|
HC CORTISOL FREE URINE 24HR
|
Facility
|
OP
|
$233.38
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
63001499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$74.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.15
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Centivo All Commercial |
$126.96
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Humana Medicare |
$74.68
|
| Rate for Payer: Lucent All Commercial |
$126.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: Managed Health Services Medicaid |
$16.71
|
| Rate for Payer: MDWise Medicaid |
$16.71
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.02
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
| Rate for Payer: United Healthcare Medicare |
$74.68
|
|
|
HC CORTISOL FREE URINE 24HR
|
Facility
|
IP
|
$233.38
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
63001499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$201.64
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
|
|
HC CORTISOL-PM
|
Facility
|
OP
|
$235.62
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$198.86
|
| Rate for Payer: Aetna Medicare |
$75.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.94
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Centivo All Commercial |
$128.18
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Humana Medicare |
$75.40
|
| Rate for Payer: Lucent All Commercial |
$128.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16.30
|
| Rate for Payer: MDWise Medicaid |
$16.30
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.89
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.28
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
|
|
HC CORTISOL-PM
|
Facility
|
IP
|
$235.62
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$203.58
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
|
|
HC CORTISOL -SALIVA
|
Facility
|
OP
|
$169.28
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$157.43 |
| Rate for Payer: Aetna Commercial |
$142.87
|
| Rate for Payer: Aetna Medicare |
$54.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.59
|
| Rate for Payer: Cash Price |
$101.57
|
| Rate for Payer: Cash Price |
$101.57
|
| Rate for Payer: Centivo All Commercial |
$92.09
|
| Rate for Payer: Cigna All Commercial |
$146.09
|
| Rate for Payer: CORVEL All Commercial |
$157.43
|
| Rate for Payer: Coventry All Commercial |
$148.97
|
| Rate for Payer: Encore All Commercial |
$155.82
|
| Rate for Payer: Frontpath All Commercial |
$155.74
|
| Rate for Payer: Humana ChoiceCare |
$146.21
|
| Rate for Payer: Humana Medicare |
$54.17
|
| Rate for Payer: Lucent All Commercial |
$92.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.35
|
| Rate for Payer: Managed Health Services Medicaid |
$16.30
|
| Rate for Payer: MDWise Medicaid |
$16.30
|
| Rate for Payer: PHCS All Commercial |
$126.96
|
| Rate for Payer: PHP All Commercial |
$128.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.02
|
| Rate for Payer: Sagamore Health Network All Products |
$130.68
|
| Rate for Payer: Signature Care EPO |
$140.50
|
| Rate for Payer: Signature Care PPO |
$148.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.89
|
| Rate for Payer: United Healthcare Commercial |
$133.39
|
| Rate for Payer: United Healthcare Medicare |
$54.17
|
|
|
HC CORTISOL -SALIVA
|
Facility
|
IP
|
$169.28
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.96 |
| Max. Negotiated Rate |
$157.43 |
| Rate for Payer: Aetna Commercial |
$146.26
|
| Rate for Payer: Cash Price |
$101.57
|
| Rate for Payer: Cigna All Commercial |
$146.09
|
| Rate for Payer: CORVEL All Commercial |
$157.43
|
| Rate for Payer: Coventry All Commercial |
$148.97
|
| Rate for Payer: Encore All Commercial |
$155.82
|
| Rate for Payer: Frontpath All Commercial |
$155.74
|
| Rate for Payer: Humana ChoiceCare |
$146.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.35
|
| Rate for Payer: PHCS All Commercial |
$126.96
|
| Rate for Payer: PHP All Commercial |
$128.38
|
| Rate for Payer: Sagamore Health Network All Products |
$130.68
|
| Rate for Payer: Signature Care EPO |
$140.50
|
| Rate for Payer: Signature Care PPO |
$148.97
|
| Rate for Payer: United Healthcare Commercial |
$133.39
|
|
|
HC CORTISOL TOTAL
|
Facility
|
OP
|
$235.62
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$198.86
|
| Rate for Payer: Aetna Medicare |
$75.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.94
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Centivo All Commercial |
$128.18
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Humana Medicare |
$75.40
|
| Rate for Payer: Lucent All Commercial |
$128.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16.30
|
| Rate for Payer: MDWise Medicaid |
$16.30
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.89
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.28
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
|
|
HC CORTISOL TOTAL
|
Facility
|
IP
|
$235.62
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$203.58
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
|
|
HC COTININE SCREEN, URINE
|
Facility
|
OP
|
$56.97
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$62.14 |
| Rate for Payer: Aetna Commercial |
$48.08
|
| Rate for Payer: Aetna Medicare |
$18.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Centivo All Commercial |
$30.99
|
| Rate for Payer: Cigna All Commercial |
$49.17
|
| Rate for Payer: CORVEL All Commercial |
$52.98
|
| Rate for Payer: Coventry All Commercial |
$50.13
|
| Rate for Payer: Encore All Commercial |
$52.44
|
| Rate for Payer: Frontpath All Commercial |
$52.41
|
| Rate for Payer: Humana ChoiceCare |
$49.20
|
| Rate for Payer: Humana Medicare |
$18.23
|
| Rate for Payer: Lucent All Commercial |
$30.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.27
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$42.73
|
| Rate for Payer: PHP All Commercial |
$43.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.22
|
| Rate for Payer: Sagamore Health Network All Products |
$43.98
|
| Rate for Payer: Signature Care EPO |
$47.29
|
| Rate for Payer: Signature Care PPO |
$50.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.42
|
| Rate for Payer: United Healthcare Commercial |
$44.89
|
| Rate for Payer: United Healthcare Medicare |
$18.23
|
|
|
HC COTININE SCREEN, URINE
|
Facility
|
IP
|
$56.97
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$52.98 |
| Rate for Payer: Aetna Commercial |
$49.22
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cigna All Commercial |
$49.17
|
| Rate for Payer: CORVEL All Commercial |
$52.98
|
| Rate for Payer: Coventry All Commercial |
$50.13
|
| Rate for Payer: Encore All Commercial |
$52.44
|
| Rate for Payer: Frontpath All Commercial |
$52.41
|
| Rate for Payer: Humana ChoiceCare |
$49.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.27
|
| Rate for Payer: PHCS All Commercial |
$42.73
|
| Rate for Payer: PHP All Commercial |
$43.21
|
| Rate for Payer: Sagamore Health Network All Products |
$43.98
|
| Rate for Payer: Signature Care EPO |
$47.29
|
| Rate for Payer: Signature Care PPO |
$50.13
|
| Rate for Payer: United Healthcare Commercial |
$44.89
|
|
|
HC CPAP-BIPAP PER DAY
|
Facility
|
OP
|
$949.15
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
1704660
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$882.71 |
| Rate for Payer: Aetna Commercial |
$801.08
|
| Rate for Payer: Aetna Medicare |
$303.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$545.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.10
|
| Rate for Payer: Cash Price |
$569.49
|
| Rate for Payer: Cash Price |
$569.49
|
| Rate for Payer: Centivo All Commercial |
$516.34
|
| Rate for Payer: Cigna All Commercial |
$819.12
|
| Rate for Payer: CORVEL All Commercial |
$882.71
|
| Rate for Payer: Coventry All Commercial |
$835.25
|
| Rate for Payer: Encore All Commercial |
$873.69
|
| Rate for Payer: Frontpath All Commercial |
$873.22
|
| Rate for Payer: Humana ChoiceCare |
$819.78
|
| Rate for Payer: Humana Medicare |
$303.73
|
| Rate for Payer: Lucent All Commercial |
$516.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$854.24
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$711.86
|
| Rate for Payer: PHP All Commercial |
$719.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.17
|
| Rate for Payer: Sagamore Health Network All Products |
$732.74
|
| Rate for Payer: Signature Care EPO |
$787.79
|
| Rate for Payer: Signature Care PPO |
$835.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$806.78
|
| Rate for Payer: United Healthcare Commercial |
$747.93
|
| Rate for Payer: United Healthcare Medicare |
$303.73
|
|
|
HC CPAP-BIPAP PER DAY
|
Facility
|
IP
|
$949.15
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
1704660
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$711.86 |
| Max. Negotiated Rate |
$882.71 |
| Rate for Payer: Aetna Commercial |
$820.07
|
| Rate for Payer: Cash Price |
$569.49
|
| Rate for Payer: Cigna All Commercial |
$819.12
|
| Rate for Payer: CORVEL All Commercial |
$882.71
|
| Rate for Payer: Coventry All Commercial |
$835.25
|
| Rate for Payer: Encore All Commercial |
$873.69
|
| Rate for Payer: Frontpath All Commercial |
$873.22
|
| Rate for Payer: Humana ChoiceCare |
$819.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$854.24
|
| Rate for Payer: PHCS All Commercial |
$711.86
|
| Rate for Payer: PHP All Commercial |
$719.84
|
| Rate for Payer: Sagamore Health Network All Products |
$732.74
|
| Rate for Payer: Signature Care EPO |
$787.79
|
| Rate for Payer: Signature Care PPO |
$835.25
|
| Rate for Payer: United Healthcare Commercial |
$747.93
|
|
|
HC C-PEPTIDE
|
Facility
|
IP
|
$204.98
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
63001004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$190.63 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Cash Price |
$122.99
|
| Rate for Payer: Cigna All Commercial |
$176.90
|
| Rate for Payer: CORVEL All Commercial |
$190.63
|
| Rate for Payer: Coventry All Commercial |
$180.38
|
| Rate for Payer: Encore All Commercial |
$188.68
|
| Rate for Payer: Frontpath All Commercial |
$188.58
|
| Rate for Payer: Humana ChoiceCare |
$177.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.48
|
| Rate for Payer: PHCS All Commercial |
$153.74
|
| Rate for Payer: PHP All Commercial |
$155.46
|
| Rate for Payer: Sagamore Health Network All Products |
$158.24
|
| Rate for Payer: Signature Care EPO |
$170.13
|
| Rate for Payer: Signature Care PPO |
$180.38
|
| Rate for Payer: United Healthcare Commercial |
$161.52
|
|
|
HC C-PEPTIDE
|
Facility
|
OP
|
$204.98
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
63001004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$190.63 |
| Rate for Payer: Aetna Commercial |
$173.00
|
| Rate for Payer: Aetna Medicare |
$65.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.15
|
| Rate for Payer: Cash Price |
$122.99
|
| Rate for Payer: Cash Price |
$122.99
|
| Rate for Payer: Centivo All Commercial |
$111.51
|
| Rate for Payer: Cigna All Commercial |
$176.90
|
| Rate for Payer: CORVEL All Commercial |
$190.63
|
| Rate for Payer: Coventry All Commercial |
$180.38
|
| Rate for Payer: Encore All Commercial |
$188.68
|
| Rate for Payer: Frontpath All Commercial |
$188.58
|
| Rate for Payer: Humana ChoiceCare |
$177.04
|
| Rate for Payer: Humana Medicare |
$65.59
|
| Rate for Payer: Lucent All Commercial |
$111.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.48
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$153.74
|
| Rate for Payer: PHP All Commercial |
$155.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.94
|
| Rate for Payer: Sagamore Health Network All Products |
$158.24
|
| Rate for Payer: Signature Care EPO |
$170.13
|
| Rate for Payer: Signature Care PPO |
$180.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.23
|
| Rate for Payer: United Healthcare Commercial |
$161.52
|
| Rate for Payer: United Healthcare Medicare |
$65.59
|
|
|
HC CPK
|
Facility
|
IP
|
$83.03
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
63001120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Aetna Commercial |
$71.74
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Cigna All Commercial |
$71.65
|
| Rate for Payer: CORVEL All Commercial |
$77.22
|
| Rate for Payer: Coventry All Commercial |
$73.07
|
| Rate for Payer: Encore All Commercial |
$76.43
|
| Rate for Payer: Frontpath All Commercial |
$76.39
|
| Rate for Payer: Humana ChoiceCare |
$71.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.73
|
| Rate for Payer: PHCS All Commercial |
$62.27
|
| Rate for Payer: PHP All Commercial |
$62.97
|
| Rate for Payer: Sagamore Health Network All Products |
$64.10
|
| Rate for Payer: Signature Care EPO |
$68.91
|
| Rate for Payer: Signature Care PPO |
$73.07
|
| Rate for Payer: United Healthcare Commercial |
$65.43
|
|
|
HC CPK
|
Facility
|
OP
|
$83.03
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
63001120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Aetna Commercial |
$70.08
|
| Rate for Payer: Aetna Medicare |
$26.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.23
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Centivo All Commercial |
$45.17
|
| Rate for Payer: Cigna All Commercial |
$71.65
|
| Rate for Payer: CORVEL All Commercial |
$77.22
|
| Rate for Payer: Coventry All Commercial |
$73.07
|
| Rate for Payer: Encore All Commercial |
$76.43
|
| Rate for Payer: Frontpath All Commercial |
$76.39
|
| Rate for Payer: Humana ChoiceCare |
$71.71
|
| Rate for Payer: Humana Medicare |
$26.57
|
| Rate for Payer: Lucent All Commercial |
$45.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.73
|
| Rate for Payer: Managed Health Services Medicaid |
$6.51
|
| Rate for Payer: MDWise Medicaid |
$6.51
|
| Rate for Payer: PHCS All Commercial |
$62.27
|
| Rate for Payer: PHP All Commercial |
$62.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.38
|
| Rate for Payer: Sagamore Health Network All Products |
$64.10
|
| Rate for Payer: Signature Care EPO |
$68.91
|
| Rate for Payer: Signature Care PPO |
$73.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.58
|
| Rate for Payer: United Healthcare Commercial |
$65.43
|
| Rate for Payer: United Healthcare Medicare |
$26.57
|
|
|
HC CPK ISOENZYMES
|
Facility
|
OP
|
$188.50
|
|
|
Service Code
|
CPT 82552
|
| Hospital Charge Code |
63001521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$175.31 |
| Rate for Payer: Aetna Commercial |
$159.09
|
| Rate for Payer: Aetna Medicare |
$60.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.35
|
| Rate for Payer: Cash Price |
$113.10
|
| Rate for Payer: Cash Price |
$113.10
|
| Rate for Payer: Centivo All Commercial |
$102.54
|
| Rate for Payer: Cigna All Commercial |
$162.68
|
| Rate for Payer: CORVEL All Commercial |
$175.31
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.81
|
| Rate for Payer: Humana Medicare |
$60.32
|
| Rate for Payer: Lucent All Commercial |
$102.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$141.38
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.52
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.46
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.22
|
| Rate for Payer: United Healthcare Commercial |
$148.54
|
| Rate for Payer: United Healthcare Medicare |
$60.32
|
|
|
HC CPK ISOENZYMES
|
Facility
|
IP
|
$188.50
|
|
|
Service Code
|
CPT 82552
|
| Hospital Charge Code |
63001521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.38 |
| Max. Negotiated Rate |
$175.31 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Cash Price |
$113.10
|
| Rate for Payer: Cigna All Commercial |
$162.68
|
| Rate for Payer: CORVEL All Commercial |
$175.31
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: PHCS All Commercial |
$141.38
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.46
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: United Healthcare Commercial |
$148.54
|
|
|
HC CPPD - INITIAL
|
Facility
|
OP
|
$238.68
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
1706476
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$221.97 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$137.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.02
|
| Rate for Payer: Cash Price |
$143.21
|
| Rate for Payer: Cash Price |
$143.21
|
| Rate for Payer: Centivo All Commercial |
$129.84
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Humana Medicare |
$76.38
|
| Rate for Payer: Lucent All Commercial |
$129.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.09
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202.88
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
| Rate for Payer: United Healthcare Medicare |
$76.38
|
|
|
HC CPPD - INITIAL
|
Facility
|
IP
|
$238.68
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
1706476
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$221.97 |
| Rate for Payer: Aetna Commercial |
$206.22
|
| Rate for Payer: Cash Price |
$143.21
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
|
|
HC CPPD - SUBSEQUENT
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
1704668
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$151.66 |
| Rate for Payer: Aetna Commercial |
$137.63
|
| Rate for Payer: Aetna Medicare |
$52.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$93.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.40
|
| Rate for Payer: Cash Price |
$97.84
|
| Rate for Payer: Cash Price |
$97.84
|
| Rate for Payer: Centivo All Commercial |
$88.71
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.66
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.11
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Humana Medicare |
$52.18
|
| Rate for Payer: Lucent All Commercial |
$88.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.60
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.61
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
| Rate for Payer: United Healthcare Medicare |
$52.18
|
|
|
HC CPPD - SUBSEQUENT
|
Facility
|
IP
|
$163.07
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
1704668
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$151.66 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Cash Price |
$97.84
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.66
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.11
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
|
|
HC C-REACTIVE PROTEIN (CRP), QUANT
|
Facility
|
OP
|
$133.30
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
63001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$123.97 |
| Rate for Payer: Aetna Commercial |
$112.51
|
| Rate for Payer: Aetna Medicare |
$42.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$61.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.92
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Centivo All Commercial |
$72.52
|
| Rate for Payer: Cigna All Commercial |
$115.04
|
| Rate for Payer: CORVEL All Commercial |
$123.97
|
| Rate for Payer: Coventry All Commercial |
$117.30
|
| Rate for Payer: Encore All Commercial |
$122.70
|
| Rate for Payer: Frontpath All Commercial |
$122.64
|
| Rate for Payer: Humana ChoiceCare |
$115.13
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$72.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.97
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$99.97
|
| Rate for Payer: PHP All Commercial |
$101.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.99
|
| Rate for Payer: Sagamore Health Network All Products |
$102.91
|
| Rate for Payer: Signature Care EPO |
$110.64
|
| Rate for Payer: Signature Care PPO |
$117.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113.31
|
| Rate for Payer: United Healthcare Commercial |
$105.04
|
| Rate for Payer: United Healthcare Medicare |
$42.66
|
|
|
HC C-REACTIVE PROTEIN (CRP), QUANT
|
Facility
|
IP
|
$133.30
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
63001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$123.97 |
| Rate for Payer: Aetna Commercial |
$115.17
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Cigna All Commercial |
$115.04
|
| Rate for Payer: CORVEL All Commercial |
$123.97
|
| Rate for Payer: Coventry All Commercial |
$117.30
|
| Rate for Payer: Encore All Commercial |
$122.70
|
| Rate for Payer: Frontpath All Commercial |
$122.64
|
| Rate for Payer: Humana ChoiceCare |
$115.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.97
|
| Rate for Payer: PHCS All Commercial |
$99.97
|
| Rate for Payer: PHP All Commercial |
$101.09
|
| Rate for Payer: Sagamore Health Network All Products |
$102.91
|
| Rate for Payer: Signature Care EPO |
$110.64
|
| Rate for Payer: Signature Care PPO |
$117.30
|
| Rate for Payer: United Healthcare Commercial |
$105.04
|
|
|
HC CREATININE CLEARANCE
|
Facility
|
IP
|
$151.47
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
63001118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$130.87
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Cigna All Commercial |
$130.72
|
| Rate for Payer: CORVEL All Commercial |
$140.87
|
| Rate for Payer: Coventry All Commercial |
$133.29
|
| Rate for Payer: Encore All Commercial |
$139.43
|
| Rate for Payer: Frontpath All Commercial |
$139.35
|
| Rate for Payer: Humana ChoiceCare |
$130.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.32
|
| Rate for Payer: PHCS All Commercial |
$113.60
|
| Rate for Payer: PHP All Commercial |
$114.87
|
| Rate for Payer: Sagamore Health Network All Products |
$116.93
|
| Rate for Payer: Signature Care EPO |
$125.72
|
| Rate for Payer: Signature Care PPO |
$133.29
|
| Rate for Payer: United Healthcare Commercial |
$119.36
|
|
