|
HC CAUTERY FORCE TRI VERSE
|
Facility
IP
|
$299.36
|
|
| Hospital Charge Code |
41601866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.52 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$258.65
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cigna All Commercial |
$258.35
|
| Rate for Payer: CORVEL All Commercial |
$278.40
|
| Rate for Payer: Coventry All Commercial |
$263.44
|
| Rate for Payer: Encore All Commercial |
$275.56
|
| Rate for Payer: Frontpath All Commercial |
$275.41
|
| Rate for Payer: Humana ChoiceCare |
$258.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.42
|
| Rate for Payer: PHCS All Commercial |
$224.52
|
| Rate for Payer: PHP All Commercial |
$227.03
|
| Rate for Payer: Sagamore Health Network All Products |
$231.11
|
| Rate for Payer: Signature Care EPO |
$248.47
|
| Rate for Payer: Signature Care PPO |
$263.44
|
| Rate for Payer: United Healthcare Commercial |
$235.90
|
|
|
HC CBC/AUTO
|
Facility
OP
|
$80.82
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna Commercial |
$68.22
|
| Rate for Payer: Aetna Medicare |
$26.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.34
|
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Centivo All Commercial |
$41.22
|
| Rate for Payer: Cigna All Commercial |
$69.75
|
| Rate for Payer: CORVEL All Commercial |
$75.17
|
| Rate for Payer: Coventry All Commercial |
$71.13
|
| Rate for Payer: Encore All Commercial |
$74.40
|
| Rate for Payer: Frontpath All Commercial |
$74.36
|
| Rate for Payer: Humana ChoiceCare |
$69.81
|
| Rate for Payer: Humana Medicare |
$41.22
|
| Rate for Payer: Lucent All Commercial |
$41.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.74
|
| Rate for Payer: Managed Health Services Medicaid |
$7.77
|
| Rate for Payer: MDWise Medicaid |
$7.77
|
| Rate for Payer: PHCS All Commercial |
$60.62
|
| Rate for Payer: PHP All Commercial |
$61.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.52
|
| Rate for Payer: Sagamore Health Network All Products |
$62.40
|
| Rate for Payer: Signature Care EPO |
$67.08
|
| Rate for Payer: Signature Care PPO |
$71.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.70
|
| Rate for Payer: United Healthcare Commercial |
$63.69
|
| Rate for Payer: United Healthcare Medicare |
$26.67
|
|
|
HC CBC/AUTO
|
Facility
IP
|
$80.82
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna Commercial |
$69.83
|
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Cigna All Commercial |
$69.75
|
| Rate for Payer: CORVEL All Commercial |
$75.17
|
| Rate for Payer: Coventry All Commercial |
$71.13
|
| Rate for Payer: Encore All Commercial |
$74.40
|
| Rate for Payer: Frontpath All Commercial |
$74.36
|
| Rate for Payer: Humana ChoiceCare |
$69.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.74
|
| Rate for Payer: PHCS All Commercial |
$60.62
|
| Rate for Payer: PHP All Commercial |
$61.30
|
| Rate for Payer: Sagamore Health Network All Products |
$62.40
|
| Rate for Payer: Signature Care EPO |
$67.08
|
| Rate for Payer: Signature Care PPO |
$71.13
|
| Rate for Payer: United Healthcare Commercial |
$63.69
|
|
|
HC CBC/AUTO DIFFERENTIAL
|
Facility
IP
|
$80.82
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna Commercial |
$69.83
|
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Cigna All Commercial |
$69.75
|
| Rate for Payer: CORVEL All Commercial |
$75.17
|
| Rate for Payer: Coventry All Commercial |
$71.13
|
| Rate for Payer: Encore All Commercial |
$74.40
|
| Rate for Payer: Frontpath All Commercial |
$74.36
|
| Rate for Payer: Humana ChoiceCare |
$69.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.74
|
| Rate for Payer: PHCS All Commercial |
$60.62
|
| Rate for Payer: PHP All Commercial |
$61.30
|
| Rate for Payer: Sagamore Health Network All Products |
$62.40
|
| Rate for Payer: Signature Care EPO |
$67.08
|
| Rate for Payer: Signature Care PPO |
$71.13
|
| Rate for Payer: United Healthcare Commercial |
$63.69
|
|
|
HC CBC/AUTO DIFFERENTIAL
|
Facility
OP
|
$80.82
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
63001220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna Commercial |
$68.22
|
| Rate for Payer: Aetna Medicare |
$26.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.34
|
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Centivo All Commercial |
$41.22
|
| Rate for Payer: Cigna All Commercial |
$69.75
|
| Rate for Payer: CORVEL All Commercial |
$75.17
|
| Rate for Payer: Coventry All Commercial |
$71.13
|
| Rate for Payer: Encore All Commercial |
$74.40
|
| Rate for Payer: Frontpath All Commercial |
$74.36
|
| Rate for Payer: Humana ChoiceCare |
$69.81
|
| Rate for Payer: Humana Medicare |
$41.22
|
| Rate for Payer: Lucent All Commercial |
$41.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.74
|
| Rate for Payer: Managed Health Services Medicaid |
$7.77
|
| Rate for Payer: MDWise Medicaid |
$7.77
|
| Rate for Payer: PHCS All Commercial |
$60.62
|
| Rate for Payer: PHP All Commercial |
$61.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.52
|
| Rate for Payer: Sagamore Health Network All Products |
$62.40
|
| Rate for Payer: Signature Care EPO |
$67.08
|
| Rate for Payer: Signature Care PPO |
$71.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.70
|
| Rate for Payer: United Healthcare Commercial |
$63.69
|
| Rate for Payer: United Healthcare Medicare |
$26.67
|
|
|
HC CBC W/OUT DIFF
|
Facility
OP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$49.29
|
| Rate for Payer: Aetna Medicare |
$19.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.20
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Centivo All Commercial |
$29.79
|
| Rate for Payer: Cigna All Commercial |
$50.40
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.76
|
| Rate for Payer: Frontpath All Commercial |
$53.73
|
| Rate for Payer: Humana ChoiceCare |
$50.44
|
| Rate for Payer: Humana Medicare |
$29.79
|
| Rate for Payer: Lucent All Commercial |
$29.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.56
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$43.80
|
| Rate for Payer: PHP All Commercial |
$44.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.78
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.64
|
| Rate for Payer: United Healthcare Commercial |
$46.02
|
| Rate for Payer: United Healthcare Medicare |
$19.27
|
|
|
HC CBC W/OUT DIFF
|
Facility
IP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$50.46
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cigna All Commercial |
$50.40
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.76
|
| Rate for Payer: Frontpath All Commercial |
$53.73
|
| Rate for Payer: Humana ChoiceCare |
$50.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.56
|
| Rate for Payer: PHCS All Commercial |
$43.80
|
| Rate for Payer: PHP All Commercial |
$44.29
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: United Healthcare Commercial |
$46.02
|
|
|
HC CBC W/OUT DIFFERENTIAL
|
Facility
OP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$49.29
|
| Rate for Payer: Aetna Medicare |
$19.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.20
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Centivo All Commercial |
$29.79
|
| Rate for Payer: Cigna All Commercial |
$50.40
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.76
|
| Rate for Payer: Frontpath All Commercial |
$53.73
|
| Rate for Payer: Humana ChoiceCare |
$50.44
|
| Rate for Payer: Humana Medicare |
$29.79
|
| Rate for Payer: Lucent All Commercial |
$29.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.56
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$43.80
|
| Rate for Payer: PHP All Commercial |
$44.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.78
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.64
|
| Rate for Payer: United Healthcare Commercial |
$46.02
|
| Rate for Payer: United Healthcare Medicare |
$19.27
|
|
|
HC CBC W/OUT DIFFERENTIAL
|
Facility
IP
|
$58.41
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
63001245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna Commercial |
$50.46
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cigna All Commercial |
$50.40
|
| Rate for Payer: CORVEL All Commercial |
$54.32
|
| Rate for Payer: Coventry All Commercial |
$51.40
|
| Rate for Payer: Encore All Commercial |
$53.76
|
| Rate for Payer: Frontpath All Commercial |
$53.73
|
| Rate for Payer: Humana ChoiceCare |
$50.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.56
|
| Rate for Payer: PHCS All Commercial |
$43.80
|
| Rate for Payer: PHP All Commercial |
$44.29
|
| Rate for Payer: Sagamore Health Network All Products |
$45.09
|
| Rate for Payer: Signature Care EPO |
$48.48
|
| Rate for Payer: Signature Care PPO |
$51.40
|
| Rate for Payer: United Healthcare Commercial |
$46.02
|
|
|
HC CCCMCH - RESPIRATORY PANEL (COV2, FLU A/B, RSV) BY PCR
|
Facility
OP
|
$268.52
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
63087637
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$226.63
|
| Rate for Payer: Aetna Medicare |
$88.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$167.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$142.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.47
|
| Rate for Payer: Cash Price |
$166.48
|
| Rate for Payer: Cash Price |
$166.48
|
| Rate for Payer: Centivo All Commercial |
$136.94
|
| Rate for Payer: Cigna All Commercial |
$231.73
|
| Rate for Payer: CORVEL All Commercial |
$249.72
|
| Rate for Payer: Coventry All Commercial |
$236.29
|
| Rate for Payer: Encore All Commercial |
$247.17
|
| Rate for Payer: Frontpath All Commercial |
$247.03
|
| Rate for Payer: Humana ChoiceCare |
$231.92
|
| Rate for Payer: Humana Medicare |
$136.94
|
| Rate for Payer: Lucent All Commercial |
$136.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.66
|
| Rate for Payer: Managed Health Services Medicaid |
$142.63
|
| Rate for Payer: MDWise Medicaid |
$142.63
|
| Rate for Payer: PHCS All Commercial |
$201.39
|
| Rate for Payer: PHP All Commercial |
$203.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.72
|
| Rate for Payer: Sagamore Health Network All Products |
$207.29
|
| Rate for Payer: Signature Care EPO |
$222.87
|
| Rate for Payer: Signature Care PPO |
$236.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$228.24
|
| Rate for Payer: United Healthcare Commercial |
$211.59
|
| Rate for Payer: United Healthcare Medicare |
$88.61
|
|
|
HC CCCMCH - RESPIRATORY PANEL (COV2, FLU A/B, RSV) BY PCR
|
Facility
IP
|
$268.52
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
63087637
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.39 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$232.00
|
| Rate for Payer: Cash Price |
$166.48
|
| Rate for Payer: Cigna All Commercial |
$231.73
|
| Rate for Payer: CORVEL All Commercial |
$249.72
|
| Rate for Payer: Coventry All Commercial |
$236.29
|
| Rate for Payer: Encore All Commercial |
$247.17
|
| Rate for Payer: Frontpath All Commercial |
$247.03
|
| Rate for Payer: Humana ChoiceCare |
$231.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.66
|
| Rate for Payer: PHCS All Commercial |
$201.39
|
| Rate for Payer: PHP All Commercial |
$203.64
|
| Rate for Payer: Sagamore Health Network All Products |
$207.29
|
| Rate for Payer: Signature Care EPO |
$222.87
|
| Rate for Payer: Signature Care PPO |
$236.29
|
| Rate for Payer: United Healthcare Commercial |
$211.59
|
|
|
HC CD4&TCELL LYMPHS
|
Facility
OP
|
$206.08
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
63001046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$191.66 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: Aetna Medicare |
$68.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$26.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.81
|
| Rate for Payer: Cash Price |
$127.77
|
| Rate for Payer: Cash Price |
$127.77
|
| Rate for Payer: Centivo All Commercial |
$105.10
|
| Rate for Payer: Cigna All Commercial |
$177.85
|
| Rate for Payer: CORVEL All Commercial |
$191.66
|
| Rate for Payer: Coventry All Commercial |
$181.35
|
| Rate for Payer: Encore All Commercial |
$189.70
|
| Rate for Payer: Frontpath All Commercial |
$189.59
|
| Rate for Payer: Humana ChoiceCare |
$177.99
|
| Rate for Payer: Humana Medicare |
$105.10
|
| Rate for Payer: Lucent All Commercial |
$105.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.47
|
| Rate for Payer: Managed Health Services Medicaid |
$26.78
|
| Rate for Payer: MDWise Medicaid |
$26.78
|
| Rate for Payer: PHCS All Commercial |
$154.56
|
| Rate for Payer: PHP All Commercial |
$156.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.37
|
| Rate for Payer: Sagamore Health Network All Products |
$159.09
|
| Rate for Payer: Signature Care EPO |
$171.05
|
| Rate for Payer: Signature Care PPO |
$181.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.17
|
| Rate for Payer: United Healthcare Commercial |
$162.39
|
| Rate for Payer: United Healthcare Medicare |
$68.01
|
|
|
HC CD4&TCELL LYMPHS
|
Facility
IP
|
$206.08
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
63001046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$191.66 |
| Rate for Payer: Aetna Commercial |
$178.05
|
| Rate for Payer: Cash Price |
$127.77
|
| Rate for Payer: Cigna All Commercial |
$177.85
|
| Rate for Payer: CORVEL All Commercial |
$191.66
|
| Rate for Payer: Coventry All Commercial |
$181.35
|
| Rate for Payer: Encore All Commercial |
$189.70
|
| Rate for Payer: Frontpath All Commercial |
$189.59
|
| Rate for Payer: Humana ChoiceCare |
$177.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.47
|
| Rate for Payer: PHCS All Commercial |
$154.56
|
| Rate for Payer: PHP All Commercial |
$156.29
|
| Rate for Payer: Sagamore Health Network All Products |
$159.09
|
| Rate for Payer: Signature Care EPO |
$171.05
|
| Rate for Payer: Signature Care PPO |
$181.35
|
| Rate for Payer: United Healthcare Commercial |
$162.39
|
|
|
HC C DIFF AG TOXIN A & B-FECES, NAA IF IND
|
Facility
OP
|
$52.47
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
63001083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$44.28
|
| Rate for Payer: Aetna Medicare |
$17.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.05
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Centivo All Commercial |
$26.76
|
| Rate for Payer: Cigna All Commercial |
$45.28
|
| Rate for Payer: CORVEL All Commercial |
$48.80
|
| Rate for Payer: Coventry All Commercial |
$46.17
|
| Rate for Payer: Encore All Commercial |
$48.30
|
| Rate for Payer: Frontpath All Commercial |
$48.27
|
| Rate for Payer: Humana ChoiceCare |
$45.32
|
| Rate for Payer: Humana Medicare |
$26.76
|
| Rate for Payer: Lucent All Commercial |
$26.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.22
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$39.35
|
| Rate for Payer: PHP All Commercial |
$39.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.46
|
| Rate for Payer: Sagamore Health Network All Products |
$40.51
|
| Rate for Payer: Signature Care EPO |
$43.55
|
| Rate for Payer: Signature Care PPO |
$46.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.60
|
| Rate for Payer: United Healthcare Commercial |
$41.35
|
| Rate for Payer: United Healthcare Medicare |
$17.31
|
|
|
HC C DIFF AG TOXIN A & B-FECES, NAA IF IND
|
Facility
IP
|
$52.47
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
63001083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.35 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$45.33
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cigna All Commercial |
$45.28
|
| Rate for Payer: CORVEL All Commercial |
$48.80
|
| Rate for Payer: Coventry All Commercial |
$46.17
|
| Rate for Payer: Encore All Commercial |
$48.30
|
| Rate for Payer: Frontpath All Commercial |
$48.27
|
| Rate for Payer: Humana ChoiceCare |
$45.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.22
|
| Rate for Payer: PHCS All Commercial |
$39.35
|
| Rate for Payer: PHP All Commercial |
$39.79
|
| Rate for Payer: Sagamore Health Network All Products |
$40.51
|
| Rate for Payer: Signature Care EPO |
$43.55
|
| Rate for Payer: Signature Care PPO |
$46.17
|
| Rate for Payer: United Healthcare Commercial |
$41.35
|
|
|
HC C DIFFICILE CULTURE W/CYTOTOXIN IF IND
|
Facility
OP
|
$206.04
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63002000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$173.90
|
| Rate for Payer: Aetna Medicare |
$67.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.79
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Centivo All Commercial |
$105.08
|
| Rate for Payer: Cigna All Commercial |
$177.81
|
| Rate for Payer: CORVEL All Commercial |
$191.62
|
| Rate for Payer: Coventry All Commercial |
$181.32
|
| Rate for Payer: Encore All Commercial |
$189.66
|
| Rate for Payer: Frontpath All Commercial |
$189.56
|
| Rate for Payer: Humana ChoiceCare |
$177.96
|
| Rate for Payer: Humana Medicare |
$105.08
|
| Rate for Payer: Lucent All Commercial |
$105.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.44
|
| Rate for Payer: Managed Health Services Medicaid |
$8.48
|
| Rate for Payer: MDWise Medicaid |
$8.48
|
| Rate for Payer: PHCS All Commercial |
$154.53
|
| Rate for Payer: PHP All Commercial |
$156.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.36
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$171.01
|
| Rate for Payer: Signature Care PPO |
$181.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.13
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
| Rate for Payer: United Healthcare Medicare |
$67.99
|
|
|
HC C DIFFICILE CULTURE W/CYTOTOXIN IF IND
|
Facility
IP
|
$206.04
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63002000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.53 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$178.02
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Cigna All Commercial |
$177.81
|
| Rate for Payer: CORVEL All Commercial |
$191.62
|
| Rate for Payer: Coventry All Commercial |
$181.32
|
| Rate for Payer: Encore All Commercial |
$189.66
|
| Rate for Payer: Frontpath All Commercial |
$189.56
|
| Rate for Payer: Humana ChoiceCare |
$177.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.44
|
| Rate for Payer: PHCS All Commercial |
$154.53
|
| Rate for Payer: PHP All Commercial |
$156.26
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$171.01
|
| Rate for Payer: Signature Care PPO |
$181.32
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
|
|
HC C DIFFICILE CYTOTOXIN
|
Facility
OP
|
$136.14
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
63002018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$126.61 |
| Rate for Payer: Aetna Commercial |
$114.90
|
| Rate for Payer: Aetna Medicare |
$44.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.42
|
| Rate for Payer: Cash Price |
$84.41
|
| Rate for Payer: Cash Price |
$84.41
|
| Rate for Payer: Centivo All Commercial |
$69.43
|
| Rate for Payer: Cigna All Commercial |
$117.49
|
| Rate for Payer: CORVEL All Commercial |
$126.61
|
| Rate for Payer: Coventry All Commercial |
$119.80
|
| Rate for Payer: Encore All Commercial |
$125.32
|
| Rate for Payer: Frontpath All Commercial |
$125.25
|
| Rate for Payer: Humana ChoiceCare |
$117.58
|
| Rate for Payer: Humana Medicare |
$69.43
|
| Rate for Payer: Lucent All Commercial |
$69.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.53
|
| Rate for Payer: Managed Health Services Medicaid |
$13.70
|
| Rate for Payer: MDWise Medicaid |
$13.70
|
| Rate for Payer: PHCS All Commercial |
$102.10
|
| Rate for Payer: PHP All Commercial |
$103.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.09
|
| Rate for Payer: Sagamore Health Network All Products |
$105.10
|
| Rate for Payer: Signature Care EPO |
$113.00
|
| Rate for Payer: Signature Care PPO |
$119.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.72
|
| Rate for Payer: United Healthcare Commercial |
$107.28
|
| Rate for Payer: United Healthcare Medicare |
$44.93
|
|
|
HC C DIFFICILE CYTOTOXIN
|
Facility
IP
|
$136.14
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
63002018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$126.61 |
| Rate for Payer: Aetna Commercial |
$117.62
|
| Rate for Payer: Cash Price |
$84.41
|
| Rate for Payer: Cigna All Commercial |
$117.49
|
| Rate for Payer: CORVEL All Commercial |
$126.61
|
| Rate for Payer: Coventry All Commercial |
$119.80
|
| Rate for Payer: Encore All Commercial |
$125.32
|
| Rate for Payer: Frontpath All Commercial |
$125.25
|
| Rate for Payer: Humana ChoiceCare |
$117.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.53
|
| Rate for Payer: PHCS All Commercial |
$102.10
|
| Rate for Payer: PHP All Commercial |
$103.25
|
| Rate for Payer: Sagamore Health Network All Products |
$105.10
|
| Rate for Payer: Signature Care EPO |
$113.00
|
| Rate for Payer: Signature Care PPO |
$119.80
|
| Rate for Payer: United Healthcare Commercial |
$107.28
|
|
|
HC C DIFFICILE TOXIN A/B BY DNA
|
Facility
IP
|
$230.01
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
63001008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.51 |
| Max. Negotiated Rate |
$213.91 |
| Rate for Payer: Aetna Commercial |
$198.73
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cigna All Commercial |
$198.50
|
| Rate for Payer: CORVEL All Commercial |
$213.91
|
| Rate for Payer: Coventry All Commercial |
$202.41
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.61
|
| Rate for Payer: Humana ChoiceCare |
$198.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.01
|
| Rate for Payer: PHCS All Commercial |
$172.51
|
| Rate for Payer: PHP All Commercial |
$174.44
|
| Rate for Payer: Sagamore Health Network All Products |
$177.57
|
| Rate for Payer: Signature Care EPO |
$190.91
|
| Rate for Payer: Signature Care PPO |
$202.41
|
| Rate for Payer: United Healthcare Commercial |
$181.25
|
|
|
HC C DIFFICILE TOXIN A/B BY DNA
|
Facility
OP
|
$230.01
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
63001008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$213.91 |
| Rate for Payer: Aetna Commercial |
$194.13
|
| Rate for Payer: Aetna Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.49
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Centivo All Commercial |
$117.31
|
| Rate for Payer: Cigna All Commercial |
$198.50
|
| Rate for Payer: CORVEL All Commercial |
$213.91
|
| Rate for Payer: Coventry All Commercial |
$202.41
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.61
|
| Rate for Payer: Humana ChoiceCare |
$198.66
|
| Rate for Payer: Humana Medicare |
$117.31
|
| Rate for Payer: Lucent All Commercial |
$117.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.01
|
| Rate for Payer: Managed Health Services Medicaid |
$37.27
|
| Rate for Payer: MDWise Medicaid |
$37.27
|
| Rate for Payer: PHCS All Commercial |
$172.51
|
| Rate for Payer: PHP All Commercial |
$174.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.70
|
| Rate for Payer: Sagamore Health Network All Products |
$177.57
|
| Rate for Payer: Signature Care EPO |
$190.91
|
| Rate for Payer: Signature Care PPO |
$202.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.51
|
| Rate for Payer: United Healthcare Commercial |
$181.25
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
|
|
HC CEA
|
Facility
IP
|
$267.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
63001337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$200.25 |
| Max. Negotiated Rate |
$248.31 |
| Rate for Payer: Aetna Commercial |
$230.68
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cigna All Commercial |
$230.42
|
| Rate for Payer: CORVEL All Commercial |
$248.31
|
| Rate for Payer: Coventry All Commercial |
$234.96
|
| Rate for Payer: Encore All Commercial |
$245.77
|
| Rate for Payer: Frontpath All Commercial |
$245.64
|
| Rate for Payer: Humana ChoiceCare |
$230.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.30
|
| Rate for Payer: PHCS All Commercial |
$200.25
|
| Rate for Payer: PHP All Commercial |
$202.49
|
| Rate for Payer: Sagamore Health Network All Products |
$206.12
|
| Rate for Payer: Signature Care EPO |
$221.61
|
| Rate for Payer: Signature Care PPO |
$234.96
|
| Rate for Payer: United Healthcare Commercial |
$210.39
|
|
|
HC CEA
|
Facility
OP
|
$267.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
63001337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$248.31 |
| Rate for Payer: Aetna Commercial |
$225.34
|
| Rate for Payer: Aetna Medicare |
$88.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.92
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Centivo All Commercial |
$136.17
|
| Rate for Payer: Cigna All Commercial |
$230.42
|
| Rate for Payer: CORVEL All Commercial |
$248.31
|
| Rate for Payer: Coventry All Commercial |
$234.96
|
| Rate for Payer: Encore All Commercial |
$245.77
|
| Rate for Payer: Frontpath All Commercial |
$245.64
|
| Rate for Payer: Humana ChoiceCare |
$230.60
|
| Rate for Payer: Humana Medicare |
$136.17
|
| Rate for Payer: Lucent All Commercial |
$136.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.30
|
| Rate for Payer: Managed Health Services Medicaid |
$18.96
|
| Rate for Payer: MDWise Medicaid |
$18.96
|
| Rate for Payer: PHCS All Commercial |
$200.25
|
| Rate for Payer: PHP All Commercial |
$202.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.13
|
| Rate for Payer: Sagamore Health Network All Products |
$206.12
|
| Rate for Payer: Signature Care EPO |
$221.61
|
| Rate for Payer: Signature Care PPO |
$234.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.95
|
| Rate for Payer: United Healthcare Commercial |
$210.39
|
| Rate for Payer: United Healthcare Medicare |
$88.11
|
|
|
HC CELL COUNT BODY FLUID
|
Facility
IP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.39 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$124.86
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cigna All Commercial |
$124.72
|
| Rate for Payer: CORVEL All Commercial |
$134.40
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: PHCS All Commercial |
$108.39
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.95
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: United Healthcare Commercial |
$113.88
|
|
|
HC CELL COUNT BODY FLUID
|
Facility
OP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Aetna Medicare |
$47.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.46
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Centivo All Commercial |
$73.70
|
| Rate for Payer: Cigna All Commercial |
$124.72
|
| Rate for Payer: CORVEL All Commercial |
$134.40
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.82
|
| Rate for Payer: Humana Medicare |
$73.70
|
| Rate for Payer: Lucent All Commercial |
$73.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: Managed Health Services Medicaid |
$4.72
|
| Rate for Payer: MDWise Medicaid |
$4.72
|
| Rate for Payer: PHCS All Commercial |
$108.39
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.36
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.95
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.84
|
| Rate for Payer: United Healthcare Commercial |
$113.88
|
| Rate for Payer: United Healthcare Medicare |
$47.69
|
|
