|
HC ACU VDU PLATE RIGHT LONG
|
Facility
OP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,679.14
|
| Rate for Payer: Aetna Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,183.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,465.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,103.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,012.47
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Centivo All Commercial |
$2,827.44
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Humana Medicare |
$2,827.44
|
| Rate for Payer: Lucent All Commercial |
$2,827.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,162.16
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,712.40
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
| Rate for Payer: United Healthcare Medicare |
$1,829.52
|
|
|
HC ACU VDU PLATE RIGHT LONG
|
Facility
IP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,158.00 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,790.02
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
|
|
HC ACU VDU PLATE RIGHT STD
|
Facility
IP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,158.00 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,790.02
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
|
|
HC ACU VDU PLATE RIGHT STD
|
Facility
OP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,679.14
|
| Rate for Payer: Aetna Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,183.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,465.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,103.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,012.47
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Centivo All Commercial |
$2,827.44
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Humana Medicare |
$2,827.44
|
| Rate for Payer: Lucent All Commercial |
$2,827.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,162.16
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,712.40
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
| Rate for Payer: United Healthcare Medicare |
$1,829.52
|
|
|
HC ACU VOLAR LUNATE SUT PLATE
|
Facility
OP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,177.80
|
| Rate for Payer: Aetna Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,842.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,094.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,878.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,796.85
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Centivo All Commercial |
$2,524.50
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Humana Medicare |
$2,524.50
|
| Rate for Payer: Lucent All Commercial |
$2,524.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,930.50
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,207.50
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare Medicare |
$1,633.50
|
|
|
HC ACU VOLAR LUNATE SUT PLATE
|
Facility
IP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,712.50 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,276.80
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
|
|
HC ACYLCARNITINE QT
|
Facility
IP
|
$173.47
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
63001447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.10 |
| Max. Negotiated Rate |
$161.33 |
| Rate for Payer: Aetna Commercial |
$149.88
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cigna All Commercial |
$149.71
|
| Rate for Payer: CORVEL All Commercial |
$161.33
|
| Rate for Payer: Coventry All Commercial |
$152.65
|
| Rate for Payer: Encore All Commercial |
$159.68
|
| Rate for Payer: Frontpath All Commercial |
$159.59
|
| Rate for Payer: Humana ChoiceCare |
$149.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.12
|
| Rate for Payer: PHCS All Commercial |
$130.10
|
| Rate for Payer: PHP All Commercial |
$131.56
|
| Rate for Payer: Sagamore Health Network All Products |
$133.92
|
| Rate for Payer: Signature Care EPO |
$143.98
|
| Rate for Payer: Signature Care PPO |
$152.65
|
| Rate for Payer: United Healthcare Commercial |
$136.70
|
|
|
HC ACYLCARNITINE QT
|
Facility
OP
|
$173.47
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
63001447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$161.33 |
| Rate for Payer: Aetna Commercial |
$146.41
|
| Rate for Payer: Aetna Medicare |
$57.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.97
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Centivo All Commercial |
$88.47
|
| Rate for Payer: Cigna All Commercial |
$149.71
|
| Rate for Payer: CORVEL All Commercial |
$161.33
|
| Rate for Payer: Coventry All Commercial |
$152.65
|
| Rate for Payer: Encore All Commercial |
$159.68
|
| Rate for Payer: Frontpath All Commercial |
$159.59
|
| Rate for Payer: Humana ChoiceCare |
$149.83
|
| Rate for Payer: Humana Medicare |
$88.47
|
| Rate for Payer: Lucent All Commercial |
$88.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.12
|
| Rate for Payer: Managed Health Services Medicaid |
$16.87
|
| Rate for Payer: MDWise Medicaid |
$16.87
|
| Rate for Payer: PHCS All Commercial |
$130.10
|
| Rate for Payer: PHP All Commercial |
$131.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.65
|
| Rate for Payer: Sagamore Health Network All Products |
$133.92
|
| Rate for Payer: Signature Care EPO |
$143.98
|
| Rate for Payer: Signature Care PPO |
$152.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.45
|
| Rate for Payer: United Healthcare Commercial |
$136.70
|
| Rate for Payer: United Healthcare Medicare |
$57.25
|
|
|
HC ADAPTER 3.2MM MEDTRONIC STYLE
|
Facility
OP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.61 |
| Max. Negotiated Rate |
$331.45 |
| Rate for Payer: Aetna Commercial |
$300.80
|
| Rate for Payer: Aetna Medicare |
$117.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.37
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Centivo All Commercial |
$181.76
|
| Rate for Payer: Cigna All Commercial |
$307.57
|
| Rate for Payer: CORVEL All Commercial |
$331.45
|
| Rate for Payer: Coventry All Commercial |
$313.63
|
| Rate for Payer: Encore All Commercial |
$328.07
|
| Rate for Payer: Frontpath All Commercial |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Humana Medicare |
$181.76
|
| Rate for Payer: Lucent All Commercial |
$181.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$267.30
|
| Rate for Payer: PHP All Commercial |
$270.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.00
|
| Rate for Payer: Sagamore Health Network All Products |
$275.14
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.94
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
| Rate for Payer: United Healthcare Medicare |
$117.61
|
|
|
HC ADAPTER 3.2MM MEDTRONIC STYLE
|
Facility
IP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$331.45 |
| Rate for Payer: Aetna Commercial |
$307.93
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cigna All Commercial |
$307.57
|
| Rate for Payer: CORVEL All Commercial |
$331.45
|
| Rate for Payer: Coventry All Commercial |
$313.63
|
| Rate for Payer: Encore All Commercial |
$328.07
|
| Rate for Payer: Frontpath All Commercial |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.76
|
| Rate for Payer: PHCS All Commercial |
$267.30
|
| Rate for Payer: PHP All Commercial |
$270.29
|
| Rate for Payer: Sagamore Health Network All Products |
$275.14
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
|
|
HC ADAPTER MULTIPORT C-MPA-200
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
41602316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$182.28 |
| Rate for Payer: Aetna Commercial |
$169.34
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cigna All Commercial |
$169.15
|
| Rate for Payer: CORVEL All Commercial |
$182.28
|
| Rate for Payer: Coventry All Commercial |
$172.48
|
| Rate for Payer: Encore All Commercial |
$180.42
|
| Rate for Payer: Frontpath All Commercial |
$180.32
|
| Rate for Payer: Humana ChoiceCare |
$169.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.40
|
| Rate for Payer: PHCS All Commercial |
$147.00
|
| Rate for Payer: PHP All Commercial |
$148.65
|
| Rate for Payer: Sagamore Health Network All Products |
$151.31
|
| Rate for Payer: Signature Care EPO |
$162.68
|
| Rate for Payer: Signature Care PPO |
$172.48
|
| Rate for Payer: United Healthcare Commercial |
$154.45
|
|
|
HC ADAPTER MULTIPORT C-MPA-200
|
Facility
OP
|
$196.00
|
|
| Hospital Charge Code |
41602316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$182.28 |
| Rate for Payer: Aetna Commercial |
$165.42
|
| Rate for Payer: Aetna Medicare |
$64.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.15
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Centivo All Commercial |
$99.96
|
| Rate for Payer: Cigna All Commercial |
$169.15
|
| Rate for Payer: CORVEL All Commercial |
$182.28
|
| Rate for Payer: Coventry All Commercial |
$172.48
|
| Rate for Payer: Encore All Commercial |
$180.42
|
| Rate for Payer: Frontpath All Commercial |
$180.32
|
| Rate for Payer: Humana ChoiceCare |
$169.29
|
| Rate for Payer: Humana Medicare |
$99.96
|
| Rate for Payer: Lucent All Commercial |
$99.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.40
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$147.00
|
| Rate for Payer: PHP All Commercial |
$148.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.44
|
| Rate for Payer: Sagamore Health Network All Products |
$151.31
|
| Rate for Payer: Signature Care EPO |
$162.68
|
| Rate for Payer: Signature Care PPO |
$172.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$166.60
|
| Rate for Payer: United Healthcare Commercial |
$154.45
|
| Rate for Payer: United Healthcare Medicare |
$64.68
|
|
|
HC ADDL HIGH RESOLUTION
|
Facility
IP
|
$174.19
|
|
|
Service Code
|
CPT 88289
|
| Hospital Charge Code |
63002094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.64 |
| Max. Negotiated Rate |
$161.99 |
| Rate for Payer: Aetna Commercial |
$150.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna All Commercial |
$150.32
|
| Rate for Payer: CORVEL All Commercial |
$161.99
|
| Rate for Payer: Coventry All Commercial |
$153.28
|
| Rate for Payer: Encore All Commercial |
$160.34
|
| Rate for Payer: Frontpath All Commercial |
$160.25
|
| Rate for Payer: Humana ChoiceCare |
$150.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.77
|
| Rate for Payer: PHCS All Commercial |
$130.64
|
| Rate for Payer: PHP All Commercial |
$132.10
|
| Rate for Payer: Sagamore Health Network All Products |
$134.47
|
| Rate for Payer: Signature Care EPO |
$144.57
|
| Rate for Payer: Signature Care PPO |
$153.28
|
| Rate for Payer: United Healthcare Commercial |
$137.26
|
|
|
HC ADDL HIGH RESOLUTION
|
Facility
OP
|
$174.19
|
|
|
Service Code
|
CPT 88289
|
| Hospital Charge Code |
63002094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$161.99 |
| Rate for Payer: Aetna Commercial |
$147.01
|
| Rate for Payer: Aetna Medicare |
$57.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.23
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Centivo All Commercial |
$88.83
|
| Rate for Payer: Cigna All Commercial |
$150.32
|
| Rate for Payer: CORVEL All Commercial |
$161.99
|
| Rate for Payer: Coventry All Commercial |
$153.28
|
| Rate for Payer: Encore All Commercial |
$160.34
|
| Rate for Payer: Frontpath All Commercial |
$160.25
|
| Rate for Payer: Humana ChoiceCare |
$150.44
|
| Rate for Payer: Humana Medicare |
$88.83
|
| Rate for Payer: Lucent All Commercial |
$88.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.77
|
| Rate for Payer: Managed Health Services Medicaid |
$34.43
|
| Rate for Payer: MDWise Medicaid |
$34.43
|
| Rate for Payer: PHCS All Commercial |
$130.64
|
| Rate for Payer: PHP All Commercial |
$132.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.93
|
| Rate for Payer: Sagamore Health Network All Products |
$134.47
|
| Rate for Payer: Signature Care EPO |
$144.57
|
| Rate for Payer: Signature Care PPO |
$153.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148.06
|
| Rate for Payer: United Healthcare Commercial |
$137.26
|
| Rate for Payer: United Healthcare Medicare |
$57.48
|
|
|
HC ADHESIVE SKIN TOPICAL SWIFTSET
|
Facility
OP
|
$201.61
|
|
| Hospital Charge Code |
41602239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$170.16
|
| Rate for Payer: Aetna Medicare |
$66.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$115.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$126.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.18
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Centivo All Commercial |
$102.82
|
| Rate for Payer: Cigna All Commercial |
$173.99
|
| Rate for Payer: CORVEL All Commercial |
$187.50
|
| Rate for Payer: Coventry All Commercial |
$177.42
|
| Rate for Payer: Encore All Commercial |
$185.58
|
| Rate for Payer: Frontpath All Commercial |
$185.48
|
| Rate for Payer: Humana ChoiceCare |
$174.13
|
| Rate for Payer: Humana Medicare |
$102.82
|
| Rate for Payer: Lucent All Commercial |
$102.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$151.21
|
| Rate for Payer: PHP All Commercial |
$152.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.63
|
| Rate for Payer: Sagamore Health Network All Products |
$155.64
|
| Rate for Payer: Signature Care EPO |
$167.34
|
| Rate for Payer: Signature Care PPO |
$177.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171.37
|
| Rate for Payer: United Healthcare Commercial |
$158.87
|
| Rate for Payer: United Healthcare Medicare |
$66.53
|
|
|
HC ADHESIVE SKIN TOPICAL SWIFTSET
|
Facility
IP
|
$201.61
|
|
| Hospital Charge Code |
41602239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.21 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$174.19
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna All Commercial |
$173.99
|
| Rate for Payer: CORVEL All Commercial |
$187.50
|
| Rate for Payer: Coventry All Commercial |
$177.42
|
| Rate for Payer: Encore All Commercial |
$185.58
|
| Rate for Payer: Frontpath All Commercial |
$185.48
|
| Rate for Payer: Humana ChoiceCare |
$174.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.45
|
| Rate for Payer: PHCS All Commercial |
$151.21
|
| Rate for Payer: PHP All Commercial |
$152.90
|
| Rate for Payer: Sagamore Health Network All Products |
$155.64
|
| Rate for Payer: Signature Care EPO |
$167.34
|
| Rate for Payer: Signature Care PPO |
$177.42
|
| Rate for Payer: United Healthcare Commercial |
$158.87
|
|
|
HC ADL/SELF CARE/15 MIN-OT
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
01738000
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$118.16
|
| Rate for Payer: Aetna Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.82
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Centivo All Commercial |
$71.40
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.91
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: Lucent All Commercial |
$71.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
|
|
HC ADL/SELF CARE/15 MIN-OT
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
01738000
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$120.96
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.17
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
|
|
HC ADL/SELF CARE/15 MIN-PT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
01728000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC ADL/SELF CARE/15 MIN-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
01728000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC ADMIN HEPATITIS B VACCINE
|
Facility
OP
|
$95.47
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
01290010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.51 |
| Max. Negotiated Rate |
$88.79 |
| Rate for Payer: Aetna Commercial |
$80.58
|
| Rate for Payer: Aetna Medicare |
$31.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.66
|
| Rate for Payer: Cash Price |
$59.19
|
| Rate for Payer: Centivo All Commercial |
$48.69
|
| Rate for Payer: Cigna All Commercial |
$82.39
|
| Rate for Payer: CORVEL All Commercial |
$88.79
|
| Rate for Payer: Coventry All Commercial |
$84.02
|
| Rate for Payer: Encore All Commercial |
$87.88
|
| Rate for Payer: Frontpath All Commercial |
$87.83
|
| Rate for Payer: Humana ChoiceCare |
$82.46
|
| Rate for Payer: Humana Medicare |
$48.69
|
| Rate for Payer: Lucent All Commercial |
$48.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.92
|
| Rate for Payer: PHCS All Commercial |
$71.60
|
| Rate for Payer: PHP All Commercial |
$72.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.23
|
| Rate for Payer: Sagamore Health Network All Products |
$73.70
|
| Rate for Payer: Signature Care EPO |
$79.24
|
| Rate for Payer: Signature Care PPO |
$84.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.15
|
| Rate for Payer: United Healthcare Commercial |
$75.23
|
| Rate for Payer: United Healthcare Medicare |
$31.51
|
|
|
HC ADMIN HEPATITIS B VACCINE
|
Facility
IP
|
$95.47
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
01290010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$88.79 |
| Rate for Payer: Aetna Commercial |
$82.49
|
| Rate for Payer: Cash Price |
$59.19
|
| Rate for Payer: Cigna All Commercial |
$82.39
|
| Rate for Payer: CORVEL All Commercial |
$88.79
|
| Rate for Payer: Coventry All Commercial |
$84.02
|
| Rate for Payer: Encore All Commercial |
$87.88
|
| Rate for Payer: Frontpath All Commercial |
$87.83
|
| Rate for Payer: Humana ChoiceCare |
$82.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.92
|
| Rate for Payer: PHCS All Commercial |
$71.60
|
| Rate for Payer: PHP All Commercial |
$72.41
|
| Rate for Payer: Sagamore Health Network All Products |
$73.70
|
| Rate for Payer: Signature Care EPO |
$79.24
|
| Rate for Payer: Signature Care PPO |
$84.02
|
| Rate for Payer: United Healthcare Commercial |
$75.23
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
01299004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Centivo All Commercial |
$46.82
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent All Commercial |
$46.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$30.29
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
01299004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC ADMIN HEPATITIS B VACCINE CMCH
|
Facility
IP
|
$95.12
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
01299001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna All Commercial |
$82.08
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.70
|
| Rate for Payer: Encore All Commercial |
$87.55
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.60
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
