|
HC CREATININE-PRECONTRAST
|
Facility
IP
|
$53.65
|
|
|
Service Code
|
CPT 82540
|
| Hospital Charge Code |
63001506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Cash Price |
$33.26
|
| 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: Lutheran Preferred All Commercial |
$48.29
|
| Rate for Payer: PHCS All Commercial |
$40.24
|
| Rate for Payer: PHP All Commercial |
$40.69
|
| 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: United Healthcare Commercial |
$42.28
|
|
|
HC CREATININE SERUM
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
63001094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$39.75
|
| Rate for Payer: Cash Price |
$28.52
|
| 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 CREATININE SERUM
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
63001094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$38.83
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.70
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centivo All Commercial |
$23.46
|
| 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 |
$23.46
|
| Rate for Payer: Lucent All Commercial |
$23.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: Managed Health Services Medicaid |
$5.12
|
| Rate for Payer: MDWise Medicaid |
$5.12
|
| 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 |
$15.18
|
|
|
HC CREAT URINE
|
Facility
OP
|
$106.52
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63001175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$99.06 |
| Rate for Payer: Aetna Commercial |
$89.90
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.67
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Centivo All Commercial |
$54.32
|
| Rate for Payer: Cigna All Commercial |
$91.93
|
| Rate for Payer: CORVEL All Commercial |
$99.06
|
| Rate for Payer: Coventry All Commercial |
$93.74
|
| Rate for Payer: Encore All Commercial |
$98.05
|
| Rate for Payer: Frontpath All Commercial |
$98.00
|
| Rate for Payer: Humana ChoiceCare |
$92.00
|
| Rate for Payer: Humana Medicare |
$54.32
|
| Rate for Payer: Lucent All Commercial |
$54.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.87
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$79.89
|
| Rate for Payer: PHP All Commercial |
$80.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.54
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$88.41
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.54
|
| Rate for Payer: United Healthcare Commercial |
$83.94
|
| Rate for Payer: United Healthcare Medicare |
$35.15
|
|
|
HC CREAT URINE
|
Facility
IP
|
$106.52
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63001175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.89 |
| Max. Negotiated Rate |
$99.06 |
| Rate for Payer: Aetna Commercial |
$92.03
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cigna All Commercial |
$91.93
|
| Rate for Payer: CORVEL All Commercial |
$99.06
|
| Rate for Payer: Coventry All Commercial |
$93.74
|
| Rate for Payer: Encore All Commercial |
$98.05
|
| Rate for Payer: Frontpath All Commercial |
$98.00
|
| Rate for Payer: Humana ChoiceCare |
$92.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.87
|
| Rate for Payer: PHCS All Commercial |
$79.89
|
| Rate for Payer: PHP All Commercial |
$80.78
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$88.41
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: United Healthcare Commercial |
$83.94
|
|
|
HC CRE WG BALLOON DIL 15-18
|
Facility
IP
|
$1,099.35
|
|
| Hospital Charge Code |
41602100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.51 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$949.84
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
|
|
HC CRE WG BALLOON DIL 15-18
|
Facility
OP
|
$1,099.35
|
|
| Hospital Charge Code |
41602100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Aetna Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.06
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Centivo All Commercial |
$560.67
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Humana Medicare |
$560.67
|
| Rate for Payer: Lucent All Commercial |
$560.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$428.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$934.45
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
| Rate for Payer: United Healthcare Medicare |
$362.79
|
|
|
HC CRE WG BALLOON DIL 18-20
|
Facility
IP
|
$1,074.70
|
|
| Hospital Charge Code |
41602099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$806.02 |
| Max. Negotiated Rate |
$999.47 |
| Rate for Payer: Aetna Commercial |
$928.54
|
| Rate for Payer: Cash Price |
$666.31
|
| Rate for Payer: Cigna All Commercial |
$927.47
|
| Rate for Payer: CORVEL All Commercial |
$999.47
|
| Rate for Payer: Coventry All Commercial |
$945.74
|
| Rate for Payer: Encore All Commercial |
$989.26
|
| Rate for Payer: Frontpath All Commercial |
$988.72
|
| Rate for Payer: Humana ChoiceCare |
$928.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$967.23
|
| Rate for Payer: PHCS All Commercial |
$806.02
|
| Rate for Payer: PHP All Commercial |
$815.05
|
| Rate for Payer: Sagamore Health Network All Products |
$829.67
|
| Rate for Payer: Signature Care EPO |
$892.00
|
| Rate for Payer: Signature Care PPO |
$945.74
|
| Rate for Payer: United Healthcare Commercial |
$846.86
|
|
|
HC CRE WG BALLOON DIL 18-20
|
Facility
OP
|
$1,074.70
|
|
| Hospital Charge Code |
41602099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$999.47 |
| Rate for Payer: Aetna Commercial |
$907.05
|
| Rate for Payer: Aetna Medicare |
$354.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$354.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$617.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$671.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$390.12
|
| Rate for Payer: Cash Price |
$666.31
|
| Rate for Payer: Cash Price |
$666.31
|
| Rate for Payer: Centivo All Commercial |
$548.10
|
| Rate for Payer: Cigna All Commercial |
$927.47
|
| Rate for Payer: CORVEL All Commercial |
$999.47
|
| Rate for Payer: Coventry All Commercial |
$945.74
|
| Rate for Payer: Encore All Commercial |
$989.26
|
| Rate for Payer: Frontpath All Commercial |
$988.72
|
| Rate for Payer: Humana ChoiceCare |
$928.22
|
| Rate for Payer: Humana Medicare |
$548.10
|
| Rate for Payer: Lucent All Commercial |
$548.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$967.23
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$806.02
|
| Rate for Payer: PHP All Commercial |
$815.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$419.13
|
| Rate for Payer: Sagamore Health Network All Products |
$829.67
|
| Rate for Payer: Signature Care EPO |
$892.00
|
| Rate for Payer: Signature Care PPO |
$945.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$913.50
|
| Rate for Payer: United Healthcare Commercial |
$846.86
|
| Rate for Payer: United Healthcare Medicare |
$354.65
|
|
|
HC CRITICAL TEAM RESPONSE<30 MIN
|
Facility
IP
|
$3,805.57
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
01291440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,854.18 |
| Max. Negotiated Rate |
$3,539.18 |
| Rate for Payer: Aetna Commercial |
$3,288.01
|
| Rate for Payer: Cash Price |
$2,359.45
|
| Rate for Payer: Cigna All Commercial |
$3,284.21
|
| Rate for Payer: CORVEL All Commercial |
$3,539.18
|
| Rate for Payer: Coventry All Commercial |
$3,348.90
|
| Rate for Payer: Encore All Commercial |
$3,503.03
|
| Rate for Payer: Frontpath All Commercial |
$3,501.12
|
| Rate for Payer: Humana ChoiceCare |
$3,286.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,425.01
|
| Rate for Payer: PHCS All Commercial |
$2,854.18
|
| Rate for Payer: PHP All Commercial |
$2,886.14
|
| Rate for Payer: Sagamore Health Network All Products |
$2,937.90
|
| Rate for Payer: Signature Care EPO |
$3,158.62
|
| Rate for Payer: Signature Care PPO |
$3,348.90
|
| Rate for Payer: United Healthcare Commercial |
$2,998.79
|
|
|
HC CRITICAL TEAM RESPONSE<30 MIN
|
Facility
OP
|
$3,805.57
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
01291440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.62 |
| Max. Negotiated Rate |
$3,539.18 |
| Rate for Payer: Aetna Commercial |
$3,211.90
|
| Rate for Payer: Aetna Medicare |
$1,255.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,255.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,185.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,378.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,444.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,381.42
|
| Rate for Payer: Cash Price |
$2,359.45
|
| Rate for Payer: Cash Price |
$2,359.45
|
| Rate for Payer: Centivo All Commercial |
$1,940.84
|
| Rate for Payer: Cigna All Commercial |
$3,284.21
|
| Rate for Payer: CORVEL All Commercial |
$3,539.18
|
| Rate for Payer: Coventry All Commercial |
$3,348.90
|
| Rate for Payer: Encore All Commercial |
$3,503.03
|
| Rate for Payer: Frontpath All Commercial |
$3,501.12
|
| Rate for Payer: Humana ChoiceCare |
$3,286.87
|
| Rate for Payer: Humana Medicare |
$1,940.84
|
| Rate for Payer: Lucent All Commercial |
$1,940.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,425.01
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$2,854.18
|
| Rate for Payer: PHP All Commercial |
$2,886.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,484.17
|
| Rate for Payer: Sagamore Health Network All Products |
$2,937.90
|
| Rate for Payer: Signature Care EPO |
$3,158.62
|
| Rate for Payer: Signature Care PPO |
$3,348.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,234.73
|
| Rate for Payer: United Healthcare Commercial |
$2,998.79
|
| Rate for Payer: United Healthcare Medicare |
$1,255.84
|
|
|
HC CROHN'S DISEASE PROGNOSTIC PROFILE
|
Facility
OP
|
$78.42
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Aetna Commercial |
$66.18
|
| Rate for Payer: Aetna Medicare |
$25.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.47
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Centivo All Commercial |
$39.99
|
| Rate for Payer: Cigna All Commercial |
$67.67
|
| Rate for Payer: CORVEL All Commercial |
$72.93
|
| Rate for Payer: Coventry All Commercial |
$69.01
|
| Rate for Payer: Encore All Commercial |
$72.18
|
| Rate for Payer: Frontpath All Commercial |
$72.14
|
| Rate for Payer: Humana ChoiceCare |
$67.73
|
| Rate for Payer: Humana Medicare |
$39.99
|
| Rate for Payer: Lucent All Commercial |
$39.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.58
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$58.81
|
| Rate for Payer: PHP All Commercial |
$59.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.58
|
| Rate for Payer: Sagamore Health Network All Products |
$60.54
|
| Rate for Payer: Signature Care EPO |
$65.09
|
| Rate for Payer: Signature Care PPO |
$69.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.65
|
| Rate for Payer: United Healthcare Commercial |
$61.79
|
| Rate for Payer: United Healthcare Medicare |
$25.88
|
|
|
HC CROHN'S DISEASE PROGNOSTIC PROFILE
|
Facility
IP
|
$78.42
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.81 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Aetna Commercial |
$67.75
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cigna All Commercial |
$67.67
|
| Rate for Payer: CORVEL All Commercial |
$72.93
|
| Rate for Payer: Coventry All Commercial |
$69.01
|
| Rate for Payer: Encore All Commercial |
$72.18
|
| Rate for Payer: Frontpath All Commercial |
$72.14
|
| Rate for Payer: Humana ChoiceCare |
$67.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.58
|
| Rate for Payer: PHCS All Commercial |
$58.81
|
| Rate for Payer: PHP All Commercial |
$59.47
|
| Rate for Payer: Sagamore Health Network All Products |
$60.54
|
| Rate for Payer: Signature Care EPO |
$65.09
|
| Rate for Payer: Signature Care PPO |
$69.01
|
| Rate for Payer: United Healthcare Commercial |
$61.79
|
|
|
HC CROHN'S DISEASE PROGNOSTIC PROFILE-B
|
Facility
OP
|
$78.41
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
63044039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Aetna Commercial |
$66.18
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.46
|
| Rate for Payer: Cash Price |
$48.61
|
| Rate for Payer: Cash Price |
$48.61
|
| Rate for Payer: Centivo All Commercial |
$39.99
|
| Rate for Payer: Cigna All Commercial |
$67.67
|
| Rate for Payer: CORVEL All Commercial |
$72.92
|
| Rate for Payer: Coventry All Commercial |
$69.00
|
| Rate for Payer: Encore All Commercial |
$72.17
|
| Rate for Payer: Frontpath All Commercial |
$72.13
|
| Rate for Payer: Humana ChoiceCare |
$67.72
|
| Rate for Payer: Humana Medicare |
$39.99
|
| Rate for Payer: Lucent All Commercial |
$39.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.57
|
| Rate for Payer: Managed Health Services Medicaid |
$12.25
|
| Rate for Payer: MDWise Medicaid |
$12.25
|
| Rate for Payer: PHCS All Commercial |
$58.81
|
| Rate for Payer: PHP All Commercial |
$59.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.58
|
| Rate for Payer: Sagamore Health Network All Products |
$60.53
|
| Rate for Payer: Signature Care EPO |
$65.08
|
| Rate for Payer: Signature Care PPO |
$69.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.65
|
| Rate for Payer: United Healthcare Commercial |
$61.79
|
| Rate for Payer: United Healthcare Medicare |
$25.87
|
|
|
HC CROHN'S DISEASE PROGNOSTIC PROFILE-B
|
Facility
IP
|
$78.41
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
63044039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.81 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Aetna Commercial |
$67.74
|
| Rate for Payer: Cash Price |
$48.61
|
| Rate for Payer: Cigna All Commercial |
$67.67
|
| Rate for Payer: CORVEL All Commercial |
$72.92
|
| Rate for Payer: Coventry All Commercial |
$69.00
|
| Rate for Payer: Encore All Commercial |
$72.17
|
| Rate for Payer: Frontpath All Commercial |
$72.13
|
| Rate for Payer: Humana ChoiceCare |
$67.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.57
|
| Rate for Payer: PHCS All Commercial |
$58.81
|
| Rate for Payer: PHP All Commercial |
$59.46
|
| Rate for Payer: Sagamore Health Network All Products |
$60.53
|
| Rate for Payer: Signature Care EPO |
$65.08
|
| Rate for Payer: Signature Care PPO |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$61.79
|
|
|
HC CRP, QUANTITATIVE
|
Facility
OP
|
$165.33
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
63001194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$153.76 |
| Rate for Payer: Aetna Commercial |
$139.54
|
| Rate for Payer: Aetna Medicare |
$54.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.02
|
| Rate for Payer: Cash Price |
$102.51
|
| Rate for Payer: Cash Price |
$102.51
|
| Rate for Payer: Centivo All Commercial |
$84.32
|
| Rate for Payer: Cigna All Commercial |
$142.68
|
| Rate for Payer: CORVEL All Commercial |
$153.76
|
| Rate for Payer: Coventry All Commercial |
$145.49
|
| Rate for Payer: Encore All Commercial |
$152.19
|
| Rate for Payer: Frontpath All Commercial |
$152.11
|
| Rate for Payer: Humana ChoiceCare |
$142.80
|
| Rate for Payer: Humana Medicare |
$84.32
|
| Rate for Payer: Lucent All Commercial |
$84.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.80
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: MDWise Medicaid |
$12.95
|
| Rate for Payer: PHCS All Commercial |
$124.00
|
| Rate for Payer: PHP All Commercial |
$125.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.48
|
| Rate for Payer: Sagamore Health Network All Products |
$127.64
|
| Rate for Payer: Signature Care EPO |
$137.23
|
| Rate for Payer: Signature Care PPO |
$145.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.53
|
| Rate for Payer: United Healthcare Commercial |
$130.28
|
| Rate for Payer: United Healthcare Medicare |
$54.56
|
|
|
HC CRP, QUANTITATIVE
|
Facility
IP
|
$165.33
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
63001194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$153.76 |
| Rate for Payer: Aetna Commercial |
$142.85
|
| Rate for Payer: Cash Price |
$102.51
|
| Rate for Payer: Cigna All Commercial |
$142.68
|
| Rate for Payer: CORVEL All Commercial |
$153.76
|
| Rate for Payer: Coventry All Commercial |
$145.49
|
| Rate for Payer: Encore All Commercial |
$152.19
|
| Rate for Payer: Frontpath All Commercial |
$152.11
|
| Rate for Payer: Humana ChoiceCare |
$142.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.80
|
| Rate for Payer: PHCS All Commercial |
$124.00
|
| Rate for Payer: PHP All Commercial |
$125.39
|
| Rate for Payer: Sagamore Health Network All Products |
$127.64
|
| Rate for Payer: Signature Care EPO |
$137.23
|
| Rate for Payer: Signature Care PPO |
$145.49
|
| Rate for Payer: United Healthcare Commercial |
$130.28
|
|
|
HC CRYOGLOBULIN
|
Facility
OP
|
$83.64
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
63001284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$70.59
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.18
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.60
|
| Rate for Payer: Encore All Commercial |
$76.99
|
| Rate for Payer: Frontpath All Commercial |
$76.95
|
| Rate for Payer: Humana ChoiceCare |
$72.24
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$62.73
|
| Rate for Payer: PHP All Commercial |
$63.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.57
|
| Rate for Payer: Signature Care EPO |
$69.42
|
| Rate for Payer: Signature Care PPO |
$73.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.09
|
| Rate for Payer: United Healthcare Commercial |
$65.91
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC CRYOGLOBULIN
|
Facility
IP
|
$83.64
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
63001284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.73 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.26
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.18
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.60
|
| Rate for Payer: Encore All Commercial |
$76.99
|
| Rate for Payer: Frontpath All Commercial |
$76.95
|
| Rate for Payer: Humana ChoiceCare |
$72.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.73
|
| Rate for Payer: PHP All Commercial |
$63.43
|
| Rate for Payer: Sagamore Health Network All Products |
$64.57
|
| Rate for Payer: Signature Care EPO |
$69.42
|
| Rate for Payer: Signature Care PPO |
$73.60
|
| Rate for Payer: United Healthcare Commercial |
$65.91
|
|
|
HC CRYOPRECIPITATE
|
Facility
IP
|
$350.01
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
01370141
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$262.51 |
| Max. Negotiated Rate |
$325.51 |
| Rate for Payer: Aetna Commercial |
$302.41
|
| Rate for Payer: Cash Price |
$217.01
|
| Rate for Payer: Cigna All Commercial |
$302.06
|
| Rate for Payer: CORVEL All Commercial |
$325.51
|
| Rate for Payer: Coventry All Commercial |
$308.01
|
| Rate for Payer: Encore All Commercial |
$322.19
|
| Rate for Payer: Frontpath All Commercial |
$322.01
|
| Rate for Payer: Humana ChoiceCare |
$302.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.01
|
| Rate for Payer: PHCS All Commercial |
$262.51
|
| Rate for Payer: PHP All Commercial |
$265.45
|
| Rate for Payer: Sagamore Health Network All Products |
$270.21
|
| Rate for Payer: Signature Care EPO |
$290.51
|
| Rate for Payer: Signature Care PPO |
$308.01
|
| Rate for Payer: United Healthcare Commercial |
$275.81
|
|
|
HC CRYOPRECIPITATE
|
Facility
OP
|
$350.01
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
01370141
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$325.51 |
| Rate for Payer: Aetna Commercial |
$295.41
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.05
|
| Rate for Payer: Cash Price |
$217.01
|
| Rate for Payer: Cash Price |
$217.01
|
| Rate for Payer: Centivo All Commercial |
$178.51
|
| Rate for Payer: Cigna All Commercial |
$302.06
|
| Rate for Payer: CORVEL All Commercial |
$325.51
|
| Rate for Payer: Coventry All Commercial |
$308.01
|
| Rate for Payer: Encore All Commercial |
$322.19
|
| Rate for Payer: Frontpath All Commercial |
$322.01
|
| Rate for Payer: Humana ChoiceCare |
$302.31
|
| Rate for Payer: Humana Medicare |
$178.51
|
| Rate for Payer: Lucent All Commercial |
$178.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.01
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$262.51
|
| Rate for Payer: PHP All Commercial |
$265.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.51
|
| Rate for Payer: Sagamore Health Network All Products |
$270.21
|
| Rate for Payer: Signature Care EPO |
$290.51
|
| Rate for Payer: Signature Care PPO |
$308.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.51
|
| Rate for Payer: United Healthcare Commercial |
$275.81
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
|
|
HC CRYOPRECIPITATE CROSSMATC
|
Facility
OP
|
$2,048.16
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
63002210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$675.89 |
| Max. Negotiated Rate |
$1,904.79 |
| Rate for Payer: Aetna Commercial |
$1,728.65
|
| Rate for Payer: Aetna Medicare |
$675.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$675.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,176.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,280.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$777.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$743.48
|
| Rate for Payer: Cash Price |
$1,269.86
|
| Rate for Payer: Centivo All Commercial |
$1,044.56
|
| Rate for Payer: Cigna All Commercial |
$1,767.56
|
| Rate for Payer: CORVEL All Commercial |
$1,904.79
|
| Rate for Payer: Coventry All Commercial |
$1,802.38
|
| Rate for Payer: Encore All Commercial |
$1,885.33
|
| Rate for Payer: Frontpath All Commercial |
$1,884.31
|
| Rate for Payer: Humana ChoiceCare |
$1,769.00
|
| Rate for Payer: Humana Medicare |
$1,044.56
|
| Rate for Payer: Lucent All Commercial |
$1,044.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,843.34
|
| Rate for Payer: PHCS All Commercial |
$1,536.12
|
| Rate for Payer: PHP All Commercial |
$1,553.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$798.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,581.18
|
| Rate for Payer: Signature Care EPO |
$1,699.97
|
| Rate for Payer: Signature Care PPO |
$1,802.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,740.94
|
| Rate for Payer: United Healthcare Commercial |
$1,613.95
|
| Rate for Payer: United Healthcare Medicare |
$675.89
|
|
|
HC CRYOPRECIPITATE CROSSMATC
|
Facility
IP
|
$2,048.16
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
63002210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,536.12 |
| Max. Negotiated Rate |
$1,904.79 |
| Rate for Payer: Aetna Commercial |
$1,769.61
|
| Rate for Payer: Cash Price |
$1,269.86
|
| Rate for Payer: Cigna All Commercial |
$1,767.56
|
| Rate for Payer: CORVEL All Commercial |
$1,904.79
|
| Rate for Payer: Coventry All Commercial |
$1,802.38
|
| Rate for Payer: Encore All Commercial |
$1,885.33
|
| Rate for Payer: Frontpath All Commercial |
$1,884.31
|
| Rate for Payer: Humana ChoiceCare |
$1,769.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,843.34
|
| Rate for Payer: PHCS All Commercial |
$1,536.12
|
| Rate for Payer: PHP All Commercial |
$1,553.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,581.18
|
| Rate for Payer: Signature Care EPO |
$1,699.97
|
| Rate for Payer: Signature Care PPO |
$1,802.38
|
| Rate for Payer: United Healthcare Commercial |
$1,613.95
|
|
|
HC CRYOSUPERNATANT
|
Facility
OP
|
$113.94
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
01370128
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$96.17
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.36
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Centivo All Commercial |
$58.11
|
| Rate for Payer: Cigna All Commercial |
$98.33
|
| Rate for Payer: CORVEL All Commercial |
$105.97
|
| Rate for Payer: Coventry All Commercial |
$100.27
|
| Rate for Payer: Encore All Commercial |
$104.89
|
| Rate for Payer: Frontpath All Commercial |
$104.83
|
| Rate for Payer: Humana ChoiceCare |
$98.41
|
| Rate for Payer: Humana Medicare |
$58.11
|
| Rate for Payer: Lucent All Commercial |
$58.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.55
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$85.46
|
| Rate for Payer: PHP All Commercial |
$86.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.44
|
| Rate for Payer: Sagamore Health Network All Products |
$87.96
|
| Rate for Payer: Signature Care EPO |
$94.57
|
| Rate for Payer: Signature Care PPO |
$100.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.85
|
| Rate for Payer: United Healthcare Commercial |
$89.79
|
| Rate for Payer: United Healthcare Medicare |
$37.60
|
|
|
HC CRYOSUPERNATANT
|
Facility
IP
|
$113.94
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
01370128
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$85.46 |
| Max. Negotiated Rate |
$105.97 |
| Rate for Payer: Aetna Commercial |
$98.45
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna All Commercial |
$98.33
|
| Rate for Payer: CORVEL All Commercial |
$105.97
|
| Rate for Payer: Coventry All Commercial |
$100.27
|
| Rate for Payer: Encore All Commercial |
$104.89
|
| Rate for Payer: Frontpath All Commercial |
$104.83
|
| Rate for Payer: Humana ChoiceCare |
$98.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.55
|
| Rate for Payer: PHCS All Commercial |
$85.46
|
| Rate for Payer: PHP All Commercial |
$86.42
|
| Rate for Payer: Sagamore Health Network All Products |
$87.96
|
| Rate for Payer: Signature Care EPO |
$94.57
|
| Rate for Payer: Signature Care PPO |
$100.27
|
| Rate for Payer: United Healthcare Commercial |
$89.79
|
|
