|
HC FLOW CYTO MKR EA ADD X1
|
Facility
|
IP
|
$163.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
63001058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Aetna Commercial |
$141.08
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Cigna All Commercial |
$140.91
|
| Rate for Payer: CORVEL All Commercial |
$151.85
|
| Rate for Payer: Coventry All Commercial |
$143.69
|
| Rate for Payer: Encore All Commercial |
$150.30
|
| Rate for Payer: Frontpath All Commercial |
$150.22
|
| Rate for Payer: Humana ChoiceCare |
$141.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.95
|
| Rate for Payer: PHCS All Commercial |
$122.46
|
| Rate for Payer: PHP All Commercial |
$123.83
|
| Rate for Payer: Sagamore Health Network All Products |
$126.05
|
| Rate for Payer: Signature Care EPO |
$135.52
|
| Rate for Payer: Signature Care PPO |
$143.69
|
| Rate for Payer: United Healthcare Commercial |
$128.67
|
|
|
HC FLOW CYTO MKR EA ADD X1-59
|
Facility
|
IP
|
$163.28
|
|
|
Service Code
|
CPT 88185 59
|
| Hospital Charge Code |
63002157
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Aetna Commercial |
$141.08
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Cigna All Commercial |
$140.91
|
| Rate for Payer: CORVEL All Commercial |
$151.85
|
| Rate for Payer: Coventry All Commercial |
$143.69
|
| Rate for Payer: Encore All Commercial |
$150.30
|
| Rate for Payer: Frontpath All Commercial |
$150.22
|
| Rate for Payer: Humana ChoiceCare |
$141.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.95
|
| Rate for Payer: PHCS All Commercial |
$122.46
|
| Rate for Payer: PHP All Commercial |
$123.83
|
| Rate for Payer: Sagamore Health Network All Products |
$126.05
|
| Rate for Payer: Signature Care EPO |
$135.52
|
| Rate for Payer: Signature Care PPO |
$143.69
|
| Rate for Payer: United Healthcare Commercial |
$128.67
|
|
|
HC FLOW CYTO MKR EA ADD X1-59
|
Facility
|
OP
|
$163.28
|
|
|
Service Code
|
CPT 88185 59
|
| Hospital Charge Code |
63002157
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Aetna Commercial |
$137.81
|
| Rate for Payer: Aetna Medicare |
$53.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.27
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Centivo All Commercial |
$83.27
|
| Rate for Payer: Cigna All Commercial |
$140.91
|
| Rate for Payer: CORVEL All Commercial |
$151.85
|
| Rate for Payer: Coventry All Commercial |
$143.69
|
| Rate for Payer: Encore All Commercial |
$150.30
|
| Rate for Payer: Frontpath All Commercial |
$150.22
|
| Rate for Payer: Humana ChoiceCare |
$141.03
|
| Rate for Payer: Humana Medicare |
$83.27
|
| Rate for Payer: Lucent All Commercial |
$83.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.95
|
| Rate for Payer: PHCS All Commercial |
$122.46
|
| Rate for Payer: PHP All Commercial |
$123.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.68
|
| Rate for Payer: Sagamore Health Network All Products |
$126.05
|
| Rate for Payer: Signature Care EPO |
$135.52
|
| Rate for Payer: Signature Care PPO |
$143.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.79
|
| Rate for Payer: United Healthcare Commercial |
$128.67
|
| Rate for Payer: United Healthcare Medicare |
$53.88
|
|
|
HC FLUID CULTURE
|
Facility
|
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC FLUID CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
|
HC FLUIDOTHERAPY-OT
|
Facility
|
OP
|
$119.66
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
01738026
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$111.28 |
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Medicare |
$39.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.44
|
| Rate for Payer: Cash Price |
$74.19
|
| Rate for Payer: Centivo All Commercial |
$61.02
|
| Rate for Payer: Cigna All Commercial |
$103.26
|
| Rate for Payer: CORVEL All Commercial |
$111.28
|
| Rate for Payer: Coventry All Commercial |
$105.30
|
| Rate for Payer: Encore All Commercial |
$110.14
|
| Rate for Payer: Frontpath All Commercial |
$110.08
|
| Rate for Payer: Humana ChoiceCare |
$103.35
|
| Rate for Payer: Humana Medicare |
$61.02
|
| Rate for Payer: Lucent All Commercial |
$61.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.69
|
| Rate for Payer: PHCS All Commercial |
$89.74
|
| Rate for Payer: PHP All Commercial |
$90.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.67
|
| Rate for Payer: Sagamore Health Network All Products |
$92.37
|
| Rate for Payer: Signature Care EPO |
$99.31
|
| Rate for Payer: Signature Care PPO |
$105.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.71
|
| Rate for Payer: United Healthcare Commercial |
$94.29
|
| Rate for Payer: United Healthcare Medicare |
$39.49
|
|
|
HC FLUIDOTHERAPY-OT
|
Facility
|
IP
|
$119.66
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
01738026
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$111.28 |
| Rate for Payer: Aetna Commercial |
$103.38
|
| Rate for Payer: Cash Price |
$74.19
|
| Rate for Payer: Cigna All Commercial |
$103.26
|
| Rate for Payer: CORVEL All Commercial |
$111.28
|
| Rate for Payer: Coventry All Commercial |
$105.30
|
| Rate for Payer: Encore All Commercial |
$110.14
|
| Rate for Payer: Frontpath All Commercial |
$110.08
|
| Rate for Payer: Humana ChoiceCare |
$103.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.69
|
| Rate for Payer: PHCS All Commercial |
$89.74
|
| Rate for Payer: PHP All Commercial |
$90.75
|
| Rate for Payer: Sagamore Health Network All Products |
$92.37
|
| Rate for Payer: Signature Care EPO |
$99.31
|
| Rate for Payer: Signature Care PPO |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$94.29
|
|
|
HC FLUIDOTHERAPY-PT
|
Facility
|
IP
|
$115.06
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
01728033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.29 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cigna All Commercial |
$99.29
|
| Rate for Payer: CORVEL All Commercial |
$107.00
|
| Rate for Payer: Coventry All Commercial |
$101.25
|
| Rate for Payer: Encore All Commercial |
$105.91
|
| Rate for Payer: Frontpath All Commercial |
$105.85
|
| Rate for Payer: Humana ChoiceCare |
$99.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.55
|
| Rate for Payer: PHCS All Commercial |
$86.29
|
| Rate for Payer: PHP All Commercial |
$87.26
|
| Rate for Payer: Sagamore Health Network All Products |
$88.82
|
| Rate for Payer: Signature Care EPO |
$95.50
|
| Rate for Payer: Signature Care PPO |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$90.66
|
|
|
HC FLUIDOTHERAPY-PT
|
Facility
|
OP
|
$115.06
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
01728033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna Commercial |
$97.11
|
| Rate for Payer: Aetna Medicare |
$37.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.77
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Centivo All Commercial |
$58.68
|
| Rate for Payer: Cigna All Commercial |
$99.29
|
| Rate for Payer: CORVEL All Commercial |
$107.00
|
| Rate for Payer: Coventry All Commercial |
$101.25
|
| Rate for Payer: Encore All Commercial |
$105.91
|
| Rate for Payer: Frontpath All Commercial |
$105.85
|
| Rate for Payer: Humana ChoiceCare |
$99.37
|
| Rate for Payer: Humana Medicare |
$58.68
|
| Rate for Payer: Lucent All Commercial |
$58.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.55
|
| Rate for Payer: PHCS All Commercial |
$86.29
|
| Rate for Payer: PHP All Commercial |
$87.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.87
|
| Rate for Payer: Sagamore Health Network All Products |
$88.82
|
| Rate for Payer: Signature Care EPO |
$95.50
|
| Rate for Payer: Signature Care PPO |
$101.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97.80
|
| Rate for Payer: United Healthcare Commercial |
$90.66
|
| Rate for Payer: United Healthcare Medicare |
$37.97
|
|
|
HC FLUNITRAZEPAM
|
Facility
|
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$127.74
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Centivo All Commercial |
$77.19
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Humana Medicare |
$77.19
|
| Rate for Payer: Lucent All Commercial |
$77.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.03
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.65
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
| Rate for Payer: United Healthcare Medicare |
$49.94
|
|
|
HC FLUNITRAZEPAM
|
Facility
|
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
|
|
HC FLUORES AB SCREEN-EA
|
Facility
|
IP
|
$157.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$135.70
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cigna All Commercial |
$135.54
|
| Rate for Payer: CORVEL All Commercial |
$146.07
|
| Rate for Payer: Coventry All Commercial |
$138.21
|
| Rate for Payer: Encore All Commercial |
$144.57
|
| Rate for Payer: Frontpath All Commercial |
$144.49
|
| Rate for Payer: Humana ChoiceCare |
$135.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.35
|
| Rate for Payer: PHCS All Commercial |
$117.79
|
| Rate for Payer: PHP All Commercial |
$119.11
|
| Rate for Payer: Sagamore Health Network All Products |
$121.25
|
| Rate for Payer: Signature Care EPO |
$130.36
|
| Rate for Payer: Signature Care PPO |
$138.21
|
| Rate for Payer: United Healthcare Commercial |
$123.76
|
|
|
HC FLUORES AB SCREEN-EA
|
Facility
|
OP
|
$157.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$132.56
|
| Rate for Payer: Aetna Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.01
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Centivo All Commercial |
$80.10
|
| Rate for Payer: Cigna All Commercial |
$135.54
|
| Rate for Payer: CORVEL All Commercial |
$146.07
|
| Rate for Payer: Coventry All Commercial |
$138.21
|
| Rate for Payer: Encore All Commercial |
$144.57
|
| Rate for Payer: Frontpath All Commercial |
$144.49
|
| Rate for Payer: Humana ChoiceCare |
$135.65
|
| Rate for Payer: Humana Medicare |
$80.10
|
| Rate for Payer: Lucent All Commercial |
$80.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.35
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$117.79
|
| Rate for Payer: PHP All Commercial |
$119.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.25
|
| Rate for Payer: Sagamore Health Network All Products |
$121.25
|
| Rate for Payer: Signature Care EPO |
$130.36
|
| Rate for Payer: Signature Care PPO |
$138.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.50
|
| Rate for Payer: United Healthcare Commercial |
$123.76
|
| Rate for Payer: United Healthcare Medicare |
$51.83
|
|
|
HC FLUORES AB TITER
|
Facility
|
OP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$184.87
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.51
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Centivo All Commercial |
$111.71
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Humana Medicare |
$111.71
|
| Rate for Payer: Lucent All Commercial |
$111.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.42
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.18
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
| Rate for Payer: United Healthcare Medicare |
$72.28
|
|
|
HC FLUORES AB TITER
|
Facility
|
IP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.28 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
|
|
HC FLUORESCENCE POLARIZATION
|
Facility
|
OP
|
$116.05
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
63001187
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$97.94
|
| Rate for Payer: Aetna Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.12
|
| Rate for Payer: Cash Price |
$71.95
|
| Rate for Payer: Cash Price |
$71.95
|
| Rate for Payer: Centivo All Commercial |
$59.18
|
| Rate for Payer: Cigna All Commercial |
$100.15
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.82
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.23
|
| Rate for Payer: Humana Medicare |
$59.18
|
| Rate for Payer: Lucent All Commercial |
$59.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.32
|
| Rate for Payer: MDWise Medicaid |
$9.32
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.59
|
| Rate for Payer: Signature Care EPO |
$96.32
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.64
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
| Rate for Payer: United Healthcare Medicare |
$38.29
|
|
|
HC FLUORESCENCE POLARIZATION
|
Facility
|
IP
|
$116.05
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
63001187
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.03 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$100.26
|
| Rate for Payer: Cash Price |
$71.95
|
| Rate for Payer: Cigna All Commercial |
$100.15
|
| Rate for Payer: CORVEL All Commercial |
$107.92
|
| Rate for Payer: Coventry All Commercial |
$102.12
|
| Rate for Payer: Encore All Commercial |
$106.82
|
| Rate for Payer: Frontpath All Commercial |
$106.76
|
| Rate for Payer: Humana ChoiceCare |
$100.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.44
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.01
|
| Rate for Payer: Sagamore Health Network All Products |
$89.59
|
| Rate for Payer: Signature Care EPO |
$96.32
|
| Rate for Payer: Signature Care PPO |
$102.12
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
|
|
HC FLUORO GUIDANCE FOR NDL PLACE
|
Facility
|
IP
|
$874.54
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
01597600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$655.90 |
| Max. Negotiated Rate |
$813.32 |
| Rate for Payer: Aetna Commercial |
$755.60
|
| Rate for Payer: Cash Price |
$542.21
|
| Rate for Payer: Cigna All Commercial |
$754.73
|
| Rate for Payer: CORVEL All Commercial |
$813.32
|
| Rate for Payer: Coventry All Commercial |
$769.59
|
| Rate for Payer: Encore All Commercial |
$805.01
|
| Rate for Payer: Frontpath All Commercial |
$804.57
|
| Rate for Payer: Humana ChoiceCare |
$755.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.08
|
| Rate for Payer: PHCS All Commercial |
$655.90
|
| Rate for Payer: PHP All Commercial |
$663.25
|
| Rate for Payer: Sagamore Health Network All Products |
$675.14
|
| Rate for Payer: Signature Care EPO |
$725.87
|
| Rate for Payer: Signature Care PPO |
$769.59
|
| Rate for Payer: United Healthcare Commercial |
$689.14
|
|
|
HC FLUORO GUIDANCE FOR NDL PLACE
|
Facility
|
OP
|
$874.54
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
01597600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.59 |
| Max. Negotiated Rate |
$813.32 |
| Rate for Payer: Aetna Commercial |
$738.11
|
| Rate for Payer: Aetna Medicare |
$288.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$502.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$546.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$201.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$331.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$317.46
|
| Rate for Payer: Cash Price |
$542.21
|
| Rate for Payer: Cash Price |
$542.21
|
| Rate for Payer: Centivo All Commercial |
$446.01
|
| Rate for Payer: Cigna All Commercial |
$754.73
|
| Rate for Payer: CORVEL All Commercial |
$813.32
|
| Rate for Payer: Coventry All Commercial |
$769.59
|
| Rate for Payer: Encore All Commercial |
$805.01
|
| Rate for Payer: Frontpath All Commercial |
$804.57
|
| Rate for Payer: Humana ChoiceCare |
$755.34
|
| Rate for Payer: Humana Medicare |
$446.01
|
| Rate for Payer: Lucent All Commercial |
$446.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.08
|
| Rate for Payer: Managed Health Services Medicaid |
$201.59
|
| Rate for Payer: MDWise Medicaid |
$201.59
|
| Rate for Payer: PHCS All Commercial |
$655.90
|
| Rate for Payer: PHP All Commercial |
$663.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.07
|
| Rate for Payer: Sagamore Health Network All Products |
$675.14
|
| Rate for Payer: Signature Care EPO |
$725.87
|
| Rate for Payer: Signature Care PPO |
$769.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$743.36
|
| Rate for Payer: United Healthcare Commercial |
$689.14
|
| Rate for Payer: United Healthcare Medicare |
$288.60
|
|
|
HC FLUOROSCOPY EPIDURAL INJECTION
|
Facility
|
OP
|
$898.02
|
|
| Hospital Charge Code |
01619002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$296.35 |
| Max. Negotiated Rate |
$835.16 |
| Rate for Payer: Aetna Commercial |
$757.93
|
| Rate for Payer: Aetna Medicare |
$296.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$296.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$515.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$561.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.98
|
| Rate for Payer: Cash Price |
$556.77
|
| Rate for Payer: Centivo All Commercial |
$457.99
|
| Rate for Payer: Cigna All Commercial |
$774.99
|
| Rate for Payer: CORVEL All Commercial |
$835.16
|
| Rate for Payer: Coventry All Commercial |
$790.26
|
| Rate for Payer: Encore All Commercial |
$826.63
|
| Rate for Payer: Frontpath All Commercial |
$826.18
|
| Rate for Payer: Humana ChoiceCare |
$775.62
|
| Rate for Payer: Humana Medicare |
$457.99
|
| Rate for Payer: Lucent All Commercial |
$457.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.22
|
| Rate for Payer: PHCS All Commercial |
$673.51
|
| Rate for Payer: PHP All Commercial |
$681.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.23
|
| Rate for Payer: Sagamore Health Network All Products |
$693.27
|
| Rate for Payer: Signature Care EPO |
$745.36
|
| Rate for Payer: Signature Care PPO |
$790.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$763.32
|
| Rate for Payer: United Healthcare Commercial |
$707.64
|
| Rate for Payer: United Healthcare Medicare |
$296.35
|
|
|
HC FLUOROSCOPY EPIDURAL INJECTION
|
Facility
|
IP
|
$898.02
|
|
| Hospital Charge Code |
01619002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$673.51 |
| Max. Negotiated Rate |
$835.16 |
| Rate for Payer: Aetna Commercial |
$775.89
|
| Rate for Payer: Cash Price |
$556.77
|
| Rate for Payer: Cigna All Commercial |
$774.99
|
| Rate for Payer: CORVEL All Commercial |
$835.16
|
| Rate for Payer: Coventry All Commercial |
$790.26
|
| Rate for Payer: Encore All Commercial |
$826.63
|
| Rate for Payer: Frontpath All Commercial |
$826.18
|
| Rate for Payer: Humana ChoiceCare |
$775.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.22
|
| Rate for Payer: PHCS All Commercial |
$673.51
|
| Rate for Payer: PHP All Commercial |
$681.06
|
| Rate for Payer: Sagamore Health Network All Products |
$693.27
|
| Rate for Payer: Signature Care EPO |
$745.36
|
| Rate for Payer: Signature Care PPO |
$790.26
|
| Rate for Payer: United Healthcare Commercial |
$707.64
|
|
|
HC FNA ADEQUACY EVAL
|
Facility
|
OP
|
$288.21
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
63001266
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.11 |
| Max. Negotiated Rate |
$268.04 |
| Rate for Payer: Aetna Commercial |
$243.25
|
| Rate for Payer: Aetna Medicare |
$95.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$117.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$109.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$104.62
|
| Rate for Payer: Cash Price |
$178.69
|
| Rate for Payer: Cash Price |
$178.69
|
| Rate for Payer: Centivo All Commercial |
$146.99
|
| Rate for Payer: Cigna All Commercial |
$248.73
|
| Rate for Payer: CORVEL All Commercial |
$268.04
|
| Rate for Payer: Coventry All Commercial |
$253.63
|
| Rate for Payer: Encore All Commercial |
$265.30
|
| Rate for Payer: Frontpath All Commercial |
$265.15
|
| Rate for Payer: Humana ChoiceCare |
$248.93
|
| Rate for Payer: Humana Medicare |
$146.99
|
| Rate for Payer: Lucent All Commercial |
$146.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.39
|
| Rate for Payer: Managed Health Services Medicaid |
$117.00
|
| Rate for Payer: MDWise Medicaid |
$117.00
|
| Rate for Payer: PHCS All Commercial |
$216.16
|
| Rate for Payer: PHP All Commercial |
$218.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.40
|
| Rate for Payer: Sagamore Health Network All Products |
$222.50
|
| Rate for Payer: Signature Care EPO |
$239.22
|
| Rate for Payer: Signature Care PPO |
$253.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$244.98
|
| Rate for Payer: United Healthcare Commercial |
$227.11
|
| Rate for Payer: United Healthcare Medicare |
$95.11
|
|
|
HC FNA ADEQUACY EVAL
|
Facility
|
IP
|
$288.21
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
63001266
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.16 |
| Max. Negotiated Rate |
$268.04 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: Cash Price |
$178.69
|
| Rate for Payer: Cigna All Commercial |
$248.73
|
| Rate for Payer: CORVEL All Commercial |
$268.04
|
| Rate for Payer: Coventry All Commercial |
$253.63
|
| Rate for Payer: Encore All Commercial |
$265.30
|
| Rate for Payer: Frontpath All Commercial |
$265.15
|
| Rate for Payer: Humana ChoiceCare |
$248.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.39
|
| Rate for Payer: PHCS All Commercial |
$216.16
|
| Rate for Payer: PHP All Commercial |
$218.58
|
| Rate for Payer: Sagamore Health Network All Products |
$222.50
|
| Rate for Payer: Signature Care EPO |
$239.22
|
| Rate for Payer: Signature Care PPO |
$253.63
|
| Rate for Payer: United Healthcare Commercial |
$227.11
|
|
|
HC FNA BX W/CT GDN 1ST LES
|
Facility
|
IP
|
$1,734.00
|
|
| Hospital Charge Code |
01660009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC FNA BX W/CT GDN 1ST LES
|
Facility
|
OP
|
$1,734.00
|
|
| Hospital Charge Code |
01660009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
