORACENTESIS W/O IMAGING
|
Facility
|
IP
|
$1,157.33
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
01682554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$868.00 |
| Max. Negotiated Rate |
$1,076.32 |
| Rate for Payer: Aetna Commercial |
$999.94
|
| Rate for Payer: Cash Price |
$717.55
|
| Rate for Payer: Cigna All Commercial |
$998.78
|
| Rate for Payer: CORVEL All Commercial |
$1,076.32
|
| Rate for Payer: Coventry All Commercial |
$1,018.45
|
| Rate for Payer: Encore All Commercial |
$1,065.32
|
| Rate for Payer: Frontpath All Commercial |
$1,064.75
|
| Rate for Payer: Humana ChoiceCare |
$999.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,041.60
|
| Rate for Payer: PHCS All Commercial |
$868.00
|
| Rate for Payer: PHP All Commercial |
$877.72
|
| Rate for Payer: Sagamore Health Network All Products |
$893.46
|
| Rate for Payer: Signature Care EPO |
$960.59
|
| Rate for Payer: Signature Care PPO |
$1,018.45
|
| Rate for Payer: United Healthcare Commercial |
$911.98
|
|
|
HC THORACIC MYELOGRAM
|
Facility
|
OP
|
$2,024.57
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
01612256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.20 |
| Max. Negotiated Rate |
$1,882.85 |
| Rate for Payer: Aetna Commercial |
$1,708.73
|
| Rate for Payer: Aetna Medicare |
$668.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$668.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,162.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,265.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$212.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$768.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$734.92
|
| Rate for Payer: Cash Price |
$1,255.23
|
| Rate for Payer: Cash Price |
$1,255.23
|
| Rate for Payer: Centivo All Commercial |
$1,032.53
|
| Rate for Payer: Cigna All Commercial |
$1,747.20
|
| Rate for Payer: CORVEL All Commercial |
$1,882.85
|
| Rate for Payer: Coventry All Commercial |
$1,781.62
|
| Rate for Payer: Encore All Commercial |
$1,863.61
|
| Rate for Payer: Frontpath All Commercial |
$1,862.60
|
| Rate for Payer: Humana ChoiceCare |
$1,748.62
|
| Rate for Payer: Humana Medicare |
$1,032.53
|
| Rate for Payer: Lucent All Commercial |
$1,032.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,822.11
|
| Rate for Payer: Managed Health Services Medicaid |
$212.20
|
| Rate for Payer: MDWise Medicaid |
$212.20
|
| Rate for Payer: PHCS All Commercial |
$1,518.43
|
| Rate for Payer: PHP All Commercial |
$1,535.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$789.58
|
| Rate for Payer: Sagamore Health Network All Products |
$1,562.97
|
| Rate for Payer: Signature Care EPO |
$1,680.39
|
| Rate for Payer: Signature Care PPO |
$1,781.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,720.88
|
| Rate for Payer: United Healthcare Commercial |
$1,595.36
|
| Rate for Payer: United Healthcare Medicare |
$668.11
|
|
|
HC THORACIC MYELOGRAM
|
Facility
|
IP
|
$2,024.57
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
01612256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,518.43 |
| Max. Negotiated Rate |
$1,882.85 |
| Rate for Payer: Aetna Commercial |
$1,749.23
|
| Rate for Payer: Cash Price |
$1,255.23
|
| Rate for Payer: Cigna All Commercial |
$1,747.20
|
| Rate for Payer: CORVEL All Commercial |
$1,882.85
|
| Rate for Payer: Coventry All Commercial |
$1,781.62
|
| Rate for Payer: Encore All Commercial |
$1,863.61
|
| Rate for Payer: Frontpath All Commercial |
$1,862.60
|
| Rate for Payer: Humana ChoiceCare |
$1,748.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,822.11
|
| Rate for Payer: PHCS All Commercial |
$1,518.43
|
| Rate for Payer: PHP All Commercial |
$1,535.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,562.97
|
| Rate for Payer: Signature Care EPO |
$1,680.39
|
| Rate for Payer: Signature Care PPO |
$1,781.62
|
| Rate for Payer: United Healthcare Commercial |
$1,595.36
|
|
|
HC THROAT CULTURE
|
Facility
|
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001995
|
|
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 THROAT CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001995
|
|
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 THROMBIN CLOTTING TIME
|
Facility
|
OP
|
$312.46
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
63001754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$290.58 |
| Rate for Payer: Aetna Commercial |
$263.71
|
| Rate for Payer: Aetna Medicare |
$103.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$179.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.42
|
| Rate for Payer: Cash Price |
$193.72
|
| Rate for Payer: Cash Price |
$193.72
|
| Rate for Payer: Centivo All Commercial |
$159.35
|
| Rate for Payer: Cigna All Commercial |
$269.65
|
| Rate for Payer: CORVEL All Commercial |
$290.58
|
| Rate for Payer: Coventry All Commercial |
$274.96
|
| Rate for Payer: Encore All Commercial |
$287.62
|
| Rate for Payer: Frontpath All Commercial |
$287.46
|
| Rate for Payer: Humana ChoiceCare |
$269.87
|
| Rate for Payer: Humana Medicare |
$159.35
|
| Rate for Payer: Lucent All Commercial |
$159.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.77
|
| Rate for Payer: MDWise Medicaid |
$5.77
|
| Rate for Payer: PHCS All Commercial |
$234.34
|
| Rate for Payer: PHP All Commercial |
$236.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.86
|
| Rate for Payer: Sagamore Health Network All Products |
$241.22
|
| Rate for Payer: Signature Care EPO |
$259.34
|
| Rate for Payer: Signature Care PPO |
$274.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$265.59
|
| Rate for Payer: United Healthcare Commercial |
$246.22
|
| Rate for Payer: United Healthcare Medicare |
$103.11
|
|
|
HC THROMBIN CLOTTING TIME
|
Facility
|
IP
|
$312.46
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
63001754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$234.34 |
| Max. Negotiated Rate |
$290.58 |
| Rate for Payer: Aetna Commercial |
$269.96
|
| Rate for Payer: Cash Price |
$193.72
|
| Rate for Payer: Cigna All Commercial |
$269.65
|
| Rate for Payer: CORVEL All Commercial |
$290.58
|
| Rate for Payer: Coventry All Commercial |
$274.96
|
| Rate for Payer: Encore All Commercial |
$287.62
|
| Rate for Payer: Frontpath All Commercial |
$287.46
|
| Rate for Payer: Humana ChoiceCare |
$269.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.21
|
| Rate for Payer: PHCS All Commercial |
$234.34
|
| Rate for Payer: PHP All Commercial |
$236.97
|
| Rate for Payer: Sagamore Health Network All Products |
$241.22
|
| Rate for Payer: Signature Care EPO |
$259.34
|
| Rate for Payer: Signature Care PPO |
$274.96
|
| Rate for Payer: United Healthcare Commercial |
$246.22
|
|
|
HC THROMBO INHIBITION
|
Facility
|
OP
|
$175.48
|
|
|
Service Code
|
CPT 85705
|
| Hospital Charge Code |
63001755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$148.11
|
| Rate for Payer: Aetna Medicare |
$57.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.70
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Centivo All Commercial |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$151.44
|
| Rate for Payer: CORVEL All Commercial |
$163.20
|
| Rate for Payer: Coventry All Commercial |
$154.42
|
| Rate for Payer: Encore All Commercial |
$161.53
|
| Rate for Payer: Frontpath All Commercial |
$161.44
|
| Rate for Payer: Humana ChoiceCare |
$151.56
|
| Rate for Payer: Humana Medicare |
$89.50
|
| Rate for Payer: Lucent All Commercial |
$89.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.93
|
| Rate for Payer: Managed Health Services Medicaid |
$9.63
|
| Rate for Payer: MDWise Medicaid |
$9.63
|
| Rate for Payer: PHCS All Commercial |
$131.61
|
| Rate for Payer: PHP All Commercial |
$133.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.44
|
| Rate for Payer: Sagamore Health Network All Products |
$135.47
|
| Rate for Payer: Signature Care EPO |
$145.65
|
| Rate for Payer: Signature Care PPO |
$154.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.16
|
| Rate for Payer: United Healthcare Commercial |
$138.28
|
| Rate for Payer: United Healthcare Medicare |
$57.91
|
|
|
HC THROMBO INHIBITION
|
Facility
|
IP
|
$175.48
|
|
|
Service Code
|
CPT 85705
|
| Hospital Charge Code |
63001755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.61 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$151.62
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cigna All Commercial |
$151.44
|
| Rate for Payer: CORVEL All Commercial |
$163.20
|
| Rate for Payer: Coventry All Commercial |
$154.42
|
| Rate for Payer: Encore All Commercial |
$161.53
|
| Rate for Payer: Frontpath All Commercial |
$161.44
|
| Rate for Payer: Humana ChoiceCare |
$151.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.93
|
| Rate for Payer: PHCS All Commercial |
$131.61
|
| Rate for Payer: PHP All Commercial |
$133.08
|
| Rate for Payer: Sagamore Health Network All Products |
$135.47
|
| Rate for Payer: Signature Care EPO |
$145.65
|
| Rate for Payer: Signature Care PPO |
$154.42
|
| Rate for Payer: United Healthcare Commercial |
$138.28
|
|
|
HC THUNDERBEAT BIG JAW OPEN
|
Facility
|
OP
|
$1,890.00
|
|
| Hospital Charge Code |
41602187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC THUNDERBEAT BIG JAW OPEN
|
Facility
|
IP
|
$1,890.00
|
|
| Hospital Charge Code |
41602187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC THUNDERBEAT LAP 5MM, 35 CM
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
41602185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
