|
HC BONE SCAN - SINGLE AREA
|
Facility
IP
|
$1,497.45
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
01638300
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,123.09 |
| Max. Negotiated Rate |
$1,392.63 |
| Rate for Payer: Aetna Commercial |
$1,293.80
|
| Rate for Payer: Cash Price |
$928.42
|
| Rate for Payer: Cigna All Commercial |
$1,292.30
|
| Rate for Payer: CORVEL All Commercial |
$1,392.63
|
| Rate for Payer: Coventry All Commercial |
$1,317.76
|
| Rate for Payer: Encore All Commercial |
$1,378.40
|
| Rate for Payer: Frontpath All Commercial |
$1,377.66
|
| Rate for Payer: Humana ChoiceCare |
$1,293.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,347.71
|
| Rate for Payer: PHCS All Commercial |
$1,123.09
|
| Rate for Payer: PHP All Commercial |
$1,135.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.03
|
| Rate for Payer: Signature Care EPO |
$1,242.88
|
| Rate for Payer: Signature Care PPO |
$1,317.76
|
| Rate for Payer: United Healthcare Commercial |
$1,179.99
|
|
|
HC BONE SCAN - SINGLE AREA
|
Facility
OP
|
$1,497.45
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
01638300
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,392.63 |
| Rate for Payer: Aetna Commercial |
$1,263.85
|
| Rate for Payer: Aetna Medicare |
$494.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$494.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$859.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$936.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$412.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$568.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.58
|
| Rate for Payer: Cash Price |
$928.42
|
| Rate for Payer: Cash Price |
$928.42
|
| Rate for Payer: Centivo All Commercial |
$763.70
|
| Rate for Payer: Cigna All Commercial |
$1,292.30
|
| Rate for Payer: CORVEL All Commercial |
$1,392.63
|
| Rate for Payer: Coventry All Commercial |
$1,317.76
|
| Rate for Payer: Encore All Commercial |
$1,378.40
|
| Rate for Payer: Frontpath All Commercial |
$1,377.66
|
| Rate for Payer: Humana ChoiceCare |
$1,293.35
|
| Rate for Payer: Humana Medicare |
$763.70
|
| Rate for Payer: Lucent All Commercial |
$763.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,347.71
|
| Rate for Payer: Managed Health Services Medicaid |
$412.50
|
| Rate for Payer: MDWise Medicaid |
$412.50
|
| Rate for Payer: PHCS All Commercial |
$1,123.09
|
| Rate for Payer: PHP All Commercial |
$1,135.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$584.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.03
|
| Rate for Payer: Signature Care EPO |
$1,242.88
|
| Rate for Payer: Signature Care PPO |
$1,317.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,272.83
|
| Rate for Payer: United Healthcare Commercial |
$1,179.99
|
| Rate for Payer: United Healthcare Medicare |
$494.16
|
|
|
HC BONE SCAN - THREE PHASE
|
Facility
OP
|
$2,491.56
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
01638315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$821.18 |
| Max. Negotiated Rate |
$2,317.15 |
| Rate for Payer: Aetna Commercial |
$2,102.88
|
| Rate for Payer: Aetna Medicare |
$822.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$822.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,430.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,557.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$821.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$945.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$904.44
|
| Rate for Payer: Cash Price |
$1,544.77
|
| Rate for Payer: Cash Price |
$1,544.77
|
| Rate for Payer: Centivo All Commercial |
$1,270.70
|
| Rate for Payer: Cigna All Commercial |
$2,150.22
|
| Rate for Payer: CORVEL All Commercial |
$2,317.15
|
| Rate for Payer: Coventry All Commercial |
$2,192.58
|
| Rate for Payer: Encore All Commercial |
$2,293.48
|
| Rate for Payer: Frontpath All Commercial |
$2,292.24
|
| Rate for Payer: Humana ChoiceCare |
$2,151.96
|
| Rate for Payer: Humana Medicare |
$1,270.70
|
| Rate for Payer: Lucent All Commercial |
$1,270.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,242.41
|
| Rate for Payer: Managed Health Services Medicaid |
$821.18
|
| Rate for Payer: MDWise Medicaid |
$821.18
|
| Rate for Payer: PHCS All Commercial |
$1,868.67
|
| Rate for Payer: PHP All Commercial |
$1,889.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$971.71
|
| Rate for Payer: Sagamore Health Network All Products |
$1,923.49
|
| Rate for Payer: Signature Care EPO |
$2,068.00
|
| Rate for Payer: Signature Care PPO |
$2,192.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,117.83
|
| Rate for Payer: United Healthcare Commercial |
$1,963.35
|
| Rate for Payer: United Healthcare Medicare |
$822.22
|
|
|
HC BONE SCAN - THREE PHASE
|
Facility
IP
|
$2,491.56
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
01638315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,868.67 |
| Max. Negotiated Rate |
$2,317.15 |
| Rate for Payer: Aetna Commercial |
$2,152.71
|
| Rate for Payer: Cash Price |
$1,544.77
|
| Rate for Payer: Cigna All Commercial |
$2,150.22
|
| Rate for Payer: CORVEL All Commercial |
$2,317.15
|
| Rate for Payer: Coventry All Commercial |
$2,192.58
|
| Rate for Payer: Encore All Commercial |
$2,293.48
|
| Rate for Payer: Frontpath All Commercial |
$2,292.24
|
| Rate for Payer: Humana ChoiceCare |
$2,151.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,242.41
|
| Rate for Payer: PHCS All Commercial |
$1,868.67
|
| Rate for Payer: PHP All Commercial |
$1,889.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,923.49
|
| Rate for Payer: Signature Care EPO |
$2,068.00
|
| Rate for Payer: Signature Care PPO |
$2,192.58
|
| Rate for Payer: United Healthcare Commercial |
$1,963.35
|
|
|
HC BONE SCAN - WHOLE BODY
|
Facility
IP
|
$2,275.67
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
01638306
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,706.75 |
| Max. Negotiated Rate |
$2,116.37 |
| Rate for Payer: Aetna Commercial |
$1,966.18
|
| Rate for Payer: Cash Price |
$1,410.92
|
| Rate for Payer: Cigna All Commercial |
$1,963.90
|
| Rate for Payer: CORVEL All Commercial |
$2,116.37
|
| Rate for Payer: Coventry All Commercial |
$2,002.59
|
| Rate for Payer: Encore All Commercial |
$2,094.76
|
| Rate for Payer: Frontpath All Commercial |
$2,093.62
|
| Rate for Payer: Humana ChoiceCare |
$1,965.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,048.10
|
| Rate for Payer: PHCS All Commercial |
$1,706.75
|
| Rate for Payer: PHP All Commercial |
$1,725.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,756.82
|
| Rate for Payer: Signature Care EPO |
$1,888.81
|
| Rate for Payer: Signature Care PPO |
$2,002.59
|
| Rate for Payer: United Healthcare Commercial |
$1,793.23
|
|
|
HC BONE SCAN - WHOLE BODY
|
Facility
OP
|
$2,275.67
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
01638306
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$574.82 |
| Max. Negotiated Rate |
$2,116.37 |
| Rate for Payer: Aetna Commercial |
$1,920.67
|
| Rate for Payer: Aetna Medicare |
$750.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$750.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,306.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,422.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$574.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$863.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$826.07
|
| Rate for Payer: Cash Price |
$1,410.92
|
| Rate for Payer: Cash Price |
$1,410.92
|
| Rate for Payer: Centivo All Commercial |
$1,160.59
|
| Rate for Payer: Cigna All Commercial |
$1,963.90
|
| Rate for Payer: CORVEL All Commercial |
$2,116.37
|
| Rate for Payer: Coventry All Commercial |
$2,002.59
|
| Rate for Payer: Encore All Commercial |
$2,094.76
|
| Rate for Payer: Frontpath All Commercial |
$2,093.62
|
| Rate for Payer: Humana ChoiceCare |
$1,965.50
|
| Rate for Payer: Humana Medicare |
$1,160.59
|
| Rate for Payer: Lucent All Commercial |
$1,160.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,048.10
|
| Rate for Payer: Managed Health Services Medicaid |
$574.82
|
| Rate for Payer: MDWise Medicaid |
$574.82
|
| Rate for Payer: PHCS All Commercial |
$1,706.75
|
| Rate for Payer: PHP All Commercial |
$1,725.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$887.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,756.82
|
| Rate for Payer: Signature Care EPO |
$1,888.81
|
| Rate for Payer: Signature Care PPO |
$2,002.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,934.32
|
| Rate for Payer: United Healthcare Commercial |
$1,793.23
|
| Rate for Payer: United Healthcare Medicare |
$750.97
|
|
|
HC BORDETELLA PERTUS CONFIRM - IMMUNOBLOT
|
Facility
OP
|
$96.75
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001923
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$89.97 |
| Rate for Payer: Aetna Commercial |
$81.65
|
| Rate for Payer: Aetna Medicare |
$31.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.12
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Centivo All Commercial |
$49.34
|
| Rate for Payer: Cigna All Commercial |
$83.49
|
| Rate for Payer: CORVEL All Commercial |
$89.97
|
| Rate for Payer: Coventry All Commercial |
$85.14
|
| Rate for Payer: Encore All Commercial |
$89.06
|
| Rate for Payer: Frontpath All Commercial |
$89.01
|
| Rate for Payer: Humana ChoiceCare |
$83.56
|
| Rate for Payer: Humana Medicare |
$49.34
|
| Rate for Payer: Lucent All Commercial |
$49.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.07
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$72.56
|
| Rate for Payer: PHP All Commercial |
$73.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.73
|
| Rate for Payer: Sagamore Health Network All Products |
$74.69
|
| Rate for Payer: Signature Care EPO |
$80.30
|
| Rate for Payer: Signature Care PPO |
$85.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.23
|
| Rate for Payer: United Healthcare Commercial |
$76.24
|
| Rate for Payer: United Healthcare Medicare |
$31.93
|
|
|
HC BORDETELLA PERTUS CONFIRM - IMMUNOBLOT
|
Facility
IP
|
$96.75
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001923
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$89.97 |
| Rate for Payer: Aetna Commercial |
$83.59
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cigna All Commercial |
$83.49
|
| Rate for Payer: CORVEL All Commercial |
$89.97
|
| Rate for Payer: Coventry All Commercial |
$85.14
|
| Rate for Payer: Encore All Commercial |
$89.06
|
| Rate for Payer: Frontpath All Commercial |
$89.01
|
| Rate for Payer: Humana ChoiceCare |
$83.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.07
|
| Rate for Payer: PHCS All Commercial |
$72.56
|
| Rate for Payer: PHP All Commercial |
$73.37
|
| Rate for Payer: Sagamore Health Network All Products |
$74.69
|
| Rate for Payer: Signature Care EPO |
$80.30
|
| Rate for Payer: Signature Care PPO |
$85.14
|
| Rate for Payer: United Healthcare Commercial |
$76.24
|
|
|
HC BORDETELLA PERTUS CONFIRM IMMUNOBLOT IGG
|
Facility
OP
|
$174.08
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$161.90 |
| Rate for Payer: Aetna Commercial |
$146.93
|
| Rate for Payer: Aetna Medicare |
$57.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.19
|
| Rate for Payer: Cash Price |
$107.93
|
| Rate for Payer: Cash Price |
$107.93
|
| Rate for Payer: Centivo All Commercial |
$88.78
|
| Rate for Payer: Cigna All Commercial |
$150.23
|
| Rate for Payer: CORVEL All Commercial |
$161.90
|
| Rate for Payer: Coventry All Commercial |
$153.19
|
| Rate for Payer: Encore All Commercial |
$160.24
|
| Rate for Payer: Frontpath All Commercial |
$160.16
|
| Rate for Payer: Humana ChoiceCare |
$150.36
|
| Rate for Payer: Humana Medicare |
$88.78
|
| Rate for Payer: Lucent All Commercial |
$88.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.68
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$130.56
|
| Rate for Payer: PHP All Commercial |
$132.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.89
|
| Rate for Payer: Sagamore Health Network All Products |
$134.39
|
| Rate for Payer: Signature Care EPO |
$144.49
|
| Rate for Payer: Signature Care PPO |
$153.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.97
|
| Rate for Payer: United Healthcare Commercial |
$137.18
|
| Rate for Payer: United Healthcare Medicare |
$57.45
|
|
|
HC BORDETELLA PERTUS CONFIRM IMMUNOBLOT IGG
|
Facility
IP
|
$174.08
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$161.90 |
| Rate for Payer: Aetna Commercial |
$150.41
|
| Rate for Payer: Cash Price |
$107.93
|
| Rate for Payer: Cigna All Commercial |
$150.23
|
| Rate for Payer: CORVEL All Commercial |
$161.90
|
| Rate for Payer: Coventry All Commercial |
$153.19
|
| Rate for Payer: Encore All Commercial |
$160.24
|
| Rate for Payer: Frontpath All Commercial |
$160.16
|
| Rate for Payer: Humana ChoiceCare |
$150.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.68
|
| Rate for Payer: PHCS All Commercial |
$130.56
|
| Rate for Payer: PHP All Commercial |
$132.02
|
| Rate for Payer: Sagamore Health Network All Products |
$134.39
|
| Rate for Payer: Signature Care EPO |
$144.49
|
| Rate for Payer: Signature Care PPO |
$153.19
|
| Rate for Payer: United Healthcare Commercial |
$137.18
|
|
|
HC BORDETELLA PERTUS IGG, IGA, IGM
|
Facility
OP
|
$146.12
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63002199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$135.89 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$48.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.04
|
| Rate for Payer: Cash Price |
$90.59
|
| Rate for Payer: Cash Price |
$90.59
|
| Rate for Payer: Centivo All Commercial |
$74.52
|
| Rate for Payer: Cigna All Commercial |
$126.10
|
| Rate for Payer: CORVEL All Commercial |
$135.89
|
| Rate for Payer: Coventry All Commercial |
$128.58
|
| Rate for Payer: Encore All Commercial |
$134.50
|
| Rate for Payer: Frontpath All Commercial |
$134.43
|
| Rate for Payer: Humana ChoiceCare |
$126.20
|
| Rate for Payer: Humana Medicare |
$74.52
|
| Rate for Payer: Lucent All Commercial |
$74.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.50
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$109.59
|
| Rate for Payer: PHP All Commercial |
$110.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.98
|
| Rate for Payer: Sagamore Health Network All Products |
$112.80
|
| Rate for Payer: Signature Care EPO |
$121.28
|
| Rate for Payer: Signature Care PPO |
$128.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.20
|
| Rate for Payer: United Healthcare Commercial |
$115.14
|
| Rate for Payer: United Healthcare Medicare |
$48.22
|
|
|
HC BORDETELLA PERTUS IGG, IGA, IGM
|
Facility
IP
|
$146.12
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63002199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.59 |
| Max. Negotiated Rate |
$135.89 |
| Rate for Payer: Aetna Commercial |
$126.24
|
| Rate for Payer: Cash Price |
$90.59
|
| Rate for Payer: Cigna All Commercial |
$126.10
|
| Rate for Payer: CORVEL All Commercial |
$135.89
|
| Rate for Payer: Coventry All Commercial |
$128.58
|
| Rate for Payer: Encore All Commercial |
$134.50
|
| Rate for Payer: Frontpath All Commercial |
$134.43
|
| Rate for Payer: Humana ChoiceCare |
$126.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.50
|
| Rate for Payer: PHCS All Commercial |
$109.59
|
| Rate for Payer: PHP All Commercial |
$110.81
|
| Rate for Payer: Sagamore Health Network All Products |
$112.80
|
| Rate for Payer: Signature Care EPO |
$121.28
|
| Rate for Payer: Signature Care PPO |
$128.58
|
| Rate for Payer: United Healthcare Commercial |
$115.14
|
|
|
HC BORDETELLA PERTUSSIS-PCR
|
Facility
IP
|
$304.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63001029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.05 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$262.71
|
| Rate for Payer: Cash Price |
$188.52
|
| Rate for Payer: Cigna All Commercial |
$262.41
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.66
|
| Rate for Payer: PHCS All Commercial |
$228.05
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Sagamore Health Network All Products |
$234.74
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
|
|
HC BORDETELLA PERTUSSIS-PCR
|
Facility
OP
|
$304.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63001029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$100.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$174.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.37
|
| Rate for Payer: Cash Price |
$188.52
|
| Rate for Payer: Cash Price |
$188.52
|
| Rate for Payer: Centivo All Commercial |
$155.07
|
| Rate for Payer: Cigna All Commercial |
$262.41
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Humana Medicare |
$155.07
|
| Rate for Payer: Lucent All Commercial |
$155.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.66
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$228.05
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.58
|
| Rate for Payer: Sagamore Health Network All Products |
$234.74
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.45
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
| Rate for Payer: United Healthcare Medicare |
$100.34
|
|
|
HC B PARAPERTUSSIS-PCR
|
Facility
IP
|
$336.84
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63001028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$252.63 |
| Max. Negotiated Rate |
$313.27 |
| Rate for Payer: Aetna Commercial |
$291.03
|
| Rate for Payer: Cash Price |
$208.84
|
| Rate for Payer: Cigna All Commercial |
$290.70
|
| Rate for Payer: CORVEL All Commercial |
$313.27
|
| Rate for Payer: Coventry All Commercial |
$296.42
|
| Rate for Payer: Encore All Commercial |
$310.07
|
| Rate for Payer: Frontpath All Commercial |
$309.90
|
| Rate for Payer: Humana ChoiceCare |
$290.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.16
|
| Rate for Payer: PHCS All Commercial |
$252.63
|
| Rate for Payer: PHP All Commercial |
$255.46
|
| Rate for Payer: Sagamore Health Network All Products |
$260.04
|
| Rate for Payer: Signature Care EPO |
$279.58
|
| Rate for Payer: Signature Care PPO |
$296.42
|
| Rate for Payer: United Healthcare Commercial |
$265.43
|
|
|
HC B PARAPERTUSSIS-PCR
|
Facility
OP
|
$336.84
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63001028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$313.27 |
| Rate for Payer: Aetna Commercial |
$284.30
|
| Rate for Payer: Aetna Medicare |
$111.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$210.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.27
|
| Rate for Payer: Cash Price |
$208.84
|
| Rate for Payer: Cash Price |
$208.84
|
| Rate for Payer: Centivo All Commercial |
$171.79
|
| Rate for Payer: Cigna All Commercial |
$290.70
|
| Rate for Payer: CORVEL All Commercial |
$313.27
|
| Rate for Payer: Coventry All Commercial |
$296.42
|
| Rate for Payer: Encore All Commercial |
$310.07
|
| Rate for Payer: Frontpath All Commercial |
$309.90
|
| Rate for Payer: Humana ChoiceCare |
$290.93
|
| Rate for Payer: Humana Medicare |
$171.79
|
| Rate for Payer: Lucent All Commercial |
$171.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.16
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$252.63
|
| Rate for Payer: PHP All Commercial |
$255.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.37
|
| Rate for Payer: Sagamore Health Network All Products |
$260.04
|
| Rate for Payer: Signature Care EPO |
$279.58
|
| Rate for Payer: Signature Care PPO |
$296.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$286.32
|
| Rate for Payer: United Healthcare Commercial |
$265.43
|
| Rate for Payer: United Healthcare Medicare |
$111.16
|
|
|
HC BRAIN SCAN SPECT
|
Facility
OP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
01638607
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.21 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,880.50
|
| Rate for Payer: Aetna Medicare |
$1,126.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,126.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,960.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,133.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$792.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,295.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,238.89
|
| Rate for Payer: Cash Price |
$2,116.01
|
| Rate for Payer: Cash Price |
$2,116.01
|
| Rate for Payer: Centivo All Commercial |
$1,740.59
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Humana Medicare |
$1,740.59
|
| Rate for Payer: Lucent All Commercial |
$1,740.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: Managed Health Services Medicaid |
$792.21
|
| Rate for Payer: MDWise Medicaid |
$792.21
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,331.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,900.98
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
| Rate for Payer: United Healthcare Medicare |
$1,126.26
|
|
|
HC BRAIN SCAN SPECT
|
Facility
IP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
01638607
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,559.69 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,948.76
|
| Rate for Payer: Cash Price |
$2,116.01
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
|
|
HC BRA VELCRO 28-30 X SMALL
|
Facility
OP
|
$263.48
|
|
| Hospital Charge Code |
41601394
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$222.38
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$151.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.64
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Centivo All Commercial |
$134.37
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Humana Medicare |
$134.37
|
| Rate for Payer: Lucent All Commercial |
$134.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.76
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$223.96
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
| Rate for Payer: United Healthcare Medicare |
$86.95
|
|
|
HC BRA VELCRO 28-30 X SMALL
|
Facility
IP
|
$263.48
|
|
| Hospital Charge Code |
41601394
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$197.61 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$227.65
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
|
|
HC BRA VELCRO 30-32 SMALL
|
Facility
OP
|
$263.48
|
|
| Hospital Charge Code |
41601395
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$222.38
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$151.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.64
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Centivo All Commercial |
$134.37
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Humana Medicare |
$134.37
|
| Rate for Payer: Lucent All Commercial |
$134.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.76
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$223.96
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
| Rate for Payer: United Healthcare Medicare |
$86.95
|
|
|
HC BRA VELCRO 30-32 SMALL
|
Facility
IP
|
$263.48
|
|
| Hospital Charge Code |
41601395
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$197.61 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$227.65
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
|
|
HC BRA VELCRO 34-36 MED
|
Facility
OP
|
$263.48
|
|
| Hospital Charge Code |
41601396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$222.38
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$151.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.64
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Centivo All Commercial |
$134.37
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Humana Medicare |
$134.37
|
| Rate for Payer: Lucent All Commercial |
$134.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.76
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$223.96
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
| Rate for Payer: United Healthcare Medicare |
$86.95
|
|
|
HC BRA VELCRO 34-36 MED
|
Facility
IP
|
$263.48
|
|
| Hospital Charge Code |
41601396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$197.61 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$227.65
|
| Rate for Payer: Cash Price |
$163.36
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
|
|
HC BRA VELCRO 38-40 LRG
|
Facility
IP
|
$274.33
|
|
| Hospital Charge Code |
41601397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$205.75 |
| Max. Negotiated Rate |
$255.13 |
| Rate for Payer: Aetna Commercial |
$237.02
|
| Rate for Payer: Cash Price |
$170.09
|
| Rate for Payer: Cigna All Commercial |
$236.75
|
| Rate for Payer: CORVEL All Commercial |
$255.13
|
| Rate for Payer: Coventry All Commercial |
$241.41
|
| Rate for Payer: Encore All Commercial |
$252.52
|
| Rate for Payer: Frontpath All Commercial |
$252.38
|
| Rate for Payer: Humana ChoiceCare |
$236.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.90
|
| Rate for Payer: PHCS All Commercial |
$205.75
|
| Rate for Payer: PHP All Commercial |
$208.05
|
| Rate for Payer: Sagamore Health Network All Products |
$211.78
|
| Rate for Payer: Signature Care EPO |
$227.69
|
| Rate for Payer: Signature Care PPO |
$241.41
|
| Rate for Payer: United Healthcare Commercial |
$216.17
|
|
