|
HC ENTEROVIRUS DETECTION-PCR
|
Facility
OP
|
$392.90
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
63002038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna Commercial |
$331.61
|
| Rate for Payer: Aetna Medicare |
$129.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$225.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$245.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.62
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Centivo All Commercial |
$200.38
|
| Rate for Payer: Cigna All Commercial |
$339.08
|
| Rate for Payer: CORVEL All Commercial |
$365.40
|
| Rate for Payer: Coventry All Commercial |
$345.76
|
| Rate for Payer: Encore All Commercial |
$361.67
|
| Rate for Payer: Frontpath All Commercial |
$361.47
|
| Rate for Payer: Humana ChoiceCare |
$339.35
|
| Rate for Payer: Humana Medicare |
$200.38
|
| Rate for Payer: Lucent All Commercial |
$200.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$353.61
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$294.68
|
| Rate for Payer: PHP All Commercial |
$297.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.23
|
| Rate for Payer: Sagamore Health Network All Products |
$303.32
|
| Rate for Payer: Signature Care EPO |
$326.11
|
| Rate for Payer: Signature Care PPO |
$345.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$333.97
|
| Rate for Payer: United Healthcare Commercial |
$309.61
|
| Rate for Payer: United Healthcare Medicare |
$129.66
|
|
|
HC ENTEROVIRUS DETECTION-PCR
|
Facility
IP
|
$392.90
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
63002038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.68 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna Commercial |
$339.47
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna All Commercial |
$339.08
|
| Rate for Payer: CORVEL All Commercial |
$365.40
|
| Rate for Payer: Coventry All Commercial |
$345.76
|
| Rate for Payer: Encore All Commercial |
$361.67
|
| Rate for Payer: Frontpath All Commercial |
$361.47
|
| Rate for Payer: Humana ChoiceCare |
$339.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$353.61
|
| Rate for Payer: PHCS All Commercial |
$294.68
|
| Rate for Payer: PHP All Commercial |
$297.98
|
| Rate for Payer: Sagamore Health Network All Products |
$303.32
|
| Rate for Payer: Signature Care EPO |
$326.11
|
| Rate for Payer: Signature Care PPO |
$345.76
|
| Rate for Payer: United Healthcare Commercial |
$309.61
|
|
|
HC ENZYME HISTOCHEMISTRY
|
Facility
OP
|
$759.29
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
63002106
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.83 |
| Max. Negotiated Rate |
$706.14 |
| Rate for Payer: Aetna Commercial |
$640.84
|
| Rate for Payer: Aetna Medicare |
$250.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$250.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$436.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$474.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$90.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$288.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$275.62
|
| Rate for Payer: Cash Price |
$470.76
|
| Rate for Payer: Cash Price |
$470.76
|
| Rate for Payer: Centivo All Commercial |
$387.24
|
| Rate for Payer: Cigna All Commercial |
$655.27
|
| Rate for Payer: CORVEL All Commercial |
$706.14
|
| Rate for Payer: Coventry All Commercial |
$668.17
|
| Rate for Payer: Encore All Commercial |
$698.92
|
| Rate for Payer: Frontpath All Commercial |
$698.54
|
| Rate for Payer: Humana ChoiceCare |
$655.80
|
| Rate for Payer: Humana Medicare |
$387.24
|
| Rate for Payer: Lucent All Commercial |
$387.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$683.36
|
| Rate for Payer: Managed Health Services Medicaid |
$90.83
|
| Rate for Payer: MDWise Medicaid |
$90.83
|
| Rate for Payer: PHCS All Commercial |
$569.47
|
| Rate for Payer: PHP All Commercial |
$575.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$296.12
|
| Rate for Payer: Sagamore Health Network All Products |
$586.17
|
| Rate for Payer: Signature Care EPO |
$630.21
|
| Rate for Payer: Signature Care PPO |
$668.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$645.39
|
| Rate for Payer: United Healthcare Commercial |
$598.32
|
| Rate for Payer: United Healthcare Medicare |
$250.57
|
|
|
HC ENZYME HISTOCHEMISTRY
|
Facility
IP
|
$759.29
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
63002106
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$569.47 |
| Max. Negotiated Rate |
$706.14 |
| Rate for Payer: Aetna Commercial |
$656.02
|
| Rate for Payer: Cash Price |
$470.76
|
| Rate for Payer: Cigna All Commercial |
$655.27
|
| Rate for Payer: CORVEL All Commercial |
$706.14
|
| Rate for Payer: Coventry All Commercial |
$668.17
|
| Rate for Payer: Encore All Commercial |
$698.92
|
| Rate for Payer: Frontpath All Commercial |
$698.54
|
| Rate for Payer: Humana ChoiceCare |
$655.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$683.36
|
| Rate for Payer: PHCS All Commercial |
$569.47
|
| Rate for Payer: PHP All Commercial |
$575.84
|
| Rate for Payer: Sagamore Health Network All Products |
$586.17
|
| Rate for Payer: Signature Care EPO |
$630.21
|
| Rate for Payer: Signature Care PPO |
$668.17
|
| Rate for Payer: United Healthcare Commercial |
$598.32
|
|
|
HC EOSINOPHIL CT NASAL
|
Facility
OP
|
$117.10
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
63001240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna Commercial |
$98.83
|
| Rate for Payer: Aetna Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.51
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Centivo All Commercial |
$59.72
|
| Rate for Payer: Cigna All Commercial |
$101.05
|
| Rate for Payer: CORVEL All Commercial |
$108.90
|
| Rate for Payer: Coventry All Commercial |
$103.04
|
| Rate for Payer: Encore All Commercial |
$107.79
|
| Rate for Payer: Frontpath All Commercial |
$107.73
|
| Rate for Payer: Humana ChoiceCare |
$101.14
|
| Rate for Payer: Humana Medicare |
$59.72
|
| Rate for Payer: Lucent All Commercial |
$59.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.39
|
| Rate for Payer: Managed Health Services Medicaid |
$5.79
|
| Rate for Payer: MDWise Medicaid |
$5.79
|
| Rate for Payer: PHCS All Commercial |
$87.82
|
| Rate for Payer: PHP All Commercial |
$88.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.67
|
| Rate for Payer: Sagamore Health Network All Products |
$90.40
|
| Rate for Payer: Signature Care EPO |
$97.19
|
| Rate for Payer: Signature Care PPO |
$103.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.53
|
| Rate for Payer: United Healthcare Commercial |
$92.27
|
| Rate for Payer: United Healthcare Medicare |
$38.64
|
|
|
HC EOSINOPHIL CT NASAL
|
Facility
IP
|
$117.10
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
63001240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.82 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna All Commercial |
$101.05
|
| Rate for Payer: CORVEL All Commercial |
$108.90
|
| Rate for Payer: Coventry All Commercial |
$103.04
|
| Rate for Payer: Encore All Commercial |
$107.79
|
| Rate for Payer: Frontpath All Commercial |
$107.73
|
| Rate for Payer: Humana ChoiceCare |
$101.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.39
|
| Rate for Payer: PHCS All Commercial |
$87.82
|
| Rate for Payer: PHP All Commercial |
$88.81
|
| Rate for Payer: Sagamore Health Network All Products |
$90.40
|
| Rate for Payer: Signature Care EPO |
$97.19
|
| Rate for Payer: Signature Care PPO |
$103.04
|
| Rate for Payer: United Healthcare Commercial |
$92.27
|
|
|
HC EOSINOPHIL SMEAR-FECES
|
Facility
OP
|
$82.62
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63002141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$76.84 |
| Rate for Payer: Aetna Commercial |
$69.73
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.99
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Centivo All Commercial |
$42.14
|
| Rate for Payer: Cigna All Commercial |
$71.30
|
| Rate for Payer: CORVEL All Commercial |
$76.84
|
| Rate for Payer: Coventry All Commercial |
$72.71
|
| Rate for Payer: Encore All Commercial |
$76.05
|
| Rate for Payer: Frontpath All Commercial |
$76.01
|
| Rate for Payer: Humana ChoiceCare |
$71.36
|
| Rate for Payer: Humana Medicare |
$42.14
|
| Rate for Payer: Lucent All Commercial |
$42.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.36
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$61.96
|
| Rate for Payer: PHP All Commercial |
$62.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.22
|
| Rate for Payer: Sagamore Health Network All Products |
$63.78
|
| Rate for Payer: Signature Care EPO |
$68.57
|
| Rate for Payer: Signature Care PPO |
$72.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.23
|
| Rate for Payer: United Healthcare Commercial |
$65.10
|
| Rate for Payer: United Healthcare Medicare |
$27.26
|
|
|
HC EOSINOPHIL SMEAR-FECES
|
Facility
IP
|
$82.62
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63002141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.96 |
| Max. Negotiated Rate |
$76.84 |
| Rate for Payer: Aetna Commercial |
$71.38
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Cigna All Commercial |
$71.30
|
| Rate for Payer: CORVEL All Commercial |
$76.84
|
| Rate for Payer: Coventry All Commercial |
$72.71
|
| Rate for Payer: Encore All Commercial |
$76.05
|
| Rate for Payer: Frontpath All Commercial |
$76.01
|
| Rate for Payer: Humana ChoiceCare |
$71.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.36
|
| Rate for Payer: PHCS All Commercial |
$61.96
|
| Rate for Payer: PHP All Commercial |
$62.66
|
| Rate for Payer: Sagamore Health Network All Products |
$63.78
|
| Rate for Payer: Signature Care EPO |
$68.57
|
| Rate for Payer: Signature Care PPO |
$72.71
|
| Rate for Payer: United Healthcare Commercial |
$65.10
|
|
|
HC EOSINOPHIL SMEAR-URINE
|
Facility
IP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63002140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.39 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$124.86
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cigna All Commercial |
$124.72
|
| Rate for Payer: CORVEL All Commercial |
$134.40
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: PHCS All Commercial |
$108.39
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.95
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: United Healthcare Commercial |
$113.88
|
|
|
HC EOSINOPHIL SMEAR-URINE
|
Facility
OP
|
$144.51
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
63002140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Aetna Medicare |
$47.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.46
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Centivo All Commercial |
$73.70
|
| Rate for Payer: Cigna All Commercial |
$124.72
|
| Rate for Payer: CORVEL All Commercial |
$134.40
|
| Rate for Payer: Coventry All Commercial |
$127.17
|
| Rate for Payer: Encore All Commercial |
$133.02
|
| Rate for Payer: Frontpath All Commercial |
$132.95
|
| Rate for Payer: Humana ChoiceCare |
$124.82
|
| Rate for Payer: Humana Medicare |
$73.70
|
| Rate for Payer: Lucent All Commercial |
$73.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.06
|
| Rate for Payer: Managed Health Services Medicaid |
$4.72
|
| Rate for Payer: MDWise Medicaid |
$4.72
|
| Rate for Payer: PHCS All Commercial |
$108.39
|
| Rate for Payer: PHP All Commercial |
$109.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.36
|
| Rate for Payer: Sagamore Health Network All Products |
$111.56
|
| Rate for Payer: Signature Care EPO |
$119.95
|
| Rate for Payer: Signature Care PPO |
$127.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.84
|
| Rate for Payer: United Healthcare Commercial |
$113.88
|
| Rate for Payer: United Healthcare Medicare |
$47.69
|
|
|
HC EPID GROWTH FACT-PARAFINN
|
Facility
OP
|
$163.71
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
63002132
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$220.04 |
| Rate for Payer: Aetna Commercial |
$138.17
|
| Rate for Payer: Aetna Medicare |
$54.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$220.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.43
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Centivo All Commercial |
$83.49
|
| Rate for Payer: Cigna All Commercial |
$141.28
|
| Rate for Payer: CORVEL All Commercial |
$152.25
|
| Rate for Payer: Coventry All Commercial |
$144.06
|
| Rate for Payer: Encore All Commercial |
$150.70
|
| Rate for Payer: Frontpath All Commercial |
$150.61
|
| Rate for Payer: Humana ChoiceCare |
$141.40
|
| Rate for Payer: Humana Medicare |
$83.49
|
| Rate for Payer: Lucent All Commercial |
$83.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.34
|
| Rate for Payer: Managed Health Services Medicaid |
$220.04
|
| Rate for Payer: MDWise Medicaid |
$220.04
|
| Rate for Payer: PHCS All Commercial |
$122.78
|
| Rate for Payer: PHP All Commercial |
$124.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.85
|
| Rate for Payer: Sagamore Health Network All Products |
$126.38
|
| Rate for Payer: Signature Care EPO |
$135.88
|
| Rate for Payer: Signature Care PPO |
$144.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.15
|
| Rate for Payer: United Healthcare Commercial |
$129.00
|
| Rate for Payer: United Healthcare Medicare |
$54.02
|
|
|
HC EPID GROWTH FACT-PARAFINN
|
Facility
IP
|
$163.71
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
63002132
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$122.78 |
| Max. Negotiated Rate |
$152.25 |
| Rate for Payer: Aetna Commercial |
$141.45
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna All Commercial |
$141.28
|
| Rate for Payer: CORVEL All Commercial |
$152.25
|
| Rate for Payer: Coventry All Commercial |
$144.06
|
| Rate for Payer: Encore All Commercial |
$150.70
|
| Rate for Payer: Frontpath All Commercial |
$150.61
|
| Rate for Payer: Humana ChoiceCare |
$141.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.34
|
| Rate for Payer: PHCS All Commercial |
$122.78
|
| Rate for Payer: PHP All Commercial |
$124.16
|
| Rate for Payer: Sagamore Health Network All Products |
$126.38
|
| Rate for Payer: Signature Care EPO |
$135.88
|
| Rate for Payer: Signature Care PPO |
$144.06
|
| Rate for Payer: United Healthcare Commercial |
$129.00
|
|
|
HC EPIDURAL N RX KIT
|
Facility
IP
|
$260.10
|
|
| Hospital Charge Code |
41601066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.08 |
| Max. Negotiated Rate |
$241.89 |
| Rate for Payer: Aetna Commercial |
$224.73
|
| Rate for Payer: Cash Price |
$161.26
|
| Rate for Payer: Cigna All Commercial |
$224.47
|
| Rate for Payer: CORVEL All Commercial |
$241.89
|
| Rate for Payer: Coventry All Commercial |
$228.89
|
| Rate for Payer: Encore All Commercial |
$239.42
|
| Rate for Payer: Frontpath All Commercial |
$239.29
|
| Rate for Payer: Humana ChoiceCare |
$224.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.09
|
| Rate for Payer: PHCS All Commercial |
$195.08
|
| Rate for Payer: PHP All Commercial |
$197.26
|
| Rate for Payer: Sagamore Health Network All Products |
$200.80
|
| Rate for Payer: Signature Care EPO |
$215.88
|
| Rate for Payer: Signature Care PPO |
$228.89
|
| Rate for Payer: United Healthcare Commercial |
$204.96
|
|
|
HC EPIDURAL N RX KIT
|
Facility
OP
|
$260.10
|
|
| Hospital Charge Code |
41601066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$241.89 |
| Rate for Payer: Aetna Commercial |
$219.52
|
| Rate for Payer: Aetna Medicare |
$85.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.42
|
| Rate for Payer: Cash Price |
$161.26
|
| Rate for Payer: Cash Price |
$161.26
|
| Rate for Payer: Centivo All Commercial |
$132.65
|
| Rate for Payer: Cigna All Commercial |
$224.47
|
| Rate for Payer: CORVEL All Commercial |
$241.89
|
| Rate for Payer: Coventry All Commercial |
$228.89
|
| Rate for Payer: Encore All Commercial |
$239.42
|
| Rate for Payer: Frontpath All Commercial |
$239.29
|
| Rate for Payer: Humana ChoiceCare |
$224.65
|
| Rate for Payer: Humana Medicare |
$132.65
|
| Rate for Payer: Lucent All Commercial |
$132.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$195.08
|
| Rate for Payer: PHP All Commercial |
$197.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.44
|
| Rate for Payer: Sagamore Health Network All Products |
$200.80
|
| Rate for Payer: Signature Care EPO |
$215.88
|
| Rate for Payer: Signature Care PPO |
$228.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.08
|
| Rate for Payer: United Healthcare Commercial |
$204.96
|
| Rate for Payer: United Healthcare Medicare |
$85.83
|
|
|
HC EPIDURAL PLACEMENT
|
Facility
OP
|
$795.60
|
|
| Hospital Charge Code |
01028001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$262.55 |
| Max. Negotiated Rate |
$739.91 |
| Rate for Payer: Aetna Commercial |
$671.49
|
| Rate for Payer: Aetna Medicare |
$262.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$262.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$456.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$497.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$492.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$301.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$288.80
|
| Rate for Payer: Cash Price |
$493.27
|
| Rate for Payer: Cash Price |
$493.27
|
| Rate for Payer: Centivo All Commercial |
$405.76
|
| Rate for Payer: Cigna All Commercial |
$686.60
|
| Rate for Payer: CORVEL All Commercial |
$739.91
|
| Rate for Payer: Coventry All Commercial |
$700.13
|
| Rate for Payer: Encore All Commercial |
$732.35
|
| Rate for Payer: Frontpath All Commercial |
$731.95
|
| Rate for Payer: Humana ChoiceCare |
$687.16
|
| Rate for Payer: Humana Medicare |
$405.76
|
| Rate for Payer: Lucent All Commercial |
$405.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.04
|
| Rate for Payer: Managed Health Services Medicaid |
$492.69
|
| Rate for Payer: MDWise Medicaid |
$492.69
|
| Rate for Payer: PHCS All Commercial |
$596.70
|
| Rate for Payer: PHP All Commercial |
$603.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$310.28
|
| Rate for Payer: Sagamore Health Network All Products |
$614.20
|
| Rate for Payer: Signature Care EPO |
$660.35
|
| Rate for Payer: Signature Care PPO |
$700.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$676.26
|
| Rate for Payer: United Healthcare Commercial |
$626.93
|
| Rate for Payer: United Healthcare Medicare |
$262.55
|
|
|
HC EPIDURAL PLACEMENT
|
Facility
IP
|
$795.60
|
|
| Hospital Charge Code |
01028001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$596.70 |
| Max. Negotiated Rate |
$739.91 |
| Rate for Payer: Aetna Commercial |
$687.40
|
| Rate for Payer: Cash Price |
$493.27
|
| Rate for Payer: Cigna All Commercial |
$686.60
|
| Rate for Payer: CORVEL All Commercial |
$739.91
|
| Rate for Payer: Coventry All Commercial |
$700.13
|
| Rate for Payer: Encore All Commercial |
$732.35
|
| Rate for Payer: Frontpath All Commercial |
$731.95
|
| Rate for Payer: Humana ChoiceCare |
$687.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.04
|
| Rate for Payer: PHCS All Commercial |
$596.70
|
| Rate for Payer: PHP All Commercial |
$603.38
|
| Rate for Payer: Sagamore Health Network All Products |
$614.20
|
| Rate for Payer: Signature Care EPO |
$660.35
|
| Rate for Payer: Signature Care PPO |
$700.13
|
| Rate for Payer: United Healthcare Commercial |
$626.93
|
|
|
HC EPISTAXIS RR ANTERIOR ADULT 5.5CM
|
Facility
OP
|
$327.74
|
|
| Hospital Charge Code |
41601871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.15 |
| Max. Negotiated Rate |
$304.80 |
| Rate for Payer: Aetna Commercial |
$276.61
|
| Rate for Payer: Aetna Medicare |
$108.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.97
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Centivo All Commercial |
$167.15
|
| Rate for Payer: Cigna All Commercial |
$282.84
|
| Rate for Payer: CORVEL All Commercial |
$304.80
|
| Rate for Payer: Coventry All Commercial |
$288.41
|
| Rate for Payer: Encore All Commercial |
$301.68
|
| Rate for Payer: Frontpath All Commercial |
$301.52
|
| Rate for Payer: Humana ChoiceCare |
$283.07
|
| Rate for Payer: Humana Medicare |
$167.15
|
| Rate for Payer: Lucent All Commercial |
$167.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.97
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$245.80
|
| Rate for Payer: PHP All Commercial |
$248.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.82
|
| Rate for Payer: Sagamore Health Network All Products |
$253.02
|
| Rate for Payer: Signature Care EPO |
$272.02
|
| Rate for Payer: Signature Care PPO |
$288.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$278.58
|
| Rate for Payer: United Healthcare Commercial |
$258.26
|
| Rate for Payer: United Healthcare Medicare |
$108.15
|
|
|
HC EPISTAXIS RR ANTERIOR ADULT 5.5CM
|
Facility
IP
|
$327.74
|
|
| Hospital Charge Code |
41601871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$304.80 |
| Rate for Payer: Aetna Commercial |
$283.17
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cigna All Commercial |
$282.84
|
| Rate for Payer: CORVEL All Commercial |
$304.80
|
| Rate for Payer: Coventry All Commercial |
$288.41
|
| Rate for Payer: Encore All Commercial |
$301.68
|
| Rate for Payer: Frontpath All Commercial |
$301.52
|
| Rate for Payer: Humana ChoiceCare |
$283.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.97
|
| Rate for Payer: PHCS All Commercial |
$245.80
|
| Rate for Payer: PHP All Commercial |
$248.56
|
| Rate for Payer: Sagamore Health Network All Products |
$253.02
|
| Rate for Payer: Signature Care EPO |
$272.02
|
| Rate for Payer: Signature Care PPO |
$288.41
|
| Rate for Payer: United Healthcare Commercial |
$258.26
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM
|
Facility
OP
|
$268.10
|
|
| Hospital Charge Code |
41601872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.47 |
| Max. Negotiated Rate |
$249.33 |
| Rate for Payer: Aetna Commercial |
$226.28
|
| Rate for Payer: Aetna Medicare |
$88.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$153.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$167.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.32
|
| Rate for Payer: Cash Price |
$166.22
|
| Rate for Payer: Cash Price |
$166.22
|
| Rate for Payer: Centivo All Commercial |
$136.73
|
| Rate for Payer: Cigna All Commercial |
$231.37
|
| Rate for Payer: CORVEL All Commercial |
$249.33
|
| Rate for Payer: Coventry All Commercial |
$235.93
|
| Rate for Payer: Encore All Commercial |
$246.79
|
| Rate for Payer: Frontpath All Commercial |
$246.65
|
| Rate for Payer: Humana ChoiceCare |
$231.56
|
| Rate for Payer: Humana Medicare |
$136.73
|
| Rate for Payer: Lucent All Commercial |
$136.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$201.08
|
| Rate for Payer: PHP All Commercial |
$203.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.56
|
| Rate for Payer: Sagamore Health Network All Products |
$206.97
|
| Rate for Payer: Signature Care EPO |
$222.52
|
| Rate for Payer: Signature Care PPO |
$235.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$227.88
|
| Rate for Payer: United Healthcare Commercial |
$211.26
|
| Rate for Payer: United Healthcare Medicare |
$88.47
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM
|
Facility
IP
|
$268.10
|
|
| Hospital Charge Code |
41601872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.08 |
| Max. Negotiated Rate |
$249.33 |
| Rate for Payer: Aetna Commercial |
$231.64
|
| Rate for Payer: Cash Price |
$166.22
|
| Rate for Payer: Cigna All Commercial |
$231.37
|
| Rate for Payer: CORVEL All Commercial |
$249.33
|
| Rate for Payer: Coventry All Commercial |
$235.93
|
| Rate for Payer: Encore All Commercial |
$246.79
|
| Rate for Payer: Frontpath All Commercial |
$246.65
|
| Rate for Payer: Humana ChoiceCare |
$231.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.29
|
| Rate for Payer: PHCS All Commercial |
$201.08
|
| Rate for Payer: PHP All Commercial |
$203.33
|
| Rate for Payer: Sagamore Health Network All Products |
$206.97
|
| Rate for Payer: Signature Care EPO |
$222.52
|
| Rate for Payer: Signature Care PPO |
$235.93
|
| Rate for Payer: United Healthcare Commercial |
$211.26
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM INCLD COPD
|
Facility
IP
|
$346.36
|
|
| Hospital Charge Code |
41601873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.77 |
| Max. Negotiated Rate |
$322.11 |
| Rate for Payer: Aetna Commercial |
$299.26
|
| Rate for Payer: Cash Price |
$214.74
|
| Rate for Payer: Cigna All Commercial |
$298.91
|
| Rate for Payer: CORVEL All Commercial |
$322.11
|
| Rate for Payer: Coventry All Commercial |
$304.80
|
| Rate for Payer: Encore All Commercial |
$318.82
|
| Rate for Payer: Frontpath All Commercial |
$318.65
|
| Rate for Payer: Humana ChoiceCare |
$299.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$311.72
|
| Rate for Payer: PHCS All Commercial |
$259.77
|
| Rate for Payer: PHP All Commercial |
$262.68
|
| Rate for Payer: Sagamore Health Network All Products |
$267.39
|
| Rate for Payer: Signature Care EPO |
$287.48
|
| Rate for Payer: Signature Care PPO |
$304.80
|
| Rate for Payer: United Healthcare Commercial |
$272.93
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM INCLD COPD
|
Facility
OP
|
$346.36
|
|
| Hospital Charge Code |
41601873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.30 |
| Max. Negotiated Rate |
$322.11 |
| Rate for Payer: Aetna Commercial |
$292.33
|
| Rate for Payer: Aetna Medicare |
$114.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$198.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.73
|
| Rate for Payer: Cash Price |
$214.74
|
| Rate for Payer: Cash Price |
$214.74
|
| Rate for Payer: Centivo All Commercial |
$176.64
|
| Rate for Payer: Cigna All Commercial |
$298.91
|
| Rate for Payer: CORVEL All Commercial |
$322.11
|
| Rate for Payer: Coventry All Commercial |
$304.80
|
| Rate for Payer: Encore All Commercial |
$318.82
|
| Rate for Payer: Frontpath All Commercial |
$318.65
|
| Rate for Payer: Humana ChoiceCare |
$299.15
|
| Rate for Payer: Humana Medicare |
$176.64
|
| Rate for Payer: Lucent All Commercial |
$176.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$311.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$259.77
|
| Rate for Payer: PHP All Commercial |
$262.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.08
|
| Rate for Payer: Sagamore Health Network All Products |
$267.39
|
| Rate for Payer: Signature Care EPO |
$287.48
|
| Rate for Payer: Signature Care PPO |
$304.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$294.41
|
| Rate for Payer: United Healthcare Commercial |
$272.93
|
| Rate for Payer: United Healthcare Medicare |
$114.30
|
|
|
HC EPSTEIN-BARR VIRUS, QUANTITATIVE PCR
|
Facility
OP
|
$398.82
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63002054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$370.90 |
| Rate for Payer: Aetna Commercial |
$336.60
|
| Rate for Payer: Aetna Medicare |
$131.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$183.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.77
|
| Rate for Payer: Cash Price |
$247.27
|
| Rate for Payer: Cash Price |
$247.27
|
| Rate for Payer: Centivo All Commercial |
$203.40
|
| Rate for Payer: Cigna All Commercial |
$344.18
|
| Rate for Payer: CORVEL All Commercial |
$370.90
|
| Rate for Payer: Coventry All Commercial |
$350.96
|
| Rate for Payer: Encore All Commercial |
$367.11
|
| Rate for Payer: Frontpath All Commercial |
$366.91
|
| Rate for Payer: Humana ChoiceCare |
$344.46
|
| Rate for Payer: Humana Medicare |
$203.40
|
| Rate for Payer: Lucent All Commercial |
$203.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.94
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$299.12
|
| Rate for Payer: PHP All Commercial |
$302.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.54
|
| Rate for Payer: Sagamore Health Network All Products |
$307.89
|
| Rate for Payer: Signature Care EPO |
$331.02
|
| Rate for Payer: Signature Care PPO |
$350.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$339.00
|
| Rate for Payer: United Healthcare Commercial |
$314.27
|
| Rate for Payer: United Healthcare Medicare |
$131.61
|
|
|
HC EPSTEIN-BARR VIRUS, QUANTITATIVE PCR
|
Facility
IP
|
$398.82
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63002054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$299.12 |
| Max. Negotiated Rate |
$370.90 |
| Rate for Payer: Aetna Commercial |
$344.58
|
| Rate for Payer: Cash Price |
$247.27
|
| Rate for Payer: Cigna All Commercial |
$344.18
|
| Rate for Payer: CORVEL All Commercial |
$370.90
|
| Rate for Payer: Coventry All Commercial |
$350.96
|
| Rate for Payer: Encore All Commercial |
$367.11
|
| Rate for Payer: Frontpath All Commercial |
$366.91
|
| Rate for Payer: Humana ChoiceCare |
$344.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.94
|
| Rate for Payer: PHCS All Commercial |
$299.12
|
| Rate for Payer: PHP All Commercial |
$302.47
|
| Rate for Payer: Sagamore Health Network All Products |
$307.89
|
| Rate for Payer: Signature Care EPO |
$331.02
|
| Rate for Payer: Signature Care PPO |
$350.96
|
| Rate for Payer: United Healthcare Commercial |
$314.27
|
|
|
HC ER BASIC METABOLIC W/IONIZED CALCIUM
|
Facility
OP
|
$355.89
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
63001361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$330.98 |
| Rate for Payer: Aetna Commercial |
$300.37
|
| Rate for Payer: Aetna Medicare |
$117.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.19
|
| Rate for Payer: Cash Price |
$220.65
|
| Rate for Payer: Cash Price |
$220.65
|
| Rate for Payer: Centivo All Commercial |
$181.50
|
| Rate for Payer: Cigna All Commercial |
$307.13
|
| Rate for Payer: CORVEL All Commercial |
$330.98
|
| Rate for Payer: Coventry All Commercial |
$313.18
|
| Rate for Payer: Encore All Commercial |
$327.60
|
| Rate for Payer: Frontpath All Commercial |
$327.42
|
| Rate for Payer: Humana ChoiceCare |
$307.38
|
| Rate for Payer: Humana Medicare |
$181.50
|
| Rate for Payer: Lucent All Commercial |
$181.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.30
|
| Rate for Payer: Managed Health Services Medicaid |
$8.69
|
| Rate for Payer: MDWise Medicaid |
$8.69
|
| Rate for Payer: PHCS All Commercial |
$266.92
|
| Rate for Payer: PHP All Commercial |
$269.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.80
|
| Rate for Payer: Sagamore Health Network All Products |
$274.75
|
| Rate for Payer: Signature Care EPO |
$295.39
|
| Rate for Payer: Signature Care PPO |
$313.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.50
|
| Rate for Payer: United Healthcare Commercial |
$280.44
|
| Rate for Payer: United Healthcare Medicare |
$117.44
|
|
