|
HC DEXA-BONE DENSITY PERIPHERAL
|
Facility
|
IP
|
$394.85
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
1616076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.14 |
| Max. Negotiated Rate |
$367.21 |
| Rate for Payer: Aetna Commercial |
$341.15
|
| Rate for Payer: Cash Price |
$236.91
|
| Rate for Payer: Cigna All Commercial |
$340.76
|
| Rate for Payer: CORVEL All Commercial |
$367.21
|
| Rate for Payer: Coventry All Commercial |
$347.47
|
| Rate for Payer: Encore All Commercial |
$363.46
|
| Rate for Payer: Frontpath All Commercial |
$363.26
|
| Rate for Payer: Humana ChoiceCare |
$341.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.37
|
| Rate for Payer: PHCS All Commercial |
$296.14
|
| Rate for Payer: PHP All Commercial |
$299.45
|
| Rate for Payer: Sagamore Health Network All Products |
$304.82
|
| Rate for Payer: Signature Care EPO |
$327.73
|
| Rate for Payer: Signature Care PPO |
$347.47
|
| Rate for Payer: United Healthcare Commercial |
$311.14
|
|
|
HC DEXA-BONE DENSITY PERIPHERAL
|
Facility
|
OP
|
$394.85
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
1616076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$367.21 |
| Rate for Payer: Aetna Commercial |
$333.25
|
| Rate for Payer: Aetna Medicare |
$126.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.99
|
| Rate for Payer: Cash Price |
$236.91
|
| Rate for Payer: Cash Price |
$236.91
|
| Rate for Payer: Centivo All Commercial |
$214.80
|
| Rate for Payer: Cigna All Commercial |
$340.76
|
| Rate for Payer: CORVEL All Commercial |
$367.21
|
| Rate for Payer: Coventry All Commercial |
$347.47
|
| Rate for Payer: Encore All Commercial |
$363.46
|
| Rate for Payer: Frontpath All Commercial |
$363.26
|
| Rate for Payer: Humana ChoiceCare |
$341.03
|
| Rate for Payer: Humana Medicare |
$126.35
|
| Rate for Payer: Lucent All Commercial |
$214.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.37
|
| Rate for Payer: Managed Health Services Medicaid |
$11.56
|
| Rate for Payer: MDWise Medicaid |
$11.56
|
| Rate for Payer: PHCS All Commercial |
$296.14
|
| Rate for Payer: PHP All Commercial |
$299.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.99
|
| Rate for Payer: Sagamore Health Network All Products |
$304.82
|
| Rate for Payer: Signature Care EPO |
$327.73
|
| Rate for Payer: Signature Care PPO |
$347.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.62
|
| Rate for Payer: United Healthcare Commercial |
$311.14
|
| Rate for Payer: United Healthcare Medicare |
$126.35
|
|
|
HC DEXA-BONE MINERAL ANALYSIS
|
Facility
|
OP
|
$754.39
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
740063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$701.58 |
| Rate for Payer: Aetna Commercial |
$636.71
|
| Rate for Payer: Aetna Medicare |
$241.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$233.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$433.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$277.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$265.55
|
| Rate for Payer: Cash Price |
$452.63
|
| Rate for Payer: Cash Price |
$452.63
|
| Rate for Payer: Centivo All Commercial |
$410.39
|
| Rate for Payer: Cigna All Commercial |
$651.04
|
| Rate for Payer: CORVEL All Commercial |
$701.58
|
| Rate for Payer: Coventry All Commercial |
$663.86
|
| Rate for Payer: Encore All Commercial |
$694.42
|
| Rate for Payer: Frontpath All Commercial |
$694.04
|
| Rate for Payer: Humana ChoiceCare |
$651.57
|
| Rate for Payer: Humana Medicare |
$241.40
|
| Rate for Payer: Lucent All Commercial |
$410.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$678.95
|
| Rate for Payer: Managed Health Services Medicaid |
$26.92
|
| Rate for Payer: MDWise Medicaid |
$26.92
|
| Rate for Payer: PHCS All Commercial |
$565.79
|
| Rate for Payer: PHP All Commercial |
$572.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$294.21
|
| Rate for Payer: Sagamore Health Network All Products |
$582.39
|
| Rate for Payer: Signature Care EPO |
$626.14
|
| Rate for Payer: Signature Care PPO |
$663.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$641.23
|
| Rate for Payer: United Healthcare Commercial |
$594.46
|
| Rate for Payer: United Healthcare Medicare |
$241.40
|
|
|
HC DEXA-BONE MINERAL ANALYSIS
|
Facility
|
IP
|
$754.39
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
740063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$565.79 |
| Max. Negotiated Rate |
$701.58 |
| Rate for Payer: Aetna Commercial |
$651.79
|
| Rate for Payer: Cash Price |
$452.63
|
| Rate for Payer: Cigna All Commercial |
$651.04
|
| Rate for Payer: CORVEL All Commercial |
$701.58
|
| Rate for Payer: Coventry All Commercial |
$663.86
|
| Rate for Payer: Encore All Commercial |
$694.42
|
| Rate for Payer: Frontpath All Commercial |
$694.04
|
| Rate for Payer: Humana ChoiceCare |
$651.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$678.95
|
| Rate for Payer: PHCS All Commercial |
$565.79
|
| Rate for Payer: PHP All Commercial |
$572.13
|
| Rate for Payer: Sagamore Health Network All Products |
$582.39
|
| Rate for Payer: Signature Care EPO |
$626.14
|
| Rate for Payer: Signature Care PPO |
$663.86
|
| Rate for Payer: United Healthcare Commercial |
$594.46
|
|
|
HC DHEA
|
Facility
|
IP
|
$396.07
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
63001528
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.05 |
| Max. Negotiated Rate |
$368.35 |
| Rate for Payer: Aetna Commercial |
$342.20
|
| Rate for Payer: Cash Price |
$237.64
|
| Rate for Payer: Cigna All Commercial |
$341.81
|
| Rate for Payer: CORVEL All Commercial |
$368.35
|
| Rate for Payer: Coventry All Commercial |
$348.54
|
| Rate for Payer: Encore All Commercial |
$364.58
|
| Rate for Payer: Frontpath All Commercial |
$364.38
|
| Rate for Payer: Humana ChoiceCare |
$342.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$356.46
|
| Rate for Payer: PHCS All Commercial |
$297.05
|
| Rate for Payer: PHP All Commercial |
$300.38
|
| Rate for Payer: Sagamore Health Network All Products |
$305.77
|
| Rate for Payer: Signature Care EPO |
$328.74
|
| Rate for Payer: Signature Care PPO |
$348.54
|
| Rate for Payer: United Healthcare Commercial |
$312.10
|
|
|
HC DHEA
|
Facility
|
OP
|
$396.07
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
63001528
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$368.35 |
| Rate for Payer: Aetna Commercial |
$334.28
|
| Rate for Payer: Aetna Medicare |
$126.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.42
|
| Rate for Payer: Cash Price |
$237.64
|
| Rate for Payer: Cash Price |
$237.64
|
| Rate for Payer: Centivo All Commercial |
$215.46
|
| Rate for Payer: Cigna All Commercial |
$341.81
|
| Rate for Payer: CORVEL All Commercial |
$368.35
|
| Rate for Payer: Coventry All Commercial |
$348.54
|
| Rate for Payer: Encore All Commercial |
$364.58
|
| Rate for Payer: Frontpath All Commercial |
$364.38
|
| Rate for Payer: Humana ChoiceCare |
$342.09
|
| Rate for Payer: Humana Medicare |
$126.74
|
| Rate for Payer: Lucent All Commercial |
$215.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$356.46
|
| Rate for Payer: Managed Health Services Medicaid |
$25.27
|
| Rate for Payer: MDWise Medicaid |
$25.27
|
| Rate for Payer: PHCS All Commercial |
$297.05
|
| Rate for Payer: PHP All Commercial |
$300.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.47
|
| Rate for Payer: Sagamore Health Network All Products |
$305.77
|
| Rate for Payer: Signature Care EPO |
$328.74
|
| Rate for Payer: Signature Care PPO |
$348.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$336.66
|
| Rate for Payer: United Healthcare Commercial |
$312.10
|
| Rate for Payer: United Healthcare Medicare |
$126.74
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$234.78
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
63001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$218.35 |
| Rate for Payer: Aetna Commercial |
$198.15
|
| Rate for Payer: Aetna Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.64
|
| Rate for Payer: Cash Price |
$140.87
|
| Rate for Payer: Cash Price |
$140.87
|
| Rate for Payer: Centivo All Commercial |
$127.72
|
| Rate for Payer: Cigna All Commercial |
$202.62
|
| Rate for Payer: CORVEL All Commercial |
$218.35
|
| Rate for Payer: Coventry All Commercial |
$206.61
|
| Rate for Payer: Encore All Commercial |
$216.11
|
| Rate for Payer: Frontpath All Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$202.78
|
| Rate for Payer: Humana Medicare |
$75.13
|
| Rate for Payer: Lucent All Commercial |
$127.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.30
|
| Rate for Payer: Managed Health Services Medicaid |
$22.23
|
| Rate for Payer: MDWise Medicaid |
$22.23
|
| Rate for Payer: PHCS All Commercial |
$176.09
|
| Rate for Payer: PHP All Commercial |
$178.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.56
|
| Rate for Payer: Sagamore Health Network All Products |
$181.25
|
| Rate for Payer: Signature Care EPO |
$194.87
|
| Rate for Payer: Signature Care PPO |
$206.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.56
|
| Rate for Payer: United Healthcare Commercial |
$185.01
|
| Rate for Payer: United Healthcare Medicare |
$75.13
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$234.78
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
63001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$218.35 |
| Rate for Payer: Aetna Commercial |
$202.85
|
| Rate for Payer: Cash Price |
$140.87
|
| Rate for Payer: Cigna All Commercial |
$202.62
|
| Rate for Payer: CORVEL All Commercial |
$218.35
|
| Rate for Payer: Coventry All Commercial |
$206.61
|
| Rate for Payer: Encore All Commercial |
$216.11
|
| Rate for Payer: Frontpath All Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$202.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.30
|
| Rate for Payer: PHCS All Commercial |
$176.09
|
| Rate for Payer: PHP All Commercial |
$178.06
|
| Rate for Payer: Sagamore Health Network All Products |
$181.25
|
| Rate for Payer: Signature Care EPO |
$194.87
|
| Rate for Payer: Signature Care PPO |
$206.61
|
| Rate for Payer: United Healthcare Commercial |
$185.01
|
|
|
HC DIFFERENTIAL ANTIGLOBULIN TEST
|
Facility
|
IP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$59.59
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.37
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.32
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.43
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
|
|
HC DIFFERENTIAL ANTIGLOBULIN TEST
|
Facility
|
OP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$83.82
|
| Rate for Payer: Aetna Medicare |
$31.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.96
|
| Rate for Payer: Cash Price |
$59.59
|
| Rate for Payer: Cash Price |
$59.59
|
| Rate for Payer: Centivo All Commercial |
$54.02
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.37
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Humana Medicare |
$31.78
|
| Rate for Payer: Lucent All Commercial |
$54.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.73
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.43
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.41
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$31.78
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL
|
Facility
|
IP
|
$83.25
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
1617062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$71.93
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna All Commercial |
$71.84
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.92
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL
|
Facility
|
OP
|
$83.25
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
1617062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$70.26
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.30
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Centivo All Commercial |
$45.29
|
| Rate for Payer: Cigna All Commercial |
$71.84
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.90
|
| Rate for Payer: Humana Medicare |
$26.64
|
| Rate for Payer: Lucent All Commercial |
$45.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.92
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.47
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
| Rate for Payer: United Healthcare Medicare |
$26.64
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL
|
Facility
|
IP
|
$83.25
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
1617062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$71.93
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna All Commercial |
$71.84
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.92
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL
|
Facility
|
OP
|
$83.25
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
1617062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$70.26
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.30
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Centivo All Commercial |
$45.29
|
| Rate for Payer: Cigna All Commercial |
$71.84
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.90
|
| Rate for Payer: Humana Medicare |
$26.64
|
| Rate for Payer: Lucent All Commercial |
$45.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.92
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.47
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
| Rate for Payer: United Healthcare Medicare |
$26.64
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL
|
Facility
|
OP
|
$62.71
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
1617061
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$52.93
|
| Rate for Payer: Aetna Medicare |
$20.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.07
|
| Rate for Payer: Cash Price |
$37.63
|
| Rate for Payer: Centivo All Commercial |
$34.11
|
| Rate for Payer: Cigna All Commercial |
$54.12
|
| Rate for Payer: CORVEL All Commercial |
$58.32
|
| Rate for Payer: Coventry All Commercial |
$55.18
|
| Rate for Payer: Encore All Commercial |
$57.72
|
| Rate for Payer: Frontpath All Commercial |
$57.69
|
| Rate for Payer: Humana ChoiceCare |
$54.16
|
| Rate for Payer: Humana Medicare |
$20.07
|
| Rate for Payer: Lucent All Commercial |
$34.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.44
|
| Rate for Payer: PHCS All Commercial |
$47.03
|
| Rate for Payer: PHP All Commercial |
$47.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.46
|
| Rate for Payer: Sagamore Health Network All Products |
$48.41
|
| Rate for Payer: Signature Care EPO |
$52.05
|
| Rate for Payer: Signature Care PPO |
$55.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.30
|
| Rate for Payer: United Healthcare Commercial |
$49.42
|
| Rate for Payer: United Healthcare Medicare |
$20.07
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL
|
Facility
|
OP
|
$62.71
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
1617061
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$52.93
|
| Rate for Payer: Aetna Medicare |
$20.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.07
|
| Rate for Payer: Cash Price |
$37.63
|
| Rate for Payer: Centivo All Commercial |
$34.11
|
| Rate for Payer: Cigna All Commercial |
$54.12
|
| Rate for Payer: CORVEL All Commercial |
$58.32
|
| Rate for Payer: Coventry All Commercial |
$55.18
|
| Rate for Payer: Encore All Commercial |
$57.72
|
| Rate for Payer: Frontpath All Commercial |
$57.69
|
| Rate for Payer: Humana ChoiceCare |
$54.16
|
| Rate for Payer: Humana Medicare |
$20.07
|
| Rate for Payer: Lucent All Commercial |
$34.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.44
|
| Rate for Payer: PHCS All Commercial |
$47.03
|
| Rate for Payer: PHP All Commercial |
$47.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.46
|
| Rate for Payer: Sagamore Health Network All Products |
$48.41
|
| Rate for Payer: Signature Care EPO |
$52.05
|
| Rate for Payer: Signature Care PPO |
$55.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.30
|
| Rate for Payer: United Healthcare Commercial |
$49.42
|
| Rate for Payer: United Healthcare Medicare |
$20.07
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL
|
Facility
|
IP
|
$62.71
|
|
|
Service Code
|
CPT G0279
|
| Hospital Charge Code |
1617061
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$54.18
|
| Rate for Payer: Cash Price |
$37.63
|
| Rate for Payer: Cigna All Commercial |
$54.12
|
| Rate for Payer: CORVEL All Commercial |
$58.32
|
| Rate for Payer: Coventry All Commercial |
$55.18
|
| Rate for Payer: Encore All Commercial |
$57.72
|
| Rate for Payer: Frontpath All Commercial |
$57.69
|
| Rate for Payer: Humana ChoiceCare |
$54.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.44
|
| Rate for Payer: PHCS All Commercial |
$47.03
|
| Rate for Payer: PHP All Commercial |
$47.56
|
| Rate for Payer: Sagamore Health Network All Products |
$48.41
|
| Rate for Payer: Signature Care EPO |
$52.05
|
| Rate for Payer: Signature Care PPO |
$55.18
|
| Rate for Payer: United Healthcare Commercial |
$49.42
|
|
|
HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL
|
Facility
|
IP
|
$62.71
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
1617061
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$54.18
|
| Rate for Payer: Cash Price |
$37.63
|
| Rate for Payer: Cigna All Commercial |
$54.12
|
| Rate for Payer: CORVEL All Commercial |
$58.32
|
| Rate for Payer: Coventry All Commercial |
$55.18
|
| Rate for Payer: Encore All Commercial |
$57.72
|
| Rate for Payer: Frontpath All Commercial |
$57.69
|
| Rate for Payer: Humana ChoiceCare |
$54.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.44
|
| Rate for Payer: PHCS All Commercial |
$47.03
|
| Rate for Payer: PHP All Commercial |
$47.56
|
| Rate for Payer: Sagamore Health Network All Products |
$48.41
|
| Rate for Payer: Signature Care EPO |
$52.05
|
| Rate for Payer: Signature Care PPO |
$55.18
|
| Rate for Payer: United Healthcare Commercial |
$49.42
|
|
|
HC DIGOXIN
|
Facility
|
IP
|
$213.69
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
63001308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.27 |
| Max. Negotiated Rate |
$198.73 |
| Rate for Payer: Aetna Commercial |
$184.63
|
| Rate for Payer: Cash Price |
$128.21
|
| Rate for Payer: Cigna All Commercial |
$184.41
|
| Rate for Payer: CORVEL All Commercial |
$198.73
|
| Rate for Payer: Coventry All Commercial |
$188.05
|
| Rate for Payer: Encore All Commercial |
$196.70
|
| Rate for Payer: Frontpath All Commercial |
$196.59
|
| Rate for Payer: Humana ChoiceCare |
$184.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.32
|
| Rate for Payer: PHCS All Commercial |
$160.27
|
| Rate for Payer: PHP All Commercial |
$162.06
|
| Rate for Payer: Sagamore Health Network All Products |
$164.97
|
| Rate for Payer: Signature Care EPO |
$177.36
|
| Rate for Payer: Signature Care PPO |
$188.05
|
| Rate for Payer: United Healthcare Commercial |
$168.39
|
|
|
HC DIGOXIN
|
Facility
|
OP
|
$213.69
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
63001308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$198.73 |
| Rate for Payer: Aetna Commercial |
$180.35
|
| Rate for Payer: Aetna Medicare |
$68.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$98.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.22
|
| Rate for Payer: Cash Price |
$128.21
|
| Rate for Payer: Cash Price |
$128.21
|
| Rate for Payer: Centivo All Commercial |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$184.41
|
| Rate for Payer: CORVEL All Commercial |
$198.73
|
| Rate for Payer: Coventry All Commercial |
$188.05
|
| Rate for Payer: Encore All Commercial |
$196.70
|
| Rate for Payer: Frontpath All Commercial |
$196.59
|
| Rate for Payer: Humana ChoiceCare |
$184.56
|
| Rate for Payer: Humana Medicare |
$68.38
|
| Rate for Payer: Lucent All Commercial |
$116.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.32
|
| Rate for Payer: Managed Health Services Medicaid |
$13.28
|
| Rate for Payer: MDWise Medicaid |
$13.28
|
| Rate for Payer: PHCS All Commercial |
$160.27
|
| Rate for Payer: PHP All Commercial |
$162.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.34
|
| Rate for Payer: Sagamore Health Network All Products |
$164.97
|
| Rate for Payer: Signature Care EPO |
$177.36
|
| Rate for Payer: Signature Care PPO |
$188.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$181.64
|
| Rate for Payer: United Healthcare Commercial |
$168.39
|
| Rate for Payer: United Healthcare Medicare |
$68.38
|
|
|
HC DILATOR VESSEL 6FR X 20CM LONG
|
Facility
|
OP
|
$47.39
|
|
| Hospital Charge Code |
41608388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$44.07 |
| Rate for Payer: Aetna Commercial |
$40.00
|
| Rate for Payer: Aetna Medicare |
$15.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.68
|
| Rate for Payer: Cash Price |
$28.43
|
| Rate for Payer: Cash Price |
$28.43
|
| Rate for Payer: Centivo All Commercial |
$25.78
|
| Rate for Payer: Cigna All Commercial |
$40.90
|
| Rate for Payer: CORVEL All Commercial |
$44.07
|
| Rate for Payer: Coventry All Commercial |
$41.70
|
| Rate for Payer: Encore All Commercial |
$43.62
|
| Rate for Payer: Frontpath All Commercial |
$43.60
|
| Rate for Payer: Humana ChoiceCare |
$40.93
|
| Rate for Payer: Humana Medicare |
$15.16
|
| Rate for Payer: Lucent All Commercial |
$25.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.65
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$35.54
|
| Rate for Payer: PHP All Commercial |
$35.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.48
|
| Rate for Payer: Sagamore Health Network All Products |
$36.59
|
| Rate for Payer: Signature Care EPO |
$39.33
|
| Rate for Payer: Signature Care PPO |
$41.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.28
|
| Rate for Payer: United Healthcare Commercial |
$37.34
|
| Rate for Payer: United Healthcare Medicare |
$15.16
|
|
|
HC DILATOR VESSEL 6FR X 20CM LONG
|
Facility
|
IP
|
$47.39
|
|
| Hospital Charge Code |
41608388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$44.07 |
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Cash Price |
$28.43
|
| Rate for Payer: Cigna All Commercial |
$40.90
|
| Rate for Payer: CORVEL All Commercial |
$44.07
|
| Rate for Payer: Coventry All Commercial |
$41.70
|
| Rate for Payer: Encore All Commercial |
$43.62
|
| Rate for Payer: Frontpath All Commercial |
$43.60
|
| Rate for Payer: Humana ChoiceCare |
$40.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.65
|
| Rate for Payer: PHCS All Commercial |
$35.54
|
| Rate for Payer: PHP All Commercial |
$35.94
|
| Rate for Payer: Sagamore Health Network All Products |
$36.59
|
| Rate for Payer: Signature Care EPO |
$39.33
|
| Rate for Payer: Signature Care PPO |
$41.70
|
| Rate for Payer: United Healthcare Commercial |
$37.34
|
|
|
HC DILATOR VESSEL 8FR X 20CM STD
|
Facility
|
IP
|
$47.39
|
|
| Hospital Charge Code |
41608389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$44.07 |
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Cash Price |
$28.43
|
| Rate for Payer: Cigna All Commercial |
$40.90
|
| Rate for Payer: CORVEL All Commercial |
$44.07
|
| Rate for Payer: Coventry All Commercial |
$41.70
|
| Rate for Payer: Encore All Commercial |
$43.62
|
| Rate for Payer: Frontpath All Commercial |
$43.60
|
| Rate for Payer: Humana ChoiceCare |
$40.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.65
|
| Rate for Payer: PHCS All Commercial |
$35.54
|
| Rate for Payer: PHP All Commercial |
$35.94
|
| Rate for Payer: Sagamore Health Network All Products |
$36.59
|
| Rate for Payer: Signature Care EPO |
$39.33
|
| Rate for Payer: Signature Care PPO |
$41.70
|
| Rate for Payer: United Healthcare Commercial |
$37.34
|
|
|
HC DILATOR VESSEL 8FR X 20CM STD
|
Facility
|
OP
|
$47.39
|
|
| Hospital Charge Code |
41608389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$44.07 |
| Rate for Payer: Aetna Commercial |
$40.00
|
| Rate for Payer: Aetna Medicare |
$15.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.68
|
| Rate for Payer: Cash Price |
$28.43
|
| Rate for Payer: Cash Price |
$28.43
|
| Rate for Payer: Centivo All Commercial |
$25.78
|
| Rate for Payer: Cigna All Commercial |
$40.90
|
| Rate for Payer: CORVEL All Commercial |
$44.07
|
| Rate for Payer: Coventry All Commercial |
$41.70
|
| Rate for Payer: Encore All Commercial |
$43.62
|
| Rate for Payer: Frontpath All Commercial |
$43.60
|
| Rate for Payer: Humana ChoiceCare |
$40.93
|
| Rate for Payer: Humana Medicare |
$15.16
|
| Rate for Payer: Lucent All Commercial |
$25.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.65
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$35.54
|
| Rate for Payer: PHP All Commercial |
$35.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.48
|
| Rate for Payer: Sagamore Health Network All Products |
$36.59
|
| Rate for Payer: Signature Care EPO |
$39.33
|
| Rate for Payer: Signature Care PPO |
$41.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.28
|
| Rate for Payer: United Healthcare Commercial |
$37.34
|
| Rate for Payer: United Healthcare Medicare |
$15.16
|
|
|
HC DIPHTHERIA IGG AB
|
Facility
|
IP
|
$420.55
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63001035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.41 |
| Max. Negotiated Rate |
$391.11 |
| Rate for Payer: Aetna Commercial |
$363.36
|
| Rate for Payer: Cash Price |
$252.33
|
| Rate for Payer: Cigna All Commercial |
$362.93
|
| Rate for Payer: CORVEL All Commercial |
$391.11
|
| Rate for Payer: Coventry All Commercial |
$370.08
|
| Rate for Payer: Encore All Commercial |
$387.12
|
| Rate for Payer: Frontpath All Commercial |
$386.91
|
| Rate for Payer: Humana ChoiceCare |
$363.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.50
|
| Rate for Payer: PHCS All Commercial |
$315.41
|
| Rate for Payer: PHP All Commercial |
$318.95
|
| Rate for Payer: Sagamore Health Network All Products |
$324.66
|
| Rate for Payer: Signature Care EPO |
$349.06
|
| Rate for Payer: Signature Care PPO |
$370.08
|
| Rate for Payer: United Healthcare Commercial |
$331.39
|
|
