|
HC TOTAL KNEE COBALT CHROME VERIL
|
Facility
|
IP
|
$21,240.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,930.00 |
| Max. Negotiated Rate |
$19,753.20 |
| Rate for Payer: Aetna Commercial |
$18,351.36
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Cigna All Commercial |
$18,330.12
|
| Rate for Payer: CORVEL All Commercial |
$19,753.20
|
| Rate for Payer: Coventry All Commercial |
$18,691.20
|
| Rate for Payer: Encore All Commercial |
$19,551.42
|
| Rate for Payer: Frontpath All Commercial |
$19,540.80
|
| Rate for Payer: Humana ChoiceCare |
$18,344.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19,116.00
|
| Rate for Payer: PHCS All Commercial |
$15,930.00
|
| Rate for Payer: PHP All Commercial |
$16,108.42
|
| Rate for Payer: Sagamore Health Network All Products |
$16,397.28
|
| Rate for Payer: Signature Care EPO |
$17,629.20
|
| Rate for Payer: Signature Care PPO |
$18,691.20
|
| Rate for Payer: United Healthcare Commercial |
$16,737.12
|
|
|
HC TOTAL KNEE COBALT CHROME VERIL
|
Facility
|
OP
|
$21,240.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$19,753.20 |
| Rate for Payer: Aetna Commercial |
$17,926.56
|
| Rate for Payer: Aetna Medicare |
$7,009.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7,009.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12,198.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13,277.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8,060.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7,710.12
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Centivo All Commercial |
$10,832.40
|
| Rate for Payer: Cigna All Commercial |
$18,330.12
|
| Rate for Payer: CORVEL All Commercial |
$19,753.20
|
| Rate for Payer: Coventry All Commercial |
$18,691.20
|
| Rate for Payer: Encore All Commercial |
$19,551.42
|
| Rate for Payer: Frontpath All Commercial |
$19,540.80
|
| Rate for Payer: Humana ChoiceCare |
$18,344.99
|
| Rate for Payer: Humana Medicare |
$10,832.40
|
| Rate for Payer: Lucent All Commercial |
$10,832.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19,116.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$15,930.00
|
| Rate for Payer: PHP All Commercial |
$16,108.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8,283.60
|
| Rate for Payer: Sagamore Health Network All Products |
$16,397.28
|
| Rate for Payer: Signature Care EPO |
$17,629.20
|
| Rate for Payer: Signature Care PPO |
$18,691.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,054.00
|
| Rate for Payer: United Healthcare Commercial |
$16,737.12
|
| Rate for Payer: United Healthcare Medicare |
$7,009.20
|
|
|
HC TOTAL KNEE JOURNEY II W/ XLPE
|
Facility
|
OP
|
$27,540.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$25,612.20 |
| Rate for Payer: Aetna Commercial |
$23,243.76
|
| Rate for Payer: Aetna Medicare |
$9,088.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,088.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,816.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17,215.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,451.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,997.02
|
| Rate for Payer: Cash Price |
$17,074.80
|
| Rate for Payer: Cash Price |
$17,074.80
|
| Rate for Payer: Centivo All Commercial |
$14,045.40
|
| Rate for Payer: Cigna All Commercial |
$23,767.02
|
| Rate for Payer: CORVEL All Commercial |
$25,612.20
|
| Rate for Payer: Coventry All Commercial |
$24,235.20
|
| Rate for Payer: Encore All Commercial |
$25,350.57
|
| Rate for Payer: Frontpath All Commercial |
$25,336.80
|
| Rate for Payer: Humana ChoiceCare |
$23,786.30
|
| Rate for Payer: Humana Medicare |
$14,045.40
|
| Rate for Payer: Lucent All Commercial |
$14,045.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,786.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$20,655.00
|
| Rate for Payer: PHP All Commercial |
$20,886.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,740.60
|
| Rate for Payer: Sagamore Health Network All Products |
$21,260.88
|
| Rate for Payer: Signature Care EPO |
$22,858.20
|
| Rate for Payer: Signature Care PPO |
$24,235.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,409.00
|
| Rate for Payer: United Healthcare Commercial |
$21,701.52
|
| Rate for Payer: United Healthcare Medicare |
$9,088.20
|
|
|
HC TOTAL KNEE JOURNEY II W/ XLPE
|
Facility
|
IP
|
$27,540.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,655.00 |
| Max. Negotiated Rate |
$25,612.20 |
| Rate for Payer: Aetna Commercial |
$23,794.56
|
| Rate for Payer: Cash Price |
$17,074.80
|
| Rate for Payer: Cigna All Commercial |
$23,767.02
|
| Rate for Payer: CORVEL All Commercial |
$25,612.20
|
| Rate for Payer: Coventry All Commercial |
$24,235.20
|
| Rate for Payer: Encore All Commercial |
$25,350.57
|
| Rate for Payer: Frontpath All Commercial |
$25,336.80
|
| Rate for Payer: Humana ChoiceCare |
$23,786.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,786.00
|
| Rate for Payer: PHCS All Commercial |
$20,655.00
|
| Rate for Payer: PHP All Commercial |
$20,886.34
|
| Rate for Payer: Sagamore Health Network All Products |
$21,260.88
|
| Rate for Payer: Signature Care EPO |
$22,858.20
|
| Rate for Payer: Signature Care PPO |
$24,235.20
|
| Rate for Payer: United Healthcare Commercial |
$21,701.52
|
|
|
HC TOTAL KNEE OXINIUM WITH CONSTR
|
Facility
|
OP
|
$26,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$24,440.40 |
| Rate for Payer: Aetna Commercial |
$22,180.32
|
| Rate for Payer: Aetna Medicare |
$8,672.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,672.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,092.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16,427.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,973.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,539.64
|
| Rate for Payer: Cash Price |
$16,293.60
|
| Rate for Payer: Cash Price |
$16,293.60
|
| Rate for Payer: Centivo All Commercial |
$13,402.80
|
| Rate for Payer: Cigna All Commercial |
$22,679.64
|
| Rate for Payer: CORVEL All Commercial |
$24,440.40
|
| Rate for Payer: Coventry All Commercial |
$23,126.40
|
| Rate for Payer: Encore All Commercial |
$24,190.74
|
| Rate for Payer: Frontpath All Commercial |
$24,177.60
|
| Rate for Payer: Humana ChoiceCare |
$22,698.04
|
| Rate for Payer: Humana Medicare |
$13,402.80
|
| Rate for Payer: Lucent All Commercial |
$13,402.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23,652.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$19,710.00
|
| Rate for Payer: PHP All Commercial |
$19,930.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,249.20
|
| Rate for Payer: Sagamore Health Network All Products |
$20,288.16
|
| Rate for Payer: Signature Care EPO |
$21,812.40
|
| Rate for Payer: Signature Care PPO |
$23,126.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,338.00
|
| Rate for Payer: United Healthcare Commercial |
$20,708.64
|
| Rate for Payer: United Healthcare Medicare |
$8,672.40
|
|
|
HC TOTAL KNEE OXINIUM WITH CONSTR
|
Facility
|
IP
|
$26,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,710.00 |
| Max. Negotiated Rate |
$24,440.40 |
| Rate for Payer: Aetna Commercial |
$22,705.92
|
| Rate for Payer: Cash Price |
$16,293.60
|
| Rate for Payer: Cigna All Commercial |
$22,679.64
|
| Rate for Payer: CORVEL All Commercial |
$24,440.40
|
| Rate for Payer: Coventry All Commercial |
$23,126.40
|
| Rate for Payer: Encore All Commercial |
$24,190.74
|
| Rate for Payer: Frontpath All Commercial |
$24,177.60
|
| Rate for Payer: Humana ChoiceCare |
$22,698.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23,652.00
|
| Rate for Payer: PHCS All Commercial |
$19,710.00
|
| Rate for Payer: PHP All Commercial |
$19,930.75
|
| Rate for Payer: Sagamore Health Network All Products |
$20,288.16
|
| Rate for Payer: Signature Care EPO |
$21,812.40
|
| Rate for Payer: Signature Care PPO |
$23,126.40
|
| Rate for Payer: United Healthcare Commercial |
$20,708.64
|
|
|
HC TOTAL KNEE OXINIUM WITH VERILA
|
Facility
|
IP
|
$27,540.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,655.00 |
| Max. Negotiated Rate |
$25,612.20 |
| Rate for Payer: Aetna Commercial |
$23,794.56
|
| Rate for Payer: Cash Price |
$17,074.80
|
| Rate for Payer: Cigna All Commercial |
$23,767.02
|
| Rate for Payer: CORVEL All Commercial |
$25,612.20
|
| Rate for Payer: Coventry All Commercial |
$24,235.20
|
| Rate for Payer: Encore All Commercial |
$25,350.57
|
| Rate for Payer: Frontpath All Commercial |
$25,336.80
|
| Rate for Payer: Humana ChoiceCare |
$23,786.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,786.00
|
| Rate for Payer: PHCS All Commercial |
$20,655.00
|
| Rate for Payer: PHP All Commercial |
$20,886.34
|
| Rate for Payer: Sagamore Health Network All Products |
$21,260.88
|
| Rate for Payer: Signature Care EPO |
$22,858.20
|
| Rate for Payer: Signature Care PPO |
$24,235.20
|
| Rate for Payer: United Healthcare Commercial |
$21,701.52
|
|
|
HC TOTAL KNEE OXINIUM WITH VERILA
|
Facility
|
OP
|
$27,540.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$25,612.20 |
| Rate for Payer: Aetna Commercial |
$23,243.76
|
| Rate for Payer: Aetna Medicare |
$9,088.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,088.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,816.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17,215.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,451.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,997.02
|
| Rate for Payer: Cash Price |
$17,074.80
|
| Rate for Payer: Cash Price |
$17,074.80
|
| Rate for Payer: Centivo All Commercial |
$14,045.40
|
| Rate for Payer: Cigna All Commercial |
$23,767.02
|
| Rate for Payer: CORVEL All Commercial |
$25,612.20
|
| Rate for Payer: Coventry All Commercial |
$24,235.20
|
| Rate for Payer: Encore All Commercial |
$25,350.57
|
| Rate for Payer: Frontpath All Commercial |
$25,336.80
|
| Rate for Payer: Humana ChoiceCare |
$23,786.30
|
| Rate for Payer: Humana Medicare |
$14,045.40
|
| Rate for Payer: Lucent All Commercial |
$14,045.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,786.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$20,655.00
|
| Rate for Payer: PHP All Commercial |
$20,886.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,740.60
|
| Rate for Payer: Sagamore Health Network All Products |
$21,260.88
|
| Rate for Payer: Signature Care EPO |
$22,858.20
|
| Rate for Payer: Signature Care PPO |
$24,235.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,409.00
|
| Rate for Payer: United Healthcare Commercial |
$21,701.52
|
| Rate for Payer: United Healthcare Medicare |
$9,088.20
|
|
|
HC TOTAL KNEE VISIONAIRE CUTTING
|
Facility
|
IP
|
$3,420.00
|
|
| Hospital Charge Code |
41602372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,565.00 |
| Max. Negotiated Rate |
$3,180.60 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Cash Price |
$2,120.40
|
| Rate for Payer: Cigna All Commercial |
$2,951.46
|
| Rate for Payer: CORVEL All Commercial |
$3,180.60
|
| Rate for Payer: Coventry All Commercial |
$3,009.60
|
| Rate for Payer: Encore All Commercial |
$3,148.11
|
| Rate for Payer: Frontpath All Commercial |
$3,146.40
|
| Rate for Payer: Humana ChoiceCare |
$2,953.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,078.00
|
| Rate for Payer: PHCS All Commercial |
$2,565.00
|
| Rate for Payer: PHP All Commercial |
$2,593.73
|
| Rate for Payer: Sagamore Health Network All Products |
$2,640.24
|
| Rate for Payer: Signature Care EPO |
$2,838.60
|
| Rate for Payer: Signature Care PPO |
$3,009.60
|
| Rate for Payer: United Healthcare Commercial |
$2,694.96
|
|
|
HC TOTAL KNEE VISIONAIRE CUTTING
|
Facility
|
OP
|
$3,420.00
|
|
| Hospital Charge Code |
41602372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,180.60 |
| Rate for Payer: Aetna Commercial |
$2,886.48
|
| Rate for Payer: Aetna Medicare |
$1,128.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,128.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,964.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,137.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,297.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,241.46
|
| Rate for Payer: Cash Price |
$2,120.40
|
| Rate for Payer: Cash Price |
$2,120.40
|
| Rate for Payer: Centivo All Commercial |
$1,744.20
|
| Rate for Payer: Cigna All Commercial |
$2,951.46
|
| Rate for Payer: CORVEL All Commercial |
$3,180.60
|
| Rate for Payer: Coventry All Commercial |
$3,009.60
|
| Rate for Payer: Encore All Commercial |
$3,148.11
|
| Rate for Payer: Frontpath All Commercial |
$3,146.40
|
| Rate for Payer: Humana ChoiceCare |
$2,953.85
|
| Rate for Payer: Humana Medicare |
$1,744.20
|
| Rate for Payer: Lucent All Commercial |
$1,744.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,078.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,565.00
|
| Rate for Payer: PHP All Commercial |
$2,593.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,333.80
|
| Rate for Payer: Sagamore Health Network All Products |
$2,640.24
|
| Rate for Payer: Signature Care EPO |
$2,838.60
|
| Rate for Payer: Signature Care PPO |
$3,009.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,907.00
|
| Rate for Payer: United Healthcare Commercial |
$2,694.96
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
|
|
HC TOTAL PROTEIN
|
Facility
|
IP
|
$47.12
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
63001185
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Cigna All Commercial |
$40.67
|
| Rate for Payer: CORVEL All Commercial |
$43.83
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.38
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
|
|
HC TOTAL PROTEIN
|
Facility
|
OP
|
$47.12
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
63001185
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.11
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Centivo All Commercial |
$24.03
|
| Rate for Payer: Cigna All Commercial |
$40.67
|
| Rate for Payer: CORVEL All Commercial |
$43.83
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.38
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Humana Medicare |
$24.03
|
| Rate for Payer: Lucent All Commercial |
$24.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.38
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.06
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$15.55
|
|
|
HC TOUCH PREP INITIAL
|
Facility
|
OP
|
$95.39
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
63001268
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$1,147.58 |
| Rate for Payer: Aetna Commercial |
$80.51
|
| Rate for Payer: Aetna Medicare |
$31.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,147.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.63
|
| Rate for Payer: Cash Price |
$59.14
|
| Rate for Payer: Cash Price |
$59.14
|
| Rate for Payer: Centivo All Commercial |
$48.65
|
| Rate for Payer: Cigna All Commercial |
$82.32
|
| Rate for Payer: CORVEL All Commercial |
$88.71
|
| Rate for Payer: Coventry All Commercial |
$83.94
|
| Rate for Payer: Encore All Commercial |
$87.81
|
| Rate for Payer: Frontpath All Commercial |
$87.76
|
| Rate for Payer: Humana ChoiceCare |
$82.39
|
| Rate for Payer: Humana Medicare |
$48.65
|
| Rate for Payer: Lucent All Commercial |
$48.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.85
|
| Rate for Payer: Managed Health Services Medicaid |
$1,147.58
|
| Rate for Payer: MDWise Medicaid |
$1,147.58
|
| Rate for Payer: PHCS All Commercial |
$71.54
|
| Rate for Payer: PHP All Commercial |
$72.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.20
|
| Rate for Payer: Sagamore Health Network All Products |
$73.64
|
| Rate for Payer: Signature Care EPO |
$79.17
|
| Rate for Payer: Signature Care PPO |
$83.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.08
|
| Rate for Payer: United Healthcare Commercial |
$75.17
|
| Rate for Payer: United Healthcare Medicare |
$31.48
|
|
|
HC TOUCH PREP INITIAL
|
Facility
|
IP
|
$95.39
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
63001268
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$88.71 |
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Cash Price |
$59.14
|
| Rate for Payer: Cigna All Commercial |
$82.32
|
| Rate for Payer: CORVEL All Commercial |
$88.71
|
| Rate for Payer: Coventry All Commercial |
$83.94
|
| Rate for Payer: Encore All Commercial |
$87.81
|
| Rate for Payer: Frontpath All Commercial |
$87.76
|
| Rate for Payer: Humana ChoiceCare |
$82.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.85
|
| Rate for Payer: PHCS All Commercial |
$71.54
|
| Rate for Payer: PHP All Commercial |
$72.34
|
| Rate for Payer: Sagamore Health Network All Products |
$73.64
|
| Rate for Payer: Signature Care EPO |
$79.17
|
| Rate for Payer: Signature Care PPO |
$83.94
|
| Rate for Payer: United Healthcare Commercial |
$75.17
|
|
|
HC TOUCH PREP PATHOLOGY EACH ADDL
|
Facility
|
OP
|
$60.60
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
63001269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Aetna Commercial |
$51.14
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.00
|
| Rate for Payer: Cash Price |
$37.57
|
| Rate for Payer: Centivo All Commercial |
$30.91
|
| Rate for Payer: Cigna All Commercial |
$52.30
|
| Rate for Payer: CORVEL All Commercial |
$56.36
|
| Rate for Payer: Coventry All Commercial |
$53.33
|
| Rate for Payer: Encore All Commercial |
$55.78
|
| Rate for Payer: Frontpath All Commercial |
$55.75
|
| Rate for Payer: Humana ChoiceCare |
$52.34
|
| Rate for Payer: Humana Medicare |
$30.91
|
| Rate for Payer: Lucent All Commercial |
$30.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.54
|
| Rate for Payer: PHCS All Commercial |
$45.45
|
| Rate for Payer: PHP All Commercial |
$45.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.63
|
| Rate for Payer: Sagamore Health Network All Products |
$46.78
|
| Rate for Payer: Signature Care EPO |
$50.30
|
| Rate for Payer: Signature Care PPO |
$53.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.51
|
| Rate for Payer: United Healthcare Commercial |
$47.75
|
| Rate for Payer: United Healthcare Medicare |
$20.00
|
|
|
HC TOUCH PREP PATHOLOGY EACH ADDL
|
Facility
|
IP
|
$60.60
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
63001269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Cash Price |
$37.57
|
| Rate for Payer: Cigna All Commercial |
$52.30
|
| Rate for Payer: CORVEL All Commercial |
$56.36
|
| Rate for Payer: Coventry All Commercial |
$53.33
|
| Rate for Payer: Encore All Commercial |
$55.78
|
| Rate for Payer: Frontpath All Commercial |
$55.75
|
| Rate for Payer: Humana ChoiceCare |
$52.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.54
|
| Rate for Payer: PHCS All Commercial |
$45.45
|
| Rate for Payer: PHP All Commercial |
$45.96
|
| Rate for Payer: Sagamore Health Network All Products |
$46.78
|
| Rate for Payer: Signature Care EPO |
$50.30
|
| Rate for Payer: Signature Care PPO |
$53.33
|
| Rate for Payer: United Healthcare Commercial |
$47.75
|
|
|
HC TOURNI-COT LG
|
Facility
|
OP
|
$29.69
|
|
| Hospital Charge Code |
41601848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.78
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Centivo All Commercial |
$15.14
|
| Rate for Payer: Cigna All Commercial |
$25.62
|
| Rate for Payer: CORVEL All Commercial |
$27.61
|
| Rate for Payer: Coventry All Commercial |
$26.13
|
| Rate for Payer: Encore All Commercial |
$27.33
|
| Rate for Payer: Frontpath All Commercial |
$27.31
|
| Rate for Payer: Humana ChoiceCare |
$25.64
|
| Rate for Payer: Humana Medicare |
$15.14
|
| Rate for Payer: Lucent All Commercial |
$15.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.27
|
| Rate for Payer: PHP All Commercial |
$22.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.58
|
| Rate for Payer: Sagamore Health Network All Products |
$22.92
|
| Rate for Payer: Signature Care EPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$26.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.24
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Medicare |
$9.80
|
|
|
HC TOURNI-COT LG
|
Facility
|
IP
|
$29.69
|
|
| Hospital Charge Code |
41601848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$27.61 |
| Rate for Payer: Aetna Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cigna All Commercial |
$25.62
|
| Rate for Payer: CORVEL All Commercial |
$27.61
|
| Rate for Payer: Coventry All Commercial |
$26.13
|
| Rate for Payer: Encore All Commercial |
$27.33
|
| Rate for Payer: Frontpath All Commercial |
$27.31
|
| Rate for Payer: Humana ChoiceCare |
$25.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.72
|
| Rate for Payer: PHCS All Commercial |
$22.27
|
| Rate for Payer: PHP All Commercial |
$22.52
|
| Rate for Payer: Sagamore Health Network All Products |
$22.92
|
| Rate for Payer: Signature Care EPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$26.13
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
|
|
HC TOURNI-COT MED
|
Facility
|
IP
|
$29.69
|
|
| Hospital Charge Code |
41601849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$27.61 |
| Rate for Payer: Aetna Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cigna All Commercial |
$25.62
|
| Rate for Payer: CORVEL All Commercial |
$27.61
|
| Rate for Payer: Coventry All Commercial |
$26.13
|
| Rate for Payer: Encore All Commercial |
$27.33
|
| Rate for Payer: Frontpath All Commercial |
$27.31
|
| Rate for Payer: Humana ChoiceCare |
$25.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.72
|
| Rate for Payer: PHCS All Commercial |
$22.27
|
| Rate for Payer: PHP All Commercial |
$22.52
|
| Rate for Payer: Sagamore Health Network All Products |
$22.92
|
| Rate for Payer: Signature Care EPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$26.13
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
|
|
HC TOURNI-COT MED
|
Facility
|
OP
|
$29.69
|
|
| Hospital Charge Code |
41601849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.78
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Centivo All Commercial |
$15.14
|
| Rate for Payer: Cigna All Commercial |
$25.62
|
| Rate for Payer: CORVEL All Commercial |
$27.61
|
| Rate for Payer: Coventry All Commercial |
$26.13
|
| Rate for Payer: Encore All Commercial |
$27.33
|
| Rate for Payer: Frontpath All Commercial |
$27.31
|
| Rate for Payer: Humana ChoiceCare |
$25.64
|
| Rate for Payer: Humana Medicare |
$15.14
|
| Rate for Payer: Lucent All Commercial |
$15.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.27
|
| Rate for Payer: PHP All Commercial |
$22.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.58
|
| Rate for Payer: Sagamore Health Network All Products |
$22.92
|
| Rate for Payer: Signature Care EPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$26.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.24
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Medicare |
$9.80
|
|
|
HC TOURNI-COT XLG
|
Facility
|
OP
|
$29.69
|
|
| Hospital Charge Code |
41601850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.78
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Centivo All Commercial |
$15.14
|
| Rate for Payer: Cigna All Commercial |
$25.62
|
| Rate for Payer: CORVEL All Commercial |
$27.61
|
| Rate for Payer: Coventry All Commercial |
$26.13
|
| Rate for Payer: Encore All Commercial |
$27.33
|
| Rate for Payer: Frontpath All Commercial |
$27.31
|
| Rate for Payer: Humana ChoiceCare |
$25.64
|
| Rate for Payer: Humana Medicare |
$15.14
|
| Rate for Payer: Lucent All Commercial |
$15.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.27
|
| Rate for Payer: PHP All Commercial |
$22.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.58
|
| Rate for Payer: Sagamore Health Network All Products |
$22.92
|
| Rate for Payer: Signature Care EPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$26.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.24
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Medicare |
$9.80
|
|
|
HC TOURNI-COT XLG
|
Facility
|
IP
|
$29.69
|
|
| Hospital Charge Code |
41601850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$27.61 |
| Rate for Payer: Aetna Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cigna All Commercial |
$25.62
|
| Rate for Payer: CORVEL All Commercial |
$27.61
|
| Rate for Payer: Coventry All Commercial |
$26.13
|
| Rate for Payer: Encore All Commercial |
$27.33
|
| Rate for Payer: Frontpath All Commercial |
$27.31
|
| Rate for Payer: Humana ChoiceCare |
$25.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.72
|
| Rate for Payer: PHCS All Commercial |
$22.27
|
| Rate for Payer: PHP All Commercial |
$22.52
|
| Rate for Payer: Sagamore Health Network All Products |
$22.92
|
| Rate for Payer: Signature Care EPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$26.13
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
|
|
HC TOXOPLASMOS IGA
|
Facility
|
OP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$100.29
|
| Rate for Payer: Aetna Medicare |
$39.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.14
|
| Rate for Payer: Cash Price |
$73.68
|
| Rate for Payer: Cash Price |
$73.68
|
| Rate for Payer: Centivo All Commercial |
$60.60
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Humana Medicare |
$60.60
|
| Rate for Payer: Lucent All Commercial |
$60.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.34
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.01
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
| Rate for Payer: United Healthcare Medicare |
$39.21
|
|
|
HC TOXOPLASMOS IGA
|
Facility
|
IP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.12 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$102.67
|
| Rate for Payer: Cash Price |
$73.68
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
|
|
HC TOXOPLASMOSIS IGG
|
Facility
|
IP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.12 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$102.67
|
| Rate for Payer: Cash Price |
$73.68
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
|
