|
HC CHROMOSOME COUNT ADDITIONAL CHARGE
|
Facility
OP
|
$72.37
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
63002093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Aetna Commercial |
$61.08
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.27
|
| Rate for Payer: Cash Price |
$44.87
|
| Rate for Payer: Cash Price |
$44.87
|
| Rate for Payer: Centivo All Commercial |
$36.91
|
| Rate for Payer: Cigna All Commercial |
$62.45
|
| Rate for Payer: CORVEL All Commercial |
$67.30
|
| Rate for Payer: Coventry All Commercial |
$63.68
|
| Rate for Payer: Encore All Commercial |
$66.62
|
| Rate for Payer: Frontpath All Commercial |
$66.58
|
| Rate for Payer: Humana ChoiceCare |
$62.51
|
| Rate for Payer: Humana Medicare |
$36.91
|
| Rate for Payer: Lucent All Commercial |
$36.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.13
|
| Rate for Payer: Managed Health Services Medicaid |
$25.86
|
| Rate for Payer: MDWise Medicaid |
$25.86
|
| Rate for Payer: PHCS All Commercial |
$54.28
|
| Rate for Payer: PHP All Commercial |
$54.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.22
|
| Rate for Payer: Sagamore Health Network All Products |
$55.87
|
| Rate for Payer: Signature Care EPO |
$60.07
|
| Rate for Payer: Signature Care PPO |
$63.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.51
|
| Rate for Payer: United Healthcare Commercial |
$57.03
|
| Rate for Payer: United Healthcare Medicare |
$23.88
|
|
|
HC CHROMOSOME KARYOTYPE STUDY CHARGE
|
Facility
OP
|
$93.05
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
63002092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$86.54 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Aetna Medicare |
$30.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$33.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.78
|
| Rate for Payer: Cash Price |
$57.69
|
| Rate for Payer: Cash Price |
$57.69
|
| Rate for Payer: Centivo All Commercial |
$47.46
|
| Rate for Payer: Cigna All Commercial |
$80.31
|
| Rate for Payer: CORVEL All Commercial |
$86.54
|
| Rate for Payer: Coventry All Commercial |
$81.89
|
| Rate for Payer: Encore All Commercial |
$85.66
|
| Rate for Payer: Frontpath All Commercial |
$85.61
|
| Rate for Payer: Humana ChoiceCare |
$80.37
|
| Rate for Payer: Humana Medicare |
$47.46
|
| Rate for Payer: Lucent All Commercial |
$47.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.75
|
| Rate for Payer: Managed Health Services Medicaid |
$33.47
|
| Rate for Payer: MDWise Medicaid |
$33.47
|
| Rate for Payer: PHCS All Commercial |
$69.79
|
| Rate for Payer: PHP All Commercial |
$70.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.29
|
| Rate for Payer: Sagamore Health Network All Products |
$71.84
|
| Rate for Payer: Signature Care EPO |
$77.24
|
| Rate for Payer: Signature Care PPO |
$81.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.10
|
| Rate for Payer: United Healthcare Commercial |
$73.33
|
| Rate for Payer: United Healthcare Medicare |
$30.71
|
|
|
HC CHROMOSOME KARYOTYPE STUDY CHARGE
|
Facility
IP
|
$93.05
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
63002092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$86.54 |
| Rate for Payer: Aetna Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$57.69
|
| Rate for Payer: Cigna All Commercial |
$80.31
|
| Rate for Payer: CORVEL All Commercial |
$86.54
|
| Rate for Payer: Coventry All Commercial |
$81.89
|
| Rate for Payer: Encore All Commercial |
$85.66
|
| Rate for Payer: Frontpath All Commercial |
$85.61
|
| Rate for Payer: Humana ChoiceCare |
$80.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.75
|
| Rate for Payer: PHCS All Commercial |
$69.79
|
| Rate for Payer: PHP All Commercial |
$70.57
|
| Rate for Payer: Sagamore Health Network All Products |
$71.84
|
| Rate for Payer: Signature Care EPO |
$77.24
|
| Rate for Payer: Signature Care PPO |
$81.89
|
| Rate for Payer: United Healthcare Commercial |
$73.33
|
|
|
HC CIRCULATORY ENHANCER RESQPOD
|
Facility
OP
|
$647.50
|
|
| Hospital Charge Code |
41601249
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$546.49
|
| Rate for Payer: Aetna Medicare |
$213.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$371.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$404.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$245.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.04
|
| Rate for Payer: Cash Price |
$401.45
|
| Rate for Payer: Cash Price |
$401.45
|
| Rate for Payer: Centivo All Commercial |
$330.22
|
| Rate for Payer: Cigna All Commercial |
$558.79
|
| Rate for Payer: CORVEL All Commercial |
$602.18
|
| Rate for Payer: Coventry All Commercial |
$569.80
|
| Rate for Payer: Encore All Commercial |
$596.02
|
| Rate for Payer: Frontpath All Commercial |
$595.70
|
| Rate for Payer: Humana ChoiceCare |
$559.25
|
| Rate for Payer: Humana Medicare |
$330.22
|
| Rate for Payer: Lucent All Commercial |
$330.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$582.75
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$485.62
|
| Rate for Payer: PHP All Commercial |
$491.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$252.52
|
| Rate for Payer: Sagamore Health Network All Products |
$499.87
|
| Rate for Payer: Signature Care EPO |
$537.42
|
| Rate for Payer: Signature Care PPO |
$569.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$550.38
|
| Rate for Payer: United Healthcare Commercial |
$510.23
|
| Rate for Payer: United Healthcare Medicare |
$213.68
|
|
|
HC CIRCULATORY ENHANCER RESQPOD
|
Facility
IP
|
$647.50
|
|
| Hospital Charge Code |
41601249
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$485.62 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$559.44
|
| Rate for Payer: Cash Price |
$401.45
|
| Rate for Payer: Cigna All Commercial |
$558.79
|
| Rate for Payer: CORVEL All Commercial |
$602.18
|
| Rate for Payer: Coventry All Commercial |
$569.80
|
| Rate for Payer: Encore All Commercial |
$596.02
|
| Rate for Payer: Frontpath All Commercial |
$595.70
|
| Rate for Payer: Humana ChoiceCare |
$559.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$582.75
|
| Rate for Payer: PHCS All Commercial |
$485.62
|
| Rate for Payer: PHP All Commercial |
$491.06
|
| Rate for Payer: Sagamore Health Network All Products |
$499.87
|
| Rate for Payer: Signature Care EPO |
$537.42
|
| Rate for Payer: Signature Care PPO |
$569.80
|
| Rate for Payer: United Healthcare Commercial |
$510.23
|
|
|
HC CIRCUMCISION ROUTINE
|
Facility
OP
|
$1,060.80
|
|
| Hospital Charge Code |
01023230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.06 |
| Max. Negotiated Rate |
$986.54 |
| Rate for Payer: Aetna Commercial |
$895.32
|
| Rate for Payer: Aetna Medicare |
$350.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$350.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$609.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$663.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$402.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.07
|
| Rate for Payer: Cash Price |
$657.70
|
| Rate for Payer: Centivo All Commercial |
$541.01
|
| Rate for Payer: Cigna All Commercial |
$915.47
|
| Rate for Payer: CORVEL All Commercial |
$986.54
|
| Rate for Payer: Coventry All Commercial |
$933.50
|
| Rate for Payer: Encore All Commercial |
$976.47
|
| Rate for Payer: Frontpath All Commercial |
$975.94
|
| Rate for Payer: Humana ChoiceCare |
$916.21
|
| Rate for Payer: Humana Medicare |
$541.01
|
| Rate for Payer: Lucent All Commercial |
$541.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$954.72
|
| Rate for Payer: PHCS All Commercial |
$795.60
|
| Rate for Payer: PHP All Commercial |
$804.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$413.71
|
| Rate for Payer: Sagamore Health Network All Products |
$818.94
|
| Rate for Payer: Signature Care EPO |
$880.46
|
| Rate for Payer: Signature Care PPO |
$933.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$901.68
|
| Rate for Payer: United Healthcare Commercial |
$835.91
|
| Rate for Payer: United Healthcare Medicare |
$350.06
|
|
|
HC CIRCUMCISION ROUTINE
|
Facility
IP
|
$1,060.80
|
|
| Hospital Charge Code |
01023230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$986.54 |
| Rate for Payer: Aetna Commercial |
$916.53
|
| Rate for Payer: Cash Price |
$657.70
|
| Rate for Payer: Cigna All Commercial |
$915.47
|
| Rate for Payer: CORVEL All Commercial |
$986.54
|
| Rate for Payer: Coventry All Commercial |
$933.50
|
| Rate for Payer: Encore All Commercial |
$976.47
|
| Rate for Payer: Frontpath All Commercial |
$975.94
|
| Rate for Payer: Humana ChoiceCare |
$916.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$954.72
|
| Rate for Payer: PHCS All Commercial |
$795.60
|
| Rate for Payer: PHP All Commercial |
$804.51
|
| Rate for Payer: Sagamore Health Network All Products |
$818.94
|
| Rate for Payer: Signature Care EPO |
$880.46
|
| Rate for Payer: Signature Care PPO |
$933.50
|
| Rate for Payer: United Healthcare Commercial |
$835.91
|
|
|
HC CITADEL (THERAPULSE II) BED /DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01890101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.23
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Centivo All Commercial |
$156.27
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Humana Medicare |
$156.27
|
| Rate for Payer: Lucent All Commercial |
$156.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$101.11
|
|
|
HC CITADEL (THERAPULSE II) BED /DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01890101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC CITRIC ACID 24HR
|
Facility
OP
|
$235.06
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
63001495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$218.60 |
| Rate for Payer: Aetna Commercial |
$198.39
|
| Rate for Payer: Aetna Medicare |
$77.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.33
|
| Rate for Payer: Cash Price |
$145.74
|
| Rate for Payer: Cash Price |
$145.74
|
| Rate for Payer: Centivo All Commercial |
$119.88
|
| Rate for Payer: Cigna All Commercial |
$202.86
|
| Rate for Payer: CORVEL All Commercial |
$218.60
|
| Rate for Payer: Coventry All Commercial |
$206.85
|
| Rate for Payer: Encore All Commercial |
$216.37
|
| Rate for Payer: Frontpath All Commercial |
$216.25
|
| Rate for Payer: Humana ChoiceCare |
$203.02
|
| Rate for Payer: Humana Medicare |
$119.88
|
| Rate for Payer: Lucent All Commercial |
$119.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.55
|
| Rate for Payer: Managed Health Services Medicaid |
$27.80
|
| Rate for Payer: MDWise Medicaid |
$27.80
|
| Rate for Payer: PHCS All Commercial |
$176.29
|
| Rate for Payer: PHP All Commercial |
$178.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.67
|
| Rate for Payer: Sagamore Health Network All Products |
$181.47
|
| Rate for Payer: Signature Care EPO |
$195.10
|
| Rate for Payer: Signature Care PPO |
$206.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.80
|
| Rate for Payer: United Healthcare Commercial |
$185.23
|
| Rate for Payer: United Healthcare Medicare |
$77.57
|
|
|
HC CITRIC ACID 24HR
|
Facility
IP
|
$235.06
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
63001495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.29 |
| Max. Negotiated Rate |
$218.60 |
| Rate for Payer: Aetna Commercial |
$203.09
|
| Rate for Payer: Cash Price |
$145.74
|
| Rate for Payer: Cigna All Commercial |
$202.86
|
| Rate for Payer: CORVEL All Commercial |
$218.60
|
| Rate for Payer: Coventry All Commercial |
$206.85
|
| Rate for Payer: Encore All Commercial |
$216.37
|
| Rate for Payer: Frontpath All Commercial |
$216.25
|
| Rate for Payer: Humana ChoiceCare |
$203.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.55
|
| Rate for Payer: PHCS All Commercial |
$176.29
|
| Rate for Payer: PHP All Commercial |
$178.27
|
| Rate for Payer: Sagamore Health Network All Products |
$181.47
|
| Rate for Payer: Signature Care EPO |
$195.10
|
| Rate for Payer: Signature Care PPO |
$206.85
|
| Rate for Payer: United Healthcare Commercial |
$185.23
|
|
|
HC CITRIC ACID (CITRATE):CREATININE RATIO, RANDOM URINE
|
Facility
IP
|
$38.25
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
63044034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.69 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cigna All Commercial |
$33.01
|
| Rate for Payer: CORVEL All Commercial |
$35.57
|
| Rate for Payer: Coventry All Commercial |
$33.66
|
| Rate for Payer: Encore All Commercial |
$35.21
|
| Rate for Payer: Frontpath All Commercial |
$35.19
|
| Rate for Payer: Humana ChoiceCare |
$33.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.42
|
| Rate for Payer: PHCS All Commercial |
$28.69
|
| Rate for Payer: PHP All Commercial |
$29.01
|
| Rate for Payer: Sagamore Health Network All Products |
$29.53
|
| Rate for Payer: Signature Care EPO |
$31.75
|
| Rate for Payer: Signature Care PPO |
$33.66
|
| Rate for Payer: United Healthcare Commercial |
$30.14
|
|
|
HC CITRIC ACID (CITRATE):CREATININE RATIO, RANDOM URINE
|
Facility
OP
|
$38.25
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
63044034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.88
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Centivo All Commercial |
$19.51
|
| Rate for Payer: Cigna All Commercial |
$33.01
|
| Rate for Payer: CORVEL All Commercial |
$35.57
|
| Rate for Payer: Coventry All Commercial |
$33.66
|
| Rate for Payer: Encore All Commercial |
$35.21
|
| Rate for Payer: Frontpath All Commercial |
$35.19
|
| Rate for Payer: Humana ChoiceCare |
$33.04
|
| Rate for Payer: Humana Medicare |
$19.51
|
| Rate for Payer: Lucent All Commercial |
$19.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.42
|
| Rate for Payer: Managed Health Services Medicaid |
$27.80
|
| Rate for Payer: MDWise Medicaid |
$27.80
|
| Rate for Payer: PHCS All Commercial |
$28.69
|
| Rate for Payer: PHP All Commercial |
$29.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.92
|
| Rate for Payer: Sagamore Health Network All Products |
$29.53
|
| Rate for Payer: Signature Care EPO |
$31.75
|
| Rate for Payer: Signature Care PPO |
$33.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.51
|
| Rate for Payer: United Healthcare Commercial |
$30.14
|
| Rate for Payer: United Healthcare Medicare |
$12.62
|
|
|
HC CITRIC ACID (CITRATE):CREATININE RATIO, RANDOM URINE-B
|
Facility
OP
|
$38.25
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.88
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Centivo All Commercial |
$19.51
|
| Rate for Payer: Cigna All Commercial |
$33.01
|
| Rate for Payer: CORVEL All Commercial |
$35.57
|
| Rate for Payer: Coventry All Commercial |
$33.66
|
| Rate for Payer: Encore All Commercial |
$35.21
|
| Rate for Payer: Frontpath All Commercial |
$35.19
|
| Rate for Payer: Humana ChoiceCare |
$33.04
|
| Rate for Payer: Humana Medicare |
$19.51
|
| Rate for Payer: Lucent All Commercial |
$19.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.42
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$28.69
|
| Rate for Payer: PHP All Commercial |
$29.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.92
|
| Rate for Payer: Sagamore Health Network All Products |
$29.53
|
| Rate for Payer: Signature Care EPO |
$31.75
|
| Rate for Payer: Signature Care PPO |
$33.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.51
|
| Rate for Payer: United Healthcare Commercial |
$30.14
|
| Rate for Payer: United Healthcare Medicare |
$12.62
|
|
|
HC CITRIC ACID (CITRATE):CREATININE RATIO, RANDOM URINE-B
|
Facility
IP
|
$38.25
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.69 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cigna All Commercial |
$33.01
|
| Rate for Payer: CORVEL All Commercial |
$35.57
|
| Rate for Payer: Coventry All Commercial |
$33.66
|
| Rate for Payer: Encore All Commercial |
$35.21
|
| Rate for Payer: Frontpath All Commercial |
$35.19
|
| Rate for Payer: Humana ChoiceCare |
$33.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.42
|
| Rate for Payer: PHCS All Commercial |
$28.69
|
| Rate for Payer: PHP All Commercial |
$29.01
|
| Rate for Payer: Sagamore Health Network All Products |
$29.53
|
| Rate for Payer: Signature Care EPO |
$31.75
|
| Rate for Payer: Signature Care PPO |
$33.66
|
| Rate for Payer: United Healthcare Commercial |
$30.14
|
|
|
HC CITRIC ACID (CITRATE), RANDOM URINE
|
Facility
IP
|
$76.50
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
63044033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$71.14 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Cash Price |
$47.43
|
| Rate for Payer: Cigna All Commercial |
$66.02
|
| Rate for Payer: CORVEL All Commercial |
$71.14
|
| Rate for Payer: Coventry All Commercial |
$67.32
|
| Rate for Payer: Encore All Commercial |
$70.42
|
| Rate for Payer: Frontpath All Commercial |
$70.38
|
| Rate for Payer: Humana ChoiceCare |
$66.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.85
|
| Rate for Payer: PHCS All Commercial |
$57.38
|
| Rate for Payer: PHP All Commercial |
$58.02
|
| Rate for Payer: Sagamore Health Network All Products |
$59.06
|
| Rate for Payer: Signature Care EPO |
$63.50
|
| Rate for Payer: Signature Care PPO |
$67.32
|
| Rate for Payer: United Healthcare Commercial |
$60.28
|
|
|
HC CITRIC ACID (CITRATE), RANDOM URINE
|
Facility
OP
|
$76.50
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
63044033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.24 |
| Max. Negotiated Rate |
$71.14 |
| Rate for Payer: Aetna Commercial |
$64.57
|
| Rate for Payer: Aetna Medicare |
$25.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.77
|
| Rate for Payer: Cash Price |
$47.43
|
| Rate for Payer: Cash Price |
$47.43
|
| Rate for Payer: Centivo All Commercial |
$39.02
|
| Rate for Payer: Cigna All Commercial |
$66.02
|
| Rate for Payer: CORVEL All Commercial |
$71.14
|
| Rate for Payer: Coventry All Commercial |
$67.32
|
| Rate for Payer: Encore All Commercial |
$70.42
|
| Rate for Payer: Frontpath All Commercial |
$70.38
|
| Rate for Payer: Humana ChoiceCare |
$66.07
|
| Rate for Payer: Humana Medicare |
$39.02
|
| Rate for Payer: Lucent All Commercial |
$39.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.85
|
| Rate for Payer: Managed Health Services Medicaid |
$27.80
|
| Rate for Payer: MDWise Medicaid |
$27.80
|
| Rate for Payer: PHCS All Commercial |
$57.38
|
| Rate for Payer: PHP All Commercial |
$58.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.84
|
| Rate for Payer: Sagamore Health Network All Products |
$59.06
|
| Rate for Payer: Signature Care EPO |
$63.50
|
| Rate for Payer: Signature Care PPO |
$67.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.02
|
| Rate for Payer: United Healthcare Commercial |
$60.28
|
| Rate for Payer: United Healthcare Medicare |
$25.24
|
|
|
HC CKMB ASSAY
|
Facility
IP
|
$228.33
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
63001306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$212.34 |
| Rate for Payer: Aetna Commercial |
$197.27
|
| Rate for Payer: Cash Price |
$141.56
|
| Rate for Payer: Cigna All Commercial |
$197.05
|
| Rate for Payer: CORVEL All Commercial |
$212.34
|
| Rate for Payer: Coventry All Commercial |
$200.93
|
| Rate for Payer: Encore All Commercial |
$210.18
|
| Rate for Payer: Frontpath All Commercial |
$210.06
|
| Rate for Payer: Humana ChoiceCare |
$197.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.49
|
| Rate for Payer: PHCS All Commercial |
$171.25
|
| Rate for Payer: PHP All Commercial |
$173.16
|
| Rate for Payer: Sagamore Health Network All Products |
$176.27
|
| Rate for Payer: Signature Care EPO |
$189.51
|
| Rate for Payer: Signature Care PPO |
$200.93
|
| Rate for Payer: United Healthcare Commercial |
$179.92
|
|
|
HC CKMB ASSAY
|
Facility
OP
|
$228.33
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
63001306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$212.34 |
| Rate for Payer: Aetna Commercial |
$192.71
|
| Rate for Payer: Aetna Medicare |
$75.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$104.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.88
|
| Rate for Payer: Cash Price |
$141.56
|
| Rate for Payer: Cash Price |
$141.56
|
| Rate for Payer: Centivo All Commercial |
$116.45
|
| Rate for Payer: Cigna All Commercial |
$197.05
|
| Rate for Payer: CORVEL All Commercial |
$212.34
|
| Rate for Payer: Coventry All Commercial |
$200.93
|
| Rate for Payer: Encore All Commercial |
$210.18
|
| Rate for Payer: Frontpath All Commercial |
$210.06
|
| Rate for Payer: Humana ChoiceCare |
$197.21
|
| Rate for Payer: Humana Medicare |
$116.45
|
| Rate for Payer: Lucent All Commercial |
$116.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.49
|
| Rate for Payer: Managed Health Services Medicaid |
$8.38
|
| Rate for Payer: MDWise Medicaid |
$8.38
|
| Rate for Payer: PHCS All Commercial |
$171.25
|
| Rate for Payer: PHP All Commercial |
$173.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.05
|
| Rate for Payer: Sagamore Health Network All Products |
$176.27
|
| Rate for Payer: Signature Care EPO |
$189.51
|
| Rate for Payer: Signature Care PPO |
$200.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.08
|
| Rate for Payer: United Healthcare Commercial |
$179.92
|
| Rate for Payer: United Healthcare Medicare |
$75.35
|
|
|
HC CLAMP RAYPORT MUSCLE BIOPSY
|
Facility
OP
|
$240.45
|
|
| Hospital Charge Code |
41602317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.35 |
| Max. Negotiated Rate |
$223.62 |
| Rate for Payer: Aetna Commercial |
$202.94
|
| Rate for Payer: Aetna Medicare |
$79.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$138.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.28
|
| Rate for Payer: Cash Price |
$149.08
|
| Rate for Payer: Cash Price |
$149.08
|
| Rate for Payer: Centivo All Commercial |
$122.63
|
| Rate for Payer: Cigna All Commercial |
$207.51
|
| Rate for Payer: CORVEL All Commercial |
$223.62
|
| Rate for Payer: Coventry All Commercial |
$211.60
|
| Rate for Payer: Encore All Commercial |
$221.33
|
| Rate for Payer: Frontpath All Commercial |
$221.21
|
| Rate for Payer: Humana ChoiceCare |
$207.68
|
| Rate for Payer: Humana Medicare |
$122.63
|
| Rate for Payer: Lucent All Commercial |
$122.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$180.34
|
| Rate for Payer: PHP All Commercial |
$182.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.78
|
| Rate for Payer: Sagamore Health Network All Products |
$185.63
|
| Rate for Payer: Signature Care EPO |
$199.57
|
| Rate for Payer: Signature Care PPO |
$211.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$204.38
|
| Rate for Payer: United Healthcare Commercial |
$189.47
|
| Rate for Payer: United Healthcare Medicare |
$79.35
|
|
|
HC CLAMP RAYPORT MUSCLE BIOPSY
|
Facility
IP
|
$240.45
|
|
| Hospital Charge Code |
41602317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.34 |
| Max. Negotiated Rate |
$223.62 |
| Rate for Payer: Aetna Commercial |
$207.75
|
| Rate for Payer: Cash Price |
$149.08
|
| Rate for Payer: Cigna All Commercial |
$207.51
|
| Rate for Payer: CORVEL All Commercial |
$223.62
|
| Rate for Payer: Coventry All Commercial |
$211.60
|
| Rate for Payer: Encore All Commercial |
$221.33
|
| Rate for Payer: Frontpath All Commercial |
$221.21
|
| Rate for Payer: Humana ChoiceCare |
$207.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.40
|
| Rate for Payer: PHCS All Commercial |
$180.34
|
| Rate for Payer: PHP All Commercial |
$182.36
|
| Rate for Payer: Sagamore Health Network All Products |
$185.63
|
| Rate for Payer: Signature Care EPO |
$199.57
|
| Rate for Payer: Signature Care PPO |
$211.60
|
| Rate for Payer: United Healthcare Commercial |
$189.47
|
|
|
HC CLINICL SWALLOW EVAL-15 MIN-SP
|
Facility
OP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01748010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$436.08
|
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.56
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Centivo All Commercial |
$263.51
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Humana Medicare |
$263.51
|
| Rate for Payer: Lucent All Commercial |
$263.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.51
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.18
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
| Rate for Payer: United Healthcare Medicare |
$170.50
|
|
|
HC CLINICL SWALLOW EVAL-15 MIN-SP
|
Facility
IP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01748010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$387.51 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$446.41
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
|
|
HC CLINICL SWALLOW EVAL-30 MIN-SP
|
Facility
OP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01748011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$436.08
|
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.56
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Centivo All Commercial |
$263.51
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Humana Medicare |
$263.51
|
| Rate for Payer: Lucent All Commercial |
$263.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.51
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.18
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
| Rate for Payer: United Healthcare Medicare |
$170.50
|
|
|
HC CLINICL SWALLOW EVAL-30 MIN-SP
|
Facility
IP
|
$516.68
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
01748011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$387.51 |
| Max. Negotiated Rate |
$480.51 |
| Rate for Payer: Aetna Commercial |
$446.41
|
| Rate for Payer: Cash Price |
$320.34
|
| Rate for Payer: Cigna All Commercial |
$445.90
|
| Rate for Payer: CORVEL All Commercial |
$480.51
|
| Rate for Payer: Coventry All Commercial |
$454.68
|
| Rate for Payer: Encore All Commercial |
$475.60
|
| Rate for Payer: Frontpath All Commercial |
$475.35
|
| Rate for Payer: Humana ChoiceCare |
$446.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.01
|
| Rate for Payer: PHCS All Commercial |
$387.51
|
| Rate for Payer: PHP All Commercial |
$391.85
|
| Rate for Payer: Sagamore Health Network All Products |
$398.88
|
| Rate for Payer: Signature Care EPO |
$428.85
|
| Rate for Payer: Signature Care PPO |
$454.68
|
| Rate for Payer: United Healthcare Commercial |
$407.14
|
|
