|
HC AIRWAY NASOPHARYNGEAL 28FR
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
41601005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
|
|
HC AIRWAY NASOPHARYNGEAL 30FR
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
41601446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
|
|
HC AIRWAY NASOPHARYNGEAL 30FR
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
41601446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.95
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Centivo All Commercial |
$9.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: Lucent All Commercial |
$9.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.91
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.05
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
| Rate for Payer: United Healthcare Medicare |
$5.67
|
|
|
HC AIRWAY NASOPHARYNGEAL 32FR
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
41601447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.95
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Centivo All Commercial |
$9.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: Lucent All Commercial |
$9.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.91
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.05
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
| Rate for Payer: United Healthcare Medicare |
$5.67
|
|
|
HC AIRWAY NASOPHARYNGEAL 32FR
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
41601447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
|
|
HC AIRWAY NASOPHARYNGEAL 34FR
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
41601448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
|
|
HC AIRWAY NASOPHARYNGEAL 34FR
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
41601448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.95
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Centivo All Commercial |
$9.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: Lucent All Commercial |
$9.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.91
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.05
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
| Rate for Payer: United Healthcare Medicare |
$5.67
|
|
|
HC ALBUMIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
63001216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare |
$14.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.19
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Centivo All Commercial |
$25.02
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Humana Medicare |
$14.72
|
| Rate for Payer: Lucent All Commercial |
$25.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: Managed Health Services Medicaid |
$4.95
|
| Rate for Payer: MDWise Medicaid |
$4.95
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.94
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.10
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Medicare |
$14.72
|
|
|
HC ALBUMIN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
63001216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$39.74
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
|
|
HC ALCOHOL ETHYL-SERUM/PLASMA
|
Facility
|
IP
|
$206.04
|
|
|
Service Code
|
CPT 82077
|
| Hospital Charge Code |
63001387
|
|
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 |
$123.62
|
| 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 ALCOHOL ETHYL-SERUM/PLASMA
|
Facility
|
OP
|
$206.04
|
|
|
Service Code
|
CPT 82077
|
| Hospital Charge Code |
63001387
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$173.90
|
| Rate for Payer: Aetna Medicare |
$65.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.53
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: Centivo All Commercial |
$112.09
|
| 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 |
$65.93
|
| Rate for Payer: Lucent All Commercial |
$112.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.44
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| 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 |
$65.93
|
|
|
HC ALCOHOL ETHYL, URINE
|
Facility
|
OP
|
$196.72
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001386
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$182.95 |
| Rate for Payer: Aetna Commercial |
$166.03
|
| Rate for Payer: Aetna Medicare |
$62.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$90.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.25
|
| Rate for Payer: Cash Price |
$118.03
|
| Rate for Payer: Cash Price |
$118.03
|
| Rate for Payer: Centivo All Commercial |
$107.02
|
| Rate for Payer: Cigna All Commercial |
$169.77
|
| Rate for Payer: CORVEL All Commercial |
$182.95
|
| Rate for Payer: Coventry All Commercial |
$173.11
|
| Rate for Payer: Encore All Commercial |
$181.08
|
| Rate for Payer: Frontpath All Commercial |
$180.98
|
| Rate for Payer: Humana ChoiceCare |
$169.91
|
| Rate for Payer: Humana Medicare |
$62.95
|
| Rate for Payer: Lucent All Commercial |
$107.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.05
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$147.54
|
| Rate for Payer: PHP All Commercial |
$149.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.72
|
| Rate for Payer: Sagamore Health Network All Products |
$151.87
|
| Rate for Payer: Signature Care EPO |
$163.28
|
| Rate for Payer: Signature Care PPO |
$173.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.21
|
| Rate for Payer: United Healthcare Commercial |
$155.02
|
| Rate for Payer: United Healthcare Medicare |
$62.95
|
|
|
HC ALCOHOL ETHYL, URINE
|
Facility
|
IP
|
$196.72
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001386
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.54 |
| Max. Negotiated Rate |
$182.95 |
| Rate for Payer: Aetna Commercial |
$169.97
|
| Rate for Payer: Cash Price |
$118.03
|
| Rate for Payer: Cigna All Commercial |
$169.77
|
| Rate for Payer: CORVEL All Commercial |
$182.95
|
| Rate for Payer: Coventry All Commercial |
$173.11
|
| Rate for Payer: Encore All Commercial |
$181.08
|
| Rate for Payer: Frontpath All Commercial |
$180.98
|
| Rate for Payer: Humana ChoiceCare |
$169.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.05
|
| Rate for Payer: PHCS All Commercial |
$147.54
|
| Rate for Payer: PHP All Commercial |
$149.19
|
| Rate for Payer: Sagamore Health Network All Products |
$151.87
|
| Rate for Payer: Signature Care EPO |
$163.28
|
| Rate for Payer: Signature Care PPO |
$173.11
|
| Rate for Payer: United Healthcare Commercial |
$155.02
|
|
|
HC ALDOLASE
|
Facility
|
IP
|
$132.40
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
63001449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$123.13 |
| Rate for Payer: Aetna Commercial |
$114.39
|
| Rate for Payer: Cash Price |
$79.44
|
| Rate for Payer: Cigna All Commercial |
$114.26
|
| Rate for Payer: CORVEL All Commercial |
$123.13
|
| Rate for Payer: Coventry All Commercial |
$116.51
|
| Rate for Payer: Encore All Commercial |
$121.87
|
| Rate for Payer: Frontpath All Commercial |
$121.81
|
| Rate for Payer: Humana ChoiceCare |
$114.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.16
|
| Rate for Payer: PHCS All Commercial |
$99.30
|
| Rate for Payer: PHP All Commercial |
$100.41
|
| Rate for Payer: Sagamore Health Network All Products |
$102.21
|
| Rate for Payer: Signature Care EPO |
$109.89
|
| Rate for Payer: Signature Care PPO |
$116.51
|
| Rate for Payer: United Healthcare Commercial |
$104.33
|
|
|
HC ALDOLASE
|
Facility
|
OP
|
$132.40
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
63001449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$123.13 |
| Rate for Payer: Aetna Commercial |
$111.75
|
| Rate for Payer: Aetna Medicare |
$42.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.60
|
| Rate for Payer: Cash Price |
$79.44
|
| Rate for Payer: Cash Price |
$79.44
|
| Rate for Payer: Centivo All Commercial |
$72.03
|
| Rate for Payer: Cigna All Commercial |
$114.26
|
| Rate for Payer: CORVEL All Commercial |
$123.13
|
| Rate for Payer: Coventry All Commercial |
$116.51
|
| Rate for Payer: Encore All Commercial |
$121.87
|
| Rate for Payer: Frontpath All Commercial |
$121.81
|
| Rate for Payer: Humana ChoiceCare |
$114.35
|
| Rate for Payer: Humana Medicare |
$42.37
|
| Rate for Payer: Lucent All Commercial |
$72.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.16
|
| Rate for Payer: Managed Health Services Medicaid |
$9.71
|
| Rate for Payer: MDWise Medicaid |
$9.71
|
| Rate for Payer: PHCS All Commercial |
$99.30
|
| Rate for Payer: PHP All Commercial |
$100.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.64
|
| Rate for Payer: Sagamore Health Network All Products |
$102.21
|
| Rate for Payer: Signature Care EPO |
$109.89
|
| Rate for Payer: Signature Care PPO |
$116.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.54
|
| Rate for Payer: United Healthcare Commercial |
$104.33
|
| Rate for Payer: United Healthcare Medicare |
$42.37
|
|
|
HC ALDOSTERONE
|
Facility
|
OP
|
$380.36
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
63001450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$353.73 |
| Rate for Payer: Aetna Commercial |
$321.02
|
| Rate for Payer: Aetna Medicare |
$121.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$174.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$174.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.89
|
| Rate for Payer: Cash Price |
$228.22
|
| Rate for Payer: Cash Price |
$228.22
|
| Rate for Payer: Centivo All Commercial |
$206.92
|
| Rate for Payer: Cigna All Commercial |
$328.25
|
| Rate for Payer: CORVEL All Commercial |
$353.73
|
| Rate for Payer: Coventry All Commercial |
$334.72
|
| Rate for Payer: Encore All Commercial |
$350.12
|
| Rate for Payer: Frontpath All Commercial |
$349.93
|
| Rate for Payer: Humana ChoiceCare |
$328.52
|
| Rate for Payer: Humana Medicare |
$121.72
|
| Rate for Payer: Lucent All Commercial |
$206.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.32
|
| Rate for Payer: Managed Health Services Medicaid |
$40.75
|
| Rate for Payer: MDWise Medicaid |
$40.75
|
| Rate for Payer: PHCS All Commercial |
$285.27
|
| Rate for Payer: PHP All Commercial |
$288.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.34
|
| Rate for Payer: Sagamore Health Network All Products |
$293.64
|
| Rate for Payer: Signature Care EPO |
$315.70
|
| Rate for Payer: Signature Care PPO |
$334.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$323.31
|
| Rate for Payer: United Healthcare Commercial |
$299.72
|
| Rate for Payer: United Healthcare Medicare |
$121.72
|
|
|
HC ALDOSTERONE
|
Facility
|
IP
|
$380.36
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
63001450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.27 |
| Max. Negotiated Rate |
$353.73 |
| Rate for Payer: Aetna Commercial |
$328.63
|
| Rate for Payer: Cash Price |
$228.22
|
| Rate for Payer: Cigna All Commercial |
$328.25
|
| Rate for Payer: CORVEL All Commercial |
$353.73
|
| Rate for Payer: Coventry All Commercial |
$334.72
|
| Rate for Payer: Encore All Commercial |
$350.12
|
| Rate for Payer: Frontpath All Commercial |
$349.93
|
| Rate for Payer: Humana ChoiceCare |
$328.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.32
|
| Rate for Payer: PHCS All Commercial |
$285.27
|
| Rate for Payer: PHP All Commercial |
$288.47
|
| Rate for Payer: Sagamore Health Network All Products |
$293.64
|
| Rate for Payer: Signature Care EPO |
$315.70
|
| Rate for Payer: Signature Care PPO |
$334.72
|
| Rate for Payer: United Healthcare Commercial |
$299.72
|
|
|
HC ALK PHOS
|
Facility
|
IP
|
$91.59
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
63001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$85.18 |
| Rate for Payer: Aetna Commercial |
$79.13
|
| Rate for Payer: Cash Price |
$54.95
|
| Rate for Payer: Cigna All Commercial |
$79.04
|
| Rate for Payer: CORVEL All Commercial |
$85.18
|
| Rate for Payer: Coventry All Commercial |
$80.60
|
| Rate for Payer: Encore All Commercial |
$84.31
|
| Rate for Payer: Frontpath All Commercial |
$84.26
|
| Rate for Payer: Humana ChoiceCare |
$79.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.43
|
| Rate for Payer: PHCS All Commercial |
$68.69
|
| Rate for Payer: PHP All Commercial |
$69.46
|
| Rate for Payer: Sagamore Health Network All Products |
$70.71
|
| Rate for Payer: Signature Care EPO |
$76.02
|
| Rate for Payer: Signature Care PPO |
$80.60
|
| Rate for Payer: United Healthcare Commercial |
$72.17
|
|
|
HC ALK PHOS
|
Facility
|
OP
|
$91.59
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
63001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$85.18 |
| Rate for Payer: Aetna Commercial |
$77.30
|
| Rate for Payer: Aetna Medicare |
$29.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.24
|
| Rate for Payer: Cash Price |
$54.95
|
| Rate for Payer: Cash Price |
$54.95
|
| Rate for Payer: Centivo All Commercial |
$49.82
|
| Rate for Payer: Cigna All Commercial |
$79.04
|
| Rate for Payer: CORVEL All Commercial |
$85.18
|
| Rate for Payer: Coventry All Commercial |
$80.60
|
| Rate for Payer: Encore All Commercial |
$84.31
|
| Rate for Payer: Frontpath All Commercial |
$84.26
|
| Rate for Payer: Humana ChoiceCare |
$79.11
|
| Rate for Payer: Humana Medicare |
$29.31
|
| Rate for Payer: Lucent All Commercial |
$49.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.43
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$68.69
|
| Rate for Payer: PHP All Commercial |
$69.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.72
|
| Rate for Payer: Sagamore Health Network All Products |
$70.71
|
| Rate for Payer: Signature Care EPO |
$76.02
|
| Rate for Payer: Signature Care PPO |
$80.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.85
|
| Rate for Payer: United Healthcare Commercial |
$72.17
|
| Rate for Payer: United Healthcare Medicare |
$29.31
|
|
|
HC ALK PHOS BONE SPECIF
|
Facility
|
IP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna Commercial |
$141.53
|
| Rate for Payer: Cash Price |
$98.29
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.34
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.23
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
|
|
HC ALK PHOS BONE SPECIF
|
Facility
|
OP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Aetna Medicare |
$52.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.66
|
| Rate for Payer: Cash Price |
$98.29
|
| Rate for Payer: Cash Price |
$98.29
|
| Rate for Payer: Centivo All Commercial |
$89.11
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.34
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Humana Medicare |
$52.42
|
| Rate for Payer: Lucent All Commercial |
$89.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.89
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.24
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
| Rate for Payer: United Healthcare Medicare |
$52.42
|
|
|
HC ALK PHOS ISOENZYME
|
Facility
|
IP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna Commercial |
$141.53
|
| Rate for Payer: Cash Price |
$98.29
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.34
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.23
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
|
|
HC ALK PHOS ISOENZYME
|
Facility
|
OP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Aetna Medicare |
$52.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.66
|
| Rate for Payer: Cash Price |
$98.29
|
| Rate for Payer: Cash Price |
$98.29
|
| Rate for Payer: Centivo All Commercial |
$89.11
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.34
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Humana Medicare |
$52.42
|
| Rate for Payer: Lucent All Commercial |
$89.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.89
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.24
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
| Rate for Payer: United Healthcare Medicare |
$52.42
|
|
|
HC ALLERGEN ACREMONIUM KILIENSE
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN ACREMONIUM KILIENSE
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
