|
HC EBV EPSTEIN-BARR CAPSID VCA
|
Facility
IP
|
$31.62
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63087808
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Commercial |
$27.32
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cigna All Commercial |
$27.29
|
| Rate for Payer: CORVEL All Commercial |
$29.41
|
| Rate for Payer: Coventry All Commercial |
$27.83
|
| Rate for Payer: Encore All Commercial |
$29.11
|
| Rate for Payer: Frontpath All Commercial |
$29.09
|
| Rate for Payer: Humana ChoiceCare |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.46
|
| Rate for Payer: PHCS All Commercial |
$23.72
|
| Rate for Payer: PHP All Commercial |
$23.98
|
| Rate for Payer: Sagamore Health Network All Products |
$24.41
|
| Rate for Payer: Signature Care EPO |
$26.24
|
| Rate for Payer: Signature Care PPO |
$27.83
|
| Rate for Payer: United Healthcare Commercial |
$24.92
|
|
|
HC EBV EPSTEIN-BARR NUCLEAR ANTIGEN
|
Facility
OP
|
$31.62
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63087807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Commercial |
$26.69
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.48
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Centivo All Commercial |
$16.13
|
| Rate for Payer: Cigna All Commercial |
$27.29
|
| Rate for Payer: CORVEL All Commercial |
$29.41
|
| Rate for Payer: Coventry All Commercial |
$27.83
|
| Rate for Payer: Encore All Commercial |
$29.11
|
| Rate for Payer: Frontpath All Commercial |
$29.09
|
| Rate for Payer: Humana ChoiceCare |
$27.31
|
| Rate for Payer: Humana Medicare |
$16.13
|
| Rate for Payer: Lucent All Commercial |
$16.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.46
|
| Rate for Payer: Managed Health Services Medicaid |
$15.29
|
| Rate for Payer: MDWise Medicaid |
$15.29
|
| Rate for Payer: PHCS All Commercial |
$23.72
|
| Rate for Payer: PHP All Commercial |
$23.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.33
|
| Rate for Payer: Sagamore Health Network All Products |
$24.41
|
| Rate for Payer: Signature Care EPO |
$26.24
|
| Rate for Payer: Signature Care PPO |
$27.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.88
|
| Rate for Payer: United Healthcare Commercial |
$24.92
|
| Rate for Payer: United Healthcare Medicare |
$10.43
|
|
|
HC EBV EPSTEIN-BARR NUCLEAR ANTIGEN
|
Facility
IP
|
$31.62
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63087807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Commercial |
$27.32
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cigna All Commercial |
$27.29
|
| Rate for Payer: CORVEL All Commercial |
$29.41
|
| Rate for Payer: Coventry All Commercial |
$27.83
|
| Rate for Payer: Encore All Commercial |
$29.11
|
| Rate for Payer: Frontpath All Commercial |
$29.09
|
| Rate for Payer: Humana ChoiceCare |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.46
|
| Rate for Payer: PHCS All Commercial |
$23.72
|
| Rate for Payer: PHP All Commercial |
$23.98
|
| Rate for Payer: Sagamore Health Network All Products |
$24.41
|
| Rate for Payer: Signature Care EPO |
$26.24
|
| Rate for Payer: Signature Care PPO |
$27.83
|
| Rate for Payer: United Healthcare Commercial |
$24.92
|
|
|
HC EBV NUCLEAR AG IGG
|
Facility
OP
|
$124.54
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63001938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$115.82 |
| Rate for Payer: Aetna Commercial |
$105.11
|
| Rate for Payer: Aetna Medicare |
$41.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.21
|
| Rate for Payer: Cash Price |
$77.22
|
| Rate for Payer: Cash Price |
$77.22
|
| Rate for Payer: Centivo All Commercial |
$63.52
|
| Rate for Payer: Cigna All Commercial |
$107.48
|
| Rate for Payer: CORVEL All Commercial |
$115.82
|
| Rate for Payer: Coventry All Commercial |
$109.60
|
| Rate for Payer: Encore All Commercial |
$114.64
|
| Rate for Payer: Frontpath All Commercial |
$114.58
|
| Rate for Payer: Humana ChoiceCare |
$107.57
|
| Rate for Payer: Humana Medicare |
$63.52
|
| Rate for Payer: Lucent All Commercial |
$63.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.09
|
| Rate for Payer: Managed Health Services Medicaid |
$15.29
|
| Rate for Payer: MDWise Medicaid |
$15.29
|
| Rate for Payer: PHCS All Commercial |
$93.41
|
| Rate for Payer: PHP All Commercial |
$94.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.57
|
| Rate for Payer: Sagamore Health Network All Products |
$96.15
|
| Rate for Payer: Signature Care EPO |
$103.37
|
| Rate for Payer: Signature Care PPO |
$109.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.86
|
| Rate for Payer: United Healthcare Commercial |
$98.14
|
| Rate for Payer: United Healthcare Medicare |
$41.10
|
|
|
HC EBV NUCLEAR AG IGG
|
Facility
IP
|
$124.54
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63001938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.41 |
| Max. Negotiated Rate |
$115.82 |
| Rate for Payer: Aetna Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$77.22
|
| Rate for Payer: Cigna All Commercial |
$107.48
|
| Rate for Payer: CORVEL All Commercial |
$115.82
|
| Rate for Payer: Coventry All Commercial |
$109.60
|
| Rate for Payer: Encore All Commercial |
$114.64
|
| Rate for Payer: Frontpath All Commercial |
$114.58
|
| Rate for Payer: Humana ChoiceCare |
$107.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.09
|
| Rate for Payer: PHCS All Commercial |
$93.41
|
| Rate for Payer: PHP All Commercial |
$94.45
|
| Rate for Payer: Sagamore Health Network All Products |
$96.15
|
| Rate for Payer: Signature Care EPO |
$103.37
|
| Rate for Payer: Signature Care PPO |
$109.60
|
| Rate for Payer: United Healthcare Commercial |
$98.14
|
|
|
HC EBV QC PCR - PITTSBUR
|
Facility
OP
|
$515.56
|
|
|
Service Code
|
CPT 87797
|
| Hospital Charge Code |
63002051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$479.47 |
| Rate for Payer: Aetna Commercial |
$435.13
|
| Rate for Payer: Aetna Medicare |
$170.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$195.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.15
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Centivo All Commercial |
$262.94
|
| Rate for Payer: Cigna All Commercial |
$444.93
|
| Rate for Payer: CORVEL All Commercial |
$479.47
|
| Rate for Payer: Coventry All Commercial |
$453.69
|
| Rate for Payer: Encore All Commercial |
$474.57
|
| Rate for Payer: Frontpath All Commercial |
$474.31
|
| Rate for Payer: Humana ChoiceCare |
$445.29
|
| Rate for Payer: Humana Medicare |
$262.94
|
| Rate for Payer: Lucent All Commercial |
$262.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$464.00
|
| Rate for Payer: Managed Health Services Medicaid |
$27.29
|
| Rate for Payer: MDWise Medicaid |
$27.29
|
| Rate for Payer: PHCS All Commercial |
$386.67
|
| Rate for Payer: PHP All Commercial |
$391.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.07
|
| Rate for Payer: Sagamore Health Network All Products |
$398.01
|
| Rate for Payer: Signature Care EPO |
$427.91
|
| Rate for Payer: Signature Care PPO |
$453.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$438.23
|
| Rate for Payer: United Healthcare Commercial |
$406.26
|
| Rate for Payer: United Healthcare Medicare |
$170.13
|
|
|
HC EBV QC PCR - PITTSBUR
|
Facility
IP
|
$515.56
|
|
|
Service Code
|
CPT 87797
|
| Hospital Charge Code |
63002051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$386.67 |
| Max. Negotiated Rate |
$479.47 |
| Rate for Payer: Aetna Commercial |
$445.44
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Cigna All Commercial |
$444.93
|
| Rate for Payer: CORVEL All Commercial |
$479.47
|
| Rate for Payer: Coventry All Commercial |
$453.69
|
| Rate for Payer: Encore All Commercial |
$474.57
|
| Rate for Payer: Frontpath All Commercial |
$474.31
|
| Rate for Payer: Humana ChoiceCare |
$445.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$464.00
|
| Rate for Payer: PHCS All Commercial |
$386.67
|
| Rate for Payer: PHP All Commercial |
$391.00
|
| Rate for Payer: Sagamore Health Network All Products |
$398.01
|
| Rate for Payer: Signature Care EPO |
$427.91
|
| Rate for Payer: Signature Care PPO |
$453.69
|
| Rate for Payer: United Healthcare Commercial |
$406.26
|
|
|
HC EBV VIRAL CAPSID IGG
|
Facility
IP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC EBV VIRAL CAPSID IGG
|
Facility
OP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.09
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$85.83
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$85.83
|
| Rate for Payer: Lucent All Commercial |
$85.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$18.14
|
| Rate for Payer: MDWise Medicaid |
$18.14
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$55.54
|
|
|
HC EBV VIRAL CAPSID IGM
|
Facility
OP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.09
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$85.83
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$85.83
|
| Rate for Payer: Lucent All Commercial |
$85.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$18.14
|
| Rate for Payer: MDWise Medicaid |
$18.14
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$55.54
|
|
|
HC EBV VIRAL CAPSID IGM
|
Facility
IP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC ECG UP TO 48 HRS SCAN ANALYS RPRT HOLTER
|
Facility
OP
|
$815.61
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
01503226
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$269.15 |
| Max. Negotiated Rate |
$758.52 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Aetna Medicare |
$269.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$468.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$509.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$563.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.07
|
| Rate for Payer: Cash Price |
$505.68
|
| Rate for Payer: Cash Price |
$505.68
|
| Rate for Payer: Centivo All Commercial |
$415.96
|
| Rate for Payer: Cigna All Commercial |
$703.87
|
| Rate for Payer: CORVEL All Commercial |
$758.52
|
| Rate for Payer: Coventry All Commercial |
$717.74
|
| Rate for Payer: Encore All Commercial |
$750.77
|
| Rate for Payer: Frontpath All Commercial |
$750.36
|
| Rate for Payer: Humana ChoiceCare |
$704.44
|
| Rate for Payer: Humana Medicare |
$415.96
|
| Rate for Payer: Lucent All Commercial |
$415.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.05
|
| Rate for Payer: Managed Health Services Medicaid |
$563.90
|
| Rate for Payer: MDWise Medicaid |
$563.90
|
| Rate for Payer: PHCS All Commercial |
$611.71
|
| Rate for Payer: PHP All Commercial |
$618.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.09
|
| Rate for Payer: Sagamore Health Network All Products |
$629.65
|
| Rate for Payer: Signature Care EPO |
$676.96
|
| Rate for Payer: Signature Care PPO |
$717.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$693.27
|
| Rate for Payer: United Healthcare Commercial |
$642.70
|
| Rate for Payer: United Healthcare Medicare |
$269.15
|
|
|
HC ECG UP TO 48 HRS SCAN ANALYS RPRT HOLTER
|
Facility
IP
|
$815.61
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
01503226
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$611.71 |
| Max. Negotiated Rate |
$758.52 |
| Rate for Payer: Aetna Commercial |
$704.69
|
| Rate for Payer: Cash Price |
$505.68
|
| Rate for Payer: Cigna All Commercial |
$703.87
|
| Rate for Payer: CORVEL All Commercial |
$758.52
|
| Rate for Payer: Coventry All Commercial |
$717.74
|
| Rate for Payer: Encore All Commercial |
$750.77
|
| Rate for Payer: Frontpath All Commercial |
$750.36
|
| Rate for Payer: Humana ChoiceCare |
$704.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.05
|
| Rate for Payer: PHCS All Commercial |
$611.71
|
| Rate for Payer: PHP All Commercial |
$618.56
|
| Rate for Payer: Sagamore Health Network All Products |
$629.65
|
| Rate for Payer: Signature Care EPO |
$676.96
|
| Rate for Payer: Signature Care PPO |
$717.74
|
| Rate for Payer: United Healthcare Commercial |
$642.70
|
|
|
HC ECHO - 2-D & M-MODE - LIMITED
|
Facility
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
00863308
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna Commercial |
$860.88
|
| Rate for Payer: Aetna Medicare |
$336.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$336.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$585.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$387.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$370.26
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Centivo All Commercial |
$520.20
|
| Rate for Payer: Cigna All Commercial |
$880.26
|
| Rate for Payer: CORVEL All Commercial |
$948.60
|
| Rate for Payer: Coventry All Commercial |
$897.60
|
| Rate for Payer: Encore All Commercial |
$938.91
|
| Rate for Payer: Frontpath All Commercial |
$938.40
|
| Rate for Payer: Humana ChoiceCare |
$880.97
|
| Rate for Payer: Humana Medicare |
$520.20
|
| Rate for Payer: Lucent All Commercial |
$520.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$765.00
|
| Rate for Payer: PHP All Commercial |
$773.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.80
|
| Rate for Payer: Sagamore Health Network All Products |
$787.44
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$897.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$867.00
|
| Rate for Payer: United Healthcare Commercial |
$803.76
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
|
|
HC ECHO - 2-D & M-MODE - LIMITED
|
Facility
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
00863308
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna Commercial |
$881.28
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna All Commercial |
$880.26
|
| Rate for Payer: CORVEL All Commercial |
$948.60
|
| Rate for Payer: Coventry All Commercial |
$897.60
|
| Rate for Payer: Encore All Commercial |
$938.91
|
| Rate for Payer: Frontpath All Commercial |
$938.40
|
| Rate for Payer: Humana ChoiceCare |
$880.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: PHCS All Commercial |
$765.00
|
| Rate for Payer: PHP All Commercial |
$773.57
|
| Rate for Payer: Sagamore Health Network All Products |
$787.44
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$897.60
|
| Rate for Payer: United Healthcare Commercial |
$803.76
|
|
|
HC ECHO - 2-D & M-MODE ONLY
|
Facility
IP
|
$2,193.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
00863307
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,644.75 |
| Max. Negotiated Rate |
$2,039.49 |
| Rate for Payer: Aetna Commercial |
$1,894.75
|
| Rate for Payer: Cash Price |
$1,359.66
|
| Rate for Payer: Cigna All Commercial |
$1,892.56
|
| Rate for Payer: CORVEL All Commercial |
$2,039.49
|
| Rate for Payer: Coventry All Commercial |
$1,929.84
|
| Rate for Payer: Encore All Commercial |
$2,018.66
|
| Rate for Payer: Frontpath All Commercial |
$2,017.56
|
| Rate for Payer: Humana ChoiceCare |
$1,894.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,973.70
|
| Rate for Payer: PHCS All Commercial |
$1,644.75
|
| Rate for Payer: PHP All Commercial |
$1,663.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,693.00
|
| Rate for Payer: Signature Care EPO |
$1,820.19
|
| Rate for Payer: Signature Care PPO |
$1,929.84
|
| Rate for Payer: United Healthcare Commercial |
$1,728.08
|
|
|
HC ECHO - 2-D & M-MODE ONLY
|
Facility
OP
|
$2,193.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
00863307
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$723.69 |
| Max. Negotiated Rate |
$2,039.49 |
| Rate for Payer: Aetna Commercial |
$1,850.89
|
| Rate for Payer: Aetna Medicare |
$723.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$723.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,259.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,370.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$832.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$796.06
|
| Rate for Payer: Cash Price |
$1,359.66
|
| Rate for Payer: Cash Price |
$1,359.66
|
| Rate for Payer: Centivo All Commercial |
$1,118.43
|
| Rate for Payer: Cigna All Commercial |
$1,892.56
|
| Rate for Payer: CORVEL All Commercial |
$2,039.49
|
| Rate for Payer: Coventry All Commercial |
$1,929.84
|
| Rate for Payer: Encore All Commercial |
$2,018.66
|
| Rate for Payer: Frontpath All Commercial |
$2,017.56
|
| Rate for Payer: Humana ChoiceCare |
$1,894.09
|
| Rate for Payer: Humana Medicare |
$1,118.43
|
| Rate for Payer: Lucent All Commercial |
$1,118.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,973.70
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$1,644.75
|
| Rate for Payer: PHP All Commercial |
$1,663.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$855.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,693.00
|
| Rate for Payer: Signature Care EPO |
$1,820.19
|
| Rate for Payer: Signature Care PPO |
$1,929.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,864.05
|
| Rate for Payer: United Healthcare Commercial |
$1,728.08
|
| Rate for Payer: United Healthcare Medicare |
$723.69
|
|
|
HC ECHOCARDIOGRAPHY COMPLETE BEDSIDE
|
Facility
IP
|
$3,459.71
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
01683306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,594.78 |
| Max. Negotiated Rate |
$3,217.53 |
| Rate for Payer: Aetna Commercial |
$2,989.19
|
| Rate for Payer: Cash Price |
$2,145.02
|
| Rate for Payer: Cigna All Commercial |
$2,985.73
|
| Rate for Payer: CORVEL All Commercial |
$3,217.53
|
| Rate for Payer: Coventry All Commercial |
$3,044.54
|
| Rate for Payer: Encore All Commercial |
$3,184.66
|
| Rate for Payer: Frontpath All Commercial |
$3,182.93
|
| Rate for Payer: Humana ChoiceCare |
$2,988.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,113.74
|
| Rate for Payer: PHCS All Commercial |
$2,594.78
|
| Rate for Payer: PHP All Commercial |
$2,623.84
|
| Rate for Payer: Sagamore Health Network All Products |
$2,670.89
|
| Rate for Payer: Signature Care EPO |
$2,871.56
|
| Rate for Payer: Signature Care PPO |
$3,044.54
|
| Rate for Payer: United Healthcare Commercial |
$2,726.25
|
|
|
HC ECHOCARDIOGRAPHY COMPLETE BEDSIDE
|
Facility
OP
|
$3,459.71
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
01683306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$3,217.53 |
| Rate for Payer: Aetna Commercial |
$2,919.99
|
| Rate for Payer: Aetna Medicare |
$1,141.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,141.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,986.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,162.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,312.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,255.87
|
| Rate for Payer: Cash Price |
$2,145.02
|
| Rate for Payer: Centivo All Commercial |
$1,764.45
|
| Rate for Payer: Cigna All Commercial |
$2,985.73
|
| Rate for Payer: CORVEL All Commercial |
$3,217.53
|
| Rate for Payer: Coventry All Commercial |
$3,044.54
|
| Rate for Payer: Encore All Commercial |
$3,184.66
|
| Rate for Payer: Frontpath All Commercial |
$3,182.93
|
| Rate for Payer: Humana ChoiceCare |
$2,988.15
|
| Rate for Payer: Humana Medicare |
$1,764.45
|
| Rate for Payer: Lucent All Commercial |
$1,764.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,113.74
|
| Rate for Payer: PHCS All Commercial |
$2,594.78
|
| Rate for Payer: PHP All Commercial |
$2,623.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,349.29
|
| Rate for Payer: Sagamore Health Network All Products |
$2,670.89
|
| Rate for Payer: Signature Care EPO |
$2,871.56
|
| Rate for Payer: Signature Care PPO |
$3,044.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,940.75
|
| Rate for Payer: United Healthcare Commercial |
$2,726.25
|
| Rate for Payer: United Healthcare Medicare |
$1,141.70
|
|
|
HC ECHO MYOCARDIAL STRAIN IMAGING
|
Facility
OP
|
$564.52
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
00860399
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$186.29 |
| Max. Negotiated Rate |
$788.70 |
| Rate for Payer: Aetna Commercial |
$476.45
|
| Rate for Payer: Aetna Medicare |
$186.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$186.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$324.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$352.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$214.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.92
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Centivo All Commercial |
$287.90
|
| Rate for Payer: Cigna All Commercial |
$487.18
|
| Rate for Payer: CORVEL All Commercial |
$525.00
|
| Rate for Payer: Coventry All Commercial |
$496.78
|
| Rate for Payer: Encore All Commercial |
$519.64
|
| Rate for Payer: Frontpath All Commercial |
$519.36
|
| Rate for Payer: Humana ChoiceCare |
$487.58
|
| Rate for Payer: Humana Medicare |
$287.90
|
| Rate for Payer: Lucent All Commercial |
$287.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$508.07
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$423.39
|
| Rate for Payer: PHP All Commercial |
$428.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$220.16
|
| Rate for Payer: Sagamore Health Network All Products |
$435.81
|
| Rate for Payer: Signature Care EPO |
$468.55
|
| Rate for Payer: Signature Care PPO |
$496.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$479.84
|
| Rate for Payer: United Healthcare Commercial |
$444.84
|
| Rate for Payer: United Healthcare Medicare |
$186.29
|
|
|
HC ECHO MYOCARDIAL STRAIN IMAGING
|
Facility
IP
|
$564.52
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
00860399
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$423.39 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$487.74
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna All Commercial |
$487.18
|
| Rate for Payer: CORVEL All Commercial |
$525.00
|
| Rate for Payer: Coventry All Commercial |
$496.78
|
| Rate for Payer: Encore All Commercial |
$519.64
|
| Rate for Payer: Frontpath All Commercial |
$519.36
|
| Rate for Payer: Humana ChoiceCare |
$487.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$508.07
|
| Rate for Payer: PHCS All Commercial |
$423.39
|
| Rate for Payer: PHP All Commercial |
$428.13
|
| Rate for Payer: Sagamore Health Network All Products |
$435.81
|
| Rate for Payer: Signature Care EPO |
$468.55
|
| Rate for Payer: Signature Care PPO |
$496.78
|
| Rate for Payer: United Healthcare Commercial |
$444.84
|
|
|
HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
OP
|
$1,750.40
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
00863315
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$577.63 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: Aetna Commercial |
$1,477.34
|
| Rate for Payer: Aetna Medicare |
$577.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$577.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,005.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,094.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$664.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$635.40
|
| Rate for Payer: Cash Price |
$1,085.25
|
| Rate for Payer: Cash Price |
$1,085.25
|
| Rate for Payer: Centivo All Commercial |
$892.70
|
| Rate for Payer: Cigna All Commercial |
$1,510.60
|
| Rate for Payer: CORVEL All Commercial |
$1,627.87
|
| Rate for Payer: Coventry All Commercial |
$1,540.35
|
| Rate for Payer: Encore All Commercial |
$1,611.24
|
| Rate for Payer: Frontpath All Commercial |
$1,610.37
|
| Rate for Payer: Humana ChoiceCare |
$1,511.82
|
| Rate for Payer: Humana Medicare |
$892.70
|
| Rate for Payer: Lucent All Commercial |
$892.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.36
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
| Rate for Payer: PHCS All Commercial |
$1,312.80
|
| Rate for Payer: PHP All Commercial |
$1,327.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$682.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.31
|
| Rate for Payer: Signature Care EPO |
$1,452.83
|
| Rate for Payer: Signature Care PPO |
$1,540.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,487.84
|
| Rate for Payer: United Healthcare Commercial |
$1,379.32
|
| Rate for Payer: United Healthcare Medicare |
$577.63
|
|
|
HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
IP
|
$1,750.40
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
00863315
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$1,627.87 |
| Rate for Payer: Aetna Commercial |
$1,512.35
|
| Rate for Payer: Cash Price |
$1,085.25
|
| Rate for Payer: Cigna All Commercial |
$1,510.60
|
| Rate for Payer: CORVEL All Commercial |
$1,627.87
|
| Rate for Payer: Coventry All Commercial |
$1,540.35
|
| Rate for Payer: Encore All Commercial |
$1,611.24
|
| Rate for Payer: Frontpath All Commercial |
$1,610.37
|
| Rate for Payer: Humana ChoiceCare |
$1,511.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.36
|
| Rate for Payer: PHCS All Commercial |
$1,312.80
|
| Rate for Payer: PHP All Commercial |
$1,327.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.31
|
| Rate for Payer: Signature Care EPO |
$1,452.83
|
| Rate for Payer: Signature Care PPO |
$1,540.35
|
| Rate for Payer: United Healthcare Commercial |
$1,379.32
|
|
|
HC E COLI 0157
|
Facility
OP
|
$120.86
|
|
|
Service Code
|
CPT 87335
|
| Hospital Charge Code |
63002027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$112.40 |
| Rate for Payer: Aetna Commercial |
$102.01
|
| Rate for Payer: Aetna Medicare |
$39.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.87
|
| Rate for Payer: Cash Price |
$74.93
|
| Rate for Payer: Cash Price |
$74.93
|
| Rate for Payer: Centivo All Commercial |
$61.64
|
| Rate for Payer: Cigna All Commercial |
$104.30
|
| Rate for Payer: CORVEL All Commercial |
$112.40
|
| Rate for Payer: Coventry All Commercial |
$106.36
|
| Rate for Payer: Encore All Commercial |
$111.25
|
| Rate for Payer: Frontpath All Commercial |
$111.19
|
| Rate for Payer: Humana ChoiceCare |
$104.39
|
| Rate for Payer: Humana Medicare |
$61.64
|
| Rate for Payer: Lucent All Commercial |
$61.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.77
|
| Rate for Payer: Managed Health Services Medicaid |
$12.66
|
| Rate for Payer: MDWise Medicaid |
$12.66
|
| Rate for Payer: PHCS All Commercial |
$90.64
|
| Rate for Payer: PHP All Commercial |
$91.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.14
|
| Rate for Payer: Sagamore Health Network All Products |
$93.30
|
| Rate for Payer: Signature Care EPO |
$100.31
|
| Rate for Payer: Signature Care PPO |
$106.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.73
|
| Rate for Payer: United Healthcare Commercial |
$95.24
|
| Rate for Payer: United Healthcare Medicare |
$39.88
|
|
|
HC E COLI 0157
|
Facility
IP
|
$120.86
|
|
|
Service Code
|
CPT 87335
|
| Hospital Charge Code |
63002027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$112.40 |
| Rate for Payer: Aetna Commercial |
$104.42
|
| Rate for Payer: Cash Price |
$74.93
|
| Rate for Payer: Cigna All Commercial |
$104.30
|
| Rate for Payer: CORVEL All Commercial |
$112.40
|
| Rate for Payer: Coventry All Commercial |
$106.36
|
| Rate for Payer: Encore All Commercial |
$111.25
|
| Rate for Payer: Frontpath All Commercial |
$111.19
|
| Rate for Payer: Humana ChoiceCare |
$104.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.77
|
| Rate for Payer: PHCS All Commercial |
$90.64
|
| Rate for Payer: PHP All Commercial |
$91.66
|
| Rate for Payer: Sagamore Health Network All Products |
$93.30
|
| Rate for Payer: Signature Care EPO |
$100.31
|
| Rate for Payer: Signature Care PPO |
$106.36
|
| Rate for Payer: United Healthcare Commercial |
$95.24
|
|
