|
HC CHLAMYDIA
|
Facility
OP
|
$155.93
|
|
|
Service Code
|
CPT 87810
|
| Hospital Charge Code |
63002055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$145.01 |
| Rate for Payer: Aetna Commercial |
$131.60
|
| Rate for Payer: Aetna Medicare |
$51.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.60
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Centivo All Commercial |
$79.52
|
| Rate for Payer: Cigna All Commercial |
$134.57
|
| Rate for Payer: CORVEL All Commercial |
$145.01
|
| Rate for Payer: Coventry All Commercial |
$137.22
|
| Rate for Payer: Encore All Commercial |
$143.53
|
| Rate for Payer: Frontpath All Commercial |
$143.45
|
| Rate for Payer: Humana ChoiceCare |
$134.67
|
| Rate for Payer: Humana Medicare |
$79.52
|
| Rate for Payer: Lucent All Commercial |
$79.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.33
|
| Rate for Payer: Managed Health Services Medicaid |
$16.32
|
| Rate for Payer: MDWise Medicaid |
$16.32
|
| Rate for Payer: PHCS All Commercial |
$116.95
|
| Rate for Payer: PHP All Commercial |
$118.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.81
|
| Rate for Payer: Sagamore Health Network All Products |
$120.38
|
| Rate for Payer: Signature Care EPO |
$129.42
|
| Rate for Payer: Signature Care PPO |
$137.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.54
|
| Rate for Payer: United Healthcare Commercial |
$122.87
|
| Rate for Payer: United Healthcare Medicare |
$51.46
|
|
|
HC CHLAMYDIA AB IGM
|
Facility
OP
|
$56.25
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
63001932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$52.32 |
| Rate for Payer: Aetna Commercial |
$47.48
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.42
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Centivo All Commercial |
$28.69
|
| Rate for Payer: Cigna All Commercial |
$48.55
|
| Rate for Payer: CORVEL All Commercial |
$52.32
|
| Rate for Payer: Coventry All Commercial |
$49.50
|
| Rate for Payer: Encore All Commercial |
$51.78
|
| Rate for Payer: Frontpath All Commercial |
$51.75
|
| Rate for Payer: Humana ChoiceCare |
$48.59
|
| Rate for Payer: Humana Medicare |
$28.69
|
| Rate for Payer: Lucent All Commercial |
$28.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.63
|
| Rate for Payer: Managed Health Services Medicaid |
$12.68
|
| Rate for Payer: MDWise Medicaid |
$12.68
|
| Rate for Payer: PHCS All Commercial |
$42.19
|
| Rate for Payer: PHP All Commercial |
$42.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.94
|
| Rate for Payer: Sagamore Health Network All Products |
$43.43
|
| Rate for Payer: Signature Care EPO |
$46.69
|
| Rate for Payer: Signature Care PPO |
$49.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.82
|
| Rate for Payer: United Healthcare Commercial |
$44.33
|
| Rate for Payer: United Healthcare Medicare |
$18.56
|
|
|
HC CHLAMYDIA AB IGM
|
Facility
IP
|
$56.25
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
63001932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$52.32 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Cigna All Commercial |
$48.55
|
| Rate for Payer: CORVEL All Commercial |
$52.32
|
| Rate for Payer: Coventry All Commercial |
$49.50
|
| Rate for Payer: Encore All Commercial |
$51.78
|
| Rate for Payer: Frontpath All Commercial |
$51.75
|
| Rate for Payer: Humana ChoiceCare |
$48.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.63
|
| Rate for Payer: PHCS All Commercial |
$42.19
|
| Rate for Payer: PHP All Commercial |
$42.66
|
| Rate for Payer: Sagamore Health Network All Products |
$43.43
|
| Rate for Payer: Signature Care EPO |
$46.69
|
| Rate for Payer: Signature Care PPO |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$44.33
|
|
|
HC CHLAMYDIA CULT
|
Facility
IP
|
$143.20
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
63002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$133.17 |
| Rate for Payer: Aetna Commercial |
$123.72
|
| Rate for Payer: Cash Price |
$88.78
|
| Rate for Payer: Cigna All Commercial |
$123.58
|
| Rate for Payer: CORVEL All Commercial |
$133.17
|
| Rate for Payer: Coventry All Commercial |
$126.01
|
| Rate for Payer: Encore All Commercial |
$131.81
|
| Rate for Payer: Frontpath All Commercial |
$131.74
|
| Rate for Payer: Humana ChoiceCare |
$123.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.88
|
| Rate for Payer: PHCS All Commercial |
$107.40
|
| Rate for Payer: PHP All Commercial |
$108.60
|
| Rate for Payer: Sagamore Health Network All Products |
$110.55
|
| Rate for Payer: Signature Care EPO |
$118.85
|
| Rate for Payer: Signature Care PPO |
$126.01
|
| Rate for Payer: United Healthcare Commercial |
$112.84
|
|
|
HC CHLAMYDIA CULT
|
Facility
OP
|
$143.20
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
63002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$133.17 |
| Rate for Payer: Aetna Commercial |
$120.86
|
| Rate for Payer: Aetna Medicare |
$47.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.98
|
| Rate for Payer: Cash Price |
$88.78
|
| Rate for Payer: Cash Price |
$88.78
|
| Rate for Payer: Centivo All Commercial |
$73.03
|
| Rate for Payer: Cigna All Commercial |
$123.58
|
| Rate for Payer: CORVEL All Commercial |
$133.17
|
| Rate for Payer: Coventry All Commercial |
$126.01
|
| Rate for Payer: Encore All Commercial |
$131.81
|
| Rate for Payer: Frontpath All Commercial |
$131.74
|
| Rate for Payer: Humana ChoiceCare |
$123.68
|
| Rate for Payer: Humana Medicare |
$73.03
|
| Rate for Payer: Lucent All Commercial |
$73.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.88
|
| Rate for Payer: Managed Health Services Medicaid |
$15.84
|
| Rate for Payer: MDWise Medicaid |
$15.84
|
| Rate for Payer: PHCS All Commercial |
$107.40
|
| Rate for Payer: PHP All Commercial |
$108.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.85
|
| Rate for Payer: Sagamore Health Network All Products |
$110.55
|
| Rate for Payer: Signature Care EPO |
$118.85
|
| Rate for Payer: Signature Care PPO |
$126.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.72
|
| Rate for Payer: United Healthcare Commercial |
$112.84
|
| Rate for Payer: United Healthcare Medicare |
$47.26
|
|
|
HC CHLAMYDIA DNA-URINE
|
Facility
OP
|
$168.30
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.09
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$85.83
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$85.83
|
| Rate for Payer: Lucent All Commercial |
$85.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$55.54
|
|
|
HC CHLAMYDIA DNA-URINE
|
Facility
IP
|
$168.30
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC CHLAMYDIA IGG
|
Facility
IP
|
$37.70
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
63001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$35.06 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cigna All Commercial |
$32.53
|
| Rate for Payer: CORVEL All Commercial |
$35.06
|
| Rate for Payer: Coventry All Commercial |
$33.18
|
| Rate for Payer: Encore All Commercial |
$34.70
|
| Rate for Payer: Frontpath All Commercial |
$34.68
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.93
|
| Rate for Payer: PHCS All Commercial |
$28.27
|
| Rate for Payer: PHP All Commercial |
$28.59
|
| Rate for Payer: Sagamore Health Network All Products |
$29.10
|
| Rate for Payer: Signature Care EPO |
$31.29
|
| Rate for Payer: Signature Care PPO |
$33.18
|
| Rate for Payer: United Healthcare Commercial |
$29.71
|
|
|
HC CHLAMYDIA IGG
|
Facility
OP
|
$37.70
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
63001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$35.06 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Centivo All Commercial |
$19.23
|
| Rate for Payer: Cigna All Commercial |
$32.53
|
| Rate for Payer: CORVEL All Commercial |
$35.06
|
| Rate for Payer: Coventry All Commercial |
$33.18
|
| Rate for Payer: Encore All Commercial |
$34.70
|
| Rate for Payer: Frontpath All Commercial |
$34.68
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Humana Medicare |
$19.23
|
| Rate for Payer: Lucent All Commercial |
$19.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.93
|
| Rate for Payer: Managed Health Services Medicaid |
$11.82
|
| Rate for Payer: MDWise Medicaid |
$11.82
|
| Rate for Payer: PHCS All Commercial |
$28.27
|
| Rate for Payer: PHP All Commercial |
$28.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.70
|
| Rate for Payer: Sagamore Health Network All Products |
$29.10
|
| Rate for Payer: Signature Care EPO |
$31.29
|
| Rate for Payer: Signature Care PPO |
$33.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.04
|
| Rate for Payer: United Healthcare Commercial |
$29.71
|
| Rate for Payer: United Healthcare Medicare |
$12.44
|
|
|
HC CHLAMYDIA PNEUMONIAE IGA
|
Facility
OP
|
$143.59
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
63001930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$133.53 |
| Rate for Payer: Aetna Commercial |
$121.19
|
| Rate for Payer: Aetna Medicare |
$47.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.12
|
| Rate for Payer: Cash Price |
$89.02
|
| Rate for Payer: Cash Price |
$89.02
|
| Rate for Payer: Centivo All Commercial |
$73.23
|
| Rate for Payer: Cigna All Commercial |
$123.91
|
| Rate for Payer: CORVEL All Commercial |
$133.53
|
| Rate for Payer: Coventry All Commercial |
$126.36
|
| Rate for Payer: Encore All Commercial |
$132.17
|
| Rate for Payer: Frontpath All Commercial |
$132.10
|
| Rate for Payer: Humana ChoiceCare |
$124.01
|
| Rate for Payer: Humana Medicare |
$73.23
|
| Rate for Payer: Lucent All Commercial |
$73.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.23
|
| Rate for Payer: Managed Health Services Medicaid |
$11.82
|
| Rate for Payer: MDWise Medicaid |
$11.82
|
| Rate for Payer: PHCS All Commercial |
$107.69
|
| Rate for Payer: PHP All Commercial |
$108.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.00
|
| Rate for Payer: Sagamore Health Network All Products |
$110.85
|
| Rate for Payer: Signature Care EPO |
$119.18
|
| Rate for Payer: Signature Care PPO |
$126.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.05
|
| Rate for Payer: United Healthcare Commercial |
$113.15
|
| Rate for Payer: United Healthcare Medicare |
$47.38
|
|
|
HC CHLAMYDIA PNEUMONIAE IGA
|
Facility
IP
|
$143.59
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
63001930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.69 |
| Max. Negotiated Rate |
$133.53 |
| Rate for Payer: Aetna Commercial |
$124.06
|
| Rate for Payer: Cash Price |
$89.02
|
| Rate for Payer: Cigna All Commercial |
$123.91
|
| Rate for Payer: CORVEL All Commercial |
$133.53
|
| Rate for Payer: Coventry All Commercial |
$126.36
|
| Rate for Payer: Encore All Commercial |
$132.17
|
| Rate for Payer: Frontpath All Commercial |
$132.10
|
| Rate for Payer: Humana ChoiceCare |
$124.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.23
|
| Rate for Payer: PHCS All Commercial |
$107.69
|
| Rate for Payer: PHP All Commercial |
$108.90
|
| Rate for Payer: Sagamore Health Network All Products |
$110.85
|
| Rate for Payer: Signature Care EPO |
$119.18
|
| Rate for Payer: Signature Care PPO |
$126.36
|
| Rate for Payer: United Healthcare Commercial |
$113.15
|
|
|
HC CHLAMYDIA PNEUMONIAE IGG
|
Facility
OP
|
$143.59
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
63001931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$133.53 |
| Rate for Payer: Aetna Commercial |
$121.19
|
| Rate for Payer: Aetna Medicare |
$47.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.12
|
| Rate for Payer: Cash Price |
$89.02
|
| Rate for Payer: Cash Price |
$89.02
|
| Rate for Payer: Centivo All Commercial |
$73.23
|
| Rate for Payer: Cigna All Commercial |
$123.91
|
| Rate for Payer: CORVEL All Commercial |
$133.53
|
| Rate for Payer: Coventry All Commercial |
$126.36
|
| Rate for Payer: Encore All Commercial |
$132.17
|
| Rate for Payer: Frontpath All Commercial |
$132.10
|
| Rate for Payer: Humana ChoiceCare |
$124.01
|
| Rate for Payer: Humana Medicare |
$73.23
|
| Rate for Payer: Lucent All Commercial |
$73.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.23
|
| Rate for Payer: Managed Health Services Medicaid |
$11.82
|
| Rate for Payer: MDWise Medicaid |
$11.82
|
| Rate for Payer: PHCS All Commercial |
$107.69
|
| Rate for Payer: PHP All Commercial |
$108.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.00
|
| Rate for Payer: Sagamore Health Network All Products |
$110.85
|
| Rate for Payer: Signature Care EPO |
$119.18
|
| Rate for Payer: Signature Care PPO |
$126.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.05
|
| Rate for Payer: United Healthcare Commercial |
$113.15
|
| Rate for Payer: United Healthcare Medicare |
$47.38
|
|
|
HC CHLAMYDIA PNEUMONIAE IGG
|
Facility
IP
|
$143.59
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
63001931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.69 |
| Max. Negotiated Rate |
$133.53 |
| Rate for Payer: Aetna Commercial |
$124.06
|
| Rate for Payer: Cash Price |
$89.02
|
| Rate for Payer: Cigna All Commercial |
$123.91
|
| Rate for Payer: CORVEL All Commercial |
$133.53
|
| Rate for Payer: Coventry All Commercial |
$126.36
|
| Rate for Payer: Encore All Commercial |
$132.17
|
| Rate for Payer: Frontpath All Commercial |
$132.10
|
| Rate for Payer: Humana ChoiceCare |
$124.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.23
|
| Rate for Payer: PHCS All Commercial |
$107.69
|
| Rate for Payer: PHP All Commercial |
$108.90
|
| Rate for Payer: Sagamore Health Network All Products |
$110.85
|
| Rate for Payer: Signature Care EPO |
$119.18
|
| Rate for Payer: Signature Care PPO |
$126.36
|
| Rate for Payer: United Healthcare Commercial |
$113.15
|
|
|
HC CHLAMYDIA PNEUMONIAE IGM
|
Facility
IP
|
$29.62
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
63001933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna Commercial |
$25.59
|
| Rate for Payer: Cash Price |
$18.37
|
| Rate for Payer: Cigna All Commercial |
$25.56
|
| Rate for Payer: CORVEL All Commercial |
$27.55
|
| Rate for Payer: Coventry All Commercial |
$26.07
|
| Rate for Payer: Encore All Commercial |
$27.27
|
| Rate for Payer: Frontpath All Commercial |
$27.25
|
| Rate for Payer: Humana ChoiceCare |
$25.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.66
|
| Rate for Payer: PHCS All Commercial |
$22.22
|
| Rate for Payer: PHP All Commercial |
$22.46
|
| Rate for Payer: Sagamore Health Network All Products |
$22.87
|
| Rate for Payer: Signature Care EPO |
$24.59
|
| Rate for Payer: Signature Care PPO |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$23.34
|
|
|
HC CHLAMYDIA PNEUMONIAE IGM
|
Facility
OP
|
$29.62
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
63001933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna Commercial |
$25.00
|
| Rate for Payer: Aetna Medicare |
$9.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.75
|
| Rate for Payer: Cash Price |
$18.37
|
| Rate for Payer: Cash Price |
$18.37
|
| Rate for Payer: Centivo All Commercial |
$15.11
|
| Rate for Payer: Cigna All Commercial |
$25.56
|
| Rate for Payer: CORVEL All Commercial |
$27.55
|
| Rate for Payer: Coventry All Commercial |
$26.07
|
| Rate for Payer: Encore All Commercial |
$27.27
|
| Rate for Payer: Frontpath All Commercial |
$27.25
|
| Rate for Payer: Humana ChoiceCare |
$25.58
|
| Rate for Payer: Humana Medicare |
$15.11
|
| Rate for Payer: Lucent All Commercial |
$15.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.66
|
| Rate for Payer: Managed Health Services Medicaid |
$12.68
|
| Rate for Payer: MDWise Medicaid |
$12.68
|
| Rate for Payer: PHCS All Commercial |
$22.22
|
| Rate for Payer: PHP All Commercial |
$22.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.55
|
| Rate for Payer: Sagamore Health Network All Products |
$22.87
|
| Rate for Payer: Signature Care EPO |
$24.59
|
| Rate for Payer: Signature Care PPO |
$26.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.18
|
| Rate for Payer: United Healthcare Commercial |
$23.34
|
| Rate for Payer: United Healthcare Medicare |
$9.77
|
|
|
HC CHLORIDE 24U
|
Facility
OP
|
$58.77
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$54.66 |
| Rate for Payer: Aetna Commercial |
$49.60
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.33
|
| Rate for Payer: Cash Price |
$36.44
|
| Rate for Payer: Cash Price |
$36.44
|
| Rate for Payer: Centivo All Commercial |
$29.97
|
| Rate for Payer: Cigna All Commercial |
$50.72
|
| Rate for Payer: CORVEL All Commercial |
$54.66
|
| Rate for Payer: Coventry All Commercial |
$51.72
|
| Rate for Payer: Encore All Commercial |
$54.10
|
| Rate for Payer: Frontpath All Commercial |
$54.07
|
| Rate for Payer: Humana ChoiceCare |
$50.76
|
| Rate for Payer: Humana Medicare |
$29.97
|
| Rate for Payer: Lucent All Commercial |
$29.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.90
|
| Rate for Payer: Managed Health Services Medicaid |
$4.70
|
| Rate for Payer: MDWise Medicaid |
$4.70
|
| Rate for Payer: PHCS All Commercial |
$44.08
|
| Rate for Payer: PHP All Commercial |
$44.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.92
|
| Rate for Payer: Sagamore Health Network All Products |
$45.37
|
| Rate for Payer: Signature Care EPO |
$48.78
|
| Rate for Payer: Signature Care PPO |
$51.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.96
|
| Rate for Payer: United Healthcare Commercial |
$46.31
|
| Rate for Payer: United Healthcare Medicare |
$19.39
|
|
|
HC CHLORIDE 24U
|
Facility
IP
|
$58.77
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$54.66 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Cash Price |
$36.44
|
| Rate for Payer: Cigna All Commercial |
$50.72
|
| Rate for Payer: CORVEL All Commercial |
$54.66
|
| Rate for Payer: Coventry All Commercial |
$51.72
|
| Rate for Payer: Encore All Commercial |
$54.10
|
| Rate for Payer: Frontpath All Commercial |
$54.07
|
| Rate for Payer: Humana ChoiceCare |
$50.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.90
|
| Rate for Payer: PHCS All Commercial |
$44.08
|
| Rate for Payer: PHP All Commercial |
$44.57
|
| Rate for Payer: Sagamore Health Network All Products |
$45.37
|
| Rate for Payer: Signature Care EPO |
$48.78
|
| Rate for Payer: Signature Care PPO |
$51.72
|
| Rate for Payer: United Healthcare Commercial |
$46.31
|
|
|
HC CHLORIDE BLOOD
|
Facility
OP
|
$47.12
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
63001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.11
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Centivo All Commercial |
$24.03
|
| Rate for Payer: Cigna All Commercial |
$40.67
|
| Rate for Payer: CORVEL All Commercial |
$43.83
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.38
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Humana Medicare |
$24.03
|
| Rate for Payer: Lucent All Commercial |
$24.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: Managed Health Services Medicaid |
$4.60
|
| Rate for Payer: MDWise Medicaid |
$4.60
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.38
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.06
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$15.55
|
|
|
HC CHLORIDE BLOOD
|
Facility
IP
|
$47.12
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
63001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Cigna All Commercial |
$40.67
|
| Rate for Payer: CORVEL All Commercial |
$43.83
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.38
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
|
|
HC CHLORIDE URINE
|
Facility
IP
|
$99.86
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.89 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$61.91
|
| Rate for Payer: Cigna All Commercial |
$86.18
|
| Rate for Payer: CORVEL All Commercial |
$92.87
|
| Rate for Payer: Coventry All Commercial |
$87.88
|
| Rate for Payer: Encore All Commercial |
$91.92
|
| Rate for Payer: Frontpath All Commercial |
$91.87
|
| Rate for Payer: Humana ChoiceCare |
$86.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.87
|
| Rate for Payer: PHCS All Commercial |
$74.89
|
| Rate for Payer: PHP All Commercial |
$75.73
|
| Rate for Payer: Sagamore Health Network All Products |
$77.09
|
| Rate for Payer: Signature Care EPO |
$82.88
|
| Rate for Payer: Signature Care PPO |
$87.88
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
|
|
HC CHLORIDE URINE
|
Facility
OP
|
$99.86
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$32.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.25
|
| Rate for Payer: Cash Price |
$61.91
|
| Rate for Payer: Cash Price |
$61.91
|
| Rate for Payer: Centivo All Commercial |
$50.93
|
| Rate for Payer: Cigna All Commercial |
$86.18
|
| Rate for Payer: CORVEL All Commercial |
$92.87
|
| Rate for Payer: Coventry All Commercial |
$87.88
|
| Rate for Payer: Encore All Commercial |
$91.92
|
| Rate for Payer: Frontpath All Commercial |
$91.87
|
| Rate for Payer: Humana ChoiceCare |
$86.25
|
| Rate for Payer: Humana Medicare |
$50.93
|
| Rate for Payer: Lucent All Commercial |
$50.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.87
|
| Rate for Payer: Managed Health Services Medicaid |
$4.70
|
| Rate for Payer: MDWise Medicaid |
$4.70
|
| Rate for Payer: PHCS All Commercial |
$74.89
|
| Rate for Payer: PHP All Commercial |
$75.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.94
|
| Rate for Payer: Sagamore Health Network All Products |
$77.09
|
| Rate for Payer: Signature Care EPO |
$82.88
|
| Rate for Payer: Signature Care PPO |
$87.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.88
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
| Rate for Payer: United Healthcare Medicare |
$32.95
|
|
|
HC CHLORIDE URINE CHG
|
Facility
OP
|
$60.99
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$56.72 |
| Rate for Payer: Aetna Commercial |
$51.47
|
| Rate for Payer: Aetna Medicare |
$20.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.14
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Centivo All Commercial |
$31.10
|
| Rate for Payer: Cigna All Commercial |
$52.63
|
| Rate for Payer: CORVEL All Commercial |
$56.72
|
| Rate for Payer: Coventry All Commercial |
$53.67
|
| Rate for Payer: Encore All Commercial |
$56.14
|
| Rate for Payer: Frontpath All Commercial |
$56.11
|
| Rate for Payer: Humana ChoiceCare |
$52.67
|
| Rate for Payer: Humana Medicare |
$31.10
|
| Rate for Payer: Lucent All Commercial |
$31.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.89
|
| Rate for Payer: Managed Health Services Medicaid |
$4.70
|
| Rate for Payer: MDWise Medicaid |
$4.70
|
| Rate for Payer: PHCS All Commercial |
$45.74
|
| Rate for Payer: PHP All Commercial |
$46.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.78
|
| Rate for Payer: Sagamore Health Network All Products |
$47.08
|
| Rate for Payer: Signature Care EPO |
$50.62
|
| Rate for Payer: Signature Care PPO |
$53.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.84
|
| Rate for Payer: United Healthcare Commercial |
$48.06
|
| Rate for Payer: United Healthcare Medicare |
$20.13
|
|
|
HC CHLORIDE URINE CHG
|
Facility
IP
|
$60.99
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$56.72 |
| Rate for Payer: Aetna Commercial |
$52.69
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Cigna All Commercial |
$52.63
|
| Rate for Payer: CORVEL All Commercial |
$56.72
|
| Rate for Payer: Coventry All Commercial |
$53.67
|
| Rate for Payer: Encore All Commercial |
$56.14
|
| Rate for Payer: Frontpath All Commercial |
$56.11
|
| Rate for Payer: Humana ChoiceCare |
$52.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.89
|
| Rate for Payer: PHCS All Commercial |
$45.74
|
| Rate for Payer: PHP All Commercial |
$46.25
|
| Rate for Payer: Sagamore Health Network All Products |
$47.08
|
| Rate for Payer: Signature Care EPO |
$50.62
|
| Rate for Payer: Signature Care PPO |
$53.67
|
| Rate for Payer: United Healthcare Commercial |
$48.06
|
|
|
HC CHOLESTEROL
|
Facility
OP
|
$57.22
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
63001093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.77
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Centivo All Commercial |
$29.18
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$29.18
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$4.35
|
| Rate for Payer: MDWise Medicaid |
$4.35
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.88
|
|
|
HC CHOLESTEROL
|
Facility
IP
|
$57.22
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
63001093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
