|
HC CPK
|
Facility
OP
|
$83.03
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
63001120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Aetna Commercial |
$70.08
|
| Rate for Payer: Aetna Medicare |
$27.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.14
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Centivo All Commercial |
$42.34
|
| Rate for Payer: Cigna All Commercial |
$71.65
|
| Rate for Payer: CORVEL All Commercial |
$77.22
|
| Rate for Payer: Coventry All Commercial |
$73.06
|
| Rate for Payer: Encore All Commercial |
$76.43
|
| Rate for Payer: Frontpath All Commercial |
$76.39
|
| Rate for Payer: Humana ChoiceCare |
$71.71
|
| Rate for Payer: Humana Medicare |
$42.34
|
| Rate for Payer: Lucent All Commercial |
$42.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.73
|
| Rate for Payer: Managed Health Services Medicaid |
$6.51
|
| Rate for Payer: MDWise Medicaid |
$6.51
|
| Rate for Payer: PHCS All Commercial |
$62.27
|
| Rate for Payer: PHP All Commercial |
$62.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.38
|
| Rate for Payer: Sagamore Health Network All Products |
$64.10
|
| Rate for Payer: Signature Care EPO |
$68.91
|
| Rate for Payer: Signature Care PPO |
$73.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.57
|
| Rate for Payer: United Healthcare Commercial |
$65.43
|
| Rate for Payer: United Healthcare Medicare |
$27.40
|
|
|
HC CPK
|
Facility
IP
|
$83.03
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
63001120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Aetna Commercial |
$71.74
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cigna All Commercial |
$71.65
|
| Rate for Payer: CORVEL All Commercial |
$77.22
|
| Rate for Payer: Coventry All Commercial |
$73.06
|
| Rate for Payer: Encore All Commercial |
$76.43
|
| Rate for Payer: Frontpath All Commercial |
$76.39
|
| Rate for Payer: Humana ChoiceCare |
$71.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.73
|
| Rate for Payer: PHCS All Commercial |
$62.27
|
| Rate for Payer: PHP All Commercial |
$62.97
|
| Rate for Payer: Sagamore Health Network All Products |
$64.10
|
| Rate for Payer: Signature Care EPO |
$68.91
|
| Rate for Payer: Signature Care PPO |
$73.06
|
| Rate for Payer: United Healthcare Commercial |
$65.43
|
|
|
HC CPK ISOENZYMES
|
Facility
OP
|
$188.50
|
|
|
Service Code
|
CPT 82552
|
| Hospital Charge Code |
63001521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$175.30 |
| Rate for Payer: Aetna Commercial |
$159.09
|
| Rate for Payer: Aetna Medicare |
$62.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.42
|
| Rate for Payer: Cash Price |
$116.87
|
| Rate for Payer: Cash Price |
$116.87
|
| Rate for Payer: Centivo All Commercial |
$96.13
|
| Rate for Payer: Cigna All Commercial |
$162.67
|
| Rate for Payer: CORVEL All Commercial |
$175.30
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.80
|
| Rate for Payer: Humana Medicare |
$96.13
|
| Rate for Payer: Lucent All Commercial |
$96.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$141.37
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.51
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.45
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.22
|
| Rate for Payer: United Healthcare Commercial |
$148.53
|
| Rate for Payer: United Healthcare Medicare |
$62.20
|
|
|
HC CPK ISOENZYMES
|
Facility
IP
|
$188.50
|
|
|
Service Code
|
CPT 82552
|
| Hospital Charge Code |
63001521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.37 |
| Max. Negotiated Rate |
$175.30 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Cash Price |
$116.87
|
| Rate for Payer: Cigna All Commercial |
$162.67
|
| Rate for Payer: CORVEL All Commercial |
$175.30
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: PHCS All Commercial |
$141.37
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.45
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: United Healthcare Commercial |
$148.53
|
|
|
HC CPPD - INITIAL
|
Facility
IP
|
$238.68
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
01706476
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$221.97 |
| Rate for Payer: Aetna Commercial |
$206.22
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
|
|
HC CPPD - INITIAL
|
Facility
OP
|
$238.68
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
01706476
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$221.97 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$137.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.64
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Centivo All Commercial |
$121.73
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Humana Medicare |
$121.73
|
| Rate for Payer: Lucent All Commercial |
$121.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.09
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202.88
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
| Rate for Payer: United Healthcare Medicare |
$78.76
|
|
|
HC CPPD - SUBSEQUENT
|
Facility
OP
|
$163.07
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
01704668
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$151.65 |
| Rate for Payer: Aetna Commercial |
$137.63
|
| Rate for Payer: Aetna Medicare |
$53.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.19
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Centivo All Commercial |
$83.16
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.65
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.10
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Humana Medicare |
$83.16
|
| Rate for Payer: Lucent All Commercial |
$83.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.60
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.61
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
| Rate for Payer: United Healthcare Medicare |
$53.81
|
|
|
HC CPPD - SUBSEQUENT
|
Facility
IP
|
$163.07
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
01704668
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$151.65 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.65
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.10
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
|
|
HC CPS DIRECT PL 135DEG 47CM
|
Facility
OP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$957.10
|
| Rate for Payer: Aetna Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$651.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$708.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.64
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Centivo All Commercial |
$578.34
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Humana Medicare |
$578.34
|
| Rate for Payer: Lucent All Commercial |
$578.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.26
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$963.90
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
| Rate for Payer: United Healthcare Medicare |
$374.22
|
|
|
HC CPS DIRECT PL 135DEG 47CM
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$979.78
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
|
|
HC CPS DIRECT PL EXTRA WIDE 47CM
|
Facility
OP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$957.10
|
| Rate for Payer: Aetna Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$651.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$708.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.64
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Centivo All Commercial |
$578.34
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Humana Medicare |
$578.34
|
| Rate for Payer: Lucent All Commercial |
$578.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.26
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$963.90
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
| Rate for Payer: United Healthcare Medicare |
$374.22
|
|
|
HC CPS DIRECT PL EXTRA WIDE 47CM
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$979.78
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
|
|
HC CPS DIRECT PL MP 47CM
|
Facility
OP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$957.10
|
| Rate for Payer: Aetna Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$651.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$708.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.64
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Centivo All Commercial |
$578.34
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Humana Medicare |
$578.34
|
| Rate for Payer: Lucent All Commercial |
$578.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.26
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$963.90
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
| Rate for Payer: United Healthcare Medicare |
$374.22
|
|
|
HC CPS DIRECT PL MP 47CM
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$979.78
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
|
|
HC CPS DIRECT PL RIGHT-SIDED 47CM
|
Facility
OP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$957.10
|
| Rate for Payer: Aetna Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$651.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$708.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.64
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Centivo All Commercial |
$578.34
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Humana Medicare |
$578.34
|
| Rate for Payer: Lucent All Commercial |
$578.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.26
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$963.90
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
| Rate for Payer: United Healthcare Medicare |
$374.22
|
|
|
HC CPS DIRECT PL RIGHT-SIDED 47CM
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$979.78
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
|
|
HC CPS DIRECT PL STRAIT 47CM
|
Facility
OP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$957.10
|
| Rate for Payer: Aetna Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$374.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$651.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$708.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.64
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Centivo All Commercial |
$578.34
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Humana Medicare |
$578.34
|
| Rate for Payer: Lucent All Commercial |
$578.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.26
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$963.90
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
| Rate for Payer: United Healthcare Medicare |
$374.22
|
|
|
HC CPS DIRECT PL STRAIT 47CM
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,054.62 |
| Rate for Payer: Aetna Commercial |
$979.78
|
| Rate for Payer: Cash Price |
$703.08
|
| Rate for Payer: Cigna All Commercial |
$978.64
|
| Rate for Payer: CORVEL All Commercial |
$1,054.62
|
| Rate for Payer: Coventry All Commercial |
$997.92
|
| Rate for Payer: Encore All Commercial |
$1,043.85
|
| Rate for Payer: Frontpath All Commercial |
$1,043.28
|
| Rate for Payer: Humana ChoiceCare |
$979.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,020.60
|
| Rate for Payer: PHCS All Commercial |
$850.50
|
| Rate for Payer: PHP All Commercial |
$860.03
|
| Rate for Payer: Sagamore Health Network All Products |
$875.45
|
| Rate for Payer: Signature Care EPO |
$941.22
|
| Rate for Payer: Signature Care PPO |
$997.92
|
| Rate for Payer: United Healthcare Commercial |
$893.59
|
|
|
HC C-REACTIVE PROTEIN (CRP), HIGH SENS
|
Facility
IP
|
$132.47
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
63001195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Aetna Commercial |
$114.45
|
| Rate for Payer: Cash Price |
$82.13
|
| Rate for Payer: Cigna All Commercial |
$114.32
|
| Rate for Payer: CORVEL All Commercial |
$123.19
|
| Rate for Payer: Coventry All Commercial |
$116.57
|
| Rate for Payer: Encore All Commercial |
$121.94
|
| Rate for Payer: Frontpath All Commercial |
$121.87
|
| Rate for Payer: Humana ChoiceCare |
$114.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.22
|
| Rate for Payer: PHCS All Commercial |
$99.35
|
| Rate for Payer: PHP All Commercial |
$100.46
|
| Rate for Payer: Sagamore Health Network All Products |
$102.26
|
| Rate for Payer: Signature Care EPO |
$109.95
|
| Rate for Payer: Signature Care PPO |
$116.57
|
| Rate for Payer: United Healthcare Commercial |
$104.38
|
|
|
HC C-REACTIVE PROTEIN (CRP), HIGH SENS
|
Facility
OP
|
$132.47
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
63001195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Aetna Commercial |
$111.80
|
| Rate for Payer: Aetna Medicare |
$43.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.09
|
| Rate for Payer: Cash Price |
$82.13
|
| Rate for Payer: Cash Price |
$82.13
|
| Rate for Payer: Centivo All Commercial |
$67.56
|
| Rate for Payer: Cigna All Commercial |
$114.32
|
| Rate for Payer: CORVEL All Commercial |
$123.19
|
| Rate for Payer: Coventry All Commercial |
$116.57
|
| Rate for Payer: Encore All Commercial |
$121.94
|
| Rate for Payer: Frontpath All Commercial |
$121.87
|
| Rate for Payer: Humana ChoiceCare |
$114.41
|
| Rate for Payer: Humana Medicare |
$67.56
|
| Rate for Payer: Lucent All Commercial |
$67.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.22
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: MDWise Medicaid |
$12.95
|
| Rate for Payer: PHCS All Commercial |
$99.35
|
| Rate for Payer: PHP All Commercial |
$100.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.66
|
| Rate for Payer: Sagamore Health Network All Products |
$102.26
|
| Rate for Payer: Signature Care EPO |
$109.95
|
| Rate for Payer: Signature Care PPO |
$116.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.60
|
| Rate for Payer: United Healthcare Commercial |
$104.38
|
| Rate for Payer: United Healthcare Medicare |
$43.71
|
|
|
HC C-REACTIVE PROTEIN (CRP), QUANT
|
Facility
IP
|
$133.30
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
63001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.98 |
| Max. Negotiated Rate |
$123.97 |
| Rate for Payer: Aetna Commercial |
$115.17
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna All Commercial |
$115.04
|
| Rate for Payer: CORVEL All Commercial |
$123.97
|
| Rate for Payer: Coventry All Commercial |
$117.31
|
| Rate for Payer: Encore All Commercial |
$122.71
|
| Rate for Payer: Frontpath All Commercial |
$122.64
|
| Rate for Payer: Humana ChoiceCare |
$115.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.97
|
| Rate for Payer: PHCS All Commercial |
$99.98
|
| Rate for Payer: PHP All Commercial |
$101.10
|
| Rate for Payer: Sagamore Health Network All Products |
$102.91
|
| Rate for Payer: Signature Care EPO |
$110.64
|
| Rate for Payer: Signature Care PPO |
$117.31
|
| Rate for Payer: United Healthcare Commercial |
$105.04
|
|
|
HC C-REACTIVE PROTEIN (CRP), QUANT
|
Facility
OP
|
$133.30
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
63001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$123.97 |
| Rate for Payer: Aetna Commercial |
$112.51
|
| Rate for Payer: Aetna Medicare |
$43.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.39
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Centivo All Commercial |
$67.98
|
| Rate for Payer: Cigna All Commercial |
$115.04
|
| Rate for Payer: CORVEL All Commercial |
$123.97
|
| Rate for Payer: Coventry All Commercial |
$117.31
|
| Rate for Payer: Encore All Commercial |
$122.71
|
| Rate for Payer: Frontpath All Commercial |
$122.64
|
| Rate for Payer: Humana ChoiceCare |
$115.13
|
| Rate for Payer: Humana Medicare |
$67.98
|
| Rate for Payer: Lucent All Commercial |
$67.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.97
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$99.98
|
| Rate for Payer: PHP All Commercial |
$101.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.99
|
| Rate for Payer: Sagamore Health Network All Products |
$102.91
|
| Rate for Payer: Signature Care EPO |
$110.64
|
| Rate for Payer: Signature Care PPO |
$117.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113.31
|
| Rate for Payer: United Healthcare Commercial |
$105.04
|
| Rate for Payer: United Healthcare Medicare |
$43.99
|
|
|
HC CREATININE CLEARANCE
|
Facility
OP
|
$151.47
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
63001118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna Medicare |
$49.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.98
|
| Rate for Payer: Cash Price |
$93.91
|
| Rate for Payer: Cash Price |
$93.91
|
| Rate for Payer: Centivo All Commercial |
$77.25
|
| Rate for Payer: Cigna All Commercial |
$130.72
|
| Rate for Payer: CORVEL All Commercial |
$140.87
|
| Rate for Payer: Coventry All Commercial |
$133.29
|
| Rate for Payer: Encore All Commercial |
$139.43
|
| Rate for Payer: Frontpath All Commercial |
$139.35
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Humana Medicare |
$77.25
|
| Rate for Payer: Lucent All Commercial |
$77.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.32
|
| Rate for Payer: Managed Health Services Medicaid |
$9.46
|
| Rate for Payer: MDWise Medicaid |
$9.46
|
| Rate for Payer: PHCS All Commercial |
$113.60
|
| Rate for Payer: PHP All Commercial |
$114.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.07
|
| Rate for Payer: Sagamore Health Network All Products |
$116.93
|
| Rate for Payer: Signature Care EPO |
$125.72
|
| Rate for Payer: Signature Care PPO |
$133.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.75
|
| Rate for Payer: United Healthcare Commercial |
$119.36
|
| Rate for Payer: United Healthcare Medicare |
$49.99
|
|
|
HC CREATININE CLEARANCE
|
Facility
IP
|
$151.47
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
63001118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$130.87
|
| Rate for Payer: Cash Price |
$93.91
|
| Rate for Payer: Cigna All Commercial |
$130.72
|
| Rate for Payer: CORVEL All Commercial |
$140.87
|
| Rate for Payer: Coventry All Commercial |
$133.29
|
| Rate for Payer: Encore All Commercial |
$139.43
|
| Rate for Payer: Frontpath All Commercial |
$139.35
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.32
|
| Rate for Payer: PHCS All Commercial |
$113.60
|
| Rate for Payer: PHP All Commercial |
$114.87
|
| Rate for Payer: Sagamore Health Network All Products |
$116.93
|
| Rate for Payer: Signature Care EPO |
$125.72
|
| Rate for Payer: Signature Care PPO |
$133.29
|
| Rate for Payer: United Healthcare Commercial |
$119.36
|
|
|
HC CREATININE-PRECONTRAST
|
Facility
OP
|
$53.65
|
|
|
Service Code
|
CPT 82540
|
| Hospital Charge Code |
63001506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: Aetna Commercial |
$45.28
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.48
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Centivo All Commercial |
$27.36
|
| Rate for Payer: Cigna All Commercial |
$46.30
|
| Rate for Payer: CORVEL All Commercial |
$49.90
|
| Rate for Payer: Coventry All Commercial |
$47.21
|
| Rate for Payer: Encore All Commercial |
$49.39
|
| Rate for Payer: Frontpath All Commercial |
$49.36
|
| Rate for Payer: Humana ChoiceCare |
$46.34
|
| Rate for Payer: Humana Medicare |
$27.36
|
| Rate for Payer: Lucent All Commercial |
$27.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.29
|
| Rate for Payer: Managed Health Services Medicaid |
$4.64
|
| Rate for Payer: MDWise Medicaid |
$4.64
|
| Rate for Payer: PHCS All Commercial |
$40.24
|
| Rate for Payer: PHP All Commercial |
$40.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.92
|
| Rate for Payer: Sagamore Health Network All Products |
$41.42
|
| Rate for Payer: Signature Care EPO |
$44.53
|
| Rate for Payer: Signature Care PPO |
$47.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$42.28
|
| Rate for Payer: United Healthcare Medicare |
$17.71
|
|
