|
HC DHEA
|
Facility
IP
|
$396.07
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
63001528
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.05 |
| Max. Negotiated Rate |
$368.34 |
| Rate for Payer: Aetna Commercial |
$342.20
|
| Rate for Payer: Cash Price |
$245.56
|
| Rate for Payer: Cigna All Commercial |
$341.80
|
| Rate for Payer: CORVEL All Commercial |
$368.34
|
| Rate for Payer: Coventry All Commercial |
$348.54
|
| Rate for Payer: Encore All Commercial |
$364.58
|
| Rate for Payer: Frontpath All Commercial |
$364.38
|
| Rate for Payer: Humana ChoiceCare |
$342.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$356.46
|
| Rate for Payer: PHCS All Commercial |
$297.05
|
| Rate for Payer: PHP All Commercial |
$300.38
|
| Rate for Payer: Sagamore Health Network All Products |
$305.76
|
| Rate for Payer: Signature Care EPO |
$328.73
|
| Rate for Payer: Signature Care PPO |
$348.54
|
| Rate for Payer: United Healthcare Commercial |
$312.10
|
|
|
HC DHEA-S
|
Facility
OP
|
$234.78
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
63001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$218.35 |
| Rate for Payer: Aetna Commercial |
$198.16
|
| Rate for Payer: Aetna Medicare |
$77.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.23
|
| Rate for Payer: Cash Price |
$145.57
|
| Rate for Payer: Cash Price |
$145.57
|
| Rate for Payer: Centivo All Commercial |
$119.74
|
| Rate for Payer: Cigna All Commercial |
$202.62
|
| Rate for Payer: CORVEL All Commercial |
$218.35
|
| Rate for Payer: Coventry All Commercial |
$206.61
|
| Rate for Payer: Encore All Commercial |
$216.12
|
| Rate for Payer: Frontpath All Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$202.78
|
| Rate for Payer: Humana Medicare |
$119.74
|
| Rate for Payer: Lucent All Commercial |
$119.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.31
|
| Rate for Payer: Managed Health Services Medicaid |
$22.23
|
| Rate for Payer: MDWise Medicaid |
$22.23
|
| Rate for Payer: PHCS All Commercial |
$176.09
|
| Rate for Payer: PHP All Commercial |
$178.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.57
|
| Rate for Payer: Sagamore Health Network All Products |
$181.25
|
| Rate for Payer: Signature Care EPO |
$194.87
|
| Rate for Payer: Signature Care PPO |
$206.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.57
|
| Rate for Payer: United Healthcare Commercial |
$185.01
|
| Rate for Payer: United Healthcare Medicare |
$77.48
|
|
|
HC DHEA-S
|
Facility
IP
|
$234.78
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
63001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$218.35 |
| Rate for Payer: Aetna Commercial |
$202.85
|
| Rate for Payer: Cash Price |
$145.57
|
| Rate for Payer: Cigna All Commercial |
$202.62
|
| Rate for Payer: CORVEL All Commercial |
$218.35
|
| Rate for Payer: Coventry All Commercial |
$206.61
|
| Rate for Payer: Encore All Commercial |
$216.12
|
| Rate for Payer: Frontpath All Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$202.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.31
|
| Rate for Payer: PHCS All Commercial |
$176.09
|
| Rate for Payer: PHP All Commercial |
$178.06
|
| Rate for Payer: Sagamore Health Network All Products |
$181.25
|
| Rate for Payer: Signature Care EPO |
$194.87
|
| Rate for Payer: Signature Care PPO |
$206.61
|
| Rate for Payer: United Healthcare Commercial |
$185.01
|
|
|
HC DIABETIC ED GRP 2-4 PTS /30 MIN
|
Facility
OP
|
$66.83
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
54010001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$56.40
|
| Rate for Payer: Aetna Medicare |
$22.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.26
|
| Rate for Payer: Cash Price |
$41.44
|
| Rate for Payer: Centivo All Commercial |
$34.08
|
| Rate for Payer: Cigna All Commercial |
$57.67
|
| Rate for Payer: CORVEL All Commercial |
$62.15
|
| Rate for Payer: Coventry All Commercial |
$58.81
|
| Rate for Payer: Encore All Commercial |
$61.52
|
| Rate for Payer: Frontpath All Commercial |
$61.48
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Humana Medicare |
$34.08
|
| Rate for Payer: Lucent All Commercial |
$34.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.15
|
| Rate for Payer: PHCS All Commercial |
$50.12
|
| Rate for Payer: PHP All Commercial |
$50.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.06
|
| Rate for Payer: Sagamore Health Network All Products |
$51.59
|
| Rate for Payer: Signature Care EPO |
$55.47
|
| Rate for Payer: Signature Care PPO |
$58.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.81
|
| Rate for Payer: United Healthcare Commercial |
$52.66
|
| Rate for Payer: United Healthcare Medicare |
$22.05
|
|
|
HC DIABETIC ED GRP 2-4 PTS /30 MIN
|
Facility
IP
|
$66.83
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
54010001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$57.74
|
| Rate for Payer: Cash Price |
$41.44
|
| Rate for Payer: Cigna All Commercial |
$57.67
|
| Rate for Payer: CORVEL All Commercial |
$62.15
|
| Rate for Payer: Coventry All Commercial |
$58.81
|
| Rate for Payer: Encore All Commercial |
$61.52
|
| Rate for Payer: Frontpath All Commercial |
$61.48
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.15
|
| Rate for Payer: PHCS All Commercial |
$50.12
|
| Rate for Payer: PHP All Commercial |
$50.68
|
| Rate for Payer: Sagamore Health Network All Products |
$51.59
|
| Rate for Payer: Signature Care EPO |
$55.47
|
| Rate for Payer: Signature Care PPO |
$58.81
|
| Rate for Payer: United Healthcare Commercial |
$52.66
|
|
|
HC DIABETIC ED GRP 5-8 PTS /30 MIN
|
Facility
OP
|
$66.83
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
54010003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$56.40
|
| Rate for Payer: Aetna Medicare |
$22.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.26
|
| Rate for Payer: Cash Price |
$41.44
|
| Rate for Payer: Centivo All Commercial |
$34.08
|
| Rate for Payer: Cigna All Commercial |
$57.67
|
| Rate for Payer: CORVEL All Commercial |
$62.15
|
| Rate for Payer: Coventry All Commercial |
$58.81
|
| Rate for Payer: Encore All Commercial |
$61.52
|
| Rate for Payer: Frontpath All Commercial |
$61.48
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Humana Medicare |
$34.08
|
| Rate for Payer: Lucent All Commercial |
$34.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.15
|
| Rate for Payer: PHCS All Commercial |
$50.12
|
| Rate for Payer: PHP All Commercial |
$50.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.06
|
| Rate for Payer: Sagamore Health Network All Products |
$51.59
|
| Rate for Payer: Signature Care EPO |
$55.47
|
| Rate for Payer: Signature Care PPO |
$58.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.81
|
| Rate for Payer: United Healthcare Commercial |
$52.66
|
| Rate for Payer: United Healthcare Medicare |
$22.05
|
|
|
HC DIABETIC ED GRP 5-8 PTS /30 MIN
|
Facility
IP
|
$66.83
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
54010003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$57.74
|
| Rate for Payer: Cash Price |
$41.44
|
| Rate for Payer: Cigna All Commercial |
$57.67
|
| Rate for Payer: CORVEL All Commercial |
$62.15
|
| Rate for Payer: Coventry All Commercial |
$58.81
|
| Rate for Payer: Encore All Commercial |
$61.52
|
| Rate for Payer: Frontpath All Commercial |
$61.48
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.15
|
| Rate for Payer: PHCS All Commercial |
$50.12
|
| Rate for Payer: PHP All Commercial |
$50.68
|
| Rate for Payer: Sagamore Health Network All Products |
$51.59
|
| Rate for Payer: Signature Care EPO |
$55.47
|
| Rate for Payer: Signature Care PPO |
$58.81
|
| Rate for Payer: United Healthcare Commercial |
$52.66
|
|
|
HC DIABETIC ED INDIVIDUAL /30 MIN
|
Facility
OP
|
$83.13
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
54010002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$77.31 |
| Rate for Payer: Aetna Commercial |
$70.16
|
| Rate for Payer: Aetna Medicare |
$27.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.18
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Centivo All Commercial |
$42.40
|
| Rate for Payer: Cigna All Commercial |
$71.74
|
| Rate for Payer: CORVEL All Commercial |
$77.31
|
| Rate for Payer: Coventry All Commercial |
$73.15
|
| Rate for Payer: Encore All Commercial |
$76.52
|
| Rate for Payer: Frontpath All Commercial |
$76.48
|
| Rate for Payer: Humana ChoiceCare |
$71.80
|
| Rate for Payer: Humana Medicare |
$42.40
|
| Rate for Payer: Lucent All Commercial |
$42.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.82
|
| Rate for Payer: PHCS All Commercial |
$62.35
|
| Rate for Payer: PHP All Commercial |
$63.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.42
|
| Rate for Payer: Sagamore Health Network All Products |
$64.18
|
| Rate for Payer: Signature Care EPO |
$69.00
|
| Rate for Payer: Signature Care PPO |
$73.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.66
|
| Rate for Payer: United Healthcare Commercial |
$65.51
|
| Rate for Payer: United Healthcare Medicare |
$27.43
|
|
|
HC DIABETIC ED INDIVIDUAL /30 MIN
|
Facility
IP
|
$83.13
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
54010002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.35 |
| Max. Negotiated Rate |
$77.31 |
| Rate for Payer: Aetna Commercial |
$71.82
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Cigna All Commercial |
$71.74
|
| Rate for Payer: CORVEL All Commercial |
$77.31
|
| Rate for Payer: Coventry All Commercial |
$73.15
|
| Rate for Payer: Encore All Commercial |
$76.52
|
| Rate for Payer: Frontpath All Commercial |
$76.48
|
| Rate for Payer: Humana ChoiceCare |
$71.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.82
|
| Rate for Payer: PHCS All Commercial |
$62.35
|
| Rate for Payer: PHP All Commercial |
$63.05
|
| Rate for Payer: Sagamore Health Network All Products |
$64.18
|
| Rate for Payer: Signature Care EPO |
$69.00
|
| Rate for Payer: Signature Care PPO |
$73.15
|
| Rate for Payer: United Healthcare Commercial |
$65.51
|
|
|
HC DIETARY TEACHING / 30 MIN
|
Facility
OP
|
$42.43
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
72001001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$39.46 |
| Rate for Payer: Aetna Commercial |
$35.81
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.40
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Centivo All Commercial |
$21.64
|
| Rate for Payer: Cigna All Commercial |
$36.62
|
| Rate for Payer: CORVEL All Commercial |
$39.46
|
| Rate for Payer: Coventry All Commercial |
$37.34
|
| Rate for Payer: Encore All Commercial |
$39.06
|
| Rate for Payer: Frontpath All Commercial |
$39.04
|
| Rate for Payer: Humana ChoiceCare |
$36.65
|
| Rate for Payer: Humana Medicare |
$21.64
|
| Rate for Payer: Lucent All Commercial |
$21.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.19
|
| Rate for Payer: PHCS All Commercial |
$31.82
|
| Rate for Payer: PHP All Commercial |
$32.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.55
|
| Rate for Payer: Sagamore Health Network All Products |
$32.76
|
| Rate for Payer: Signature Care EPO |
$35.22
|
| Rate for Payer: Signature Care PPO |
$37.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.07
|
| Rate for Payer: United Healthcare Commercial |
$33.44
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
|
|
HC DIETARY TEACHING / 30 MIN
|
Facility
IP
|
$42.43
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
72001001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$39.46 |
| Rate for Payer: Aetna Commercial |
$36.66
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Cigna All Commercial |
$36.62
|
| Rate for Payer: CORVEL All Commercial |
$39.46
|
| Rate for Payer: Coventry All Commercial |
$37.34
|
| Rate for Payer: Encore All Commercial |
$39.06
|
| Rate for Payer: Frontpath All Commercial |
$39.04
|
| Rate for Payer: Humana ChoiceCare |
$36.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.19
|
| Rate for Payer: PHCS All Commercial |
$31.82
|
| Rate for Payer: PHP All Commercial |
$32.18
|
| Rate for Payer: Sagamore Health Network All Products |
$32.76
|
| Rate for Payer: Signature Care EPO |
$35.22
|
| Rate for Payer: Signature Care PPO |
$37.34
|
| Rate for Payer: United Healthcare Commercial |
$33.44
|
|
|
HC DIFF-BUFFY COAT
|
Facility
OP
|
$42.87
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
63001725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$39.87 |
| Rate for Payer: Aetna Commercial |
$36.18
|
| Rate for Payer: Aetna Medicare |
$14.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.56
|
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Centivo All Commercial |
$21.86
|
| Rate for Payer: Cigna All Commercial |
$37.00
|
| Rate for Payer: CORVEL All Commercial |
$39.87
|
| Rate for Payer: Coventry All Commercial |
$37.73
|
| Rate for Payer: Encore All Commercial |
$39.46
|
| Rate for Payer: Frontpath All Commercial |
$39.44
|
| Rate for Payer: Humana ChoiceCare |
$37.03
|
| Rate for Payer: Humana Medicare |
$21.86
|
| Rate for Payer: Lucent All Commercial |
$21.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.58
|
| Rate for Payer: Managed Health Services Medicaid |
$5.06
|
| Rate for Payer: MDWise Medicaid |
$5.06
|
| Rate for Payer: PHCS All Commercial |
$32.15
|
| Rate for Payer: PHP All Commercial |
$32.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.72
|
| Rate for Payer: Sagamore Health Network All Products |
$33.10
|
| Rate for Payer: Signature Care EPO |
$35.58
|
| Rate for Payer: Signature Care PPO |
$37.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.44
|
| Rate for Payer: United Healthcare Commercial |
$33.78
|
| Rate for Payer: United Healthcare Medicare |
$14.15
|
|
|
HC DIFF-BUFFY COAT
|
Facility
IP
|
$42.87
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
63001725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.15 |
| Max. Negotiated Rate |
$39.87 |
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Cigna All Commercial |
$37.00
|
| Rate for Payer: CORVEL All Commercial |
$39.87
|
| Rate for Payer: Coventry All Commercial |
$37.73
|
| Rate for Payer: Encore All Commercial |
$39.46
|
| Rate for Payer: Frontpath All Commercial |
$39.44
|
| Rate for Payer: Humana ChoiceCare |
$37.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.58
|
| Rate for Payer: PHCS All Commercial |
$32.15
|
| Rate for Payer: PHP All Commercial |
$32.51
|
| Rate for Payer: Sagamore Health Network All Products |
$33.10
|
| Rate for Payer: Signature Care EPO |
$35.58
|
| Rate for Payer: Signature Care PPO |
$37.73
|
| Rate for Payer: United Healthcare Commercial |
$33.78
|
|
|
HC DIFFERENTIAL ANTIGLOBULIN TEST
|
Facility
OP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$83.82
|
| Rate for Payer: Aetna Medicare |
$32.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.05
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Centivo All Commercial |
$50.65
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.36
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Humana Medicare |
$50.65
|
| Rate for Payer: Lucent All Commercial |
$50.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.73
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.42
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.41
|
| Rate for Payer: United Healthcare Commercial |
$78.25
|
| Rate for Payer: United Healthcare Medicare |
$32.77
|
|
|
HC DIFFERENTIAL ANTIGLOBULIN TEST
|
Facility
IP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.36
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.31
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.42
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: United Healthcare Commercial |
$78.25
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL
|
Facility
IP
|
$83.25
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
01617062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$71.93
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Cigna All Commercial |
$71.85
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.93
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL
|
Facility
OP
|
$83.25
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
01617062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$70.27
|
| Rate for Payer: Aetna Medicare |
$27.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.22
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Centivo All Commercial |
$42.46
|
| Rate for Payer: Cigna All Commercial |
$71.85
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.91
|
| Rate for Payer: Humana Medicare |
$42.46
|
| Rate for Payer: Lucent All Commercial |
$42.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.93
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.47
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
| Rate for Payer: United Healthcare Medicare |
$27.47
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL
|
Facility
IP
|
$62.71
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
01617061
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$54.18
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna All Commercial |
$54.12
|
| Rate for Payer: CORVEL All Commercial |
$58.32
|
| Rate for Payer: Coventry All Commercial |
$55.18
|
| Rate for Payer: Encore All Commercial |
$57.72
|
| Rate for Payer: Frontpath All Commercial |
$57.69
|
| Rate for Payer: Humana ChoiceCare |
$54.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.44
|
| Rate for Payer: PHCS All Commercial |
$47.03
|
| Rate for Payer: PHP All Commercial |
$47.56
|
| Rate for Payer: Sagamore Health Network All Products |
$48.41
|
| Rate for Payer: Signature Care EPO |
$52.05
|
| Rate for Payer: Signature Care PPO |
$55.18
|
| Rate for Payer: United Healthcare Commercial |
$49.42
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL
|
Facility
OP
|
$62.71
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
01617061
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$52.93
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.76
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Centivo All Commercial |
$31.98
|
| Rate for Payer: Cigna All Commercial |
$54.12
|
| Rate for Payer: CORVEL All Commercial |
$58.32
|
| Rate for Payer: Coventry All Commercial |
$55.18
|
| Rate for Payer: Encore All Commercial |
$57.72
|
| Rate for Payer: Frontpath All Commercial |
$57.69
|
| Rate for Payer: Humana ChoiceCare |
$54.16
|
| Rate for Payer: Humana Medicare |
$31.98
|
| Rate for Payer: Lucent All Commercial |
$31.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.44
|
| Rate for Payer: PHCS All Commercial |
$47.03
|
| Rate for Payer: PHP All Commercial |
$47.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.46
|
| Rate for Payer: Sagamore Health Network All Products |
$48.41
|
| Rate for Payer: Signature Care EPO |
$52.05
|
| Rate for Payer: Signature Care PPO |
$55.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.30
|
| Rate for Payer: United Healthcare Commercial |
$49.42
|
| Rate for Payer: United Healthcare Medicare |
$20.69
|
|
|
HC DIGOXIN
|
Facility
OP
|
$213.69
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
63001308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$198.73 |
| Rate for Payer: Aetna Commercial |
$180.35
|
| Rate for Payer: Aetna Medicare |
$70.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.57
|
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Centivo All Commercial |
$108.98
|
| Rate for Payer: Cigna All Commercial |
$184.41
|
| Rate for Payer: CORVEL All Commercial |
$198.73
|
| Rate for Payer: Coventry All Commercial |
$188.05
|
| Rate for Payer: Encore All Commercial |
$196.70
|
| Rate for Payer: Frontpath All Commercial |
$196.59
|
| Rate for Payer: Humana ChoiceCare |
$184.56
|
| Rate for Payer: Humana Medicare |
$108.98
|
| Rate for Payer: Lucent All Commercial |
$108.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.32
|
| Rate for Payer: Managed Health Services Medicaid |
$13.28
|
| Rate for Payer: MDWise Medicaid |
$13.28
|
| Rate for Payer: PHCS All Commercial |
$160.27
|
| Rate for Payer: PHP All Commercial |
$162.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.34
|
| Rate for Payer: Sagamore Health Network All Products |
$164.97
|
| Rate for Payer: Signature Care EPO |
$177.36
|
| Rate for Payer: Signature Care PPO |
$188.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$181.64
|
| Rate for Payer: United Healthcare Commercial |
$168.39
|
| Rate for Payer: United Healthcare Medicare |
$70.52
|
|
|
HC DIGOXIN
|
Facility
IP
|
$213.69
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
63001308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.27 |
| Max. Negotiated Rate |
$198.73 |
| Rate for Payer: Aetna Commercial |
$184.63
|
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Cigna All Commercial |
$184.41
|
| Rate for Payer: CORVEL All Commercial |
$198.73
|
| Rate for Payer: Coventry All Commercial |
$188.05
|
| Rate for Payer: Encore All Commercial |
$196.70
|
| Rate for Payer: Frontpath All Commercial |
$196.59
|
| Rate for Payer: Humana ChoiceCare |
$184.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.32
|
| Rate for Payer: PHCS All Commercial |
$160.27
|
| Rate for Payer: PHP All Commercial |
$162.06
|
| Rate for Payer: Sagamore Health Network All Products |
$164.97
|
| Rate for Payer: Signature Care EPO |
$177.36
|
| Rate for Payer: Signature Care PPO |
$188.05
|
| Rate for Payer: United Healthcare Commercial |
$168.39
|
|
|
HC DILATOR 12F 20CM
|
Facility
OP
|
$43.68
|
|
| Hospital Charge Code |
41607436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$36.87
|
| Rate for Payer: Aetna Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.86
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Centivo All Commercial |
$22.28
|
| Rate for Payer: Cigna All Commercial |
$37.70
|
| Rate for Payer: CORVEL All Commercial |
$40.62
|
| Rate for Payer: Coventry All Commercial |
$38.44
|
| Rate for Payer: Encore All Commercial |
$40.21
|
| Rate for Payer: Frontpath All Commercial |
$40.19
|
| Rate for Payer: Humana ChoiceCare |
$37.73
|
| Rate for Payer: Humana Medicare |
$22.28
|
| Rate for Payer: Lucent All Commercial |
$22.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.76
|
| Rate for Payer: PHP All Commercial |
$33.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.04
|
| Rate for Payer: Sagamore Health Network All Products |
$33.72
|
| Rate for Payer: Signature Care EPO |
$36.25
|
| Rate for Payer: Signature Care PPO |
$38.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$34.42
|
| Rate for Payer: United Healthcare Medicare |
$14.41
|
|
|
HC DILATOR 12F 20CM
|
Facility
IP
|
$43.68
|
|
| Hospital Charge Code |
41607436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Cigna All Commercial |
$37.70
|
| Rate for Payer: CORVEL All Commercial |
$40.62
|
| Rate for Payer: Coventry All Commercial |
$38.44
|
| Rate for Payer: Encore All Commercial |
$40.21
|
| Rate for Payer: Frontpath All Commercial |
$40.19
|
| Rate for Payer: Humana ChoiceCare |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.31
|
| Rate for Payer: PHCS All Commercial |
$32.76
|
| Rate for Payer: PHP All Commercial |
$33.13
|
| Rate for Payer: Sagamore Health Network All Products |
$33.72
|
| Rate for Payer: Signature Care EPO |
$36.25
|
| Rate for Payer: Signature Care PPO |
$38.44
|
| Rate for Payer: United Healthcare Commercial |
$34.42
|
|
|
HC DILATOR 16F 20CM
|
Facility
OP
|
$43.68
|
|
| Hospital Charge Code |
41607437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$36.87
|
| Rate for Payer: Aetna Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.86
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Centivo All Commercial |
$22.28
|
| Rate for Payer: Cigna All Commercial |
$37.70
|
| Rate for Payer: CORVEL All Commercial |
$40.62
|
| Rate for Payer: Coventry All Commercial |
$38.44
|
| Rate for Payer: Encore All Commercial |
$40.21
|
| Rate for Payer: Frontpath All Commercial |
$40.19
|
| Rate for Payer: Humana ChoiceCare |
$37.73
|
| Rate for Payer: Humana Medicare |
$22.28
|
| Rate for Payer: Lucent All Commercial |
$22.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.76
|
| Rate for Payer: PHP All Commercial |
$33.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.04
|
| Rate for Payer: Sagamore Health Network All Products |
$33.72
|
| Rate for Payer: Signature Care EPO |
$36.25
|
| Rate for Payer: Signature Care PPO |
$38.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$34.42
|
| Rate for Payer: United Healthcare Medicare |
$14.41
|
|
|
HC DILATOR 16F 20CM
|
Facility
IP
|
$43.68
|
|
| Hospital Charge Code |
41607437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Cigna All Commercial |
$37.70
|
| Rate for Payer: CORVEL All Commercial |
$40.62
|
| Rate for Payer: Coventry All Commercial |
$38.44
|
| Rate for Payer: Encore All Commercial |
$40.21
|
| Rate for Payer: Frontpath All Commercial |
$40.19
|
| Rate for Payer: Humana ChoiceCare |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.31
|
| Rate for Payer: PHCS All Commercial |
$32.76
|
| Rate for Payer: PHP All Commercial |
$33.13
|
| Rate for Payer: Sagamore Health Network All Products |
$33.72
|
| Rate for Payer: Signature Care EPO |
$36.25
|
| Rate for Payer: Signature Care PPO |
$38.44
|
| Rate for Payer: United Healthcare Commercial |
$34.42
|
|
