|
HC CA-125
|
Facility
OP
|
$257.86
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
63001205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$239.81 |
| Rate for Payer: Aetna Commercial |
$217.63
|
| Rate for Payer: Aetna Medicare |
$85.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$159.87
|
| Rate for Payer: Cash Price |
$159.87
|
| Rate for Payer: Centivo All Commercial |
$131.51
|
| Rate for Payer: Cigna All Commercial |
$222.53
|
| Rate for Payer: CORVEL All Commercial |
$239.81
|
| Rate for Payer: Coventry All Commercial |
$226.91
|
| Rate for Payer: Encore All Commercial |
$237.36
|
| Rate for Payer: Frontpath All Commercial |
$237.23
|
| Rate for Payer: Humana ChoiceCare |
$222.71
|
| Rate for Payer: Humana Medicare |
$131.51
|
| Rate for Payer: Lucent All Commercial |
$131.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.07
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$193.39
|
| Rate for Payer: PHP All Commercial |
$195.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.56
|
| Rate for Payer: Sagamore Health Network All Products |
$199.06
|
| Rate for Payer: Signature Care EPO |
$214.02
|
| Rate for Payer: Signature Care PPO |
$226.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$219.18
|
| Rate for Payer: United Healthcare Commercial |
$203.19
|
| Rate for Payer: United Healthcare Medicare |
$85.09
|
|
|
HC CA-125
|
Facility
IP
|
$257.86
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
63001205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.39 |
| Max. Negotiated Rate |
$239.81 |
| Rate for Payer: Aetna Commercial |
$222.79
|
| Rate for Payer: Cash Price |
$159.87
|
| Rate for Payer: Cigna All Commercial |
$222.53
|
| Rate for Payer: CORVEL All Commercial |
$239.81
|
| Rate for Payer: Coventry All Commercial |
$226.91
|
| Rate for Payer: Encore All Commercial |
$237.36
|
| Rate for Payer: Frontpath All Commercial |
$237.23
|
| Rate for Payer: Humana ChoiceCare |
$222.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.07
|
| Rate for Payer: PHCS All Commercial |
$193.39
|
| Rate for Payer: PHP All Commercial |
$195.56
|
| Rate for Payer: Sagamore Health Network All Products |
$199.06
|
| Rate for Payer: Signature Care EPO |
$214.02
|
| Rate for Payer: Signature Care PPO |
$226.91
|
| Rate for Payer: United Healthcare Commercial |
$203.19
|
|
|
HC CA 15-3
|
Facility
IP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.54 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Cash Price |
$107.91
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.17
|
| Rate for Payer: Encore All Commercial |
$160.22
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.17
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
|
|
HC CA 15-3
|
Facility
OP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$146.90
|
| Rate for Payer: Aetna Medicare |
$57.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$107.91
|
| Rate for Payer: Cash Price |
$107.91
|
| Rate for Payer: Centivo All Commercial |
$88.77
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.17
|
| Rate for Payer: Encore All Commercial |
$160.22
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Humana Medicare |
$88.77
|
| Rate for Payer: Lucent All Commercial |
$88.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.88
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.94
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
| Rate for Payer: United Healthcare Medicare |
$57.44
|
|
|
HC CA-19-9
|
Facility
OP
|
$228.84
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
63001206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$212.82 |
| Rate for Payer: Aetna Commercial |
$193.14
|
| Rate for Payer: Aetna Medicare |
$75.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.07
|
| Rate for Payer: Cash Price |
$141.88
|
| Rate for Payer: Cash Price |
$141.88
|
| Rate for Payer: Centivo All Commercial |
$116.71
|
| Rate for Payer: Cigna All Commercial |
$197.49
|
| Rate for Payer: CORVEL All Commercial |
$212.82
|
| Rate for Payer: Coventry All Commercial |
$201.38
|
| Rate for Payer: Encore All Commercial |
$210.64
|
| Rate for Payer: Frontpath All Commercial |
$210.53
|
| Rate for Payer: Humana ChoiceCare |
$197.65
|
| Rate for Payer: Humana Medicare |
$116.71
|
| Rate for Payer: Lucent All Commercial |
$116.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.95
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$171.63
|
| Rate for Payer: PHP All Commercial |
$173.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.25
|
| Rate for Payer: Sagamore Health Network All Products |
$176.66
|
| Rate for Payer: Signature Care EPO |
$189.93
|
| Rate for Payer: Signature Care PPO |
$201.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.51
|
| Rate for Payer: United Healthcare Commercial |
$180.32
|
| Rate for Payer: United Healthcare Medicare |
$75.52
|
|
|
HC CA-19-9
|
Facility
IP
|
$228.84
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
63001206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.63 |
| Max. Negotiated Rate |
$212.82 |
| Rate for Payer: Aetna Commercial |
$197.72
|
| Rate for Payer: Cash Price |
$141.88
|
| Rate for Payer: Cigna All Commercial |
$197.49
|
| Rate for Payer: CORVEL All Commercial |
$212.82
|
| Rate for Payer: Coventry All Commercial |
$201.38
|
| Rate for Payer: Encore All Commercial |
$210.64
|
| Rate for Payer: Frontpath All Commercial |
$210.53
|
| Rate for Payer: Humana ChoiceCare |
$197.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.95
|
| Rate for Payer: PHCS All Commercial |
$171.63
|
| Rate for Payer: PHP All Commercial |
$173.55
|
| Rate for Payer: Sagamore Health Network All Products |
$176.66
|
| Rate for Payer: Signature Care EPO |
$189.93
|
| Rate for Payer: Signature Care PPO |
$201.38
|
| Rate for Payer: United Healthcare Commercial |
$180.32
|
|
|
HC CA 27-29
|
Facility
OP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$146.90
|
| Rate for Payer: Aetna Medicare |
$57.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$107.91
|
| Rate for Payer: Cash Price |
$107.91
|
| Rate for Payer: Centivo All Commercial |
$88.77
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.17
|
| Rate for Payer: Encore All Commercial |
$160.22
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Humana Medicare |
$88.77
|
| Rate for Payer: Lucent All Commercial |
$88.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.88
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.94
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
| Rate for Payer: United Healthcare Medicare |
$57.44
|
|
|
HC CA 27-29
|
Facility
IP
|
$174.05
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
63001213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.54 |
| Max. Negotiated Rate |
$161.87 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Cash Price |
$107.91
|
| Rate for Payer: Cigna All Commercial |
$150.21
|
| Rate for Payer: CORVEL All Commercial |
$161.87
|
| Rate for Payer: Coventry All Commercial |
$153.17
|
| Rate for Payer: Encore All Commercial |
$160.22
|
| Rate for Payer: Frontpath All Commercial |
$160.13
|
| Rate for Payer: Humana ChoiceCare |
$150.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.65
|
| Rate for Payer: PHCS All Commercial |
$130.54
|
| Rate for Payer: PHP All Commercial |
$132.00
|
| Rate for Payer: Sagamore Health Network All Products |
$134.37
|
| Rate for Payer: Signature Care EPO |
$144.46
|
| Rate for Payer: Signature Care PPO |
$153.17
|
| Rate for Payer: United Healthcare Commercial |
$137.15
|
|
|
HC CABLE ACC DSPL PSA - EACH
|
Facility
OP
|
$112.50
|
|
| Hospital Charge Code |
41607333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.84
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Centivo All Commercial |
$57.38
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Humana Medicare |
$57.38
|
| Rate for Payer: Lucent All Commercial |
$57.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.88
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.62
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
|
|
HC CABLE ACC DSPL PSA - EACH
|
Facility
IP
|
$112.50
|
|
| Hospital Charge Code |
41607333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
|
|
HC CABLE S-101
|
Facility
IP
|
$562.50
|
|
| Hospital Charge Code |
41607301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.88 |
| Max. Negotiated Rate |
$523.12 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Cash Price |
$348.75
|
| Rate for Payer: Cigna All Commercial |
$485.44
|
| Rate for Payer: CORVEL All Commercial |
$523.12
|
| Rate for Payer: Coventry All Commercial |
$495.00
|
| Rate for Payer: Encore All Commercial |
$517.78
|
| Rate for Payer: Frontpath All Commercial |
$517.50
|
| Rate for Payer: Humana ChoiceCare |
$485.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.25
|
| Rate for Payer: PHCS All Commercial |
$421.88
|
| Rate for Payer: PHP All Commercial |
$426.60
|
| Rate for Payer: Sagamore Health Network All Products |
$434.25
|
| Rate for Payer: Signature Care EPO |
$466.88
|
| Rate for Payer: Signature Care PPO |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$443.25
|
|
|
HC CABLE S-101
|
Facility
OP
|
$562.50
|
|
| Hospital Charge Code |
41607301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$523.12 |
| Rate for Payer: Aetna Commercial |
$474.75
|
| Rate for Payer: Aetna Medicare |
$185.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$323.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$351.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.19
|
| Rate for Payer: Cash Price |
$348.75
|
| Rate for Payer: Cash Price |
$348.75
|
| Rate for Payer: Centivo All Commercial |
$286.88
|
| Rate for Payer: Cigna All Commercial |
$485.44
|
| Rate for Payer: CORVEL All Commercial |
$523.12
|
| Rate for Payer: Coventry All Commercial |
$495.00
|
| Rate for Payer: Encore All Commercial |
$517.78
|
| Rate for Payer: Frontpath All Commercial |
$517.50
|
| Rate for Payer: Humana ChoiceCare |
$485.83
|
| Rate for Payer: Humana Medicare |
$286.88
|
| Rate for Payer: Lucent All Commercial |
$286.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$421.88
|
| Rate for Payer: PHP All Commercial |
$426.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$219.38
|
| Rate for Payer: Sagamore Health Network All Products |
$434.25
|
| Rate for Payer: Signature Care EPO |
$466.88
|
| Rate for Payer: Signature Care PPO |
$495.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$478.12
|
| Rate for Payer: United Healthcare Commercial |
$443.25
|
| Rate for Payer: United Healthcare Medicare |
$185.62
|
|
|
HC CABLE S-101 - EACH
|
Facility
IP
|
$112.50
|
|
| Hospital Charge Code |
41607334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
|
|
HC CABLE S-101 - EACH
|
Facility
OP
|
$112.50
|
|
| Hospital Charge Code |
41607334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.84
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Centivo All Commercial |
$57.38
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Humana Medicare |
$57.38
|
| Rate for Payer: Lucent All Commercial |
$57.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.88
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.62
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
|
|
HC CADMIUM
|
Facility
OP
|
$96.83
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
63001472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$90.05 |
| Rate for Payer: Aetna Commercial |
$81.72
|
| Rate for Payer: Aetna Medicare |
$31.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.15
|
| Rate for Payer: Cash Price |
$60.03
|
| Rate for Payer: Cash Price |
$60.03
|
| Rate for Payer: Centivo All Commercial |
$49.38
|
| Rate for Payer: Cigna All Commercial |
$83.56
|
| Rate for Payer: CORVEL All Commercial |
$90.05
|
| Rate for Payer: Coventry All Commercial |
$85.21
|
| Rate for Payer: Encore All Commercial |
$89.13
|
| Rate for Payer: Frontpath All Commercial |
$89.08
|
| Rate for Payer: Humana ChoiceCare |
$83.63
|
| Rate for Payer: Humana Medicare |
$49.38
|
| Rate for Payer: Lucent All Commercial |
$49.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.15
|
| Rate for Payer: Managed Health Services Medicaid |
$23.64
|
| Rate for Payer: MDWise Medicaid |
$23.64
|
| Rate for Payer: PHCS All Commercial |
$72.62
|
| Rate for Payer: PHP All Commercial |
$73.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.76
|
| Rate for Payer: Sagamore Health Network All Products |
$74.75
|
| Rate for Payer: Signature Care EPO |
$80.37
|
| Rate for Payer: Signature Care PPO |
$85.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.30
|
| Rate for Payer: United Healthcare Commercial |
$76.30
|
| Rate for Payer: United Healthcare Medicare |
$31.95
|
|
|
HC CADMIUM
|
Facility
IP
|
$96.83
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
63001472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$90.05 |
| Rate for Payer: Aetna Commercial |
$83.66
|
| Rate for Payer: Cash Price |
$60.03
|
| Rate for Payer: Cigna All Commercial |
$83.56
|
| Rate for Payer: CORVEL All Commercial |
$90.05
|
| Rate for Payer: Coventry All Commercial |
$85.21
|
| Rate for Payer: Encore All Commercial |
$89.13
|
| Rate for Payer: Frontpath All Commercial |
$89.08
|
| Rate for Payer: Humana ChoiceCare |
$83.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.15
|
| Rate for Payer: PHCS All Commercial |
$72.62
|
| Rate for Payer: PHP All Commercial |
$73.43
|
| Rate for Payer: Sagamore Health Network All Products |
$74.75
|
| Rate for Payer: Signature Care EPO |
$80.37
|
| Rate for Payer: Signature Care PPO |
$85.21
|
| Rate for Payer: United Healthcare Commercial |
$76.30
|
|
|
HC CALCITONIN
|
Facility
OP
|
$319.64
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
63001474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$297.26 |
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna Medicare |
$105.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$183.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$199.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$26.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.03
|
| Rate for Payer: Cash Price |
$198.18
|
| Rate for Payer: Cash Price |
$198.18
|
| Rate for Payer: Centivo All Commercial |
$163.02
|
| Rate for Payer: Cigna All Commercial |
$275.85
|
| Rate for Payer: CORVEL All Commercial |
$297.26
|
| Rate for Payer: Coventry All Commercial |
$281.28
|
| Rate for Payer: Encore All Commercial |
$294.23
|
| Rate for Payer: Frontpath All Commercial |
$294.07
|
| Rate for Payer: Humana ChoiceCare |
$276.07
|
| Rate for Payer: Humana Medicare |
$163.02
|
| Rate for Payer: Lucent All Commercial |
$163.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$287.67
|
| Rate for Payer: Managed Health Services Medicaid |
$26.79
|
| Rate for Payer: MDWise Medicaid |
$26.79
|
| Rate for Payer: PHCS All Commercial |
$239.73
|
| Rate for Payer: PHP All Commercial |
$242.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.66
|
| Rate for Payer: Sagamore Health Network All Products |
$246.76
|
| Rate for Payer: Signature Care EPO |
$265.30
|
| Rate for Payer: Signature Care PPO |
$281.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$271.69
|
| Rate for Payer: United Healthcare Commercial |
$251.87
|
| Rate for Payer: United Healthcare Medicare |
$105.48
|
|
|
HC CALCITONIN
|
Facility
IP
|
$319.64
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
63001474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$239.73 |
| Max. Negotiated Rate |
$297.26 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Cash Price |
$198.18
|
| Rate for Payer: Cigna All Commercial |
$275.85
|
| Rate for Payer: CORVEL All Commercial |
$297.26
|
| Rate for Payer: Coventry All Commercial |
$281.28
|
| Rate for Payer: Encore All Commercial |
$294.23
|
| Rate for Payer: Frontpath All Commercial |
$294.07
|
| Rate for Payer: Humana ChoiceCare |
$276.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$287.67
|
| Rate for Payer: PHCS All Commercial |
$239.73
|
| Rate for Payer: PHP All Commercial |
$242.41
|
| Rate for Payer: Sagamore Health Network All Products |
$246.76
|
| Rate for Payer: Signature Care EPO |
$265.30
|
| Rate for Payer: Signature Care PPO |
$281.28
|
| Rate for Payer: United Healthcare Commercial |
$251.87
|
|
|
HC CALCIUM 24HR URINE
|
Facility
IP
|
$103.22
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
63001086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna All Commercial |
$89.08
|
| Rate for Payer: CORVEL All Commercial |
$96.00
|
| Rate for Payer: Coventry All Commercial |
$90.84
|
| Rate for Payer: Encore All Commercial |
$95.02
|
| Rate for Payer: Frontpath All Commercial |
$94.97
|
| Rate for Payer: Humana ChoiceCare |
$89.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.90
|
| Rate for Payer: PHCS All Commercial |
$77.42
|
| Rate for Payer: PHP All Commercial |
$78.29
|
| Rate for Payer: Sagamore Health Network All Products |
$79.69
|
| Rate for Payer: Signature Care EPO |
$85.68
|
| Rate for Payer: Signature Care PPO |
$90.84
|
| Rate for Payer: United Healthcare Commercial |
$81.34
|
|
|
HC CALCIUM 24HR URINE
|
Facility
OP
|
$103.22
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
63001086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$87.12
|
| Rate for Payer: Aetna Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.47
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Centivo All Commercial |
$52.64
|
| Rate for Payer: Cigna All Commercial |
$89.08
|
| Rate for Payer: CORVEL All Commercial |
$96.00
|
| Rate for Payer: Coventry All Commercial |
$90.84
|
| Rate for Payer: Encore All Commercial |
$95.02
|
| Rate for Payer: Frontpath All Commercial |
$94.97
|
| Rate for Payer: Humana ChoiceCare |
$89.15
|
| Rate for Payer: Humana Medicare |
$52.64
|
| Rate for Payer: Lucent All Commercial |
$52.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.90
|
| Rate for Payer: Managed Health Services Medicaid |
$5.60
|
| Rate for Payer: MDWise Medicaid |
$5.60
|
| Rate for Payer: PHCS All Commercial |
$77.42
|
| Rate for Payer: PHP All Commercial |
$78.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.26
|
| Rate for Payer: Sagamore Health Network All Products |
$79.69
|
| Rate for Payer: Signature Care EPO |
$85.68
|
| Rate for Payer: Signature Care PPO |
$90.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.74
|
| Rate for Payer: United Healthcare Commercial |
$81.34
|
| Rate for Payer: United Healthcare Medicare |
$34.06
|
|
|
HC CALCIUM, IONIZED-BLOOD
|
Facility
OP
|
$64.26
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
63001478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$59.76 |
| Rate for Payer: Aetna Commercial |
$54.24
|
| Rate for Payer: Aetna Medicare |
$21.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.33
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Centivo All Commercial |
$32.77
|
| Rate for Payer: Cigna All Commercial |
$55.46
|
| Rate for Payer: CORVEL All Commercial |
$59.76
|
| Rate for Payer: Coventry All Commercial |
$56.55
|
| Rate for Payer: Encore All Commercial |
$59.15
|
| Rate for Payer: Frontpath All Commercial |
$59.12
|
| Rate for Payer: Humana ChoiceCare |
$55.50
|
| Rate for Payer: Humana Medicare |
$32.77
|
| Rate for Payer: Lucent All Commercial |
$32.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.83
|
| Rate for Payer: Managed Health Services Medicaid |
$9.62
|
| Rate for Payer: MDWise Medicaid |
$9.62
|
| Rate for Payer: PHCS All Commercial |
$48.20
|
| Rate for Payer: PHP All Commercial |
$48.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.06
|
| Rate for Payer: Sagamore Health Network All Products |
$49.61
|
| Rate for Payer: Signature Care EPO |
$53.34
|
| Rate for Payer: Signature Care PPO |
$56.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.62
|
| Rate for Payer: United Healthcare Commercial |
$50.64
|
| Rate for Payer: United Healthcare Medicare |
$21.21
|
|
|
HC CALCIUM, IONIZED-BLOOD
|
Facility
IP
|
$64.26
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
63001478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$59.76 |
| Rate for Payer: Aetna Commercial |
$55.52
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cigna All Commercial |
$55.46
|
| Rate for Payer: CORVEL All Commercial |
$59.76
|
| Rate for Payer: Coventry All Commercial |
$56.55
|
| Rate for Payer: Encore All Commercial |
$59.15
|
| Rate for Payer: Frontpath All Commercial |
$59.12
|
| Rate for Payer: Humana ChoiceCare |
$55.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.83
|
| Rate for Payer: PHCS All Commercial |
$48.20
|
| Rate for Payer: PHP All Commercial |
$48.73
|
| Rate for Payer: Sagamore Health Network All Products |
$49.61
|
| Rate for Payer: Signature Care EPO |
$53.34
|
| Rate for Payer: Signature Care PPO |
$56.55
|
| Rate for Payer: United Healthcare Commercial |
$50.64
|
|
|
HC CALCIUM SERUM
|
Facility
IP
|
$47.14
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
63001092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$43.84 |
| Rate for Payer: Aetna Commercial |
$40.73
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: Cigna All Commercial |
$40.69
|
| Rate for Payer: CORVEL All Commercial |
$43.84
|
| Rate for Payer: Coventry All Commercial |
$41.49
|
| Rate for Payer: Encore All Commercial |
$43.40
|
| Rate for Payer: Frontpath All Commercial |
$43.37
|
| Rate for Payer: Humana ChoiceCare |
$40.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.43
|
| Rate for Payer: PHCS All Commercial |
$35.36
|
| Rate for Payer: PHP All Commercial |
$35.75
|
| Rate for Payer: Sagamore Health Network All Products |
$36.40
|
| Rate for Payer: Signature Care EPO |
$39.13
|
| Rate for Payer: Signature Care PPO |
$41.49
|
| Rate for Payer: United Healthcare Commercial |
$37.15
|
|
|
HC CALCIUM SERUM
|
Facility
OP
|
$47.14
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
63001092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$43.84 |
| Rate for Payer: Aetna Commercial |
$39.79
|
| Rate for Payer: Aetna Medicare |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.11
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: Centivo All Commercial |
$24.04
|
| Rate for Payer: Cigna All Commercial |
$40.69
|
| Rate for Payer: CORVEL All Commercial |
$43.84
|
| Rate for Payer: Coventry All Commercial |
$41.49
|
| Rate for Payer: Encore All Commercial |
$43.40
|
| Rate for Payer: Frontpath All Commercial |
$43.37
|
| Rate for Payer: Humana ChoiceCare |
$40.72
|
| Rate for Payer: Humana Medicare |
$24.04
|
| Rate for Payer: Lucent All Commercial |
$24.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.43
|
| Rate for Payer: Managed Health Services Medicaid |
$5.16
|
| Rate for Payer: MDWise Medicaid |
$5.16
|
| Rate for Payer: PHCS All Commercial |
$35.36
|
| Rate for Payer: PHP All Commercial |
$35.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.39
|
| Rate for Payer: Sagamore Health Network All Products |
$36.40
|
| Rate for Payer: Signature Care EPO |
$39.13
|
| Rate for Payer: Signature Care PPO |
$41.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.07
|
| Rate for Payer: United Healthcare Commercial |
$37.15
|
| Rate for Payer: United Healthcare Medicare |
$15.56
|
|
|
HC CALCIUM UR
|
Facility
IP
|
$47.14
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
63001475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$43.84 |
| Rate for Payer: Aetna Commercial |
$40.73
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: Cigna All Commercial |
$40.69
|
| Rate for Payer: CORVEL All Commercial |
$43.84
|
| Rate for Payer: Coventry All Commercial |
$41.49
|
| Rate for Payer: Encore All Commercial |
$43.40
|
| Rate for Payer: Frontpath All Commercial |
$43.37
|
| Rate for Payer: Humana ChoiceCare |
$40.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.43
|
| Rate for Payer: PHCS All Commercial |
$35.36
|
| Rate for Payer: PHP All Commercial |
$35.75
|
| Rate for Payer: Sagamore Health Network All Products |
$36.40
|
| Rate for Payer: Signature Care EPO |
$39.13
|
| Rate for Payer: Signature Care PPO |
$41.49
|
| Rate for Payer: United Healthcare Commercial |
$37.15
|
|
