|
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 INFLUENZA VACCINE
|
Facility
OP
|
$95.08
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
01689111
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$88.43 |
| Rate for Payer: Aetna Commercial |
$80.25
|
| Rate for Payer: Aetna Medicare |
$31.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.52
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Centivo All Commercial |
$48.49
|
| Rate for Payer: Cigna All Commercial |
$82.06
|
| Rate for Payer: CORVEL All Commercial |
$88.43
|
| Rate for Payer: Coventry All Commercial |
$83.67
|
| Rate for Payer: Encore All Commercial |
$87.53
|
| Rate for Payer: Frontpath All Commercial |
$87.48
|
| Rate for Payer: Humana ChoiceCare |
$82.12
|
| Rate for Payer: Humana Medicare |
$48.49
|
| Rate for Payer: Lucent All Commercial |
$48.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.58
|
| Rate for Payer: PHCS All Commercial |
$71.31
|
| Rate for Payer: PHP All Commercial |
$72.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.08
|
| Rate for Payer: Sagamore Health Network All Products |
$73.41
|
| Rate for Payer: Signature Care EPO |
$78.92
|
| Rate for Payer: Signature Care PPO |
$83.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.82
|
| Rate for Payer: United Healthcare Commercial |
$74.93
|
| Rate for Payer: United Healthcare Medicare |
$31.38
|
|
|
HC ADMIN INFLUENZA VACCINE
|
Facility
IP
|
$95.08
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
01689111
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.31 |
| Max. Negotiated Rate |
$88.43 |
| Rate for Payer: Aetna Commercial |
$82.15
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cigna All Commercial |
$82.06
|
| Rate for Payer: CORVEL All Commercial |
$88.43
|
| Rate for Payer: Coventry All Commercial |
$83.67
|
| Rate for Payer: Encore All Commercial |
$87.53
|
| Rate for Payer: Frontpath All Commercial |
$87.48
|
| Rate for Payer: Humana ChoiceCare |
$82.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.58
|
| Rate for Payer: PHCS All Commercial |
$71.31
|
| Rate for Payer: PHP All Commercial |
$72.11
|
| Rate for Payer: Sagamore Health Network All Products |
$73.41
|
| Rate for Payer: Signature Care EPO |
$78.92
|
| Rate for Payer: Signature Care PPO |
$83.67
|
| Rate for Payer: United Healthcare Commercial |
$74.93
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
01299005
|
|
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 INFLUENZA VACCINE CMCH
|
Facility
IP
|
$95.12
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
01299002
|
|
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
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
OP
|
$95.12
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
01299002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.53
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Centivo All Commercial |
$48.51
|
| 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: Humana Medicare |
$48.51
|
| Rate for Payer: Lucent All Commercial |
$48.51
|
| 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: Plain Church Group Ministry All Commercial |
$37.09
|
| 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: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$31.39
|
|
|
HC ADMIN INFLUENZA VACCINE CMCH
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
01299005
|
|
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 PNEUMOCOCCAL VACCINE
|
Facility
OP
|
$94.90
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
01689112
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$88.26 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Medicare |
$31.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.45
|
| Rate for Payer: Cash Price |
$58.84
|
| Rate for Payer: Centivo All Commercial |
$48.40
|
| Rate for Payer: Cigna All Commercial |
$81.90
|
| Rate for Payer: CORVEL All Commercial |
$88.26
|
| Rate for Payer: Coventry All Commercial |
$83.51
|
| Rate for Payer: Encore All Commercial |
$87.36
|
| Rate for Payer: Frontpath All Commercial |
$87.31
|
| Rate for Payer: Humana ChoiceCare |
$81.97
|
| Rate for Payer: Humana Medicare |
$48.40
|
| Rate for Payer: Lucent All Commercial |
$48.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.41
|
| Rate for Payer: PHCS All Commercial |
$71.18
|
| Rate for Payer: PHP All Commercial |
$71.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.01
|
| Rate for Payer: Sagamore Health Network All Products |
$73.26
|
| Rate for Payer: Signature Care EPO |
$78.77
|
| Rate for Payer: Signature Care PPO |
$83.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.67
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
| Rate for Payer: United Healthcare Medicare |
$31.32
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE
|
Facility
IP
|
$94.90
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
01689112
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$88.26 |
| Rate for Payer: Aetna Commercial |
$81.99
|
| Rate for Payer: Cash Price |
$58.84
|
| Rate for Payer: Cigna All Commercial |
$81.90
|
| Rate for Payer: CORVEL All Commercial |
$88.26
|
| Rate for Payer: Coventry All Commercial |
$83.51
|
| Rate for Payer: Encore All Commercial |
$87.36
|
| Rate for Payer: Frontpath All Commercial |
$87.31
|
| Rate for Payer: Humana ChoiceCare |
$81.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.41
|
| Rate for Payer: PHCS All Commercial |
$71.18
|
| Rate for Payer: PHP All Commercial |
$71.97
|
| Rate for Payer: Sagamore Health Network All Products |
$73.26
|
| Rate for Payer: Signature Care EPO |
$78.77
|
| Rate for Payer: Signature Care PPO |
$83.51
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE CMCH
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
01299006
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
01299006
|
|
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 PNEUMOCOCCAL VACCINE CMCH
|
Facility
OP
|
$95.12
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
01299003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.53
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Centivo All Commercial |
$48.51
|
| 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: Humana Medicare |
$48.51
|
| Rate for Payer: Lucent All Commercial |
$48.51
|
| 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: Plain Church Group Ministry All Commercial |
$37.09
|
| 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: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$31.39
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE CMCH
|
Facility
IP
|
$95.12
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
01299003
|
|
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
|
|
|
HC ADMIN STRESS ECHO CONTRAS
|
Facility
IP
|
$96.90
|
|
|
Service Code
|
CPT 93352
|
| Hospital Charge Code |
00863352
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$90.12 |
| Rate for Payer: Aetna Commercial |
$83.72
|
| Rate for Payer: Cash Price |
$60.08
|
| Rate for Payer: Cigna All Commercial |
$83.62
|
| Rate for Payer: CORVEL All Commercial |
$90.12
|
| Rate for Payer: Coventry All Commercial |
$85.27
|
| Rate for Payer: Encore All Commercial |
$89.20
|
| Rate for Payer: Frontpath All Commercial |
$89.15
|
| Rate for Payer: Humana ChoiceCare |
$83.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.21
|
| Rate for Payer: PHCS All Commercial |
$72.68
|
| Rate for Payer: PHP All Commercial |
$73.49
|
| Rate for Payer: Sagamore Health Network All Products |
$74.81
|
| Rate for Payer: Signature Care EPO |
$80.43
|
| Rate for Payer: Signature Care PPO |
$85.27
|
| Rate for Payer: United Healthcare Commercial |
$76.36
|
|
|
HC ADMIN STRESS ECHO CONTRAS
|
Facility
OP
|
$96.90
|
|
|
Service Code
|
CPT 93352
|
| Hospital Charge Code |
00863352
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$648.65 |
| Rate for Payer: Aetna Commercial |
$81.78
|
| Rate for Payer: Aetna Medicare |
$31.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.17
|
| Rate for Payer: Cash Price |
$60.08
|
| Rate for Payer: Cash Price |
$60.08
|
| Rate for Payer: Centivo All Commercial |
$49.42
|
| Rate for Payer: Cigna All Commercial |
$83.62
|
| Rate for Payer: CORVEL All Commercial |
$90.12
|
| Rate for Payer: Coventry All Commercial |
$85.27
|
| Rate for Payer: Encore All Commercial |
$89.20
|
| Rate for Payer: Frontpath All Commercial |
$89.15
|
| Rate for Payer: Humana ChoiceCare |
$83.69
|
| Rate for Payer: Humana Medicare |
$49.42
|
| Rate for Payer: Lucent All Commercial |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.21
|
| Rate for Payer: Managed Health Services Medicaid |
$648.65
|
| Rate for Payer: MDWise Medicaid |
$648.65
|
| Rate for Payer: PHCS All Commercial |
$72.68
|
| Rate for Payer: PHP All Commercial |
$73.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.79
|
| Rate for Payer: Sagamore Health Network All Products |
$74.81
|
| Rate for Payer: Signature Care EPO |
$80.43
|
| Rate for Payer: Signature Care PPO |
$85.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.36
|
| Rate for Payer: United Healthcare Commercial |
$76.36
|
| Rate for Payer: United Healthcare Medicare |
$31.98
|
|
|
HC ADMN RSV MONOC ANTB IM CNSL
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
00526380
|
|
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 ADMN RSV MONOC ANTB IM CNSL
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
00526380
|
|
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 ADMN SARSCOV2 VACC 1 DOSE
|
Facility
OP
|
$20.40
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
00520480
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.22
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.41
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Centivo All Commercial |
$10.40
|
| Rate for Payer: Cigna All Commercial |
$17.61
|
| Rate for Payer: CORVEL All Commercial |
$18.97
|
| Rate for Payer: Coventry All Commercial |
$17.95
|
| Rate for Payer: Encore All Commercial |
$18.78
|
| Rate for Payer: Frontpath All Commercial |
$18.77
|
| Rate for Payer: Humana ChoiceCare |
$17.62
|
| Rate for Payer: Humana Medicare |
$10.40
|
| Rate for Payer: Lucent All Commercial |
$10.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.36
|
| Rate for Payer: PHCS All Commercial |
$15.30
|
| Rate for Payer: PHP All Commercial |
$15.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.96
|
| Rate for Payer: Sagamore Health Network All Products |
$15.75
|
| Rate for Payer: Signature Care EPO |
$16.93
|
| Rate for Payer: Signature Care PPO |
$17.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.34
|
| Rate for Payer: United Healthcare Commercial |
$16.08
|
| Rate for Payer: United Healthcare Medicare |
$6.73
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
IP
|
$20.40
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
00520480
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cigna All Commercial |
$17.61
|
| Rate for Payer: CORVEL All Commercial |
$18.97
|
| Rate for Payer: Coventry All Commercial |
$17.95
|
| Rate for Payer: Encore All Commercial |
$18.78
|
| Rate for Payer: Frontpath All Commercial |
$18.77
|
| Rate for Payer: Humana ChoiceCare |
$17.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.36
|
| Rate for Payer: PHCS All Commercial |
$15.30
|
| Rate for Payer: PHP All Commercial |
$15.47
|
| Rate for Payer: Sagamore Health Network All Products |
$15.75
|
| Rate for Payer: Signature Care EPO |
$16.93
|
| Rate for Payer: Signature Care PPO |
$17.95
|
| Rate for Payer: United Healthcare Commercial |
$16.08
|
|
|
HC AEROBIC BACTERIA ID
|
Facility
IP
|
$123.74
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$115.07 |
| Rate for Payer: Aetna Commercial |
$106.91
|
| Rate for Payer: Cash Price |
$76.72
|
| Rate for Payer: Cigna All Commercial |
$106.78
|
| Rate for Payer: CORVEL All Commercial |
$115.07
|
| Rate for Payer: Coventry All Commercial |
$108.89
|
| Rate for Payer: Encore All Commercial |
$113.90
|
| Rate for Payer: Frontpath All Commercial |
$113.84
|
| Rate for Payer: Humana ChoiceCare |
$106.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.36
|
| Rate for Payer: PHCS All Commercial |
$92.80
|
| Rate for Payer: PHP All Commercial |
$93.84
|
| Rate for Payer: Sagamore Health Network All Products |
$95.52
|
| Rate for Payer: Signature Care EPO |
$102.70
|
| Rate for Payer: Signature Care PPO |
$108.89
|
| Rate for Payer: United Healthcare Commercial |
$97.50
|
|
|
HC AEROBIC BACTERIA ID
|
Facility
OP
|
$123.74
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
63001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$115.07 |
| Rate for Payer: Aetna Commercial |
$104.43
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.92
|
| Rate for Payer: Cash Price |
$76.72
|
| Rate for Payer: Cash Price |
$76.72
|
| Rate for Payer: Centivo All Commercial |
$63.11
|
| Rate for Payer: Cigna All Commercial |
$106.78
|
| Rate for Payer: CORVEL All Commercial |
$115.07
|
| Rate for Payer: Coventry All Commercial |
$108.89
|
| Rate for Payer: Encore All Commercial |
$113.90
|
| Rate for Payer: Frontpath All Commercial |
$113.84
|
| Rate for Payer: Humana ChoiceCare |
$106.87
|
| Rate for Payer: Humana Medicare |
$63.11
|
| Rate for Payer: Lucent All Commercial |
$63.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.36
|
| Rate for Payer: Managed Health Services Medicaid |
$8.08
|
| Rate for Payer: MDWise Medicaid |
$8.08
|
| Rate for Payer: PHCS All Commercial |
$92.80
|
| Rate for Payer: PHP All Commercial |
$93.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.26
|
| Rate for Payer: Sagamore Health Network All Products |
$95.52
|
| Rate for Payer: Signature Care EPO |
$102.70
|
| Rate for Payer: Signature Care PPO |
$108.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.18
|
| Rate for Payer: United Healthcare Commercial |
$97.50
|
| Rate for Payer: United Healthcare Medicare |
$40.83
|
|
|
HC AEROBIC CULTURE
|
Facility
OP
|
$323.81
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
63001998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$301.14 |
| Rate for Payer: Aetna Commercial |
$273.29
|
| Rate for Payer: Aetna Medicare |
$106.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.54
|
| Rate for Payer: Cash Price |
$200.76
|
| Rate for Payer: Cash Price |
$200.76
|
| Rate for Payer: Centivo All Commercial |
$165.14
|
| Rate for Payer: Cigna All Commercial |
$279.45
|
| Rate for Payer: CORVEL All Commercial |
$301.14
|
| Rate for Payer: Coventry All Commercial |
$284.95
|
| Rate for Payer: Encore All Commercial |
$298.07
|
| Rate for Payer: Frontpath All Commercial |
$297.90
|
| Rate for Payer: Humana ChoiceCare |
$279.67
|
| Rate for Payer: Humana Medicare |
$165.14
|
| Rate for Payer: Lucent All Commercial |
$165.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.43
|
| Rate for Payer: Managed Health Services Medicaid |
$6.43
|
| Rate for Payer: MDWise Medicaid |
$6.43
|
| Rate for Payer: PHCS All Commercial |
$242.86
|
| Rate for Payer: PHP All Commercial |
$245.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.29
|
| Rate for Payer: Sagamore Health Network All Products |
$249.98
|
| Rate for Payer: Signature Care EPO |
$268.76
|
| Rate for Payer: Signature Care PPO |
$284.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$275.24
|
| Rate for Payer: United Healthcare Commercial |
$255.16
|
| Rate for Payer: United Healthcare Medicare |
$106.86
|
|
|
HC AEROBIC CULTURE
|
Facility
IP
|
$323.81
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
63001998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$242.86 |
| Max. Negotiated Rate |
$301.14 |
| Rate for Payer: Aetna Commercial |
$279.77
|
| Rate for Payer: Cash Price |
$200.76
|
| Rate for Payer: Cigna All Commercial |
$279.45
|
| Rate for Payer: CORVEL All Commercial |
$301.14
|
| Rate for Payer: Coventry All Commercial |
$284.95
|
| Rate for Payer: Encore All Commercial |
$298.07
|
| Rate for Payer: Frontpath All Commercial |
$297.90
|
| Rate for Payer: Humana ChoiceCare |
$279.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.43
|
| Rate for Payer: PHCS All Commercial |
$242.86
|
| Rate for Payer: PHP All Commercial |
$245.58
|
| Rate for Payer: Sagamore Health Network All Products |
$249.98
|
| Rate for Payer: Signature Care EPO |
$268.76
|
| Rate for Payer: Signature Care PPO |
$284.95
|
| Rate for Payer: United Healthcare Commercial |
$255.16
|
|
|
HC AEROBIKA OSCILLATING POSITIVE EXPIRATORY
|
Facility
IP
|
$330.02
|
|
| Hospital Charge Code |
41601818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$247.52 |
| Max. Negotiated Rate |
$306.92 |
| Rate for Payer: Aetna Commercial |
$285.14
|
| Rate for Payer: Cash Price |
$204.61
|
| Rate for Payer: Cigna All Commercial |
$284.81
|
| Rate for Payer: CORVEL All Commercial |
$306.92
|
| Rate for Payer: Coventry All Commercial |
$290.42
|
| Rate for Payer: Encore All Commercial |
$303.78
|
| Rate for Payer: Frontpath All Commercial |
$303.62
|
| Rate for Payer: Humana ChoiceCare |
$285.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.02
|
| Rate for Payer: PHCS All Commercial |
$247.52
|
| Rate for Payer: PHP All Commercial |
$250.29
|
| Rate for Payer: Sagamore Health Network All Products |
$254.78
|
| Rate for Payer: Signature Care EPO |
$273.92
|
| Rate for Payer: Signature Care PPO |
$290.42
|
| Rate for Payer: United Healthcare Commercial |
$260.06
|
|
|
HC AEROBIKA OSCILLATING POSITIVE EXPIRATORY
|
Facility
OP
|
$330.02
|
|
| Hospital Charge Code |
41601818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$306.92 |
| Rate for Payer: Aetna Commercial |
$278.54
|
| Rate for Payer: Aetna Medicare |
$108.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.80
|
| Rate for Payer: Cash Price |
$204.61
|
| Rate for Payer: Cash Price |
$204.61
|
| Rate for Payer: Centivo All Commercial |
$168.31
|
| Rate for Payer: Cigna All Commercial |
$284.81
|
| Rate for Payer: CORVEL All Commercial |
$306.92
|
| Rate for Payer: Coventry All Commercial |
$290.42
|
| Rate for Payer: Encore All Commercial |
$303.78
|
| Rate for Payer: Frontpath All Commercial |
$303.62
|
| Rate for Payer: Humana ChoiceCare |
$285.04
|
| Rate for Payer: Humana Medicare |
$168.31
|
| Rate for Payer: Lucent All Commercial |
$168.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.02
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$247.52
|
| Rate for Payer: PHP All Commercial |
$250.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.71
|
| Rate for Payer: Sagamore Health Network All Products |
$254.78
|
| Rate for Payer: Signature Care EPO |
$273.92
|
| Rate for Payer: Signature Care PPO |
$290.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$280.52
|
| Rate for Payer: United Healthcare Commercial |
$260.06
|
| Rate for Payer: United Healthcare Medicare |
$108.91
|
|
