|
HC FERRITIN
|
Facility
IP
|
$208.30
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
63001307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$179.98
|
| Rate for Payer: Cash Price |
$129.15
|
| 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: Lutheran Preferred All Commercial |
$187.47
|
| Rate for Payer: PHCS All Commercial |
$156.23
|
| Rate for Payer: PHP All Commercial |
$157.98
|
| 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: United Healthcare Commercial |
$164.14
|
|
|
HC FETAL BIOPHYSICAL PROFILE W/ NON-STRESS TESTING
|
Facility
OP
|
$976.18
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
01646818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.06 |
| Max. Negotiated Rate |
$907.85 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Aetna Medicare |
$322.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$322.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$560.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$610.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$188.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$370.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$354.35
|
| Rate for Payer: Cash Price |
$605.23
|
| Rate for Payer: Cash Price |
$605.23
|
| Rate for Payer: Centivo All Commercial |
$497.85
|
| Rate for Payer: Cigna All Commercial |
$842.44
|
| Rate for Payer: CORVEL All Commercial |
$907.85
|
| Rate for Payer: Coventry All Commercial |
$859.04
|
| Rate for Payer: Encore All Commercial |
$898.57
|
| Rate for Payer: Frontpath All Commercial |
$898.09
|
| Rate for Payer: Humana ChoiceCare |
$843.13
|
| Rate for Payer: Humana Medicare |
$497.85
|
| Rate for Payer: Lucent All Commercial |
$497.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$878.56
|
| Rate for Payer: Managed Health Services Medicaid |
$188.06
|
| Rate for Payer: MDWise Medicaid |
$188.06
|
| Rate for Payer: PHCS All Commercial |
$732.14
|
| Rate for Payer: PHP All Commercial |
$740.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$380.71
|
| Rate for Payer: Sagamore Health Network All Products |
$753.61
|
| Rate for Payer: Signature Care EPO |
$810.23
|
| Rate for Payer: Signature Care PPO |
$859.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$829.75
|
| Rate for Payer: United Healthcare Commercial |
$769.23
|
| Rate for Payer: United Healthcare Medicare |
$322.14
|
|
|
HC FETAL BIOPHYSICAL PROFILE W/ NON-STRESS TESTING
|
Facility
IP
|
$976.18
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
01646818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$732.14 |
| Max. Negotiated Rate |
$907.85 |
| Rate for Payer: Aetna Commercial |
$843.42
|
| Rate for Payer: Cash Price |
$605.23
|
| Rate for Payer: Cigna All Commercial |
$842.44
|
| Rate for Payer: CORVEL All Commercial |
$907.85
|
| Rate for Payer: Coventry All Commercial |
$859.04
|
| Rate for Payer: Encore All Commercial |
$898.57
|
| Rate for Payer: Frontpath All Commercial |
$898.09
|
| Rate for Payer: Humana ChoiceCare |
$843.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$878.56
|
| Rate for Payer: PHCS All Commercial |
$732.14
|
| Rate for Payer: PHP All Commercial |
$740.34
|
| Rate for Payer: Sagamore Health Network All Products |
$753.61
|
| Rate for Payer: Signature Care EPO |
$810.23
|
| Rate for Payer: Signature Care PPO |
$859.04
|
| Rate for Payer: United Healthcare Commercial |
$769.23
|
|
|
HC FETAL CONTRACTION STRESS TEST
|
Facility
OP
|
$635.42
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
01229020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$590.94 |
| Rate for Payer: Aetna Commercial |
$536.29
|
| Rate for Payer: Aetna Medicare |
$209.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$209.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$364.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$397.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.66
|
| Rate for Payer: Cash Price |
$393.96
|
| Rate for Payer: Centivo All Commercial |
$324.06
|
| Rate for Payer: Cigna All Commercial |
$548.37
|
| Rate for Payer: CORVEL All Commercial |
$590.94
|
| Rate for Payer: Coventry All Commercial |
$559.17
|
| Rate for Payer: Encore All Commercial |
$584.90
|
| Rate for Payer: Frontpath All Commercial |
$584.59
|
| Rate for Payer: Humana ChoiceCare |
$548.81
|
| Rate for Payer: Humana Medicare |
$324.06
|
| Rate for Payer: Lucent All Commercial |
$324.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$571.88
|
| Rate for Payer: PHCS All Commercial |
$476.56
|
| Rate for Payer: PHP All Commercial |
$481.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$247.81
|
| Rate for Payer: Sagamore Health Network All Products |
$490.54
|
| Rate for Payer: Signature Care EPO |
$527.40
|
| Rate for Payer: Signature Care PPO |
$559.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$540.11
|
| Rate for Payer: United Healthcare Commercial |
$500.71
|
| Rate for Payer: United Healthcare Medicare |
$209.69
|
|
|
HC FETAL CONTRACTION STRESS TEST
|
Facility
IP
|
$635.42
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
01229020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$476.56 |
| Max. Negotiated Rate |
$590.94 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Cash Price |
$393.96
|
| Rate for Payer: Cigna All Commercial |
$548.37
|
| Rate for Payer: CORVEL All Commercial |
$590.94
|
| Rate for Payer: Coventry All Commercial |
$559.17
|
| Rate for Payer: Encore All Commercial |
$584.90
|
| Rate for Payer: Frontpath All Commercial |
$584.59
|
| Rate for Payer: Humana ChoiceCare |
$548.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$571.88
|
| Rate for Payer: PHCS All Commercial |
$476.56
|
| Rate for Payer: PHP All Commercial |
$481.90
|
| Rate for Payer: Sagamore Health Network All Products |
$490.54
|
| Rate for Payer: Signature Care EPO |
$527.40
|
| Rate for Payer: Signature Care PPO |
$559.17
|
| Rate for Payer: United Healthcare Commercial |
$500.71
|
|
|
HC FETAL FIBRONECTIN
|
Facility
IP
|
$921.19
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
63001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$690.89 |
| Max. Negotiated Rate |
$856.71 |
| Rate for Payer: Aetna Commercial |
$795.91
|
| Rate for Payer: Cash Price |
$571.14
|
| Rate for Payer: Cigna All Commercial |
$794.99
|
| Rate for Payer: CORVEL All Commercial |
$856.71
|
| Rate for Payer: Coventry All Commercial |
$810.65
|
| Rate for Payer: Encore All Commercial |
$847.96
|
| Rate for Payer: Frontpath All Commercial |
$847.50
|
| Rate for Payer: Humana ChoiceCare |
$795.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$829.07
|
| Rate for Payer: PHCS All Commercial |
$690.89
|
| Rate for Payer: PHP All Commercial |
$698.63
|
| Rate for Payer: Sagamore Health Network All Products |
$711.16
|
| Rate for Payer: Signature Care EPO |
$764.59
|
| Rate for Payer: Signature Care PPO |
$810.65
|
| Rate for Payer: United Healthcare Commercial |
$725.90
|
|
|
HC FETAL FIBRONECTIN
|
Facility
OP
|
$921.19
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
63001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$856.71 |
| Rate for Payer: Aetna Commercial |
$777.49
|
| Rate for Payer: Aetna Medicare |
$303.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$303.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$529.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$575.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$64.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.39
|
| Rate for Payer: Cash Price |
$571.14
|
| Rate for Payer: Cash Price |
$571.14
|
| Rate for Payer: Centivo All Commercial |
$469.81
|
| Rate for Payer: Cigna All Commercial |
$794.99
|
| Rate for Payer: CORVEL All Commercial |
$856.71
|
| Rate for Payer: Coventry All Commercial |
$810.65
|
| Rate for Payer: Encore All Commercial |
$847.96
|
| Rate for Payer: Frontpath All Commercial |
$847.50
|
| Rate for Payer: Humana ChoiceCare |
$795.63
|
| Rate for Payer: Humana Medicare |
$469.81
|
| Rate for Payer: Lucent All Commercial |
$469.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$829.07
|
| Rate for Payer: Managed Health Services Medicaid |
$64.41
|
| Rate for Payer: MDWise Medicaid |
$64.41
|
| Rate for Payer: PHCS All Commercial |
$690.89
|
| Rate for Payer: PHP All Commercial |
$698.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$359.27
|
| Rate for Payer: Sagamore Health Network All Products |
$711.16
|
| Rate for Payer: Signature Care EPO |
$764.59
|
| Rate for Payer: Signature Care PPO |
$810.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$783.01
|
| Rate for Payer: United Healthcare Commercial |
$725.90
|
| Rate for Payer: United Healthcare Medicare |
$303.99
|
|
|
HC FETAL MATERN BLEED QL
|
Facility
IP
|
$159.10
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
63001345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.32 |
| Max. Negotiated Rate |
$147.96 |
| Rate for Payer: Aetna Commercial |
$137.46
|
| Rate for Payer: Cash Price |
$98.64
|
| Rate for Payer: Cigna All Commercial |
$137.30
|
| Rate for Payer: CORVEL All Commercial |
$147.96
|
| Rate for Payer: Coventry All Commercial |
$140.01
|
| Rate for Payer: Encore All Commercial |
$146.45
|
| Rate for Payer: Frontpath All Commercial |
$146.37
|
| Rate for Payer: Humana ChoiceCare |
$137.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.19
|
| Rate for Payer: PHCS All Commercial |
$119.32
|
| Rate for Payer: PHP All Commercial |
$120.66
|
| Rate for Payer: Sagamore Health Network All Products |
$122.82
|
| Rate for Payer: Signature Care EPO |
$132.05
|
| Rate for Payer: Signature Care PPO |
$140.01
|
| Rate for Payer: United Healthcare Commercial |
$125.37
|
|
|
HC FETAL MATERN BLEED QL
|
Facility
OP
|
$159.10
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
63001345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$147.96 |
| Rate for Payer: Aetna Commercial |
$134.28
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.75
|
| Rate for Payer: Cash Price |
$98.64
|
| Rate for Payer: Cash Price |
$98.64
|
| Rate for Payer: Centivo All Commercial |
$81.14
|
| Rate for Payer: Cigna All Commercial |
$137.30
|
| Rate for Payer: CORVEL All Commercial |
$147.96
|
| Rate for Payer: Coventry All Commercial |
$140.01
|
| Rate for Payer: Encore All Commercial |
$146.45
|
| Rate for Payer: Frontpath All Commercial |
$146.37
|
| Rate for Payer: Humana ChoiceCare |
$137.41
|
| Rate for Payer: Humana Medicare |
$81.14
|
| Rate for Payer: Lucent All Commercial |
$81.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.19
|
| Rate for Payer: Managed Health Services Medicaid |
$9.03
|
| Rate for Payer: MDWise Medicaid |
$9.03
|
| Rate for Payer: PHCS All Commercial |
$119.32
|
| Rate for Payer: PHP All Commercial |
$120.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.05
|
| Rate for Payer: Sagamore Health Network All Products |
$122.82
|
| Rate for Payer: Signature Care EPO |
$132.05
|
| Rate for Payer: Signature Care PPO |
$140.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.23
|
| Rate for Payer: United Healthcare Commercial |
$125.37
|
| Rate for Payer: United Healthcare Medicare |
$52.50
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
IP
|
$635.42
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
01229025
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$476.56 |
| Max. Negotiated Rate |
$590.94 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Cash Price |
$393.96
|
| Rate for Payer: Cigna All Commercial |
$548.37
|
| Rate for Payer: CORVEL All Commercial |
$590.94
|
| Rate for Payer: Coventry All Commercial |
$559.17
|
| Rate for Payer: Encore All Commercial |
$584.90
|
| Rate for Payer: Frontpath All Commercial |
$584.59
|
| Rate for Payer: Humana ChoiceCare |
$548.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$571.88
|
| Rate for Payer: PHCS All Commercial |
$476.56
|
| Rate for Payer: PHP All Commercial |
$481.90
|
| Rate for Payer: Sagamore Health Network All Products |
$490.54
|
| Rate for Payer: Signature Care EPO |
$527.40
|
| Rate for Payer: Signature Care PPO |
$559.17
|
| Rate for Payer: United Healthcare Commercial |
$500.71
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
OP
|
$635.42
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
01229025
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$590.94 |
| Rate for Payer: Aetna Commercial |
$536.29
|
| Rate for Payer: Aetna Medicare |
$209.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$209.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$364.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$397.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.66
|
| Rate for Payer: Cash Price |
$393.96
|
| Rate for Payer: Centivo All Commercial |
$324.06
|
| Rate for Payer: Cigna All Commercial |
$548.37
|
| Rate for Payer: CORVEL All Commercial |
$590.94
|
| Rate for Payer: Coventry All Commercial |
$559.17
|
| Rate for Payer: Encore All Commercial |
$584.90
|
| Rate for Payer: Frontpath All Commercial |
$584.59
|
| Rate for Payer: Humana ChoiceCare |
$548.81
|
| Rate for Payer: Humana Medicare |
$324.06
|
| Rate for Payer: Lucent All Commercial |
$324.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$571.88
|
| Rate for Payer: PHCS All Commercial |
$476.56
|
| Rate for Payer: PHP All Commercial |
$481.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$247.81
|
| Rate for Payer: Sagamore Health Network All Products |
$490.54
|
| Rate for Payer: Signature Care EPO |
$527.40
|
| Rate for Payer: Signature Care PPO |
$559.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$540.11
|
| Rate for Payer: United Healthcare Commercial |
$500.71
|
| Rate for Payer: United Healthcare Medicare |
$209.69
|
|
|
HC FET-MATERN BLEED QT
|
Facility
IP
|
$286.14
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63002065
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$214.61 |
| Max. Negotiated Rate |
$266.11 |
| Rate for Payer: Aetna Commercial |
$247.23
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cigna All Commercial |
$246.94
|
| Rate for Payer: CORVEL All Commercial |
$266.11
|
| Rate for Payer: Coventry All Commercial |
$251.80
|
| Rate for Payer: Encore All Commercial |
$263.39
|
| Rate for Payer: Frontpath All Commercial |
$263.25
|
| Rate for Payer: Humana ChoiceCare |
$247.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$257.53
|
| Rate for Payer: PHCS All Commercial |
$214.61
|
| Rate for Payer: PHP All Commercial |
$217.01
|
| Rate for Payer: Sagamore Health Network All Products |
$220.90
|
| Rate for Payer: Signature Care EPO |
$237.50
|
| Rate for Payer: Signature Care PPO |
$251.80
|
| Rate for Payer: United Healthcare Commercial |
$225.48
|
|
|
HC FET-MATERN BLEED QT
|
Facility
OP
|
$286.14
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63002065
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$266.11 |
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna Medicare |
$94.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$164.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$178.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$134.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.87
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Centivo All Commercial |
$145.93
|
| Rate for Payer: Cigna All Commercial |
$246.94
|
| Rate for Payer: CORVEL All Commercial |
$266.11
|
| Rate for Payer: Coventry All Commercial |
$251.80
|
| Rate for Payer: Encore All Commercial |
$263.39
|
| Rate for Payer: Frontpath All Commercial |
$263.25
|
| Rate for Payer: Humana ChoiceCare |
$247.14
|
| Rate for Payer: Humana Medicare |
$145.93
|
| Rate for Payer: Lucent All Commercial |
$145.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$257.53
|
| Rate for Payer: Managed Health Services Medicaid |
$134.43
|
| Rate for Payer: MDWise Medicaid |
$134.43
|
| Rate for Payer: PHCS All Commercial |
$214.61
|
| Rate for Payer: PHP All Commercial |
$217.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.59
|
| Rate for Payer: Sagamore Health Network All Products |
$220.90
|
| Rate for Payer: Signature Care EPO |
$237.50
|
| Rate for Payer: Signature Care PPO |
$251.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$243.22
|
| Rate for Payer: United Healthcare Commercial |
$225.48
|
| Rate for Payer: United Healthcare Medicare |
$94.43
|
|
|
HC FIAPC CIRCUM PROBE
|
Facility
OP
|
$1,158.50
|
|
| Hospital Charge Code |
41608214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,077.40 |
| Rate for Payer: Aetna Commercial |
$977.77
|
| Rate for Payer: Aetna Medicare |
$382.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$382.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$665.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$724.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$439.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$420.54
|
| Rate for Payer: Cash Price |
$718.27
|
| Rate for Payer: Cash Price |
$718.27
|
| Rate for Payer: Centivo All Commercial |
$590.84
|
| Rate for Payer: Cigna All Commercial |
$999.79
|
| Rate for Payer: CORVEL All Commercial |
$1,077.40
|
| Rate for Payer: Coventry All Commercial |
$1,019.48
|
| Rate for Payer: Encore All Commercial |
$1,066.40
|
| Rate for Payer: Frontpath All Commercial |
$1,065.82
|
| Rate for Payer: Humana ChoiceCare |
$1,000.60
|
| Rate for Payer: Humana Medicare |
$590.84
|
| Rate for Payer: Lucent All Commercial |
$590.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,042.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$868.88
|
| Rate for Payer: PHP All Commercial |
$878.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$451.82
|
| Rate for Payer: Sagamore Health Network All Products |
$894.36
|
| Rate for Payer: Signature Care EPO |
$961.56
|
| Rate for Payer: Signature Care PPO |
$1,019.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$984.72
|
| Rate for Payer: United Healthcare Commercial |
$912.90
|
| Rate for Payer: United Healthcare Medicare |
$382.30
|
|
|
HC FIAPC CIRCUM PROBE
|
Facility
IP
|
$1,158.50
|
|
| Hospital Charge Code |
41608214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$868.88 |
| Max. Negotiated Rate |
$1,077.40 |
| Rate for Payer: Aetna Commercial |
$1,000.94
|
| Rate for Payer: Cash Price |
$718.27
|
| Rate for Payer: Cigna All Commercial |
$999.79
|
| Rate for Payer: CORVEL All Commercial |
$1,077.40
|
| Rate for Payer: Coventry All Commercial |
$1,019.48
|
| Rate for Payer: Encore All Commercial |
$1,066.40
|
| Rate for Payer: Frontpath All Commercial |
$1,065.82
|
| Rate for Payer: Humana ChoiceCare |
$1,000.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,042.65
|
| Rate for Payer: PHCS All Commercial |
$868.88
|
| Rate for Payer: PHP All Commercial |
$878.61
|
| Rate for Payer: Sagamore Health Network All Products |
$894.36
|
| Rate for Payer: Signature Care EPO |
$961.56
|
| Rate for Payer: Signature Care PPO |
$1,019.48
|
| Rate for Payer: United Healthcare Commercial |
$912.90
|
|
|
HC FIAPC ST FIRE PROBE
|
Facility
OP
|
$1,127.50
|
|
| Hospital Charge Code |
41608213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,048.58 |
| Rate for Payer: Aetna Commercial |
$951.61
|
| Rate for Payer: Aetna Medicare |
$372.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$372.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$647.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$704.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$427.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$409.28
|
| Rate for Payer: Cash Price |
$699.05
|
| Rate for Payer: Cash Price |
$699.05
|
| Rate for Payer: Centivo All Commercial |
$575.02
|
| Rate for Payer: Cigna All Commercial |
$973.03
|
| Rate for Payer: CORVEL All Commercial |
$1,048.58
|
| Rate for Payer: Coventry All Commercial |
$992.20
|
| Rate for Payer: Encore All Commercial |
$1,037.86
|
| Rate for Payer: Frontpath All Commercial |
$1,037.30
|
| Rate for Payer: Humana ChoiceCare |
$973.82
|
| Rate for Payer: Humana Medicare |
$575.02
|
| Rate for Payer: Lucent All Commercial |
$575.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$845.62
|
| Rate for Payer: PHP All Commercial |
$855.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$439.72
|
| Rate for Payer: Sagamore Health Network All Products |
$870.43
|
| Rate for Payer: Signature Care EPO |
$935.82
|
| Rate for Payer: Signature Care PPO |
$992.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$958.38
|
| Rate for Payer: United Healthcare Commercial |
$888.47
|
| Rate for Payer: United Healthcare Medicare |
$372.08
|
|
|
HC FIAPC ST FIRE PROBE
|
Facility
IP
|
$1,127.50
|
|
| Hospital Charge Code |
41608213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$1,048.58 |
| Rate for Payer: Aetna Commercial |
$974.16
|
| Rate for Payer: Cash Price |
$699.05
|
| Rate for Payer: Cigna All Commercial |
$973.03
|
| Rate for Payer: CORVEL All Commercial |
$1,048.58
|
| Rate for Payer: Coventry All Commercial |
$992.20
|
| Rate for Payer: Encore All Commercial |
$1,037.86
|
| Rate for Payer: Frontpath All Commercial |
$1,037.30
|
| Rate for Payer: Humana ChoiceCare |
$973.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.75
|
| Rate for Payer: PHCS All Commercial |
$845.62
|
| Rate for Payer: PHP All Commercial |
$855.10
|
| Rate for Payer: Sagamore Health Network All Products |
$870.43
|
| Rate for Payer: Signature Care EPO |
$935.82
|
| Rate for Payer: Signature Care PPO |
$992.20
|
| Rate for Payer: United Healthcare Commercial |
$888.47
|
|
|
HC FIBER LASER ELEVATE ELITE
|
Facility
IP
|
$3,690.00
|
|
| Hospital Charge Code |
41603396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,767.50 |
| Max. Negotiated Rate |
$3,431.70 |
| Rate for Payer: Aetna Commercial |
$3,188.16
|
| Rate for Payer: Cash Price |
$2,287.80
|
| Rate for Payer: Cigna All Commercial |
$3,184.47
|
| Rate for Payer: CORVEL All Commercial |
$3,431.70
|
| Rate for Payer: Coventry All Commercial |
$3,247.20
|
| Rate for Payer: Encore All Commercial |
$3,396.64
|
| Rate for Payer: Frontpath All Commercial |
$3,394.80
|
| Rate for Payer: Humana ChoiceCare |
$3,187.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,321.00
|
| Rate for Payer: PHCS All Commercial |
$2,767.50
|
| Rate for Payer: PHP All Commercial |
$2,798.50
|
| Rate for Payer: Sagamore Health Network All Products |
$2,848.68
|
| Rate for Payer: Signature Care EPO |
$3,062.70
|
| Rate for Payer: Signature Care PPO |
$3,247.20
|
| Rate for Payer: United Healthcare Commercial |
$2,907.72
|
|
|
HC FIBER LASER ELEVATE ELITE
|
Facility
OP
|
$3,690.00
|
|
| Hospital Charge Code |
41603396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,431.70 |
| Rate for Payer: Aetna Commercial |
$3,114.36
|
| Rate for Payer: Aetna Medicare |
$1,217.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,217.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,119.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,306.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,400.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,339.47
|
| Rate for Payer: Cash Price |
$2,287.80
|
| Rate for Payer: Cash Price |
$2,287.80
|
| Rate for Payer: Centivo All Commercial |
$1,881.90
|
| Rate for Payer: Cigna All Commercial |
$3,184.47
|
| Rate for Payer: CORVEL All Commercial |
$3,431.70
|
| Rate for Payer: Coventry All Commercial |
$3,247.20
|
| Rate for Payer: Encore All Commercial |
$3,396.64
|
| Rate for Payer: Frontpath All Commercial |
$3,394.80
|
| Rate for Payer: Humana ChoiceCare |
$3,187.05
|
| Rate for Payer: Humana Medicare |
$1,881.90
|
| Rate for Payer: Lucent All Commercial |
$1,881.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,321.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,767.50
|
| Rate for Payer: PHP All Commercial |
$2,798.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,439.10
|
| Rate for Payer: Sagamore Health Network All Products |
$2,848.68
|
| Rate for Payer: Signature Care EPO |
$3,062.70
|
| Rate for Payer: Signature Care PPO |
$3,247.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,136.50
|
| Rate for Payer: United Healthcare Commercial |
$2,907.72
|
| Rate for Payer: United Healthcare Medicare |
$1,217.70
|
|
|
HC FIBER LASER QUANTA SYSTEM Q1
|
Facility
IP
|
$3,582.00
|
|
| Hospital Charge Code |
41603425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,686.50 |
| Max. Negotiated Rate |
$3,331.26 |
| Rate for Payer: Aetna Commercial |
$3,094.85
|
| Rate for Payer: Cash Price |
$2,220.84
|
| Rate for Payer: Cigna All Commercial |
$3,091.27
|
| Rate for Payer: CORVEL All Commercial |
$3,331.26
|
| Rate for Payer: Coventry All Commercial |
$3,152.16
|
| Rate for Payer: Encore All Commercial |
$3,297.23
|
| Rate for Payer: Frontpath All Commercial |
$3,295.44
|
| Rate for Payer: Humana ChoiceCare |
$3,093.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,223.80
|
| Rate for Payer: PHCS All Commercial |
$2,686.50
|
| Rate for Payer: PHP All Commercial |
$2,716.59
|
| Rate for Payer: Sagamore Health Network All Products |
$2,765.30
|
| Rate for Payer: Signature Care EPO |
$2,973.06
|
| Rate for Payer: Signature Care PPO |
$3,152.16
|
| Rate for Payer: United Healthcare Commercial |
$2,822.62
|
|
|
HC FIBER LASER QUANTA SYSTEM Q1
|
Facility
OP
|
$3,582.00
|
|
| Hospital Charge Code |
41603425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,331.26 |
| Rate for Payer: Aetna Commercial |
$3,023.21
|
| Rate for Payer: Aetna Medicare |
$1,182.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,182.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,057.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,239.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,359.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,300.27
|
| Rate for Payer: Cash Price |
$2,220.84
|
| Rate for Payer: Cash Price |
$2,220.84
|
| Rate for Payer: Centivo All Commercial |
$1,826.82
|
| Rate for Payer: Cigna All Commercial |
$3,091.27
|
| Rate for Payer: CORVEL All Commercial |
$3,331.26
|
| Rate for Payer: Coventry All Commercial |
$3,152.16
|
| Rate for Payer: Encore All Commercial |
$3,297.23
|
| Rate for Payer: Frontpath All Commercial |
$3,295.44
|
| Rate for Payer: Humana ChoiceCare |
$3,093.77
|
| Rate for Payer: Humana Medicare |
$1,826.82
|
| Rate for Payer: Lucent All Commercial |
$1,826.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,223.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,686.50
|
| Rate for Payer: PHP All Commercial |
$2,716.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,396.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,765.30
|
| Rate for Payer: Signature Care EPO |
$2,973.06
|
| Rate for Payer: Signature Care PPO |
$3,152.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,044.70
|
| Rate for Payer: United Healthcare Commercial |
$2,822.62
|
| Rate for Payer: United Healthcare Medicare |
$1,182.06
|
|
|
HC FIBRINOGEN
|
Facility
OP
|
$152.09
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
63001274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$141.45 |
| Rate for Payer: Aetna Commercial |
$128.37
|
| Rate for Payer: Aetna Medicare |
$50.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.21
|
| Rate for Payer: Cash Price |
$94.30
|
| Rate for Payer: Cash Price |
$94.30
|
| Rate for Payer: Centivo All Commercial |
$77.57
|
| Rate for Payer: Cigna All Commercial |
$131.26
|
| Rate for Payer: CORVEL All Commercial |
$141.45
|
| Rate for Payer: Coventry All Commercial |
$133.84
|
| Rate for Payer: Encore All Commercial |
$140.00
|
| Rate for Payer: Frontpath All Commercial |
$139.92
|
| Rate for Payer: Humana ChoiceCare |
$131.36
|
| Rate for Payer: Humana Medicare |
$77.57
|
| Rate for Payer: Lucent All Commercial |
$77.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.88
|
| Rate for Payer: Managed Health Services Medicaid |
$9.72
|
| Rate for Payer: MDWise Medicaid |
$9.72
|
| Rate for Payer: PHCS All Commercial |
$114.07
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.32
|
| Rate for Payer: Sagamore Health Network All Products |
$117.42
|
| Rate for Payer: Signature Care EPO |
$126.24
|
| Rate for Payer: Signature Care PPO |
$133.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.28
|
| Rate for Payer: United Healthcare Commercial |
$119.85
|
| Rate for Payer: United Healthcare Medicare |
$50.19
|
|
|
HC FIBRINOGEN
|
Facility
IP
|
$152.09
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
63001274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.07 |
| Max. Negotiated Rate |
$141.45 |
| Rate for Payer: Aetna Commercial |
$131.41
|
| Rate for Payer: Cash Price |
$94.30
|
| Rate for Payer: Cigna All Commercial |
$131.26
|
| Rate for Payer: CORVEL All Commercial |
$141.45
|
| Rate for Payer: Coventry All Commercial |
$133.84
|
| Rate for Payer: Encore All Commercial |
$140.00
|
| Rate for Payer: Frontpath All Commercial |
$139.92
|
| Rate for Payer: Humana ChoiceCare |
$131.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.88
|
| Rate for Payer: PHCS All Commercial |
$114.07
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Sagamore Health Network All Products |
$117.42
|
| Rate for Payer: Signature Care EPO |
$126.24
|
| Rate for Payer: Signature Care PPO |
$133.84
|
| Rate for Payer: United Healthcare Commercial |
$119.85
|
|
|
HC FIBRINOGEN
|
Facility
OP
|
$166.66
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
63001273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$154.99 |
| Rate for Payer: Aetna Commercial |
$140.66
|
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.50
|
| Rate for Payer: Cash Price |
$103.33
|
| Rate for Payer: Cash Price |
$103.33
|
| Rate for Payer: Centivo All Commercial |
$85.00
|
| Rate for Payer: Cigna All Commercial |
$143.83
|
| Rate for Payer: CORVEL All Commercial |
$154.99
|
| Rate for Payer: Coventry All Commercial |
$146.66
|
| Rate for Payer: Encore All Commercial |
$153.41
|
| Rate for Payer: Frontpath All Commercial |
$153.33
|
| Rate for Payer: Humana ChoiceCare |
$143.94
|
| Rate for Payer: Humana Medicare |
$85.00
|
| Rate for Payer: Lucent All Commercial |
$85.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.99
|
| Rate for Payer: Managed Health Services Medicaid |
$9.72
|
| Rate for Payer: MDWise Medicaid |
$9.72
|
| Rate for Payer: PHCS All Commercial |
$124.99
|
| Rate for Payer: PHP All Commercial |
$126.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.00
|
| Rate for Payer: Sagamore Health Network All Products |
$128.66
|
| Rate for Payer: Signature Care EPO |
$138.33
|
| Rate for Payer: Signature Care PPO |
$146.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.66
|
| Rate for Payer: United Healthcare Commercial |
$131.33
|
| Rate for Payer: United Healthcare Medicare |
$55.00
|
|
|
HC FIBRINOGEN
|
Facility
IP
|
$166.66
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
63001273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.99 |
| Max. Negotiated Rate |
$154.99 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Cash Price |
$103.33
|
| Rate for Payer: Cigna All Commercial |
$143.83
|
| Rate for Payer: CORVEL All Commercial |
$154.99
|
| Rate for Payer: Coventry All Commercial |
$146.66
|
| Rate for Payer: Encore All Commercial |
$153.41
|
| Rate for Payer: Frontpath All Commercial |
$153.33
|
| Rate for Payer: Humana ChoiceCare |
$143.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.99
|
| Rate for Payer: PHCS All Commercial |
$124.99
|
| Rate for Payer: PHP All Commercial |
$126.39
|
| Rate for Payer: Sagamore Health Network All Products |
$128.66
|
| Rate for Payer: Signature Care EPO |
$138.33
|
| Rate for Payer: Signature Care PPO |
$146.66
|
| Rate for Payer: United Healthcare Commercial |
$131.33
|
|
