|
HC BETA HCG
|
Facility
IP
|
$146.91
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
63001341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.18 |
| Max. Negotiated Rate |
$136.63 |
| Rate for Payer: Aetna Commercial |
$126.93
|
| Rate for Payer: Cash Price |
$91.09
|
| Rate for Payer: Cigna All Commercial |
$126.78
|
| Rate for Payer: CORVEL All Commercial |
$136.63
|
| Rate for Payer: Coventry All Commercial |
$129.28
|
| Rate for Payer: Encore All Commercial |
$135.23
|
| Rate for Payer: Frontpath All Commercial |
$135.16
|
| Rate for Payer: Humana ChoiceCare |
$126.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.22
|
| Rate for Payer: PHCS All Commercial |
$110.18
|
| Rate for Payer: PHP All Commercial |
$111.42
|
| Rate for Payer: Sagamore Health Network All Products |
$113.41
|
| Rate for Payer: Signature Care EPO |
$121.94
|
| Rate for Payer: Signature Care PPO |
$129.28
|
| Rate for Payer: United Healthcare Commercial |
$115.77
|
|
|
HC BETA HCG
|
Facility
OP
|
$146.91
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
63001341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$136.63 |
| Rate for Payer: Aetna Commercial |
$123.99
|
| Rate for Payer: Aetna Medicare |
$48.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.33
|
| Rate for Payer: Cash Price |
$91.09
|
| Rate for Payer: Cash Price |
$91.09
|
| Rate for Payer: Centivo All Commercial |
$74.92
|
| Rate for Payer: Cigna All Commercial |
$126.78
|
| Rate for Payer: CORVEL All Commercial |
$136.63
|
| Rate for Payer: Coventry All Commercial |
$129.28
|
| Rate for Payer: Encore All Commercial |
$135.23
|
| Rate for Payer: Frontpath All Commercial |
$135.16
|
| Rate for Payer: Humana ChoiceCare |
$126.89
|
| Rate for Payer: Humana Medicare |
$74.92
|
| Rate for Payer: Lucent All Commercial |
$74.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.22
|
| Rate for Payer: Managed Health Services Medicaid |
$9.51
|
| Rate for Payer: MDWise Medicaid |
$9.51
|
| Rate for Payer: PHCS All Commercial |
$110.18
|
| Rate for Payer: PHP All Commercial |
$111.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.30
|
| Rate for Payer: Sagamore Health Network All Products |
$113.41
|
| Rate for Payer: Signature Care EPO |
$121.94
|
| Rate for Payer: Signature Care PPO |
$129.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.87
|
| Rate for Payer: United Healthcare Commercial |
$115.77
|
| Rate for Payer: United Healthcare Medicare |
$48.48
|
|
|
HC BETA HCG TUMOR MARKER
|
Facility
IP
|
$146.91
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
63001720
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.18 |
| Max. Negotiated Rate |
$136.63 |
| Rate for Payer: Aetna Commercial |
$126.93
|
| Rate for Payer: Cash Price |
$91.09
|
| Rate for Payer: Cigna All Commercial |
$126.78
|
| Rate for Payer: CORVEL All Commercial |
$136.63
|
| Rate for Payer: Coventry All Commercial |
$129.28
|
| Rate for Payer: Encore All Commercial |
$135.23
|
| Rate for Payer: Frontpath All Commercial |
$135.16
|
| Rate for Payer: Humana ChoiceCare |
$126.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.22
|
| Rate for Payer: PHCS All Commercial |
$110.18
|
| Rate for Payer: PHP All Commercial |
$111.42
|
| Rate for Payer: Sagamore Health Network All Products |
$113.41
|
| Rate for Payer: Signature Care EPO |
$121.94
|
| Rate for Payer: Signature Care PPO |
$129.28
|
| Rate for Payer: United Healthcare Commercial |
$115.77
|
|
|
HC BETA HCG TUMOR MARKER
|
Facility
OP
|
$146.91
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
63001720
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$136.63 |
| Rate for Payer: Aetna Commercial |
$123.99
|
| Rate for Payer: Aetna Medicare |
$48.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.33
|
| Rate for Payer: Cash Price |
$91.09
|
| Rate for Payer: Cash Price |
$91.09
|
| Rate for Payer: Centivo All Commercial |
$74.92
|
| Rate for Payer: Cigna All Commercial |
$126.78
|
| Rate for Payer: CORVEL All Commercial |
$136.63
|
| Rate for Payer: Coventry All Commercial |
$129.28
|
| Rate for Payer: Encore All Commercial |
$135.23
|
| Rate for Payer: Frontpath All Commercial |
$135.16
|
| Rate for Payer: Humana ChoiceCare |
$126.89
|
| Rate for Payer: Humana Medicare |
$74.92
|
| Rate for Payer: Lucent All Commercial |
$74.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.22
|
| Rate for Payer: Managed Health Services Medicaid |
$9.51
|
| Rate for Payer: MDWise Medicaid |
$9.51
|
| Rate for Payer: PHCS All Commercial |
$110.18
|
| Rate for Payer: PHP All Commercial |
$111.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.30
|
| Rate for Payer: Sagamore Health Network All Products |
$113.41
|
| Rate for Payer: Signature Care EPO |
$121.94
|
| Rate for Payer: Signature Care PPO |
$129.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.87
|
| Rate for Payer: United Healthcare Commercial |
$115.77
|
| Rate for Payer: United Healthcare Medicare |
$48.48
|
|
|
HC BETA-HYDROXYBUTYRATE, SERUM OR PLASMA
|
Facility
IP
|
$131.27
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
63001171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.46 |
| Max. Negotiated Rate |
$122.08 |
| Rate for Payer: Cigna All Commercial |
$113.29
|
| Rate for Payer: Aetna Commercial |
$113.42
|
| Rate for Payer: Cash Price |
$81.39
|
| Rate for Payer: CORVEL All Commercial |
$122.08
|
| Rate for Payer: Coventry All Commercial |
$115.52
|
| Rate for Payer: Encore All Commercial |
$120.84
|
| Rate for Payer: Frontpath All Commercial |
$120.77
|
| Rate for Payer: Humana ChoiceCare |
$113.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.15
|
| Rate for Payer: PHCS All Commercial |
$98.46
|
| Rate for Payer: PHP All Commercial |
$99.56
|
| Rate for Payer: Sagamore Health Network All Products |
$101.34
|
| Rate for Payer: Signature Care EPO |
$108.96
|
| Rate for Payer: Signature Care PPO |
$115.52
|
| Rate for Payer: United Healthcare Commercial |
$103.44
|
|
|
HC BETA-HYDROXYBUTYRATE, SERUM OR PLASMA
|
Facility
OP
|
$131.27
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
63001171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$122.08 |
| Rate for Payer: Aetna Commercial |
$110.80
|
| Rate for Payer: Aetna Medicare |
$43.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.65
|
| Rate for Payer: Cash Price |
$81.39
|
| Rate for Payer: Cash Price |
$81.39
|
| Rate for Payer: Centivo All Commercial |
$66.95
|
| Rate for Payer: Cigna All Commercial |
$113.29
|
| Rate for Payer: CORVEL All Commercial |
$122.08
|
| Rate for Payer: Coventry All Commercial |
$115.52
|
| Rate for Payer: Encore All Commercial |
$120.84
|
| Rate for Payer: Frontpath All Commercial |
$120.77
|
| Rate for Payer: Humana ChoiceCare |
$113.38
|
| Rate for Payer: Humana Medicare |
$66.95
|
| Rate for Payer: Lucent All Commercial |
$66.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.15
|
| Rate for Payer: Managed Health Services Medicaid |
$8.17
|
| Rate for Payer: MDWise Medicaid |
$8.17
|
| Rate for Payer: PHCS All Commercial |
$98.46
|
| Rate for Payer: PHP All Commercial |
$99.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.20
|
| Rate for Payer: Sagamore Health Network All Products |
$101.34
|
| Rate for Payer: Signature Care EPO |
$108.96
|
| Rate for Payer: Signature Care PPO |
$115.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.58
|
| Rate for Payer: United Healthcare Commercial |
$103.44
|
| Rate for Payer: United Healthcare Medicare |
$43.32
|
|
|
HC BIL APP COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
IP
|
$393.76
|
|
|
Service Code
|
CPT 29581 50,GP
|
| Hospital Charge Code |
01722010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$295.32 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$340.21
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
|
|
HC BIL APP COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
OP
|
$393.76
|
|
|
Service Code
|
CPT 29581 50,GP
|
| Hospital Charge Code |
01722010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$129.94 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$332.33
|
| Rate for Payer: Aetna Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.94
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Centivo All Commercial |
$200.82
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Humana Medicare |
$200.82
|
| Rate for Payer: Lucent All Commercial |
$200.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.57
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$334.70
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
| Rate for Payer: United Healthcare Medicare |
$129.94
|
|
|
HC BIL APP COMPRESS UPPER ARM/FA/H/F PT
|
Facility
OP
|
$393.76
|
|
|
Service Code
|
CPT 29584 50,GP
|
| Hospital Charge Code |
01722013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$129.94 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$332.33
|
| Rate for Payer: Aetna Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.94
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Centivo All Commercial |
$200.82
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Humana Medicare |
$200.82
|
| Rate for Payer: Lucent All Commercial |
$200.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.57
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$334.70
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
| Rate for Payer: United Healthcare Medicare |
$129.94
|
|
|
HC BIL APP COMPRESS UPPER ARM/FA/H/F PT
|
Facility
IP
|
$393.76
|
|
|
Service Code
|
CPT 29584 50,GP
|
| Hospital Charge Code |
01722013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$295.32 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$340.21
|
| Rate for Payer: Cash Price |
$244.13
|
| Rate for Payer: Cigna All Commercial |
$339.82
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
|
|
HC BILE ACID - FRACT
|
Facility
IP
|
$208.85
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
63001631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.63 |
| Max. Negotiated Rate |
$194.23 |
| Rate for Payer: Aetna Commercial |
$180.44
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cigna All Commercial |
$180.23
|
| Rate for Payer: CORVEL All Commercial |
$194.23
|
| Rate for Payer: Coventry All Commercial |
$183.78
|
| Rate for Payer: Encore All Commercial |
$192.24
|
| Rate for Payer: Frontpath All Commercial |
$192.14
|
| Rate for Payer: Humana ChoiceCare |
$180.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.96
|
| Rate for Payer: PHCS All Commercial |
$156.63
|
| Rate for Payer: PHP All Commercial |
$158.39
|
| Rate for Payer: Sagamore Health Network All Products |
$161.23
|
| Rate for Payer: Signature Care EPO |
$173.34
|
| Rate for Payer: Signature Care PPO |
$183.78
|
| Rate for Payer: United Healthcare Commercial |
$164.57
|
|
|
HC BILE ACID - FRACT
|
Facility
OP
|
$208.85
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
63001631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$194.23 |
| Rate for Payer: Aetna Commercial |
$176.27
|
| Rate for Payer: Aetna Medicare |
$68.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.81
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Centivo All Commercial |
$106.51
|
| Rate for Payer: Cigna All Commercial |
$180.23
|
| Rate for Payer: CORVEL All Commercial |
$194.23
|
| Rate for Payer: Coventry All Commercial |
$183.78
|
| Rate for Payer: Encore All Commercial |
$192.24
|
| Rate for Payer: Frontpath All Commercial |
$192.14
|
| Rate for Payer: Humana ChoiceCare |
$180.38
|
| Rate for Payer: Humana Medicare |
$106.51
|
| Rate for Payer: Lucent All Commercial |
$106.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.96
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$156.63
|
| Rate for Payer: PHP All Commercial |
$158.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.45
|
| Rate for Payer: Sagamore Health Network All Products |
$161.23
|
| Rate for Payer: Signature Care EPO |
$173.34
|
| Rate for Payer: Signature Care PPO |
$183.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.52
|
| Rate for Payer: United Healthcare Commercial |
$164.57
|
| Rate for Payer: United Healthcare Medicare |
$68.92
|
|
|
HC BILIRUBIN DIRECT
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
63001132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$38.83
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.70
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centivo All Commercial |
$23.46
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Humana Medicare |
$23.46
|
| Rate for Payer: Lucent All Commercial |
$23.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: Managed Health Services Medicaid |
$5.02
|
| Rate for Payer: MDWise Medicaid |
$5.02
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.94
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.10
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
|
|
HC BILIRUBIN DIRECT
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
63001132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$39.75
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
|
|
HC BILIRUBIN TOTAL
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
63001141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$39.75
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
|
|
HC BILIRUBIN TOTAL
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
63001141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$38.83
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.70
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centivo All Commercial |
$23.46
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Humana Medicare |
$23.46
|
| Rate for Payer: Lucent All Commercial |
$23.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: Managed Health Services Medicaid |
$5.02
|
| Rate for Payer: MDWise Medicaid |
$5.02
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.94
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.10
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
|
|
HC BIOFEEDBACK-PT
|
Facility
IP
|
$110.89
|
|
|
Service Code
|
CPT 90901 GP
|
| Hospital Charge Code |
01728003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.17 |
| Max. Negotiated Rate |
$103.13 |
| Rate for Payer: Aetna Commercial |
$95.81
|
| Rate for Payer: Cash Price |
$68.76
|
| Rate for Payer: Cigna All Commercial |
$95.70
|
| Rate for Payer: CORVEL All Commercial |
$103.13
|
| Rate for Payer: Coventry All Commercial |
$97.59
|
| Rate for Payer: Encore All Commercial |
$102.08
|
| Rate for Payer: Frontpath All Commercial |
$102.02
|
| Rate for Payer: Humana ChoiceCare |
$95.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.80
|
| Rate for Payer: PHCS All Commercial |
$83.17
|
| Rate for Payer: PHP All Commercial |
$84.10
|
| Rate for Payer: Sagamore Health Network All Products |
$85.61
|
| Rate for Payer: Signature Care EPO |
$92.04
|
| Rate for Payer: Signature Care PPO |
$97.59
|
| Rate for Payer: United Healthcare Commercial |
$87.38
|
|
|
HC BIOFEEDBACK-PT
|
Facility
OP
|
$110.89
|
|
|
Service Code
|
CPT 90901 GP
|
| Hospital Charge Code |
01728003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$103.13 |
| Rate for Payer: Aetna Commercial |
$93.59
|
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.25
|
| Rate for Payer: Cash Price |
$68.76
|
| Rate for Payer: Centivo All Commercial |
$56.56
|
| Rate for Payer: Cigna All Commercial |
$95.70
|
| Rate for Payer: CORVEL All Commercial |
$103.13
|
| Rate for Payer: Coventry All Commercial |
$97.59
|
| Rate for Payer: Encore All Commercial |
$102.08
|
| Rate for Payer: Frontpath All Commercial |
$102.02
|
| Rate for Payer: Humana ChoiceCare |
$95.78
|
| Rate for Payer: Humana Medicare |
$56.56
|
| Rate for Payer: Lucent All Commercial |
$56.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.80
|
| Rate for Payer: PHCS All Commercial |
$83.17
|
| Rate for Payer: PHP All Commercial |
$84.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.25
|
| Rate for Payer: Sagamore Health Network All Products |
$85.61
|
| Rate for Payer: Signature Care EPO |
$92.04
|
| Rate for Payer: Signature Care PPO |
$97.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.26
|
| Rate for Payer: United Healthcare Commercial |
$87.38
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
|
|
HC BIOPRO GR TOE M-P JOINT
|
Facility
OP
|
$7,740.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41602506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,198.20 |
| Rate for Payer: Aetna Commercial |
$6,532.56
|
| Rate for Payer: Aetna Medicare |
$2,554.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,445.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,838.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,937.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,809.62
|
| Rate for Payer: Cash Price |
$4,798.80
|
| Rate for Payer: Cash Price |
$4,798.80
|
| Rate for Payer: Centivo All Commercial |
$3,947.40
|
| Rate for Payer: Cigna All Commercial |
$6,679.62
|
| Rate for Payer: CORVEL All Commercial |
$7,198.20
|
| Rate for Payer: Coventry All Commercial |
$6,811.20
|
| Rate for Payer: Encore All Commercial |
$7,124.67
|
| Rate for Payer: Frontpath All Commercial |
$7,120.80
|
| Rate for Payer: Humana ChoiceCare |
$6,685.04
|
| Rate for Payer: Humana Medicare |
$3,947.40
|
| Rate for Payer: Lucent All Commercial |
$3,947.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,966.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,805.00
|
| Rate for Payer: PHP All Commercial |
$5,870.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,018.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,975.28
|
| Rate for Payer: Signature Care EPO |
$6,424.20
|
| Rate for Payer: Signature Care PPO |
$6,811.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,579.00
|
| Rate for Payer: United Healthcare Commercial |
$6,099.12
|
| Rate for Payer: United Healthcare Medicare |
$2,554.20
|
|
|
HC BIOPRO GR TOE M-P JOINT
|
Facility
IP
|
$7,740.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41602506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,805.00 |
| Max. Negotiated Rate |
$7,198.20 |
| Rate for Payer: Aetna Commercial |
$6,687.36
|
| Rate for Payer: Cash Price |
$4,798.80
|
| Rate for Payer: Cigna All Commercial |
$6,679.62
|
| Rate for Payer: CORVEL All Commercial |
$7,198.20
|
| Rate for Payer: Coventry All Commercial |
$6,811.20
|
| Rate for Payer: Encore All Commercial |
$7,124.67
|
| Rate for Payer: Frontpath All Commercial |
$7,120.80
|
| Rate for Payer: Humana ChoiceCare |
$6,685.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,966.00
|
| Rate for Payer: PHCS All Commercial |
$5,805.00
|
| Rate for Payer: PHP All Commercial |
$5,870.02
|
| Rate for Payer: Sagamore Health Network All Products |
$5,975.28
|
| Rate for Payer: Signature Care EPO |
$6,424.20
|
| Rate for Payer: Signature Care PPO |
$6,811.20
|
| Rate for Payer: United Healthcare Commercial |
$6,099.12
|
|
|
HC BIOPSY FCP BRONCH
|
Facility
OP
|
$698.88
|
|
| Hospital Charge Code |
41602261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$649.96 |
| Rate for Payer: Aetna Commercial |
$589.85
|
| Rate for Payer: Aetna Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$436.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.69
|
| Rate for Payer: Cash Price |
$433.31
|
| Rate for Payer: Cash Price |
$433.31
|
| Rate for Payer: Centivo All Commercial |
$356.43
|
| Rate for Payer: Cigna All Commercial |
$603.13
|
| Rate for Payer: CORVEL All Commercial |
$649.96
|
| Rate for Payer: Coventry All Commercial |
$615.01
|
| Rate for Payer: Encore All Commercial |
$643.32
|
| Rate for Payer: Frontpath All Commercial |
$642.97
|
| Rate for Payer: Humana ChoiceCare |
$603.62
|
| Rate for Payer: Humana Medicare |
$356.43
|
| Rate for Payer: Lucent All Commercial |
$356.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.99
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$524.16
|
| Rate for Payer: PHP All Commercial |
$530.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.56
|
| Rate for Payer: Sagamore Health Network All Products |
$539.54
|
| Rate for Payer: Signature Care EPO |
$580.07
|
| Rate for Payer: Signature Care PPO |
$615.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.05
|
| Rate for Payer: United Healthcare Commercial |
$550.72
|
| Rate for Payer: United Healthcare Medicare |
$230.63
|
|
|
HC BIOPSY FCP BRONCH
|
Facility
IP
|
$698.88
|
|
| Hospital Charge Code |
41602261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$649.96 |
| Rate for Payer: Aetna Commercial |
$603.83
|
| Rate for Payer: Cash Price |
$433.31
|
| Rate for Payer: Cigna All Commercial |
$603.13
|
| Rate for Payer: CORVEL All Commercial |
$649.96
|
| Rate for Payer: Coventry All Commercial |
$615.01
|
| Rate for Payer: Encore All Commercial |
$643.32
|
| Rate for Payer: Frontpath All Commercial |
$642.97
|
| Rate for Payer: Humana ChoiceCare |
$603.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.99
|
| Rate for Payer: PHCS All Commercial |
$524.16
|
| Rate for Payer: PHP All Commercial |
$530.03
|
| Rate for Payer: Sagamore Health Network All Products |
$539.54
|
| Rate for Payer: Signature Care EPO |
$580.07
|
| Rate for Payer: Signature Care PPO |
$615.01
|
| Rate for Payer: United Healthcare Commercial |
$550.72
|
|
|
HC BIOPSY FCP COLON HOT
|
Facility
OP
|
$120.06
|
|
| Hospital Charge Code |
41601896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$101.33
|
| Rate for Payer: Aetna Medicare |
$39.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.58
|
| Rate for Payer: Cash Price |
$74.44
|
| Rate for Payer: Cash Price |
$74.44
|
| Rate for Payer: Centivo All Commercial |
$61.23
|
| Rate for Payer: Cigna All Commercial |
$103.61
|
| Rate for Payer: CORVEL All Commercial |
$111.66
|
| Rate for Payer: Coventry All Commercial |
$105.65
|
| Rate for Payer: Encore All Commercial |
$110.52
|
| Rate for Payer: Frontpath All Commercial |
$110.46
|
| Rate for Payer: Humana ChoiceCare |
$103.70
|
| Rate for Payer: Humana Medicare |
$61.23
|
| Rate for Payer: Lucent All Commercial |
$61.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$90.04
|
| Rate for Payer: PHP All Commercial |
$91.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.82
|
| Rate for Payer: Sagamore Health Network All Products |
$92.69
|
| Rate for Payer: Signature Care EPO |
$99.65
|
| Rate for Payer: Signature Care PPO |
$105.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.05
|
| Rate for Payer: United Healthcare Commercial |
$94.61
|
| Rate for Payer: United Healthcare Medicare |
$39.62
|
|
|
HC BIOPSY FCP COLON HOT
|
Facility
IP
|
$120.06
|
|
| Hospital Charge Code |
41601896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.04 |
| Max. Negotiated Rate |
$111.66 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Cash Price |
$74.44
|
| Rate for Payer: Cigna All Commercial |
$103.61
|
| Rate for Payer: CORVEL All Commercial |
$111.66
|
| Rate for Payer: Coventry All Commercial |
$105.65
|
| Rate for Payer: Encore All Commercial |
$110.52
|
| Rate for Payer: Frontpath All Commercial |
$110.46
|
| Rate for Payer: Humana ChoiceCare |
$103.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.05
|
| Rate for Payer: PHCS All Commercial |
$90.04
|
| Rate for Payer: PHP All Commercial |
$91.05
|
| Rate for Payer: Sagamore Health Network All Products |
$92.69
|
| Rate for Payer: Signature Care EPO |
$99.65
|
| Rate for Payer: Signature Care PPO |
$105.65
|
| Rate for Payer: United Healthcare Commercial |
$94.61
|
|
|
HC BIOPSY FCP RADIAL 4 HOT
|
Facility
OP
|
$187.46
|
|
| Hospital Charge Code |
41608212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$174.34 |
| Rate for Payer: Aetna Commercial |
$158.22
|
| Rate for Payer: Aetna Medicare |
$61.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.05
|
| Rate for Payer: Cash Price |
$116.23
|
| Rate for Payer: Cash Price |
$116.23
|
| Rate for Payer: Centivo All Commercial |
$95.60
|
| Rate for Payer: Cigna All Commercial |
$161.78
|
| Rate for Payer: CORVEL All Commercial |
$174.34
|
| Rate for Payer: Coventry All Commercial |
$164.96
|
| Rate for Payer: Encore All Commercial |
$172.56
|
| Rate for Payer: Frontpath All Commercial |
$172.46
|
| Rate for Payer: Humana ChoiceCare |
$161.91
|
| Rate for Payer: Humana Medicare |
$95.60
|
| Rate for Payer: Lucent All Commercial |
$95.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.60
|
| Rate for Payer: PHP All Commercial |
$142.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.11
|
| Rate for Payer: Sagamore Health Network All Products |
$144.72
|
| Rate for Payer: Signature Care EPO |
$155.59
|
| Rate for Payer: Signature Care PPO |
$164.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.34
|
| Rate for Payer: United Healthcare Commercial |
$147.72
|
| Rate for Payer: United Healthcare Medicare |
$61.86
|
|
