|
HC FNA BX W/US GDN 1ST LES
|
Facility
OP
|
$1,661.84
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
01640005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$548.41 |
| Max. Negotiated Rate |
$2,273.62 |
| Rate for Payer: Aetna Commercial |
$1,402.59
|
| Rate for Payer: Aetna Medicare |
$548.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$548.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$954.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,038.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,273.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$630.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$603.25
|
| Rate for Payer: Cash Price |
$1,030.34
|
| Rate for Payer: Cash Price |
$1,030.34
|
| Rate for Payer: Centivo All Commercial |
$847.54
|
| Rate for Payer: Cigna All Commercial |
$1,434.16
|
| Rate for Payer: CORVEL All Commercial |
$1,545.51
|
| Rate for Payer: Coventry All Commercial |
$1,462.41
|
| Rate for Payer: Encore All Commercial |
$1,529.72
|
| Rate for Payer: Frontpath All Commercial |
$1,528.89
|
| Rate for Payer: Humana ChoiceCare |
$1,435.33
|
| Rate for Payer: Humana Medicare |
$847.54
|
| Rate for Payer: Lucent All Commercial |
$847.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,495.65
|
| Rate for Payer: Managed Health Services Medicaid |
$2,273.62
|
| Rate for Payer: MDWise Medicaid |
$2,273.62
|
| Rate for Payer: PHCS All Commercial |
$1,246.38
|
| Rate for Payer: PHP All Commercial |
$1,260.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$648.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,282.94
|
| Rate for Payer: Signature Care EPO |
$1,379.32
|
| Rate for Payer: Signature Care PPO |
$1,462.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,412.56
|
| Rate for Payer: United Healthcare Commercial |
$1,309.53
|
| Rate for Payer: United Healthcare Medicare |
$548.41
|
|
|
HC FNA BX W/US GDN 1ST LES
|
Facility
IP
|
$1,661.84
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
01640005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,246.38 |
| Max. Negotiated Rate |
$1,545.51 |
| Rate for Payer: Aetna Commercial |
$1,435.83
|
| Rate for Payer: Cash Price |
$1,030.34
|
| Rate for Payer: Cigna All Commercial |
$1,434.16
|
| Rate for Payer: CORVEL All Commercial |
$1,545.51
|
| Rate for Payer: Coventry All Commercial |
$1,462.41
|
| Rate for Payer: Encore All Commercial |
$1,529.72
|
| Rate for Payer: Frontpath All Commercial |
$1,528.89
|
| Rate for Payer: Humana ChoiceCare |
$1,435.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,495.65
|
| Rate for Payer: PHCS All Commercial |
$1,246.38
|
| Rate for Payer: PHP All Commercial |
$1,260.34
|
| Rate for Payer: Sagamore Health Network All Products |
$1,282.94
|
| Rate for Payer: Signature Care EPO |
$1,379.32
|
| Rate for Payer: Signature Care PPO |
$1,462.41
|
| Rate for Payer: United Healthcare Commercial |
$1,309.53
|
|
|
HC FNA BX W/US GDN EA ADDL
|
Facility
OP
|
$1,081.71
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
01640006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.96 |
| Max. Negotiated Rate |
$1,005.99 |
| Rate for Payer: Aetna Commercial |
$912.96
|
| Rate for Payer: Aetna Medicare |
$356.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$356.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$621.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$676.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$410.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$392.66
|
| Rate for Payer: Cash Price |
$670.66
|
| Rate for Payer: Centivo All Commercial |
$551.67
|
| Rate for Payer: Cigna All Commercial |
$933.52
|
| Rate for Payer: CORVEL All Commercial |
$1,005.99
|
| Rate for Payer: Coventry All Commercial |
$951.90
|
| Rate for Payer: Encore All Commercial |
$995.71
|
| Rate for Payer: Frontpath All Commercial |
$995.17
|
| Rate for Payer: Humana ChoiceCare |
$934.27
|
| Rate for Payer: Humana Medicare |
$551.67
|
| Rate for Payer: Lucent All Commercial |
$551.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$973.54
|
| Rate for Payer: PHCS All Commercial |
$811.28
|
| Rate for Payer: PHP All Commercial |
$820.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$421.87
|
| Rate for Payer: Sagamore Health Network All Products |
$835.08
|
| Rate for Payer: Signature Care EPO |
$897.82
|
| Rate for Payer: Signature Care PPO |
$951.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$919.45
|
| Rate for Payer: United Healthcare Commercial |
$852.39
|
| Rate for Payer: United Healthcare Medicare |
$356.96
|
|
|
HC FNA BX W/US GDN EA ADDL
|
Facility
IP
|
$1,081.71
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
01640006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$811.28 |
| Max. Negotiated Rate |
$1,005.99 |
| Rate for Payer: Aetna Commercial |
$934.60
|
| Rate for Payer: Cash Price |
$670.66
|
| Rate for Payer: Cigna All Commercial |
$933.52
|
| Rate for Payer: CORVEL All Commercial |
$1,005.99
|
| Rate for Payer: Coventry All Commercial |
$951.90
|
| Rate for Payer: Encore All Commercial |
$995.71
|
| Rate for Payer: Frontpath All Commercial |
$995.17
|
| Rate for Payer: Humana ChoiceCare |
$934.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$973.54
|
| Rate for Payer: PHCS All Commercial |
$811.28
|
| Rate for Payer: PHP All Commercial |
$820.37
|
| Rate for Payer: Sagamore Health Network All Products |
$835.08
|
| Rate for Payer: Signature Care EPO |
$897.82
|
| Rate for Payer: Signature Care PPO |
$951.90
|
| Rate for Payer: United Healthcare Commercial |
$852.39
|
|
|
HC FOLATE LEVEL, RBC
|
Facility
OP
|
$209.44
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
63001158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$194.78 |
| Rate for Payer: Aetna Commercial |
$176.76
|
| Rate for Payer: Aetna Medicare |
$69.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.03
|
| Rate for Payer: Cash Price |
$129.85
|
| Rate for Payer: Cash Price |
$129.85
|
| Rate for Payer: Centivo All Commercial |
$106.81
|
| Rate for Payer: Cigna All Commercial |
$180.74
|
| Rate for Payer: CORVEL All Commercial |
$194.78
|
| Rate for Payer: Coventry All Commercial |
$184.30
|
| Rate for Payer: Encore All Commercial |
$192.79
|
| Rate for Payer: Frontpath All Commercial |
$192.68
|
| Rate for Payer: Humana ChoiceCare |
$180.89
|
| Rate for Payer: Humana Medicare |
$106.81
|
| Rate for Payer: Lucent All Commercial |
$106.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.49
|
| Rate for Payer: Managed Health Services Medicaid |
$17.65
|
| Rate for Payer: MDWise Medicaid |
$17.65
|
| Rate for Payer: PHCS All Commercial |
$157.08
|
| Rate for Payer: PHP All Commercial |
$158.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.68
|
| Rate for Payer: Sagamore Health Network All Products |
$161.69
|
| Rate for Payer: Signature Care EPO |
$173.83
|
| Rate for Payer: Signature Care PPO |
$184.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.02
|
| Rate for Payer: United Healthcare Commercial |
$165.04
|
| Rate for Payer: United Healthcare Medicare |
$69.11
|
|
|
HC FOLATE LEVEL, RBC
|
Facility
IP
|
$209.44
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
63001158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$194.78 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Cash Price |
$129.85
|
| Rate for Payer: Cigna All Commercial |
$180.74
|
| Rate for Payer: CORVEL All Commercial |
$194.78
|
| Rate for Payer: Coventry All Commercial |
$184.30
|
| Rate for Payer: Encore All Commercial |
$192.79
|
| Rate for Payer: Frontpath All Commercial |
$192.68
|
| Rate for Payer: Humana ChoiceCare |
$180.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.49
|
| Rate for Payer: PHCS All Commercial |
$157.08
|
| Rate for Payer: PHP All Commercial |
$158.84
|
| Rate for Payer: Sagamore Health Network All Products |
$161.69
|
| Rate for Payer: Signature Care EPO |
$173.83
|
| Rate for Payer: Signature Care PPO |
$184.30
|
| Rate for Payer: United Healthcare Commercial |
$165.04
|
|
|
HC FOLATE SERUM
|
Facility
IP
|
$199.81
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
63001157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.86 |
| Max. Negotiated Rate |
$185.82 |
| Rate for Payer: Aetna Commercial |
$172.63
|
| Rate for Payer: Cash Price |
$123.88
|
| Rate for Payer: Cigna All Commercial |
$172.43
|
| Rate for Payer: CORVEL All Commercial |
$185.82
|
| Rate for Payer: Coventry All Commercial |
$175.83
|
| Rate for Payer: Encore All Commercial |
$183.92
|
| Rate for Payer: Frontpath All Commercial |
$183.82
|
| Rate for Payer: Humana ChoiceCare |
$172.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.83
|
| Rate for Payer: PHCS All Commercial |
$149.86
|
| Rate for Payer: PHP All Commercial |
$151.53
|
| Rate for Payer: Sagamore Health Network All Products |
$154.25
|
| Rate for Payer: Signature Care EPO |
$165.84
|
| Rate for Payer: Signature Care PPO |
$175.83
|
| Rate for Payer: United Healthcare Commercial |
$157.45
|
|
|
HC FOLATE SERUM
|
Facility
OP
|
$199.81
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
63001157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$185.82 |
| Rate for Payer: Aetna Commercial |
$168.64
|
| Rate for Payer: Aetna Medicare |
$65.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.53
|
| Rate for Payer: Cash Price |
$123.88
|
| Rate for Payer: Cash Price |
$123.88
|
| Rate for Payer: Centivo All Commercial |
$101.90
|
| Rate for Payer: Cigna All Commercial |
$172.43
|
| Rate for Payer: CORVEL All Commercial |
$185.82
|
| Rate for Payer: Coventry All Commercial |
$175.83
|
| Rate for Payer: Encore All Commercial |
$183.92
|
| Rate for Payer: Frontpath All Commercial |
$183.82
|
| Rate for Payer: Humana ChoiceCare |
$172.57
|
| Rate for Payer: Humana Medicare |
$101.90
|
| Rate for Payer: Lucent All Commercial |
$101.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.83
|
| Rate for Payer: Managed Health Services Medicaid |
$14.70
|
| Rate for Payer: MDWise Medicaid |
$14.70
|
| Rate for Payer: PHCS All Commercial |
$149.86
|
| Rate for Payer: PHP All Commercial |
$151.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.93
|
| Rate for Payer: Sagamore Health Network All Products |
$154.25
|
| Rate for Payer: Signature Care EPO |
$165.84
|
| Rate for Payer: Signature Care PPO |
$175.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$169.84
|
| Rate for Payer: United Healthcare Commercial |
$157.45
|
| Rate for Payer: United Healthcare Medicare |
$65.94
|
|
|
HC FORCEPS GI BX W/NEEDLE
|
Facility
OP
|
$112.00
|
|
| Hospital Charge Code |
41604629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.53
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.66
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Centivo All Commercial |
$57.12
|
| Rate for Payer: Cigna All Commercial |
$96.66
|
| Rate for Payer: CORVEL All Commercial |
$104.16
|
| Rate for Payer: Coventry All Commercial |
$98.56
|
| Rate for Payer: Encore All Commercial |
$103.10
|
| Rate for Payer: Frontpath All Commercial |
$103.04
|
| Rate for Payer: Humana ChoiceCare |
$96.73
|
| Rate for Payer: Humana Medicare |
$57.12
|
| Rate for Payer: Lucent All Commercial |
$57.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$84.00
|
| Rate for Payer: PHP All Commercial |
$84.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.68
|
| Rate for Payer: Sagamore Health Network All Products |
$86.46
|
| Rate for Payer: Signature Care EPO |
$92.96
|
| Rate for Payer: Signature Care PPO |
$98.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$88.26
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
|
|
HC FORCEPS GI BX W/NEEDLE
|
Facility
IP
|
$112.00
|
|
| Hospital Charge Code |
41604629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$104.16 |
| Rate for Payer: Aetna Commercial |
$96.77
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cigna All Commercial |
$96.66
|
| Rate for Payer: CORVEL All Commercial |
$104.16
|
| Rate for Payer: Coventry All Commercial |
$98.56
|
| Rate for Payer: Encore All Commercial |
$103.10
|
| Rate for Payer: Frontpath All Commercial |
$103.04
|
| Rate for Payer: Humana ChoiceCare |
$96.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.80
|
| Rate for Payer: PHCS All Commercial |
$84.00
|
| Rate for Payer: PHP All Commercial |
$84.94
|
| Rate for Payer: Sagamore Health Network All Products |
$86.46
|
| Rate for Payer: Signature Care EPO |
$92.96
|
| Rate for Payer: Signature Care PPO |
$98.56
|
| Rate for Payer: United Healthcare Commercial |
$88.26
|
|
|
HC FOREIGN BODY HOOD PROTECT
|
Facility
OP
|
$168.64
|
|
| Hospital Charge Code |
41608231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$156.84 |
| Rate for Payer: Aetna Commercial |
$142.33
|
| Rate for Payer: Aetna Medicare |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.22
|
| Rate for Payer: Cash Price |
$104.56
|
| Rate for Payer: Cash Price |
$104.56
|
| Rate for Payer: Centivo All Commercial |
$86.01
|
| Rate for Payer: Cigna All Commercial |
$145.54
|
| Rate for Payer: CORVEL All Commercial |
$156.84
|
| Rate for Payer: Coventry All Commercial |
$148.40
|
| Rate for Payer: Encore All Commercial |
$155.23
|
| Rate for Payer: Frontpath All Commercial |
$155.15
|
| Rate for Payer: Humana ChoiceCare |
$145.65
|
| Rate for Payer: Humana Medicare |
$86.01
|
| Rate for Payer: Lucent All Commercial |
$86.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.78
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$126.48
|
| Rate for Payer: PHP All Commercial |
$127.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.77
|
| Rate for Payer: Sagamore Health Network All Products |
$130.19
|
| Rate for Payer: Signature Care EPO |
$139.97
|
| Rate for Payer: Signature Care PPO |
$148.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.34
|
| Rate for Payer: United Healthcare Commercial |
$132.89
|
| Rate for Payer: United Healthcare Medicare |
$55.65
|
|
|
HC FOREIGN BODY HOOD PROTECT
|
Facility
IP
|
$168.64
|
|
| Hospital Charge Code |
41608231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$156.84 |
| Rate for Payer: Aetna Commercial |
$145.70
|
| Rate for Payer: Cash Price |
$104.56
|
| Rate for Payer: Cigna All Commercial |
$145.54
|
| Rate for Payer: CORVEL All Commercial |
$156.84
|
| Rate for Payer: Coventry All Commercial |
$148.40
|
| Rate for Payer: Encore All Commercial |
$155.23
|
| Rate for Payer: Frontpath All Commercial |
$155.15
|
| Rate for Payer: Humana ChoiceCare |
$145.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.78
|
| Rate for Payer: PHCS All Commercial |
$126.48
|
| Rate for Payer: PHP All Commercial |
$127.90
|
| Rate for Payer: Sagamore Health Network All Products |
$130.19
|
| Rate for Payer: Signature Care EPO |
$139.97
|
| Rate for Payer: Signature Care PPO |
$148.40
|
| Rate for Payer: United Healthcare Commercial |
$132.89
|
|
|
HC FORENSIC DRUG BLOOD
|
Facility
OP
|
$331.85
|
|
| Hospital Charge Code |
63002221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.51 |
| Max. Negotiated Rate |
$308.62 |
| Rate for Payer: Aetna Commercial |
$280.08
|
| Rate for Payer: Aetna Medicare |
$109.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$190.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$207.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.46
|
| Rate for Payer: Cash Price |
$205.75
|
| Rate for Payer: Centivo All Commercial |
$169.24
|
| Rate for Payer: Cigna All Commercial |
$286.38
|
| Rate for Payer: CORVEL All Commercial |
$308.62
|
| Rate for Payer: Coventry All Commercial |
$292.03
|
| Rate for Payer: Encore All Commercial |
$305.46
|
| Rate for Payer: Frontpath All Commercial |
$305.30
|
| Rate for Payer: Humana ChoiceCare |
$286.62
|
| Rate for Payer: Humana Medicare |
$169.24
|
| Rate for Payer: Lucent All Commercial |
$169.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$298.66
|
| Rate for Payer: PHCS All Commercial |
$248.89
|
| Rate for Payer: PHP All Commercial |
$251.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.42
|
| Rate for Payer: Sagamore Health Network All Products |
$256.19
|
| Rate for Payer: Signature Care EPO |
$275.43
|
| Rate for Payer: Signature Care PPO |
$292.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$282.07
|
| Rate for Payer: United Healthcare Commercial |
$261.50
|
| Rate for Payer: United Healthcare Medicare |
$109.51
|
|
|
HC FORENSIC DRUG BLOOD
|
Facility
IP
|
$331.85
|
|
| Hospital Charge Code |
63002221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$308.62 |
| Rate for Payer: Aetna Commercial |
$286.72
|
| Rate for Payer: Cash Price |
$205.75
|
| Rate for Payer: Cigna All Commercial |
$286.38
|
| Rate for Payer: CORVEL All Commercial |
$308.62
|
| Rate for Payer: Coventry All Commercial |
$292.03
|
| Rate for Payer: Encore All Commercial |
$305.46
|
| Rate for Payer: Frontpath All Commercial |
$305.30
|
| Rate for Payer: Humana ChoiceCare |
$286.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$298.66
|
| Rate for Payer: PHCS All Commercial |
$248.89
|
| Rate for Payer: PHP All Commercial |
$251.67
|
| Rate for Payer: Sagamore Health Network All Products |
$256.19
|
| Rate for Payer: Signature Care EPO |
$275.43
|
| Rate for Payer: Signature Care PPO |
$292.03
|
| Rate for Payer: United Healthcare Commercial |
$261.50
|
|
|
HC FORENSIC DRUG URINE
|
Facility
OP
|
$474.36
|
|
| Hospital Charge Code |
63002222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.54 |
| Max. Negotiated Rate |
$441.16 |
| Rate for Payer: Aetna Commercial |
$400.36
|
| Rate for Payer: Aetna Medicare |
$156.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$156.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$272.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$296.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.19
|
| Rate for Payer: Cash Price |
$294.10
|
| Rate for Payer: Centivo All Commercial |
$241.92
|
| Rate for Payer: Cigna All Commercial |
$409.37
|
| Rate for Payer: CORVEL All Commercial |
$441.16
|
| Rate for Payer: Coventry All Commercial |
$417.44
|
| Rate for Payer: Encore All Commercial |
$436.65
|
| Rate for Payer: Frontpath All Commercial |
$436.41
|
| Rate for Payer: Humana ChoiceCare |
$409.71
|
| Rate for Payer: Humana Medicare |
$241.92
|
| Rate for Payer: Lucent All Commercial |
$241.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$426.93
|
| Rate for Payer: PHCS All Commercial |
$355.77
|
| Rate for Payer: PHP All Commercial |
$359.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.00
|
| Rate for Payer: Sagamore Health Network All Products |
$366.21
|
| Rate for Payer: Signature Care EPO |
$393.72
|
| Rate for Payer: Signature Care PPO |
$417.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$403.21
|
| Rate for Payer: United Healthcare Commercial |
$373.80
|
| Rate for Payer: United Healthcare Medicare |
$156.54
|
|
|
HC FORENSIC DRUG URINE
|
Facility
IP
|
$474.36
|
|
| Hospital Charge Code |
63002222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$355.77 |
| Max. Negotiated Rate |
$441.16 |
| Rate for Payer: Aetna Commercial |
$409.85
|
| Rate for Payer: Cash Price |
$294.10
|
| Rate for Payer: Cigna All Commercial |
$409.37
|
| Rate for Payer: CORVEL All Commercial |
$441.16
|
| Rate for Payer: Coventry All Commercial |
$417.44
|
| Rate for Payer: Encore All Commercial |
$436.65
|
| Rate for Payer: Frontpath All Commercial |
$436.41
|
| Rate for Payer: Humana ChoiceCare |
$409.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$426.93
|
| Rate for Payer: PHCS All Commercial |
$355.77
|
| Rate for Payer: PHP All Commercial |
$359.76
|
| Rate for Payer: Sagamore Health Network All Products |
$366.21
|
| Rate for Payer: Signature Care EPO |
$393.72
|
| Rate for Payer: Signature Care PPO |
$417.44
|
| Rate for Payer: United Healthcare Commercial |
$373.80
|
|
|
HC FREE T4
|
Facility
IP
|
$123.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.44 |
| Max. Negotiated Rate |
$114.63 |
| Rate for Payer: Aetna Commercial |
$106.49
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Cigna All Commercial |
$106.37
|
| Rate for Payer: CORVEL All Commercial |
$114.63
|
| Rate for Payer: Coventry All Commercial |
$108.47
|
| Rate for Payer: Encore All Commercial |
$113.46
|
| Rate for Payer: Frontpath All Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$106.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.93
|
| Rate for Payer: PHCS All Commercial |
$92.44
|
| Rate for Payer: PHP All Commercial |
$93.48
|
| Rate for Payer: Sagamore Health Network All Products |
$95.15
|
| Rate for Payer: Signature Care EPO |
$102.30
|
| Rate for Payer: Signature Care PPO |
$108.47
|
| Rate for Payer: United Healthcare Commercial |
$97.13
|
|
|
HC FREE T4
|
Facility
OP
|
$123.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$114.63 |
| Rate for Payer: Aetna Commercial |
$104.03
|
| Rate for Payer: Aetna Medicare |
$40.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.74
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Centivo All Commercial |
$62.86
|
| Rate for Payer: Cigna All Commercial |
$106.37
|
| Rate for Payer: CORVEL All Commercial |
$114.63
|
| Rate for Payer: Coventry All Commercial |
$108.47
|
| Rate for Payer: Encore All Commercial |
$113.46
|
| Rate for Payer: Frontpath All Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$106.46
|
| Rate for Payer: Humana Medicare |
$62.86
|
| Rate for Payer: Lucent All Commercial |
$62.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.93
|
| Rate for Payer: Managed Health Services Medicaid |
$9.02
|
| Rate for Payer: MDWise Medicaid |
$9.02
|
| Rate for Payer: PHCS All Commercial |
$92.44
|
| Rate for Payer: PHP All Commercial |
$93.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.07
|
| Rate for Payer: Sagamore Health Network All Products |
$95.15
|
| Rate for Payer: Signature Care EPO |
$102.30
|
| Rate for Payer: Signature Care PPO |
$108.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.77
|
| Rate for Payer: United Healthcare Commercial |
$97.13
|
| Rate for Payer: United Healthcare Medicare |
$40.67
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
OP
|
$307.63
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
01370151
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$286.10 |
| Rate for Payer: Aetna Commercial |
$259.64
|
| Rate for Payer: Aetna Medicare |
$101.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.67
|
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Centivo All Commercial |
$156.89
|
| Rate for Payer: Cigna All Commercial |
$265.49
|
| Rate for Payer: CORVEL All Commercial |
$286.10
|
| Rate for Payer: Coventry All Commercial |
$270.72
|
| Rate for Payer: Encore All Commercial |
$283.18
|
| Rate for Payer: Frontpath All Commercial |
$283.02
|
| Rate for Payer: Humana ChoiceCare |
$265.70
|
| Rate for Payer: Humana Medicare |
$156.89
|
| Rate for Payer: Lucent All Commercial |
$156.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.87
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$230.72
|
| Rate for Payer: PHP All Commercial |
$233.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.98
|
| Rate for Payer: Sagamore Health Network All Products |
$237.49
|
| Rate for Payer: Signature Care EPO |
$255.33
|
| Rate for Payer: Signature Care PPO |
$270.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.49
|
| Rate for Payer: United Healthcare Commercial |
$242.41
|
| Rate for Payer: United Healthcare Medicare |
$101.52
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
IP
|
$307.63
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
01370151
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$230.72 |
| Max. Negotiated Rate |
$286.10 |
| Rate for Payer: Aetna Commercial |
$265.79
|
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Cigna All Commercial |
$265.49
|
| Rate for Payer: CORVEL All Commercial |
$286.10
|
| Rate for Payer: Coventry All Commercial |
$270.72
|
| Rate for Payer: Encore All Commercial |
$283.18
|
| Rate for Payer: Frontpath All Commercial |
$283.02
|
| Rate for Payer: Humana ChoiceCare |
$265.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.87
|
| Rate for Payer: PHCS All Commercial |
$230.72
|
| Rate for Payer: PHP All Commercial |
$233.31
|
| Rate for Payer: Sagamore Health Network All Products |
$237.49
|
| Rate for Payer: Signature Care EPO |
$255.33
|
| Rate for Payer: Signature Care PPO |
$270.72
|
| Rate for Payer: United Healthcare Commercial |
$242.41
|
|
|
HC FROZEN SECTION PATH 1ST BLOCK
|
Facility
OP
|
$213.24
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
63001249
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.37 |
| Max. Negotiated Rate |
$248.94 |
| Rate for Payer: Aetna Commercial |
$179.98
|
| Rate for Payer: Aetna Medicare |
$70.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$248.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.41
|
| Rate for Payer: Cash Price |
$132.21
|
| Rate for Payer: Cash Price |
$132.21
|
| Rate for Payer: Centivo All Commercial |
$108.75
|
| Rate for Payer: Cigna All Commercial |
$184.03
|
| Rate for Payer: CORVEL All Commercial |
$198.31
|
| Rate for Payer: Coventry All Commercial |
$187.65
|
| Rate for Payer: Encore All Commercial |
$196.29
|
| Rate for Payer: Frontpath All Commercial |
$196.18
|
| Rate for Payer: Humana ChoiceCare |
$184.18
|
| Rate for Payer: Humana Medicare |
$108.75
|
| Rate for Payer: Lucent All Commercial |
$108.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.92
|
| Rate for Payer: Managed Health Services Medicaid |
$248.94
|
| Rate for Payer: MDWise Medicaid |
$248.94
|
| Rate for Payer: PHCS All Commercial |
$159.93
|
| Rate for Payer: PHP All Commercial |
$161.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.16
|
| Rate for Payer: Sagamore Health Network All Products |
$164.62
|
| Rate for Payer: Signature Care EPO |
$176.99
|
| Rate for Payer: Signature Care PPO |
$187.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$181.26
|
| Rate for Payer: United Healthcare Commercial |
$168.03
|
| Rate for Payer: United Healthcare Medicare |
$70.37
|
|
|
HC FROZEN SECTION PATH 1ST BLOCK
|
Facility
IP
|
$213.24
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
63001249
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$159.93 |
| Max. Negotiated Rate |
$198.31 |
| Rate for Payer: Aetna Commercial |
$184.24
|
| Rate for Payer: Cash Price |
$132.21
|
| Rate for Payer: Cigna All Commercial |
$184.03
|
| Rate for Payer: CORVEL All Commercial |
$198.31
|
| Rate for Payer: Coventry All Commercial |
$187.65
|
| Rate for Payer: Encore All Commercial |
$196.29
|
| Rate for Payer: Frontpath All Commercial |
$196.18
|
| Rate for Payer: Humana ChoiceCare |
$184.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.92
|
| Rate for Payer: PHCS All Commercial |
$159.93
|
| Rate for Payer: PHP All Commercial |
$161.72
|
| Rate for Payer: Sagamore Health Network All Products |
$164.62
|
| Rate for Payer: Signature Care EPO |
$176.99
|
| Rate for Payer: Signature Care PPO |
$187.65
|
| Rate for Payer: United Healthcare Commercial |
$168.03
|
|
|
HC FROZEN SECTION PATH 1ST BLOCK
|
Facility
IP
|
$169.46
|
|
|
Service Code
|
CPT 88331 59
|
| Hospital Charge Code |
63002186
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.10 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna Commercial |
$146.42
|
| Rate for Payer: Cash Price |
$105.07
|
| Rate for Payer: Cigna All Commercial |
$146.25
|
| Rate for Payer: CORVEL All Commercial |
$157.60
|
| Rate for Payer: Coventry All Commercial |
$149.13
|
| Rate for Payer: Encore All Commercial |
$155.99
|
| Rate for Payer: Frontpath All Commercial |
$155.91
|
| Rate for Payer: Humana ChoiceCare |
$146.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.52
|
| Rate for Payer: PHCS All Commercial |
$127.10
|
| Rate for Payer: PHP All Commercial |
$128.52
|
| Rate for Payer: Sagamore Health Network All Products |
$130.83
|
| Rate for Payer: Signature Care EPO |
$140.65
|
| Rate for Payer: Signature Care PPO |
$149.13
|
| Rate for Payer: United Healthcare Commercial |
$133.54
|
|
|
HC FROZEN SECTION PATH 1ST BLOCK
|
Facility
OP
|
$169.46
|
|
|
Service Code
|
CPT 88331 59
|
| Hospital Charge Code |
63002186
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna Commercial |
$143.03
|
| Rate for Payer: Aetna Medicare |
$55.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.51
|
| Rate for Payer: Cash Price |
$105.07
|
| Rate for Payer: Centivo All Commercial |
$86.43
|
| Rate for Payer: Cigna All Commercial |
$146.25
|
| Rate for Payer: CORVEL All Commercial |
$157.60
|
| Rate for Payer: Coventry All Commercial |
$149.13
|
| Rate for Payer: Encore All Commercial |
$155.99
|
| Rate for Payer: Frontpath All Commercial |
$155.91
|
| Rate for Payer: Humana ChoiceCare |
$146.37
|
| Rate for Payer: Humana Medicare |
$86.43
|
| Rate for Payer: Lucent All Commercial |
$86.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.52
|
| Rate for Payer: PHCS All Commercial |
$127.10
|
| Rate for Payer: PHP All Commercial |
$128.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.09
|
| Rate for Payer: Sagamore Health Network All Products |
$130.83
|
| Rate for Payer: Signature Care EPO |
$140.65
|
| Rate for Payer: Signature Care PPO |
$149.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.04
|
| Rate for Payer: United Healthcare Commercial |
$133.54
|
| Rate for Payer: United Healthcare Medicare |
$55.92
|
|
|
HC FROZEN SECTION PATH EA ADDTL
|
Facility
IP
|
$121.82
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
63001262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$91.36 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: Aetna Commercial |
$105.25
|
| Rate for Payer: Cash Price |
$75.53
|
| Rate for Payer: Cigna All Commercial |
$105.13
|
| Rate for Payer: CORVEL All Commercial |
$113.29
|
| Rate for Payer: Coventry All Commercial |
$107.20
|
| Rate for Payer: Encore All Commercial |
$112.13
|
| Rate for Payer: Frontpath All Commercial |
$112.07
|
| Rate for Payer: Humana ChoiceCare |
$105.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.64
|
| Rate for Payer: PHCS All Commercial |
$91.36
|
| Rate for Payer: PHP All Commercial |
$92.39
|
| Rate for Payer: Sagamore Health Network All Products |
$94.04
|
| Rate for Payer: Signature Care EPO |
$101.11
|
| Rate for Payer: Signature Care PPO |
$107.20
|
| Rate for Payer: United Healthcare Commercial |
$95.99
|
|
