|
HC UV LIGHT THERAPY - PT
|
Facility
|
OP
|
$122.42
|
|
|
Service Code
|
CPT 97028 GP
|
| Hospital Charge Code |
01722015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$103.32
|
| Rate for Payer: Aetna Medicare |
$40.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Centivo All Commercial |
$62.43
|
| Rate for Payer: Cigna All Commercial |
$105.65
|
| Rate for Payer: CORVEL All Commercial |
$113.85
|
| Rate for Payer: Coventry All Commercial |
$107.73
|
| Rate for Payer: Encore All Commercial |
$112.69
|
| Rate for Payer: Frontpath All Commercial |
$112.63
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Humana Medicare |
$62.43
|
| Rate for Payer: Lucent All Commercial |
$62.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.18
|
| Rate for Payer: PHCS All Commercial |
$91.82
|
| Rate for Payer: PHP All Commercial |
$92.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.51
|
| Rate for Payer: Signature Care EPO |
$101.61
|
| Rate for Payer: Signature Care PPO |
$107.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.06
|
| Rate for Payer: United Healthcare Commercial |
$96.47
|
| Rate for Payer: United Healthcare Medicare |
$40.40
|
|
|
HC VACUUM EXTRACTOR
|
Facility
|
IP
|
$342.01
|
|
| Hospital Charge Code |
41602443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.51 |
| Max. Negotiated Rate |
$318.07 |
| Rate for Payer: Aetna Commercial |
$295.50
|
| Rate for Payer: Cash Price |
$212.05
|
| Rate for Payer: Cigna All Commercial |
$295.15
|
| Rate for Payer: CORVEL All Commercial |
$318.07
|
| Rate for Payer: Coventry All Commercial |
$300.97
|
| Rate for Payer: Encore All Commercial |
$314.82
|
| Rate for Payer: Frontpath All Commercial |
$314.65
|
| Rate for Payer: Humana ChoiceCare |
$295.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$307.81
|
| Rate for Payer: PHCS All Commercial |
$256.51
|
| Rate for Payer: PHP All Commercial |
$259.38
|
| Rate for Payer: Sagamore Health Network All Products |
$264.03
|
| Rate for Payer: Signature Care EPO |
$283.87
|
| Rate for Payer: Signature Care PPO |
$300.97
|
| Rate for Payer: United Healthcare Commercial |
$269.50
|
|
|
HC VACUUM EXTRACTOR
|
Facility
|
OP
|
$342.01
|
|
| Hospital Charge Code |
41602443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$318.07 |
| Rate for Payer: Aetna Commercial |
$288.66
|
| Rate for Payer: Aetna Medicare |
$112.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$196.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$129.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.15
|
| Rate for Payer: Cash Price |
$212.05
|
| Rate for Payer: Cash Price |
$212.05
|
| Rate for Payer: Centivo All Commercial |
$174.43
|
| Rate for Payer: Cigna All Commercial |
$295.15
|
| Rate for Payer: CORVEL All Commercial |
$318.07
|
| Rate for Payer: Coventry All Commercial |
$300.97
|
| Rate for Payer: Encore All Commercial |
$314.82
|
| Rate for Payer: Frontpath All Commercial |
$314.65
|
| Rate for Payer: Humana ChoiceCare |
$295.39
|
| Rate for Payer: Humana Medicare |
$174.43
|
| Rate for Payer: Lucent All Commercial |
$174.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$307.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$256.51
|
| Rate for Payer: PHP All Commercial |
$259.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$133.38
|
| Rate for Payer: Sagamore Health Network All Products |
$264.03
|
| Rate for Payer: Signature Care EPO |
$283.87
|
| Rate for Payer: Signature Care PPO |
$300.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$290.71
|
| Rate for Payer: United Healthcare Commercial |
$269.50
|
| Rate for Payer: United Healthcare Medicare |
$112.86
|
|
|
HC VAGINAL DELIVERY-ROUTINE
|
Facility
|
OP
|
$6,470.88
|
|
| Hospital Charge Code |
01223233
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$492.69 |
| Max. Negotiated Rate |
$6,017.92 |
| Rate for Payer: Aetna Commercial |
$5,461.42
|
| Rate for Payer: Aetna Medicare |
$2,135.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,135.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,716.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,044.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$492.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,455.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,348.93
|
| Rate for Payer: Cash Price |
$4,011.95
|
| Rate for Payer: Cash Price |
$4,011.95
|
| Rate for Payer: Centivo All Commercial |
$3,300.15
|
| Rate for Payer: Cigna All Commercial |
$5,584.37
|
| Rate for Payer: CORVEL All Commercial |
$6,017.92
|
| Rate for Payer: Coventry All Commercial |
$5,694.37
|
| Rate for Payer: Encore All Commercial |
$5,956.45
|
| Rate for Payer: Frontpath All Commercial |
$5,953.21
|
| Rate for Payer: Humana ChoiceCare |
$5,588.90
|
| Rate for Payer: Humana Medicare |
$3,300.15
|
| Rate for Payer: Lucent All Commercial |
$3,300.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,823.79
|
| Rate for Payer: Managed Health Services Medicaid |
$492.69
|
| Rate for Payer: MDWise Medicaid |
$492.69
|
| Rate for Payer: PHCS All Commercial |
$4,853.16
|
| Rate for Payer: PHP All Commercial |
$4,907.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,523.64
|
| Rate for Payer: Sagamore Health Network All Products |
$4,995.52
|
| Rate for Payer: Signature Care EPO |
$5,370.83
|
| Rate for Payer: Signature Care PPO |
$5,694.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.25
|
| Rate for Payer: United Healthcare Commercial |
$5,099.05
|
| Rate for Payer: United Healthcare Medicare |
$2,135.39
|
|
|
HC VAGINAL DELIVERY-ROUTINE
|
Facility
|
IP
|
$6,470.88
|
|
| Hospital Charge Code |
01223233
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$4,853.16 |
| Max. Negotiated Rate |
$6,017.92 |
| Rate for Payer: Aetna Commercial |
$5,590.84
|
| Rate for Payer: Cash Price |
$4,011.95
|
| Rate for Payer: Cigna All Commercial |
$5,584.37
|
| Rate for Payer: CORVEL All Commercial |
$6,017.92
|
| Rate for Payer: Coventry All Commercial |
$5,694.37
|
| Rate for Payer: Encore All Commercial |
$5,956.45
|
| Rate for Payer: Frontpath All Commercial |
$5,953.21
|
| Rate for Payer: Humana ChoiceCare |
$5,588.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,823.79
|
| Rate for Payer: PHCS All Commercial |
$4,853.16
|
| Rate for Payer: PHP All Commercial |
$4,907.52
|
| Rate for Payer: Sagamore Health Network All Products |
$4,995.52
|
| Rate for Payer: Signature Care EPO |
$5,370.83
|
| Rate for Payer: Signature Care PPO |
$5,694.37
|
| Rate for Payer: United Healthcare Commercial |
$5,099.05
|
|
|
HC VALVE CHEST DRAIN
|
Facility
|
OP
|
$817.81
|
|
| Hospital Charge Code |
41606979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$760.56 |
| Rate for Payer: Aetna Commercial |
$690.23
|
| Rate for Payer: Aetna Medicare |
$269.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$469.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$511.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$310.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.87
|
| Rate for Payer: Cash Price |
$507.04
|
| Rate for Payer: Cash Price |
$507.04
|
| Rate for Payer: Centivo All Commercial |
$417.08
|
| Rate for Payer: Cigna All Commercial |
$705.77
|
| Rate for Payer: CORVEL All Commercial |
$760.56
|
| Rate for Payer: Coventry All Commercial |
$719.67
|
| Rate for Payer: Encore All Commercial |
$752.79
|
| Rate for Payer: Frontpath All Commercial |
$752.39
|
| Rate for Payer: Humana ChoiceCare |
$706.34
|
| Rate for Payer: Humana Medicare |
$417.08
|
| Rate for Payer: Lucent All Commercial |
$417.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$736.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$613.36
|
| Rate for Payer: PHP All Commercial |
$620.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.95
|
| Rate for Payer: Sagamore Health Network All Products |
$631.35
|
| Rate for Payer: Signature Care EPO |
$678.78
|
| Rate for Payer: Signature Care PPO |
$719.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$695.14
|
| Rate for Payer: United Healthcare Commercial |
$644.43
|
| Rate for Payer: United Healthcare Medicare |
$269.88
|
|
|
HC VALVE CHEST DRAIN
|
Facility
|
IP
|
$817.81
|
|
| Hospital Charge Code |
41606979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$613.36 |
| Max. Negotiated Rate |
$760.56 |
| Rate for Payer: Aetna Commercial |
$706.59
|
| Rate for Payer: Cash Price |
$507.04
|
| Rate for Payer: Cigna All Commercial |
$705.77
|
| Rate for Payer: CORVEL All Commercial |
$760.56
|
| Rate for Payer: Coventry All Commercial |
$719.67
|
| Rate for Payer: Encore All Commercial |
$752.79
|
| Rate for Payer: Frontpath All Commercial |
$752.39
|
| Rate for Payer: Humana ChoiceCare |
$706.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$736.03
|
| Rate for Payer: PHCS All Commercial |
$613.36
|
| Rate for Payer: PHP All Commercial |
$620.23
|
| Rate for Payer: Sagamore Health Network All Products |
$631.35
|
| Rate for Payer: Signature Care EPO |
$678.78
|
| Rate for Payer: Signature Care PPO |
$719.67
|
| Rate for Payer: United Healthcare Commercial |
$644.43
|
|
|
HC VALVE HEIMLICH CHEST DRAIN
|
Facility
|
OP
|
$220.37
|
|
| Hospital Charge Code |
41601869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.72 |
| Max. Negotiated Rate |
$204.94 |
| Rate for Payer: Aetna Commercial |
$185.99
|
| Rate for Payer: Aetna Medicare |
$72.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$126.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$137.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.99
|
| Rate for Payer: Cash Price |
$136.63
|
| Rate for Payer: Cash Price |
$136.63
|
| Rate for Payer: Centivo All Commercial |
$112.39
|
| Rate for Payer: Cigna All Commercial |
$190.18
|
| Rate for Payer: CORVEL All Commercial |
$204.94
|
| Rate for Payer: Coventry All Commercial |
$193.93
|
| Rate for Payer: Encore All Commercial |
$202.85
|
| Rate for Payer: Frontpath All Commercial |
$202.74
|
| Rate for Payer: Humana ChoiceCare |
$190.33
|
| Rate for Payer: Humana Medicare |
$112.39
|
| Rate for Payer: Lucent All Commercial |
$112.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$165.28
|
| Rate for Payer: PHP All Commercial |
$167.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.94
|
| Rate for Payer: Sagamore Health Network All Products |
$170.13
|
| Rate for Payer: Signature Care EPO |
$182.91
|
| Rate for Payer: Signature Care PPO |
$193.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.31
|
| Rate for Payer: United Healthcare Commercial |
$173.65
|
| Rate for Payer: United Healthcare Medicare |
$72.72
|
|
|
HC VALVE HEIMLICH CHEST DRAIN
|
Facility
|
IP
|
$220.37
|
|
| Hospital Charge Code |
41601869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.28 |
| Max. Negotiated Rate |
$204.94 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$136.63
|
| Rate for Payer: Cigna All Commercial |
$190.18
|
| Rate for Payer: CORVEL All Commercial |
$204.94
|
| Rate for Payer: Coventry All Commercial |
$193.93
|
| Rate for Payer: Encore All Commercial |
$202.85
|
| Rate for Payer: Frontpath All Commercial |
$202.74
|
| Rate for Payer: Humana ChoiceCare |
$190.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.33
|
| Rate for Payer: PHCS All Commercial |
$165.28
|
| Rate for Payer: PHP All Commercial |
$167.13
|
| Rate for Payer: Sagamore Health Network All Products |
$170.13
|
| Rate for Payer: Signature Care EPO |
$182.91
|
| Rate for Payer: Signature Care PPO |
$193.93
|
| Rate for Payer: United Healthcare Commercial |
$173.65
|
|
|
HC VANCOMYCIN PK
|
Facility
|
OP
|
$216.38
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
63001338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$201.24 |
| Rate for Payer: Aetna Commercial |
$182.63
|
| Rate for Payer: Aetna Medicare |
$71.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.55
|
| Rate for Payer: Cash Price |
$134.16
|
| Rate for Payer: Cash Price |
$134.16
|
| Rate for Payer: Centivo All Commercial |
$110.36
|
| Rate for Payer: Cigna All Commercial |
$186.74
|
| Rate for Payer: CORVEL All Commercial |
$201.24
|
| Rate for Payer: Coventry All Commercial |
$190.42
|
| Rate for Payer: Encore All Commercial |
$199.18
|
| Rate for Payer: Frontpath All Commercial |
$199.07
|
| Rate for Payer: Humana ChoiceCare |
$186.89
|
| Rate for Payer: Humana Medicare |
$110.36
|
| Rate for Payer: Lucent All Commercial |
$110.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.74
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$162.29
|
| Rate for Payer: PHP All Commercial |
$164.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.39
|
| Rate for Payer: Sagamore Health Network All Products |
$167.05
|
| Rate for Payer: Signature Care EPO |
$179.60
|
| Rate for Payer: Signature Care PPO |
$190.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.93
|
| Rate for Payer: United Healthcare Commercial |
$170.51
|
| Rate for Payer: United Healthcare Medicare |
$71.41
|
|
|
HC VANCOMYCIN PK
|
Facility
|
IP
|
$216.38
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
63001338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.29 |
| Max. Negotiated Rate |
$201.24 |
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Cash Price |
$134.16
|
| Rate for Payer: Cigna All Commercial |
$186.74
|
| Rate for Payer: CORVEL All Commercial |
$201.24
|
| Rate for Payer: Coventry All Commercial |
$190.42
|
| Rate for Payer: Encore All Commercial |
$199.18
|
| Rate for Payer: Frontpath All Commercial |
$199.07
|
| Rate for Payer: Humana ChoiceCare |
$186.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.74
|
| Rate for Payer: PHCS All Commercial |
$162.29
|
| Rate for Payer: PHP All Commercial |
$164.10
|
| Rate for Payer: Sagamore Health Network All Products |
$167.05
|
| Rate for Payer: Signature Care EPO |
$179.60
|
| Rate for Payer: Signature Care PPO |
$190.42
|
| Rate for Payer: United Healthcare Commercial |
$170.51
|
|
|
HC VANCOMYCIN RANDOM
|
Facility
|
OP
|
$255.82
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
63001339
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$237.91 |
| Rate for Payer: Aetna Commercial |
$215.91
|
| Rate for Payer: Aetna Medicare |
$84.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.86
|
| Rate for Payer: Cash Price |
$158.61
|
| Rate for Payer: Cash Price |
$158.61
|
| Rate for Payer: Centivo All Commercial |
$130.47
|
| Rate for Payer: Cigna All Commercial |
$220.77
|
| Rate for Payer: CORVEL All Commercial |
$237.91
|
| Rate for Payer: Coventry All Commercial |
$225.12
|
| Rate for Payer: Encore All Commercial |
$235.48
|
| Rate for Payer: Frontpath All Commercial |
$235.35
|
| Rate for Payer: Humana ChoiceCare |
$220.95
|
| Rate for Payer: Humana Medicare |
$130.47
|
| Rate for Payer: Lucent All Commercial |
$130.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.23
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$191.86
|
| Rate for Payer: PHP All Commercial |
$194.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.77
|
| Rate for Payer: Sagamore Health Network All Products |
$197.49
|
| Rate for Payer: Signature Care EPO |
$212.33
|
| Rate for Payer: Signature Care PPO |
$225.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$217.44
|
| Rate for Payer: United Healthcare Commercial |
$201.58
|
| Rate for Payer: United Healthcare Medicare |
$84.42
|
|
|
HC VANCOMYCIN RANDOM
|
Facility
|
IP
|
$255.82
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
63001339
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.86 |
| Max. Negotiated Rate |
$237.91 |
| Rate for Payer: Aetna Commercial |
$221.03
|
| Rate for Payer: Cash Price |
$158.61
|
| Rate for Payer: Cigna All Commercial |
$220.77
|
| Rate for Payer: CORVEL All Commercial |
$237.91
|
| Rate for Payer: Coventry All Commercial |
$225.12
|
| Rate for Payer: Encore All Commercial |
$235.48
|
| Rate for Payer: Frontpath All Commercial |
$235.35
|
| Rate for Payer: Humana ChoiceCare |
$220.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.23
|
| Rate for Payer: PHCS All Commercial |
$191.86
|
| Rate for Payer: PHP All Commercial |
$194.01
|
| Rate for Payer: Sagamore Health Network All Products |
$197.49
|
| Rate for Payer: Signature Care EPO |
$212.33
|
| Rate for Payer: Signature Care PPO |
$225.12
|
| Rate for Payer: United Healthcare Commercial |
$201.58
|
|
|
HC VANCOMYCIN TR
|
Facility
|
IP
|
$255.82
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
63001340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.86 |
| Max. Negotiated Rate |
$237.91 |
| Rate for Payer: Aetna Commercial |
$221.03
|
| Rate for Payer: Cash Price |
$158.61
|
| Rate for Payer: Cigna All Commercial |
$220.77
|
| Rate for Payer: CORVEL All Commercial |
$237.91
|
| Rate for Payer: Coventry All Commercial |
$225.12
|
| Rate for Payer: Encore All Commercial |
$235.48
|
| Rate for Payer: Frontpath All Commercial |
$235.35
|
| Rate for Payer: Humana ChoiceCare |
$220.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.23
|
| Rate for Payer: PHCS All Commercial |
$191.86
|
| Rate for Payer: PHP All Commercial |
$194.01
|
| Rate for Payer: Sagamore Health Network All Products |
$197.49
|
| Rate for Payer: Signature Care EPO |
$212.33
|
| Rate for Payer: Signature Care PPO |
$225.12
|
| Rate for Payer: United Healthcare Commercial |
$201.58
|
|
|
HC VANCOMYCIN TR
|
Facility
|
OP
|
$255.82
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
63001340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$237.91 |
| Rate for Payer: Aetna Commercial |
$215.91
|
| Rate for Payer: Aetna Medicare |
$84.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.86
|
| Rate for Payer: Cash Price |
$158.61
|
| Rate for Payer: Cash Price |
$158.61
|
| Rate for Payer: Centivo All Commercial |
$130.47
|
| Rate for Payer: Cigna All Commercial |
$220.77
|
| Rate for Payer: CORVEL All Commercial |
$237.91
|
| Rate for Payer: Coventry All Commercial |
$225.12
|
| Rate for Payer: Encore All Commercial |
$235.48
|
| Rate for Payer: Frontpath All Commercial |
$235.35
|
| Rate for Payer: Humana ChoiceCare |
$220.95
|
| Rate for Payer: Humana Medicare |
$130.47
|
| Rate for Payer: Lucent All Commercial |
$130.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.23
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$191.86
|
| Rate for Payer: PHP All Commercial |
$194.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.77
|
| Rate for Payer: Sagamore Health Network All Products |
$197.49
|
| Rate for Payer: Signature Care EPO |
$212.33
|
| Rate for Payer: Signature Care PPO |
$225.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$217.44
|
| Rate for Payer: United Healthcare Commercial |
$201.58
|
| Rate for Payer: United Healthcare Medicare |
$84.42
|
|
|
HC VANILLYLMANDELIC ACID (VMA) 24HR
|
Facility
|
IP
|
$167.49
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
63001711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.62 |
| Max. Negotiated Rate |
$155.77 |
| Rate for Payer: Aetna Commercial |
$144.71
|
| Rate for Payer: Cash Price |
$103.85
|
| Rate for Payer: Cigna All Commercial |
$144.55
|
| Rate for Payer: CORVEL All Commercial |
$155.77
|
| Rate for Payer: Coventry All Commercial |
$147.39
|
| Rate for Payer: Encore All Commercial |
$154.18
|
| Rate for Payer: Frontpath All Commercial |
$154.09
|
| Rate for Payer: Humana ChoiceCare |
$144.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.74
|
| Rate for Payer: PHCS All Commercial |
$125.62
|
| Rate for Payer: PHP All Commercial |
$127.03
|
| Rate for Payer: Sagamore Health Network All Products |
$129.31
|
| Rate for Payer: Signature Care EPO |
$139.02
|
| Rate for Payer: Signature Care PPO |
$147.39
|
| Rate for Payer: United Healthcare Commercial |
$131.99
|
|
|
HC VANILLYLMANDELIC ACID (VMA) 24HR
|
Facility
|
OP
|
$167.49
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
63001711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$155.77 |
| Rate for Payer: Aetna Commercial |
$141.37
|
| Rate for Payer: Aetna Medicare |
$55.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.80
|
| Rate for Payer: Cash Price |
$103.85
|
| Rate for Payer: Cash Price |
$103.85
|
| Rate for Payer: Centivo All Commercial |
$85.42
|
| Rate for Payer: Cigna All Commercial |
$144.55
|
| Rate for Payer: CORVEL All Commercial |
$155.77
|
| Rate for Payer: Coventry All Commercial |
$147.39
|
| Rate for Payer: Encore All Commercial |
$154.18
|
| Rate for Payer: Frontpath All Commercial |
$154.09
|
| Rate for Payer: Humana ChoiceCare |
$144.66
|
| Rate for Payer: Humana Medicare |
$85.42
|
| Rate for Payer: Lucent All Commercial |
$85.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.74
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: MDWise Medicaid |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$125.62
|
| Rate for Payer: PHP All Commercial |
$127.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.32
|
| Rate for Payer: Sagamore Health Network All Products |
$129.31
|
| Rate for Payer: Signature Care EPO |
$139.02
|
| Rate for Payer: Signature Care PPO |
$147.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.37
|
| Rate for Payer: United Healthcare Commercial |
$131.99
|
| Rate for Payer: United Healthcare Medicare |
$55.27
|
|
|
HC VANILLYLMANDELIC ACID (VMA) RANDOM URINE
|
Facility
|
OP
|
$204.99
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
63001712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$190.64 |
| Rate for Payer: Aetna Commercial |
$173.01
|
| Rate for Payer: Aetna Medicare |
$67.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.41
|
| Rate for Payer: Cash Price |
$127.09
|
| Rate for Payer: Cash Price |
$127.09
|
| Rate for Payer: Centivo All Commercial |
$104.54
|
| Rate for Payer: Cigna All Commercial |
$176.91
|
| Rate for Payer: CORVEL All Commercial |
$190.64
|
| Rate for Payer: Coventry All Commercial |
$180.39
|
| Rate for Payer: Encore All Commercial |
$188.69
|
| Rate for Payer: Frontpath All Commercial |
$188.59
|
| Rate for Payer: Humana ChoiceCare |
$177.05
|
| Rate for Payer: Humana Medicare |
$104.54
|
| Rate for Payer: Lucent All Commercial |
$104.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.49
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: MDWise Medicaid |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$153.74
|
| Rate for Payer: PHP All Commercial |
$155.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.95
|
| Rate for Payer: Sagamore Health Network All Products |
$158.25
|
| Rate for Payer: Signature Care EPO |
$170.14
|
| Rate for Payer: Signature Care PPO |
$180.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.24
|
| Rate for Payer: United Healthcare Commercial |
$161.53
|
| Rate for Payer: United Healthcare Medicare |
$67.65
|
|
|
HC VANILLYLMANDELIC ACID (VMA) RANDOM URINE
|
Facility
|
IP
|
$204.99
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
63001712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$190.64 |
| Rate for Payer: Aetna Commercial |
$177.11
|
| Rate for Payer: Cash Price |
$127.09
|
| Rate for Payer: Cigna All Commercial |
$176.91
|
| Rate for Payer: CORVEL All Commercial |
$190.64
|
| Rate for Payer: Coventry All Commercial |
$180.39
|
| Rate for Payer: Encore All Commercial |
$188.69
|
| Rate for Payer: Frontpath All Commercial |
$188.59
|
| Rate for Payer: Humana ChoiceCare |
$177.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.49
|
| Rate for Payer: PHCS All Commercial |
$153.74
|
| Rate for Payer: PHP All Commercial |
$155.46
|
| Rate for Payer: Sagamore Health Network All Products |
$158.25
|
| Rate for Payer: Signature Care EPO |
$170.14
|
| Rate for Payer: Signature Care PPO |
$180.39
|
| Rate for Payer: United Healthcare Commercial |
$161.53
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$150.91
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
63001974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$140.35 |
| Rate for Payer: Aetna Commercial |
$130.39
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cigna All Commercial |
$130.23
|
| Rate for Payer: CORVEL All Commercial |
$140.35
|
| Rate for Payer: Coventry All Commercial |
$132.80
|
| Rate for Payer: Encore All Commercial |
$138.91
|
| Rate for Payer: Frontpath All Commercial |
$138.84
|
| Rate for Payer: Humana ChoiceCare |
$130.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.82
|
| Rate for Payer: PHCS All Commercial |
$113.18
|
| Rate for Payer: PHP All Commercial |
$114.45
|
| Rate for Payer: Sagamore Health Network All Products |
$116.50
|
| Rate for Payer: Signature Care EPO |
$125.25
|
| Rate for Payer: Signature Care PPO |
$132.80
|
| Rate for Payer: United Healthcare Commercial |
$118.92
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$150.91
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
63001974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$140.35 |
| Rate for Payer: Aetna Commercial |
$127.37
|
| Rate for Payer: Aetna Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.78
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Centivo All Commercial |
$76.96
|
| Rate for Payer: Cigna All Commercial |
$130.23
|
| Rate for Payer: CORVEL All Commercial |
$140.35
|
| Rate for Payer: Coventry All Commercial |
$132.80
|
| Rate for Payer: Encore All Commercial |
$138.91
|
| Rate for Payer: Frontpath All Commercial |
$138.84
|
| Rate for Payer: Humana ChoiceCare |
$130.34
|
| Rate for Payer: Humana Medicare |
$76.96
|
| Rate for Payer: Lucent All Commercial |
$76.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.82
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$113.18
|
| Rate for Payer: PHP All Commercial |
$114.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.85
|
| Rate for Payer: Sagamore Health Network All Products |
$116.50
|
| Rate for Payer: Signature Care EPO |
$125.25
|
| Rate for Payer: Signature Care PPO |
$132.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.27
|
| Rate for Payer: United Healthcare Commercial |
$118.92
|
| Rate for Payer: United Healthcare Medicare |
$49.80
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$150.91
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
63001975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$140.35 |
| Rate for Payer: Aetna Commercial |
$130.39
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cigna All Commercial |
$130.23
|
| Rate for Payer: CORVEL All Commercial |
$140.35
|
| Rate for Payer: Coventry All Commercial |
$132.80
|
| Rate for Payer: Encore All Commercial |
$138.91
|
| Rate for Payer: Frontpath All Commercial |
$138.84
|
| Rate for Payer: Humana ChoiceCare |
$130.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.82
|
| Rate for Payer: PHCS All Commercial |
$113.18
|
| Rate for Payer: PHP All Commercial |
$114.45
|
| Rate for Payer: Sagamore Health Network All Products |
$116.50
|
| Rate for Payer: Signature Care EPO |
$125.25
|
| Rate for Payer: Signature Care PPO |
$132.80
|
| Rate for Payer: United Healthcare Commercial |
$118.92
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$150.91
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
63001975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$140.35 |
| Rate for Payer: Aetna Commercial |
$127.37
|
| Rate for Payer: Aetna Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.78
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Centivo All Commercial |
$76.96
|
| Rate for Payer: Cigna All Commercial |
$130.23
|
| Rate for Payer: CORVEL All Commercial |
$140.35
|
| Rate for Payer: Coventry All Commercial |
$132.80
|
| Rate for Payer: Encore All Commercial |
$138.91
|
| Rate for Payer: Frontpath All Commercial |
$138.84
|
| Rate for Payer: Humana ChoiceCare |
$130.34
|
| Rate for Payer: Humana Medicare |
$76.96
|
| Rate for Payer: Lucent All Commercial |
$76.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.82
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$113.18
|
| Rate for Payer: PHP All Commercial |
$114.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.85
|
| Rate for Payer: Sagamore Health Network All Products |
$116.50
|
| Rate for Payer: Signature Care EPO |
$125.25
|
| Rate for Payer: Signature Care PPO |
$132.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.27
|
| Rate for Payer: United Healthcare Commercial |
$118.92
|
| Rate for Payer: United Healthcare Medicare |
$49.80
|
|
|
HC VASO INTESTINAL PEP
|
Facility
|
OP
|
$617.17
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
63001713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$573.97 |
| Rate for Payer: Aetna Commercial |
$520.89
|
| Rate for Payer: Aetna Medicare |
$203.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$224.03
|
| Rate for Payer: Cash Price |
$382.65
|
| Rate for Payer: Cash Price |
$382.65
|
| Rate for Payer: Centivo All Commercial |
$314.76
|
| Rate for Payer: Cigna All Commercial |
$532.62
|
| Rate for Payer: CORVEL All Commercial |
$573.97
|
| Rate for Payer: Coventry All Commercial |
$543.11
|
| Rate for Payer: Encore All Commercial |
$568.11
|
| Rate for Payer: Frontpath All Commercial |
$567.80
|
| Rate for Payer: Humana ChoiceCare |
$533.05
|
| Rate for Payer: Humana Medicare |
$314.76
|
| Rate for Payer: Lucent All Commercial |
$314.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.45
|
| Rate for Payer: Managed Health Services Medicaid |
$35.33
|
| Rate for Payer: MDWise Medicaid |
$35.33
|
| Rate for Payer: PHCS All Commercial |
$462.88
|
| Rate for Payer: PHP All Commercial |
$468.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.70
|
| Rate for Payer: Sagamore Health Network All Products |
$476.46
|
| Rate for Payer: Signature Care EPO |
$512.25
|
| Rate for Payer: Signature Care PPO |
$543.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.60
|
| Rate for Payer: United Healthcare Commercial |
$486.33
|
| Rate for Payer: United Healthcare Medicare |
$203.67
|
|
|
HC VASO INTESTINAL PEP
|
Facility
|
IP
|
$617.17
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
63001713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$462.88 |
| Max. Negotiated Rate |
$573.97 |
| Rate for Payer: Aetna Commercial |
$533.24
|
| Rate for Payer: Cash Price |
$382.65
|
| Rate for Payer: Cigna All Commercial |
$532.62
|
| Rate for Payer: CORVEL All Commercial |
$573.97
|
| Rate for Payer: Coventry All Commercial |
$543.11
|
| Rate for Payer: Encore All Commercial |
$568.11
|
| Rate for Payer: Frontpath All Commercial |
$567.80
|
| Rate for Payer: Humana ChoiceCare |
$533.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.45
|
| Rate for Payer: PHCS All Commercial |
$462.88
|
| Rate for Payer: PHP All Commercial |
$468.06
|
| Rate for Payer: Sagamore Health Network All Products |
$476.46
|
| Rate for Payer: Signature Care EPO |
$512.25
|
| Rate for Payer: Signature Care PPO |
$543.11
|
| Rate for Payer: United Healthcare Commercial |
$486.33
|
|
