|
HC FC STOOL CULTURE
|
Facility
OP
|
$36.14
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
63001986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$33.61 |
| Rate for Payer: Aetna Commercial |
$30.50
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.12
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: Centivo All Commercial |
$18.43
|
| Rate for Payer: Cigna All Commercial |
$31.19
|
| Rate for Payer: CORVEL All Commercial |
$33.61
|
| Rate for Payer: Coventry All Commercial |
$31.80
|
| Rate for Payer: Encore All Commercial |
$33.27
|
| Rate for Payer: Frontpath All Commercial |
$33.25
|
| Rate for Payer: Humana ChoiceCare |
$31.21
|
| Rate for Payer: Humana Medicare |
$18.43
|
| Rate for Payer: Lucent All Commercial |
$18.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.52
|
| Rate for Payer: Managed Health Services Medicaid |
$9.44
|
| Rate for Payer: MDWise Medicaid |
$9.44
|
| Rate for Payer: PHCS All Commercial |
$27.10
|
| Rate for Payer: PHP All Commercial |
$27.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.09
|
| Rate for Payer: Sagamore Health Network All Products |
$27.90
|
| Rate for Payer: Signature Care EPO |
$30.00
|
| Rate for Payer: Signature Care PPO |
$31.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.72
|
| Rate for Payer: United Healthcare Commercial |
$28.48
|
| Rate for Payer: United Healthcare Medicare |
$11.93
|
|
|
HC FC STOOL CULTURE
|
Facility
IP
|
$36.14
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
63001986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.10 |
| Max. Negotiated Rate |
$33.61 |
| Rate for Payer: Aetna Commercial |
$31.22
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: Cigna All Commercial |
$31.19
|
| Rate for Payer: CORVEL All Commercial |
$33.61
|
| Rate for Payer: Coventry All Commercial |
$31.80
|
| Rate for Payer: Encore All Commercial |
$33.27
|
| Rate for Payer: Frontpath All Commercial |
$33.25
|
| Rate for Payer: Humana ChoiceCare |
$31.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.52
|
| Rate for Payer: PHCS All Commercial |
$27.10
|
| Rate for Payer: PHP All Commercial |
$27.41
|
| Rate for Payer: Sagamore Health Network All Products |
$27.90
|
| Rate for Payer: Signature Care EPO |
$30.00
|
| Rate for Payer: Signature Care PPO |
$31.80
|
| Rate for Payer: United Healthcare Commercial |
$28.48
|
|
|
HC FC TSH
|
Facility
OP
|
$16.58
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna Commercial |
$13.99
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.02
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Centivo All Commercial |
$8.45
|
| Rate for Payer: Cigna All Commercial |
$14.30
|
| Rate for Payer: CORVEL All Commercial |
$15.41
|
| Rate for Payer: Coventry All Commercial |
$14.59
|
| Rate for Payer: Encore All Commercial |
$15.26
|
| Rate for Payer: Frontpath All Commercial |
$15.25
|
| Rate for Payer: Humana ChoiceCare |
$14.32
|
| Rate for Payer: Humana Medicare |
$8.45
|
| Rate for Payer: Lucent All Commercial |
$8.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16.80
|
| Rate for Payer: MDWise Medicaid |
$16.80
|
| Rate for Payer: PHCS All Commercial |
$12.43
|
| Rate for Payer: PHP All Commercial |
$12.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.46
|
| Rate for Payer: Sagamore Health Network All Products |
$12.80
|
| Rate for Payer: Signature Care EPO |
$13.76
|
| Rate for Payer: Signature Care PPO |
$14.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.09
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
| Rate for Payer: United Healthcare Medicare |
$5.47
|
|
|
HC FC TSH
|
Facility
IP
|
$16.58
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cigna All Commercial |
$14.30
|
| Rate for Payer: CORVEL All Commercial |
$15.41
|
| Rate for Payer: Coventry All Commercial |
$14.59
|
| Rate for Payer: Encore All Commercial |
$15.26
|
| Rate for Payer: Frontpath All Commercial |
$15.25
|
| Rate for Payer: Humana ChoiceCare |
$14.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.92
|
| Rate for Payer: PHCS All Commercial |
$12.43
|
| Rate for Payer: PHP All Commercial |
$12.57
|
| Rate for Payer: Sagamore Health Network All Products |
$12.80
|
| Rate for Payer: Signature Care EPO |
$13.76
|
| Rate for Payer: Signature Care PPO |
$14.59
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
|
|
HC FC URIC ACID
|
Facility
OP
|
$10.57
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
63001707
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.84
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Lucent All Commercial |
$5.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: Managed Health Services Medicaid |
$4.52
|
| Rate for Payer: MDWise Medicaid |
$4.52
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.12
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
| Rate for Payer: United Healthcare Medicare |
$3.49
|
|
|
HC FC URIC ACID
|
Facility
IP
|
$10.57
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
63001707
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
|
|
HC FC VALPROIC ACID
|
Facility
OP
|
$24.74
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
63001372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.98
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Centivo All Commercial |
$12.61
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Humana Medicare |
$12.61
|
| Rate for Payer: Lucent All Commercial |
$12.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.65
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.02
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
| Rate for Payer: United Healthcare Medicare |
$8.16
|
|
|
HC FC VALPROIC ACID
|
Facility
IP
|
$24.74
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
63001372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$21.37
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
|
|
HC FC WBC STOOL
|
Facility
IP
|
$10.57
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63002142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
|
|
HC FC WBC STOOL
|
Facility
OP
|
$10.57
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63002142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.84
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Lucent All Commercial |
$5.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.12
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
| Rate for Payer: United Healthcare Medicare |
$3.49
|
|
|
HC FECAL FAT-QT
|
Facility
IP
|
$366.03
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
63001538
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$274.52 |
| Max. Negotiated Rate |
$340.41 |
| Rate for Payer: Aetna Commercial |
$316.25
|
| Rate for Payer: Cash Price |
$226.94
|
| Rate for Payer: Cigna All Commercial |
$315.88
|
| Rate for Payer: CORVEL All Commercial |
$340.41
|
| Rate for Payer: Coventry All Commercial |
$322.10
|
| Rate for Payer: Encore All Commercial |
$336.93
|
| Rate for Payer: Frontpath All Commercial |
$336.74
|
| Rate for Payer: Humana ChoiceCare |
$316.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$329.42
|
| Rate for Payer: PHCS All Commercial |
$274.52
|
| Rate for Payer: PHP All Commercial |
$277.59
|
| Rate for Payer: Sagamore Health Network All Products |
$282.57
|
| Rate for Payer: Signature Care EPO |
$303.80
|
| Rate for Payer: Signature Care PPO |
$322.10
|
| Rate for Payer: United Healthcare Commercial |
$288.43
|
|
|
HC FECAL FAT-QT
|
Facility
OP
|
$366.03
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
63001538
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$340.41 |
| Rate for Payer: Aetna Commercial |
$308.93
|
| Rate for Payer: Aetna Medicare |
$120.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$210.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$138.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$132.87
|
| Rate for Payer: Cash Price |
$226.94
|
| Rate for Payer: Cash Price |
$226.94
|
| Rate for Payer: Centivo All Commercial |
$186.67
|
| Rate for Payer: Cigna All Commercial |
$315.88
|
| Rate for Payer: CORVEL All Commercial |
$340.41
|
| Rate for Payer: Coventry All Commercial |
$322.10
|
| Rate for Payer: Encore All Commercial |
$336.93
|
| Rate for Payer: Frontpath All Commercial |
$336.74
|
| Rate for Payer: Humana ChoiceCare |
$316.14
|
| Rate for Payer: Humana Medicare |
$186.67
|
| Rate for Payer: Lucent All Commercial |
$186.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$329.42
|
| Rate for Payer: Managed Health Services Medicaid |
$15.84
|
| Rate for Payer: MDWise Medicaid |
$15.84
|
| Rate for Payer: PHCS All Commercial |
$274.52
|
| Rate for Payer: PHP All Commercial |
$277.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.75
|
| Rate for Payer: Sagamore Health Network All Products |
$282.57
|
| Rate for Payer: Signature Care EPO |
$303.80
|
| Rate for Payer: Signature Care PPO |
$322.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$311.12
|
| Rate for Payer: United Healthcare Commercial |
$288.43
|
| Rate for Payer: United Healthcare Medicare |
$120.79
|
|
|
HC FECAL FAT-QUAL
|
Facility
OP
|
$105.92
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
63001537
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$98.50 |
| Rate for Payer: Aetna Commercial |
$89.39
|
| Rate for Payer: Aetna Medicare |
$34.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.45
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Centivo All Commercial |
$54.02
|
| Rate for Payer: Cigna All Commercial |
$91.41
|
| Rate for Payer: CORVEL All Commercial |
$98.50
|
| Rate for Payer: Coventry All Commercial |
$93.21
|
| Rate for Payer: Encore All Commercial |
$97.50
|
| Rate for Payer: Frontpath All Commercial |
$97.44
|
| Rate for Payer: Humana ChoiceCare |
$91.48
|
| Rate for Payer: Humana Medicare |
$54.02
|
| Rate for Payer: Lucent All Commercial |
$54.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.33
|
| Rate for Payer: Managed Health Services Medicaid |
$2.40
|
| Rate for Payer: MDWise Medicaid |
$2.40
|
| Rate for Payer: PHCS All Commercial |
$79.44
|
| Rate for Payer: PHP All Commercial |
$80.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.31
|
| Rate for Payer: Sagamore Health Network All Products |
$81.77
|
| Rate for Payer: Signature Care EPO |
$87.91
|
| Rate for Payer: Signature Care PPO |
$93.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.03
|
| Rate for Payer: United Healthcare Commercial |
$83.46
|
| Rate for Payer: United Healthcare Medicare |
$34.95
|
|
|
HC FECAL FAT-QUAL
|
Facility
IP
|
$105.92
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
63001537
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$98.50 |
| Rate for Payer: Aetna Commercial |
$91.51
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Cigna All Commercial |
$91.41
|
| Rate for Payer: CORVEL All Commercial |
$98.50
|
| Rate for Payer: Coventry All Commercial |
$93.21
|
| Rate for Payer: Encore All Commercial |
$97.50
|
| Rate for Payer: Frontpath All Commercial |
$97.44
|
| Rate for Payer: Humana ChoiceCare |
$91.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.33
|
| Rate for Payer: PHCS All Commercial |
$79.44
|
| Rate for Payer: PHP All Commercial |
$80.33
|
| Rate for Payer: Sagamore Health Network All Products |
$81.77
|
| Rate for Payer: Signature Care EPO |
$87.91
|
| Rate for Payer: Signature Care PPO |
$93.21
|
| Rate for Payer: United Healthcare Commercial |
$83.46
|
|
|
HC FECAL FAT, QUALITATIVE
|
Facility
IP
|
$105.92
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
63044044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$98.50 |
| Rate for Payer: Aetna Commercial |
$91.51
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Cigna All Commercial |
$91.41
|
| Rate for Payer: CORVEL All Commercial |
$98.50
|
| Rate for Payer: Coventry All Commercial |
$93.21
|
| Rate for Payer: Encore All Commercial |
$97.50
|
| Rate for Payer: Frontpath All Commercial |
$97.44
|
| Rate for Payer: Humana ChoiceCare |
$91.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.33
|
| Rate for Payer: PHCS All Commercial |
$79.44
|
| Rate for Payer: PHP All Commercial |
$80.33
|
| Rate for Payer: Sagamore Health Network All Products |
$81.77
|
| Rate for Payer: Signature Care EPO |
$87.91
|
| Rate for Payer: Signature Care PPO |
$93.21
|
| Rate for Payer: United Healthcare Commercial |
$83.46
|
|
|
HC FECAL FAT, QUALITATIVE
|
Facility
OP
|
$105.92
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
63044044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$98.50 |
| Rate for Payer: Aetna Commercial |
$89.39
|
| Rate for Payer: Aetna Medicare |
$34.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.45
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Centivo All Commercial |
$54.02
|
| Rate for Payer: Cigna All Commercial |
$91.41
|
| Rate for Payer: CORVEL All Commercial |
$98.50
|
| Rate for Payer: Coventry All Commercial |
$93.21
|
| Rate for Payer: Encore All Commercial |
$97.50
|
| Rate for Payer: Frontpath All Commercial |
$97.44
|
| Rate for Payer: Humana ChoiceCare |
$91.48
|
| Rate for Payer: Humana Medicare |
$54.02
|
| Rate for Payer: Lucent All Commercial |
$54.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.33
|
| Rate for Payer: Managed Health Services Medicaid |
$2.40
|
| Rate for Payer: MDWise Medicaid |
$2.40
|
| Rate for Payer: PHCS All Commercial |
$79.44
|
| Rate for Payer: PHP All Commercial |
$80.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.31
|
| Rate for Payer: Sagamore Health Network All Products |
$81.77
|
| Rate for Payer: Signature Care EPO |
$87.91
|
| Rate for Payer: Signature Care PPO |
$93.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.03
|
| Rate for Payer: United Healthcare Commercial |
$83.46
|
| Rate for Payer: United Healthcare Medicare |
$34.95
|
|
|
HC FECAL REDUCING S
|
Facility
OP
|
$56.50
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
63001043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$52.54 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.51
|
| Rate for Payer: Cash Price |
$35.03
|
| Rate for Payer: Cash Price |
$35.03
|
| Rate for Payer: Centivo All Commercial |
$28.81
|
| Rate for Payer: Cigna All Commercial |
$48.76
|
| Rate for Payer: CORVEL All Commercial |
$52.54
|
| Rate for Payer: Coventry All Commercial |
$49.72
|
| Rate for Payer: Encore All Commercial |
$52.01
|
| Rate for Payer: Frontpath All Commercial |
$51.98
|
| Rate for Payer: Humana ChoiceCare |
$48.80
|
| Rate for Payer: Humana Medicare |
$28.81
|
| Rate for Payer: Lucent All Commercial |
$28.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.85
|
| Rate for Payer: Managed Health Services Medicaid |
$3.19
|
| Rate for Payer: MDWise Medicaid |
$3.19
|
| Rate for Payer: PHCS All Commercial |
$42.37
|
| Rate for Payer: PHP All Commercial |
$42.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.03
|
| Rate for Payer: Sagamore Health Network All Products |
$43.62
|
| Rate for Payer: Signature Care EPO |
$46.89
|
| Rate for Payer: Signature Care PPO |
$49.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.02
|
| Rate for Payer: United Healthcare Commercial |
$44.52
|
| Rate for Payer: United Healthcare Medicare |
$18.64
|
|
|
HC FECAL REDUCING S
|
Facility
IP
|
$56.50
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
63001043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$52.54 |
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Cash Price |
$35.03
|
| Rate for Payer: Cigna All Commercial |
$48.76
|
| Rate for Payer: CORVEL All Commercial |
$52.54
|
| Rate for Payer: Coventry All Commercial |
$49.72
|
| Rate for Payer: Encore All Commercial |
$52.01
|
| Rate for Payer: Frontpath All Commercial |
$51.98
|
| Rate for Payer: Humana ChoiceCare |
$48.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.85
|
| Rate for Payer: PHCS All Commercial |
$42.37
|
| Rate for Payer: PHP All Commercial |
$42.85
|
| Rate for Payer: Sagamore Health Network All Products |
$43.62
|
| Rate for Payer: Signature Care EPO |
$46.89
|
| Rate for Payer: Signature Care PPO |
$49.72
|
| Rate for Payer: United Healthcare Commercial |
$44.52
|
|
|
HC FEEDING TUBE 8FR X16IN
|
Facility
OP
|
$9.80
|
|
| Hospital Charge Code |
41601435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.27
|
| Rate for Payer: Aetna Medicare |
$3.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.56
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Centivo All Commercial |
$5.00
|
| Rate for Payer: Cigna All Commercial |
$8.46
|
| Rate for Payer: CORVEL All Commercial |
$9.11
|
| Rate for Payer: Coventry All Commercial |
$8.62
|
| Rate for Payer: Encore All Commercial |
$9.02
|
| Rate for Payer: Frontpath All Commercial |
$9.02
|
| Rate for Payer: Humana ChoiceCare |
$8.46
|
| Rate for Payer: Humana Medicare |
$5.00
|
| Rate for Payer: Lucent All Commercial |
$5.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.35
|
| Rate for Payer: PHP All Commercial |
$7.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.82
|
| Rate for Payer: Sagamore Health Network All Products |
$7.57
|
| Rate for Payer: Signature Care EPO |
$8.13
|
| Rate for Payer: Signature Care PPO |
$8.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.33
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
| Rate for Payer: United Healthcare Medicare |
$3.23
|
|
|
HC FEEDING TUBE 8FR X16IN
|
Facility
IP
|
$9.80
|
|
| Hospital Charge Code |
41601435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cigna All Commercial |
$8.46
|
| Rate for Payer: CORVEL All Commercial |
$9.11
|
| Rate for Payer: Coventry All Commercial |
$8.62
|
| Rate for Payer: Encore All Commercial |
$9.02
|
| Rate for Payer: Frontpath All Commercial |
$9.02
|
| Rate for Payer: Humana ChoiceCare |
$8.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.82
|
| Rate for Payer: PHCS All Commercial |
$7.35
|
| Rate for Payer: PHP All Commercial |
$7.43
|
| Rate for Payer: Sagamore Health Network All Products |
$7.57
|
| Rate for Payer: Signature Care EPO |
$8.13
|
| Rate for Payer: Signature Care PPO |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
|
|
HC FENTANYL & METAB
|
Facility
OP
|
$208.98
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.96 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$176.38
|
| Rate for Payer: Aetna Medicare |
$68.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.86
|
| Rate for Payer: Cash Price |
$129.57
|
| Rate for Payer: Cash Price |
$129.57
|
| Rate for Payer: Centivo All Commercial |
$106.58
|
| Rate for Payer: Cigna All Commercial |
$180.35
|
| Rate for Payer: CORVEL All Commercial |
$194.35
|
| Rate for Payer: Coventry All Commercial |
$183.90
|
| Rate for Payer: Encore All Commercial |
$192.36
|
| Rate for Payer: Frontpath All Commercial |
$192.26
|
| Rate for Payer: Humana ChoiceCare |
$180.49
|
| Rate for Payer: Humana Medicare |
$106.58
|
| Rate for Payer: Lucent All Commercial |
$106.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.08
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$156.73
|
| Rate for Payer: PHP All Commercial |
$158.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.50
|
| Rate for Payer: Sagamore Health Network All Products |
$161.33
|
| Rate for Payer: Signature Care EPO |
$173.45
|
| Rate for Payer: Signature Care PPO |
$183.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.63
|
| Rate for Payer: United Healthcare Commercial |
$164.67
|
| Rate for Payer: United Healthcare Medicare |
$68.96
|
|
|
HC FENTANYL & METAB
|
Facility
IP
|
$208.98
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.73 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$180.56
|
| Rate for Payer: Cash Price |
$129.57
|
| Rate for Payer: Cigna All Commercial |
$180.35
|
| Rate for Payer: CORVEL All Commercial |
$194.35
|
| Rate for Payer: Coventry All Commercial |
$183.90
|
| Rate for Payer: Encore All Commercial |
$192.36
|
| Rate for Payer: Frontpath All Commercial |
$192.26
|
| Rate for Payer: Humana ChoiceCare |
$180.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.08
|
| Rate for Payer: PHCS All Commercial |
$156.73
|
| Rate for Payer: PHP All Commercial |
$158.49
|
| Rate for Payer: Sagamore Health Network All Products |
$161.33
|
| Rate for Payer: Signature Care EPO |
$173.45
|
| Rate for Payer: Signature Care PPO |
$183.90
|
| Rate for Payer: United Healthcare Commercial |
$164.67
|
|
|
HC FENTANYL MS UR
|
Facility
OP
|
$227.30
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$211.39 |
| Rate for Payer: Aetna Commercial |
$191.84
|
| Rate for Payer: Aetna Medicare |
$75.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$104.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.51
|
| Rate for Payer: Cash Price |
$140.92
|
| Rate for Payer: Cash Price |
$140.92
|
| Rate for Payer: Centivo All Commercial |
$115.92
|
| Rate for Payer: Cigna All Commercial |
$196.16
|
| Rate for Payer: CORVEL All Commercial |
$211.39
|
| Rate for Payer: Coventry All Commercial |
$200.02
|
| Rate for Payer: Encore All Commercial |
$209.23
|
| Rate for Payer: Frontpath All Commercial |
$209.11
|
| Rate for Payer: Humana ChoiceCare |
$196.32
|
| Rate for Payer: Humana Medicare |
$115.92
|
| Rate for Payer: Lucent All Commercial |
$115.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.57
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$170.47
|
| Rate for Payer: PHP All Commercial |
$172.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.65
|
| Rate for Payer: Sagamore Health Network All Products |
$175.47
|
| Rate for Payer: Signature Care EPO |
$188.66
|
| Rate for Payer: Signature Care PPO |
$200.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$193.20
|
| Rate for Payer: United Healthcare Commercial |
$179.11
|
| Rate for Payer: United Healthcare Medicare |
$75.01
|
|
|
HC FENTANYL MS UR
|
Facility
IP
|
$227.30
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$211.39 |
| Rate for Payer: Aetna Commercial |
$196.38
|
| Rate for Payer: Cash Price |
$140.92
|
| Rate for Payer: Cigna All Commercial |
$196.16
|
| Rate for Payer: CORVEL All Commercial |
$211.39
|
| Rate for Payer: Coventry All Commercial |
$200.02
|
| Rate for Payer: Encore All Commercial |
$209.23
|
| Rate for Payer: Frontpath All Commercial |
$209.11
|
| Rate for Payer: Humana ChoiceCare |
$196.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.57
|
| Rate for Payer: PHCS All Commercial |
$170.47
|
| Rate for Payer: PHP All Commercial |
$172.38
|
| Rate for Payer: Sagamore Health Network All Products |
$175.47
|
| Rate for Payer: Signature Care EPO |
$188.66
|
| Rate for Payer: Signature Care PPO |
$200.02
|
| Rate for Payer: United Healthcare Commercial |
$179.11
|
|
|
HC FERRITIN
|
Facility
OP
|
$208.30
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
63001307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$175.81
|
| Rate for Payer: Aetna Medicare |
$68.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.61
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Centivo All Commercial |
$106.24
|
| Rate for Payer: Cigna All Commercial |
$179.77
|
| Rate for Payer: CORVEL All Commercial |
$193.72
|
| Rate for Payer: Coventry All Commercial |
$183.31
|
| Rate for Payer: Encore All Commercial |
$191.74
|
| Rate for Payer: Frontpath All Commercial |
$191.64
|
| Rate for Payer: Humana ChoiceCare |
$179.91
|
| Rate for Payer: Humana Medicare |
$106.24
|
| Rate for Payer: Lucent All Commercial |
$106.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.47
|
| Rate for Payer: Managed Health Services Medicaid |
$13.63
|
| Rate for Payer: MDWise Medicaid |
$13.63
|
| Rate for Payer: PHCS All Commercial |
$156.23
|
| Rate for Payer: PHP All Commercial |
$157.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.24
|
| Rate for Payer: Sagamore Health Network All Products |
$160.81
|
| Rate for Payer: Signature Care EPO |
$172.89
|
| Rate for Payer: Signature Care PPO |
$183.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.06
|
| Rate for Payer: United Healthcare Commercial |
$164.14
|
| Rate for Payer: United Healthcare Medicare |
$68.74
|
|
