|
HC VASOPNEUMATIC DEVICES-PT
|
Facility
|
OP
|
$431.26
|
|
|
Service Code
|
CPT 97016 GP
|
| Hospital Charge Code |
01728088
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$142.31 |
| Max. Negotiated Rate |
$401.07 |
| Rate for Payer: Aetna Commercial |
$363.98
|
| Rate for Payer: Aetna Medicare |
$142.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$247.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.55
|
| Rate for Payer: Cash Price |
$267.38
|
| Rate for Payer: Centivo All Commercial |
$219.94
|
| Rate for Payer: Cigna All Commercial |
$372.17
|
| Rate for Payer: CORVEL All Commercial |
$401.07
|
| Rate for Payer: Coventry All Commercial |
$379.51
|
| Rate for Payer: Encore All Commercial |
$396.97
|
| Rate for Payer: Frontpath All Commercial |
$396.76
|
| Rate for Payer: Humana ChoiceCare |
$372.48
|
| Rate for Payer: Humana Medicare |
$219.94
|
| Rate for Payer: Lucent All Commercial |
$219.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$388.13
|
| Rate for Payer: PHCS All Commercial |
$323.44
|
| Rate for Payer: PHP All Commercial |
$327.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.19
|
| Rate for Payer: Sagamore Health Network All Products |
$332.93
|
| Rate for Payer: Signature Care EPO |
$357.94
|
| Rate for Payer: Signature Care PPO |
$379.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$366.57
|
| Rate for Payer: United Healthcare Commercial |
$339.83
|
| Rate for Payer: United Healthcare Medicare |
$142.31
|
|
|
HC VASOPNEUMATIC DEVICES-PT
|
Facility
|
IP
|
$431.26
|
|
|
Service Code
|
CPT 97016 GP
|
| Hospital Charge Code |
01728088
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$323.44 |
| Max. Negotiated Rate |
$401.07 |
| Rate for Payer: Aetna Commercial |
$372.61
|
| Rate for Payer: Cash Price |
$267.38
|
| Rate for Payer: Cigna All Commercial |
$372.17
|
| Rate for Payer: CORVEL All Commercial |
$401.07
|
| Rate for Payer: Coventry All Commercial |
$379.51
|
| Rate for Payer: Encore All Commercial |
$396.97
|
| Rate for Payer: Frontpath All Commercial |
$396.76
|
| Rate for Payer: Humana ChoiceCare |
$372.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$388.13
|
| Rate for Payer: PHCS All Commercial |
$323.44
|
| Rate for Payer: PHP All Commercial |
$327.06
|
| Rate for Payer: Sagamore Health Network All Products |
$332.93
|
| Rate for Payer: Signature Care EPO |
$357.94
|
| Rate for Payer: Signature Care PPO |
$379.51
|
| Rate for Payer: United Healthcare Commercial |
$339.83
|
|
|
HC V BLADE CRESCENT ANGLED
|
Facility
|
OP
|
$85.05
|
|
| Hospital Charge Code |
41606344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$71.78
|
| Rate for Payer: Aetna Medicare |
$28.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.87
|
| Rate for Payer: Cash Price |
$52.73
|
| Rate for Payer: Cash Price |
$52.73
|
| Rate for Payer: Centivo All Commercial |
$43.38
|
| Rate for Payer: Cigna All Commercial |
$73.40
|
| Rate for Payer: CORVEL All Commercial |
$79.10
|
| Rate for Payer: Coventry All Commercial |
$74.84
|
| Rate for Payer: Encore All Commercial |
$78.29
|
| Rate for Payer: Frontpath All Commercial |
$78.25
|
| Rate for Payer: Humana ChoiceCare |
$73.46
|
| Rate for Payer: Humana Medicare |
$43.38
|
| Rate for Payer: Lucent All Commercial |
$43.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.54
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$63.79
|
| Rate for Payer: PHP All Commercial |
$64.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.17
|
| Rate for Payer: Sagamore Health Network All Products |
$65.66
|
| Rate for Payer: Signature Care EPO |
$70.59
|
| Rate for Payer: Signature Care PPO |
$74.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.29
|
| Rate for Payer: United Healthcare Commercial |
$67.02
|
| Rate for Payer: United Healthcare Medicare |
$28.07
|
|
|
HC V BLADE CRESCENT ANGLED
|
Facility
|
IP
|
$85.05
|
|
| Hospital Charge Code |
41606344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$79.10 |
| Rate for Payer: Aetna Commercial |
$73.48
|
| Rate for Payer: Cash Price |
$52.73
|
| Rate for Payer: Cigna All Commercial |
$73.40
|
| Rate for Payer: CORVEL All Commercial |
$79.10
|
| Rate for Payer: Coventry All Commercial |
$74.84
|
| Rate for Payer: Encore All Commercial |
$78.29
|
| Rate for Payer: Frontpath All Commercial |
$78.25
|
| Rate for Payer: Humana ChoiceCare |
$73.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.54
|
| Rate for Payer: PHCS All Commercial |
$63.79
|
| Rate for Payer: PHP All Commercial |
$64.50
|
| Rate for Payer: Sagamore Health Network All Products |
$65.66
|
| Rate for Payer: Signature Care EPO |
$70.59
|
| Rate for Payer: Signature Care PPO |
$74.84
|
| Rate for Payer: United Healthcare Commercial |
$67.02
|
|
|
HC V CORNEA PROSHIELD
|
Facility
|
OP
|
$305.34
|
|
| Hospital Charge Code |
41606343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$283.97 |
| Rate for Payer: Aetna Commercial |
$257.71
|
| Rate for Payer: Aetna Medicare |
$100.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.84
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Centivo All Commercial |
$155.72
|
| Rate for Payer: Cigna All Commercial |
$263.51
|
| Rate for Payer: CORVEL All Commercial |
$283.97
|
| Rate for Payer: Coventry All Commercial |
$268.70
|
| Rate for Payer: Encore All Commercial |
$281.07
|
| Rate for Payer: Frontpath All Commercial |
$280.91
|
| Rate for Payer: Humana ChoiceCare |
$263.72
|
| Rate for Payer: Humana Medicare |
$155.72
|
| Rate for Payer: Lucent All Commercial |
$155.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$274.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$229.00
|
| Rate for Payer: PHP All Commercial |
$231.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.08
|
| Rate for Payer: Sagamore Health Network All Products |
$235.72
|
| Rate for Payer: Signature Care EPO |
$253.43
|
| Rate for Payer: Signature Care PPO |
$268.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$259.54
|
| Rate for Payer: United Healthcare Commercial |
$240.61
|
| Rate for Payer: United Healthcare Medicare |
$100.76
|
|
|
HC V CORNEA PROSHIELD
|
Facility
|
IP
|
$305.34
|
|
| Hospital Charge Code |
41606343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.00 |
| Max. Negotiated Rate |
$283.97 |
| Rate for Payer: Aetna Commercial |
$263.81
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cigna All Commercial |
$263.51
|
| Rate for Payer: CORVEL All Commercial |
$283.97
|
| Rate for Payer: Coventry All Commercial |
$268.70
|
| Rate for Payer: Encore All Commercial |
$281.07
|
| Rate for Payer: Frontpath All Commercial |
$280.91
|
| Rate for Payer: Humana ChoiceCare |
$263.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$274.81
|
| Rate for Payer: PHCS All Commercial |
$229.00
|
| Rate for Payer: PHP All Commercial |
$231.57
|
| Rate for Payer: Sagamore Health Network All Products |
$235.72
|
| Rate for Payer: Signature Care EPO |
$253.43
|
| Rate for Payer: Signature Care PPO |
$268.70
|
| Rate for Payer: United Healthcare Commercial |
$240.61
|
|
|
HC VEIN PICK
|
Facility
|
IP
|
$56.25
|
|
| Hospital Charge Code |
41607289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$52.31 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cigna All Commercial |
$48.54
|
| Rate for Payer: CORVEL All Commercial |
$52.31
|
| Rate for Payer: Coventry All Commercial |
$49.50
|
| Rate for Payer: Encore All Commercial |
$51.78
|
| Rate for Payer: Frontpath All Commercial |
$51.75
|
| Rate for Payer: Humana ChoiceCare |
$48.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.62
|
| Rate for Payer: PHCS All Commercial |
$42.19
|
| Rate for Payer: PHP All Commercial |
$42.66
|
| Rate for Payer: Sagamore Health Network All Products |
$43.42
|
| Rate for Payer: Signature Care EPO |
$46.69
|
| Rate for Payer: Signature Care PPO |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$44.32
|
|
|
HC VEIN PICK
|
Facility
|
OP
|
$56.25
|
|
| Hospital Charge Code |
41607289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$47.48
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.42
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Centivo All Commercial |
$28.69
|
| Rate for Payer: Cigna All Commercial |
$48.54
|
| Rate for Payer: CORVEL All Commercial |
$52.31
|
| Rate for Payer: Coventry All Commercial |
$49.50
|
| Rate for Payer: Encore All Commercial |
$51.78
|
| Rate for Payer: Frontpath All Commercial |
$51.75
|
| Rate for Payer: Humana ChoiceCare |
$48.58
|
| Rate for Payer: Humana Medicare |
$28.69
|
| Rate for Payer: Lucent All Commercial |
$28.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$42.19
|
| Rate for Payer: PHP All Commercial |
$42.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.94
|
| Rate for Payer: Sagamore Health Network All Products |
$43.42
|
| Rate for Payer: Signature Care EPO |
$46.69
|
| Rate for Payer: Signature Care PPO |
$49.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.81
|
| Rate for Payer: United Healthcare Commercial |
$44.32
|
| Rate for Payer: United Healthcare Medicare |
$18.56
|
|
|
HC VENIPUNCTURE
|
Facility
|
OP
|
$36.24
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
01263300
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.16
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Centivo All Commercial |
$18.48
|
| Rate for Payer: Cigna All Commercial |
$31.28
|
| Rate for Payer: CORVEL All Commercial |
$33.70
|
| Rate for Payer: Coventry All Commercial |
$31.89
|
| Rate for Payer: Encore All Commercial |
$33.36
|
| Rate for Payer: Frontpath All Commercial |
$33.34
|
| Rate for Payer: Humana ChoiceCare |
$31.30
|
| Rate for Payer: Humana Medicare |
$18.48
|
| Rate for Payer: Lucent All Commercial |
$18.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.62
|
| Rate for Payer: Managed Health Services Medicaid |
$3.00
|
| Rate for Payer: MDWise Medicaid |
$3.00
|
| Rate for Payer: PHCS All Commercial |
$27.18
|
| Rate for Payer: PHP All Commercial |
$27.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.13
|
| Rate for Payer: Sagamore Health Network All Products |
$27.98
|
| Rate for Payer: Signature Care EPO |
$30.08
|
| Rate for Payer: Signature Care PPO |
$31.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$28.56
|
| Rate for Payer: United Healthcare Medicare |
$11.96
|
|
|
HC VENIPUNCTURE
|
Facility
|
OP
|
$36.24
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
01260760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.16
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Centivo All Commercial |
$18.48
|
| Rate for Payer: Cigna All Commercial |
$31.28
|
| Rate for Payer: CORVEL All Commercial |
$33.70
|
| Rate for Payer: Coventry All Commercial |
$31.89
|
| Rate for Payer: Encore All Commercial |
$33.36
|
| Rate for Payer: Frontpath All Commercial |
$33.34
|
| Rate for Payer: Humana ChoiceCare |
$31.30
|
| Rate for Payer: Humana Medicare |
$18.48
|
| Rate for Payer: Lucent All Commercial |
$18.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.62
|
| Rate for Payer: Managed Health Services Medicaid |
$3.00
|
| Rate for Payer: MDWise Medicaid |
$3.00
|
| Rate for Payer: PHCS All Commercial |
$27.18
|
| Rate for Payer: PHP All Commercial |
$27.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.13
|
| Rate for Payer: Sagamore Health Network All Products |
$27.98
|
| Rate for Payer: Signature Care EPO |
$30.08
|
| Rate for Payer: Signature Care PPO |
$31.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$28.56
|
| Rate for Payer: United Healthcare Medicare |
$11.96
|
|
|
HC VENIPUNCTURE
|
Facility
|
IP
|
$36.24
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
01263300
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.31
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cigna All Commercial |
$31.28
|
| Rate for Payer: CORVEL All Commercial |
$33.70
|
| Rate for Payer: Coventry All Commercial |
$31.89
|
| Rate for Payer: Encore All Commercial |
$33.36
|
| Rate for Payer: Frontpath All Commercial |
$33.34
|
| Rate for Payer: Humana ChoiceCare |
$31.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.62
|
| Rate for Payer: PHCS All Commercial |
$27.18
|
| Rate for Payer: PHP All Commercial |
$27.48
|
| Rate for Payer: Sagamore Health Network All Products |
$27.98
|
| Rate for Payer: Signature Care EPO |
$30.08
|
| Rate for Payer: Signature Care PPO |
$31.89
|
| Rate for Payer: United Healthcare Commercial |
$28.56
|
|
|
HC VENIPUNCTURE
|
Facility
|
IP
|
$36.24
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
01260760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.31
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cigna All Commercial |
$31.28
|
| Rate for Payer: CORVEL All Commercial |
$33.70
|
| Rate for Payer: Coventry All Commercial |
$31.89
|
| Rate for Payer: Encore All Commercial |
$33.36
|
| Rate for Payer: Frontpath All Commercial |
$33.34
|
| Rate for Payer: Humana ChoiceCare |
$31.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.62
|
| Rate for Payer: PHCS All Commercial |
$27.18
|
| Rate for Payer: PHP All Commercial |
$27.48
|
| Rate for Payer: Sagamore Health Network All Products |
$27.98
|
| Rate for Payer: Signature Care EPO |
$30.08
|
| Rate for Payer: Signature Care PPO |
$31.89
|
| Rate for Payer: United Healthcare Commercial |
$28.56
|
|
|
HC VENOUS PH
|
Facility
|
IP
|
$122.30
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
63001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$113.74 |
| Rate for Payer: Aetna Commercial |
$105.67
|
| Rate for Payer: Cash Price |
$75.83
|
| Rate for Payer: Cigna All Commercial |
$105.54
|
| Rate for Payer: CORVEL All Commercial |
$113.74
|
| Rate for Payer: Coventry All Commercial |
$107.62
|
| Rate for Payer: Encore All Commercial |
$112.58
|
| Rate for Payer: Frontpath All Commercial |
$112.51
|
| Rate for Payer: Humana ChoiceCare |
$105.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.07
|
| Rate for Payer: PHCS All Commercial |
$91.72
|
| Rate for Payer: PHP All Commercial |
$92.75
|
| Rate for Payer: Sagamore Health Network All Products |
$94.41
|
| Rate for Payer: Signature Care EPO |
$101.51
|
| Rate for Payer: Signature Care PPO |
$107.62
|
| Rate for Payer: United Healthcare Commercial |
$96.37
|
|
|
HC VENOUS PH
|
Facility
|
OP
|
$122.30
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
63001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$113.74 |
| Rate for Payer: Aetna Commercial |
$103.22
|
| Rate for Payer: Aetna Medicare |
$40.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.39
|
| Rate for Payer: Cash Price |
$75.83
|
| Rate for Payer: Cash Price |
$75.83
|
| Rate for Payer: Centivo All Commercial |
$62.37
|
| Rate for Payer: Cigna All Commercial |
$105.54
|
| Rate for Payer: CORVEL All Commercial |
$113.74
|
| Rate for Payer: Coventry All Commercial |
$107.62
|
| Rate for Payer: Encore All Commercial |
$112.58
|
| Rate for Payer: Frontpath All Commercial |
$112.51
|
| Rate for Payer: Humana ChoiceCare |
$105.63
|
| Rate for Payer: Humana Medicare |
$62.37
|
| Rate for Payer: Lucent All Commercial |
$62.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.07
|
| Rate for Payer: Managed Health Services Medicaid |
$11.00
|
| Rate for Payer: MDWise Medicaid |
$11.00
|
| Rate for Payer: PHCS All Commercial |
$91.72
|
| Rate for Payer: PHP All Commercial |
$92.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.70
|
| Rate for Payer: Sagamore Health Network All Products |
$94.41
|
| Rate for Payer: Signature Care EPO |
$101.51
|
| Rate for Payer: Signature Care PPO |
$107.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.95
|
| Rate for Payer: United Healthcare Commercial |
$96.37
|
| Rate for Payer: United Healthcare Medicare |
$40.36
|
|
|
HC VENTISCAN IV
|
Facility
|
OP
|
$304.02
|
|
|
Service Code
|
NDC 99999999263
|
| Hospital Charge Code |
800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.33 |
| Max. Negotiated Rate |
$282.74 |
| Rate for Payer: Aetna Commercial |
$256.59
|
| Rate for Payer: Aetna Medicare |
$100.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$174.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.36
|
| Rate for Payer: Cash Price |
$188.49
|
| Rate for Payer: Cash Price |
$188.49
|
| Rate for Payer: Centivo All Commercial |
$155.05
|
| Rate for Payer: Cigna All Commercial |
$262.37
|
| Rate for Payer: CORVEL All Commercial |
$282.74
|
| Rate for Payer: Coventry All Commercial |
$267.54
|
| Rate for Payer: Encore All Commercial |
$279.85
|
| Rate for Payer: Frontpath All Commercial |
$279.70
|
| Rate for Payer: Humana ChoiceCare |
$262.58
|
| Rate for Payer: Humana Medicare |
$155.05
|
| Rate for Payer: Lucent All Commercial |
$155.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$228.02
|
| Rate for Payer: PHP All Commercial |
$230.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.57
|
| Rate for Payer: Sagamore Health Network All Products |
$234.70
|
| Rate for Payer: Signature Care EPO |
$252.34
|
| Rate for Payer: Signature Care PPO |
$267.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.42
|
| Rate for Payer: United Healthcare Commercial |
$239.57
|
| Rate for Payer: United Healthcare Medicare |
$100.33
|
|
|
HC VENTISCAN IV
|
Facility
|
IP
|
$304.02
|
|
|
Service Code
|
NDC 99999999263
|
| Hospital Charge Code |
800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.02 |
| Max. Negotiated Rate |
$282.74 |
| Rate for Payer: Aetna Commercial |
$262.67
|
| Rate for Payer: Cash Price |
$188.49
|
| Rate for Payer: Cigna All Commercial |
$262.37
|
| Rate for Payer: CORVEL All Commercial |
$282.74
|
| Rate for Payer: Coventry All Commercial |
$267.54
|
| Rate for Payer: Encore All Commercial |
$279.85
|
| Rate for Payer: Frontpath All Commercial |
$279.70
|
| Rate for Payer: Humana ChoiceCare |
$262.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.62
|
| Rate for Payer: PHCS All Commercial |
$228.02
|
| Rate for Payer: PHP All Commercial |
$230.57
|
| Rate for Payer: Sagamore Health Network All Products |
$234.70
|
| Rate for Payer: Signature Care EPO |
$252.34
|
| Rate for Payer: Signature Care PPO |
$267.54
|
| Rate for Payer: United Healthcare Commercial |
$239.57
|
|
|
HC VERSAJET 45
|
Facility
|
IP
|
$2,700.00
|
|
| Hospital Charge Code |
41607904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna Commercial |
$2,332.80
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna All Commercial |
$2,330.10
|
| Rate for Payer: CORVEL All Commercial |
$2,511.00
|
| Rate for Payer: Coventry All Commercial |
$2,376.00
|
| Rate for Payer: Encore All Commercial |
$2,485.35
|
| Rate for Payer: Frontpath All Commercial |
$2,484.00
|
| Rate for Payer: Humana ChoiceCare |
$2,331.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,430.00
|
| Rate for Payer: PHCS All Commercial |
$2,025.00
|
| Rate for Payer: PHP All Commercial |
$2,047.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,084.40
|
| Rate for Payer: Signature Care EPO |
$2,241.00
|
| Rate for Payer: Signature Care PPO |
$2,376.00
|
| Rate for Payer: United Healthcare Commercial |
$2,127.60
|
|
|
HC VERSAJET 45
|
Facility
|
OP
|
$2,700.00
|
|
| Hospital Charge Code |
41607904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna Commercial |
$2,278.80
|
| Rate for Payer: Aetna Medicare |
$891.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$891.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,550.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,687.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,024.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$980.10
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Centivo All Commercial |
$1,377.00
|
| Rate for Payer: Cigna All Commercial |
$2,330.10
|
| Rate for Payer: CORVEL All Commercial |
$2,511.00
|
| Rate for Payer: Coventry All Commercial |
$2,376.00
|
| Rate for Payer: Encore All Commercial |
$2,485.35
|
| Rate for Payer: Frontpath All Commercial |
$2,484.00
|
| Rate for Payer: Humana ChoiceCare |
$2,331.99
|
| Rate for Payer: Humana Medicare |
$1,377.00
|
| Rate for Payer: Lucent All Commercial |
$1,377.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,430.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,025.00
|
| Rate for Payer: PHP All Commercial |
$2,047.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,053.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,084.40
|
| Rate for Payer: Signature Care EPO |
$2,241.00
|
| Rate for Payer: Signature Care PPO |
$2,376.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,295.00
|
| Rate for Payer: United Healthcare Commercial |
$2,127.60
|
| Rate for Payer: United Healthcare Medicare |
$891.00
|
|
|
HC VERY LONG CHAIN-FAT
|
Facility
|
OP
|
$1,053.64
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
63001539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$979.88 |
| Rate for Payer: Aetna Commercial |
$889.27
|
| Rate for Payer: Aetna Medicare |
$347.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$347.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$605.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$658.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$399.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$382.47
|
| Rate for Payer: Cash Price |
$653.26
|
| Rate for Payer: Cash Price |
$653.26
|
| Rate for Payer: Centivo All Commercial |
$537.36
|
| Rate for Payer: Cigna All Commercial |
$909.29
|
| Rate for Payer: CORVEL All Commercial |
$979.88
|
| Rate for Payer: Coventry All Commercial |
$927.20
|
| Rate for Payer: Encore All Commercial |
$969.88
|
| Rate for Payer: Frontpath All Commercial |
$969.35
|
| Rate for Payer: Humana ChoiceCare |
$910.03
|
| Rate for Payer: Humana Medicare |
$537.36
|
| Rate for Payer: Lucent All Commercial |
$537.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$948.28
|
| Rate for Payer: Managed Health Services Medicaid |
$19.75
|
| Rate for Payer: MDWise Medicaid |
$19.75
|
| Rate for Payer: PHCS All Commercial |
$790.23
|
| Rate for Payer: PHP All Commercial |
$799.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$410.92
|
| Rate for Payer: Sagamore Health Network All Products |
$813.41
|
| Rate for Payer: Signature Care EPO |
$874.52
|
| Rate for Payer: Signature Care PPO |
$927.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$895.59
|
| Rate for Payer: United Healthcare Commercial |
$830.27
|
| Rate for Payer: United Healthcare Medicare |
$347.70
|
|
|
HC VERY LONG CHAIN-FAT
|
Facility
|
IP
|
$1,053.64
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
63001539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$790.23 |
| Max. Negotiated Rate |
$979.88 |
| Rate for Payer: Aetna Commercial |
$910.34
|
| Rate for Payer: Cash Price |
$653.26
|
| Rate for Payer: Cigna All Commercial |
$909.29
|
| Rate for Payer: CORVEL All Commercial |
$979.88
|
| Rate for Payer: Coventry All Commercial |
$927.20
|
| Rate for Payer: Encore All Commercial |
$969.88
|
| Rate for Payer: Frontpath All Commercial |
$969.35
|
| Rate for Payer: Humana ChoiceCare |
$910.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$948.28
|
| Rate for Payer: PHCS All Commercial |
$790.23
|
| Rate for Payer: PHP All Commercial |
$799.08
|
| Rate for Payer: Sagamore Health Network All Products |
$813.41
|
| Rate for Payer: Signature Care EPO |
$874.52
|
| Rate for Payer: Signature Care PPO |
$927.20
|
| Rate for Payer: United Healthcare Commercial |
$830.27
|
|
|
HC VIRAL CULTURE NON RESPIRATORY
|
Facility
|
OP
|
$240.67
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$223.82 |
| Rate for Payer: Aetna Commercial |
$203.12
|
| Rate for Payer: Aetna Medicare |
$79.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$138.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.36
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Centivo All Commercial |
$122.74
|
| Rate for Payer: Cigna All Commercial |
$207.70
|
| Rate for Payer: CORVEL All Commercial |
$223.82
|
| Rate for Payer: Coventry All Commercial |
$211.79
|
| Rate for Payer: Encore All Commercial |
$221.54
|
| Rate for Payer: Frontpath All Commercial |
$221.42
|
| Rate for Payer: Humana ChoiceCare |
$207.87
|
| Rate for Payer: Humana Medicare |
$122.74
|
| Rate for Payer: Lucent All Commercial |
$122.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.60
|
| Rate for Payer: Managed Health Services Medicaid |
$24.29
|
| Rate for Payer: MDWise Medicaid |
$24.29
|
| Rate for Payer: PHCS All Commercial |
$180.50
|
| Rate for Payer: PHP All Commercial |
$182.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.86
|
| Rate for Payer: Sagamore Health Network All Products |
$185.80
|
| Rate for Payer: Signature Care EPO |
$199.76
|
| Rate for Payer: Signature Care PPO |
$211.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$204.57
|
| Rate for Payer: United Healthcare Commercial |
$189.65
|
| Rate for Payer: United Healthcare Medicare |
$79.42
|
|
|
HC VIRAL CULTURE NON RESPIRATORY
|
Facility
|
IP
|
$240.67
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.50 |
| Max. Negotiated Rate |
$223.82 |
| Rate for Payer: Aetna Commercial |
$207.94
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cigna All Commercial |
$207.70
|
| Rate for Payer: CORVEL All Commercial |
$223.82
|
| Rate for Payer: Coventry All Commercial |
$211.79
|
| Rate for Payer: Encore All Commercial |
$221.54
|
| Rate for Payer: Frontpath All Commercial |
$221.42
|
| Rate for Payer: Humana ChoiceCare |
$207.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.60
|
| Rate for Payer: PHCS All Commercial |
$180.50
|
| Rate for Payer: PHP All Commercial |
$182.52
|
| Rate for Payer: Sagamore Health Network All Products |
$185.80
|
| Rate for Payer: Signature Care EPO |
$199.76
|
| Rate for Payer: Signature Care PPO |
$211.79
|
| Rate for Payer: United Healthcare Commercial |
$189.65
|
|
|
HC VIRAL CULTURE RESPIRATORY
|
Facility
|
OP
|
$497.68
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$462.84 |
| Rate for Payer: Aetna Commercial |
$420.04
|
| Rate for Payer: Aetna Medicare |
$164.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$285.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$311.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.66
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Centivo All Commercial |
$253.82
|
| Rate for Payer: Cigna All Commercial |
$429.50
|
| Rate for Payer: CORVEL All Commercial |
$462.84
|
| Rate for Payer: Coventry All Commercial |
$437.96
|
| Rate for Payer: Encore All Commercial |
$458.11
|
| Rate for Payer: Frontpath All Commercial |
$457.86
|
| Rate for Payer: Humana ChoiceCare |
$429.84
|
| Rate for Payer: Humana Medicare |
$253.82
|
| Rate for Payer: Lucent All Commercial |
$253.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.91
|
| Rate for Payer: Managed Health Services Medicaid |
$24.29
|
| Rate for Payer: MDWise Medicaid |
$24.29
|
| Rate for Payer: PHCS All Commercial |
$373.26
|
| Rate for Payer: PHP All Commercial |
$377.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$194.09
|
| Rate for Payer: Sagamore Health Network All Products |
$384.21
|
| Rate for Payer: Signature Care EPO |
$413.07
|
| Rate for Payer: Signature Care PPO |
$437.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$423.03
|
| Rate for Payer: United Healthcare Commercial |
$392.17
|
| Rate for Payer: United Healthcare Medicare |
$164.23
|
|
|
HC VIRAL CULTURE RESPIRATORY
|
Facility
|
IP
|
$497.68
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$373.26 |
| Max. Negotiated Rate |
$462.84 |
| Rate for Payer: Aetna Commercial |
$429.99
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cigna All Commercial |
$429.50
|
| Rate for Payer: CORVEL All Commercial |
$462.84
|
| Rate for Payer: Coventry All Commercial |
$437.96
|
| Rate for Payer: Encore All Commercial |
$458.11
|
| Rate for Payer: Frontpath All Commercial |
$457.86
|
| Rate for Payer: Humana ChoiceCare |
$429.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.91
|
| Rate for Payer: PHCS All Commercial |
$373.26
|
| Rate for Payer: PHP All Commercial |
$377.44
|
| Rate for Payer: Sagamore Health Network All Products |
$384.21
|
| Rate for Payer: Signature Care EPO |
$413.07
|
| Rate for Payer: Signature Care PPO |
$437.96
|
| Rate for Payer: United Healthcare Commercial |
$392.17
|
|
|
HC VISCOSITY
|
Facility
|
OP
|
$69.43
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
63044081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$64.57 |
| Rate for Payer: Aetna Commercial |
$58.60
|
| Rate for Payer: Aetna Medicare |
$22.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.20
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Centivo All Commercial |
$35.41
|
| Rate for Payer: Cigna All Commercial |
$59.92
|
| Rate for Payer: CORVEL All Commercial |
$64.57
|
| Rate for Payer: Coventry All Commercial |
$61.10
|
| Rate for Payer: Encore All Commercial |
$63.91
|
| Rate for Payer: Frontpath All Commercial |
$63.88
|
| Rate for Payer: Humana ChoiceCare |
$59.97
|
| Rate for Payer: Humana Medicare |
$35.41
|
| Rate for Payer: Lucent All Commercial |
$35.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.49
|
| Rate for Payer: Managed Health Services Medicaid |
$11.67
|
| Rate for Payer: MDWise Medicaid |
$11.67
|
| Rate for Payer: PHCS All Commercial |
$52.07
|
| Rate for Payer: PHP All Commercial |
$52.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.08
|
| Rate for Payer: Sagamore Health Network All Products |
$53.60
|
| Rate for Payer: Signature Care EPO |
$57.63
|
| Rate for Payer: Signature Care PPO |
$61.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.02
|
| Rate for Payer: United Healthcare Commercial |
$54.71
|
| Rate for Payer: United Healthcare Medicare |
$22.91
|
|
