|
HC GGTP
|
Facility
IP
|
$97.03
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
63001150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.77 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$83.84
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cigna All Commercial |
$83.74
|
| Rate for Payer: CORVEL All Commercial |
$90.24
|
| Rate for Payer: Coventry All Commercial |
$85.39
|
| Rate for Payer: Encore All Commercial |
$89.32
|
| Rate for Payer: Frontpath All Commercial |
$89.27
|
| Rate for Payer: Humana ChoiceCare |
$83.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.33
|
| Rate for Payer: PHCS All Commercial |
$72.77
|
| Rate for Payer: PHP All Commercial |
$73.59
|
| Rate for Payer: Sagamore Health Network All Products |
$74.91
|
| Rate for Payer: Signature Care EPO |
$80.54
|
| Rate for Payer: Signature Care PPO |
$85.39
|
| Rate for Payer: United Healthcare Commercial |
$76.46
|
|
|
HC GHB ACID - SERUM
|
Facility
OP
|
$300.14
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$279.13 |
| Rate for Payer: Aetna Commercial |
$253.31
|
| Rate for Payer: Aetna Medicare |
$99.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$137.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$137.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.95
|
| Rate for Payer: Cash Price |
$186.08
|
| Rate for Payer: Cash Price |
$186.08
|
| Rate for Payer: Centivo All Commercial |
$153.07
|
| Rate for Payer: Cigna All Commercial |
$259.02
|
| Rate for Payer: CORVEL All Commercial |
$279.13
|
| Rate for Payer: Coventry All Commercial |
$264.12
|
| Rate for Payer: Encore All Commercial |
$276.27
|
| Rate for Payer: Frontpath All Commercial |
$276.12
|
| Rate for Payer: Humana ChoiceCare |
$259.23
|
| Rate for Payer: Humana Medicare |
$153.07
|
| Rate for Payer: Lucent All Commercial |
$153.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.12
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$225.10
|
| Rate for Payer: PHP All Commercial |
$227.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.05
|
| Rate for Payer: Sagamore Health Network All Products |
$231.70
|
| Rate for Payer: Signature Care EPO |
$249.11
|
| Rate for Payer: Signature Care PPO |
$264.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$255.11
|
| Rate for Payer: United Healthcare Commercial |
$236.51
|
| Rate for Payer: United Healthcare Medicare |
$99.04
|
|
|
HC GHB ACID - SERUM
|
Facility
IP
|
$300.14
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$279.13 |
| Rate for Payer: Aetna Commercial |
$259.32
|
| Rate for Payer: Cash Price |
$186.08
|
| Rate for Payer: Cigna All Commercial |
$259.02
|
| Rate for Payer: CORVEL All Commercial |
$279.13
|
| Rate for Payer: Coventry All Commercial |
$264.12
|
| Rate for Payer: Encore All Commercial |
$276.27
|
| Rate for Payer: Frontpath All Commercial |
$276.12
|
| Rate for Payer: Humana ChoiceCare |
$259.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.12
|
| Rate for Payer: PHCS All Commercial |
$225.10
|
| Rate for Payer: PHP All Commercial |
$227.62
|
| Rate for Payer: Sagamore Health Network All Products |
$231.70
|
| Rate for Payer: Signature Care EPO |
$249.11
|
| Rate for Payer: Signature Care PPO |
$264.12
|
| Rate for Payer: United Healthcare Commercial |
$236.51
|
|
|
HC GHB ACID - URINE
|
Facility
OP
|
$314.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$265.57
|
| Rate for Payer: Aetna Medicare |
$103.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.22
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Centivo All Commercial |
$160.48
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Humana Medicare |
$160.48
|
| Rate for Payer: Lucent All Commercial |
$160.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$235.99
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.72
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.46
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$103.84
|
|
|
HC GHB ACID - URINE
|
Facility
IP
|
$314.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$235.99 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$271.87
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: PHCS All Commercial |
$235.99
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
HC GIARDIA AG
|
Facility
OP
|
$151.32
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
63001084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$140.72 |
| Rate for Payer: Aetna Commercial |
$127.71
|
| Rate for Payer: Aetna Medicare |
$49.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.93
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Centivo All Commercial |
$77.17
|
| Rate for Payer: Cigna All Commercial |
$130.59
|
| Rate for Payer: CORVEL All Commercial |
$140.72
|
| Rate for Payer: Coventry All Commercial |
$133.16
|
| Rate for Payer: Encore All Commercial |
$139.29
|
| Rate for Payer: Frontpath All Commercial |
$139.21
|
| Rate for Payer: Humana ChoiceCare |
$130.69
|
| Rate for Payer: Humana Medicare |
$77.17
|
| Rate for Payer: Lucent All Commercial |
$77.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.19
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$113.49
|
| Rate for Payer: PHP All Commercial |
$114.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.01
|
| Rate for Payer: Sagamore Health Network All Products |
$116.82
|
| Rate for Payer: Signature Care EPO |
$125.59
|
| Rate for Payer: Signature Care PPO |
$133.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.62
|
| Rate for Payer: United Healthcare Commercial |
$119.24
|
| Rate for Payer: United Healthcare Medicare |
$49.93
|
|
|
HC GIARDIA AG
|
Facility
IP
|
$151.32
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
63001084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$140.72 |
| Rate for Payer: Aetna Commercial |
$130.74
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cigna All Commercial |
$130.59
|
| Rate for Payer: CORVEL All Commercial |
$140.72
|
| Rate for Payer: Coventry All Commercial |
$133.16
|
| Rate for Payer: Encore All Commercial |
$139.29
|
| Rate for Payer: Frontpath All Commercial |
$139.21
|
| Rate for Payer: Humana ChoiceCare |
$130.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.19
|
| Rate for Payer: PHCS All Commercial |
$113.49
|
| Rate for Payer: PHP All Commercial |
$114.76
|
| Rate for Payer: Sagamore Health Network All Products |
$116.82
|
| Rate for Payer: Signature Care EPO |
$125.59
|
| Rate for Payer: Signature Care PPO |
$133.16
|
| Rate for Payer: United Healthcare Commercial |
$119.24
|
|
|
HC GI BLEEDING
|
Facility
IP
|
$1,497.93
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
01638460
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,123.45 |
| Max. Negotiated Rate |
$1,393.08 |
| Rate for Payer: Aetna Commercial |
$1,294.21
|
| Rate for Payer: Cash Price |
$928.72
|
| Rate for Payer: Cigna All Commercial |
$1,292.71
|
| Rate for Payer: CORVEL All Commercial |
$1,393.08
|
| Rate for Payer: Coventry All Commercial |
$1,318.18
|
| Rate for Payer: Encore All Commercial |
$1,378.85
|
| Rate for Payer: Frontpath All Commercial |
$1,378.10
|
| Rate for Payer: Humana ChoiceCare |
$1,293.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,348.14
|
| Rate for Payer: PHCS All Commercial |
$1,123.45
|
| Rate for Payer: PHP All Commercial |
$1,136.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.40
|
| Rate for Payer: Signature Care EPO |
$1,243.28
|
| Rate for Payer: Signature Care PPO |
$1,318.18
|
| Rate for Payer: United Healthcare Commercial |
$1,180.37
|
|
|
HC GI BLEEDING
|
Facility
OP
|
$1,497.93
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
01638460
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$494.32 |
| Max. Negotiated Rate |
$1,393.08 |
| Rate for Payer: Aetna Commercial |
$1,264.25
|
| Rate for Payer: Aetna Medicare |
$494.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$494.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$860.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$936.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$826.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$568.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.75
|
| Rate for Payer: Cash Price |
$928.72
|
| Rate for Payer: Cash Price |
$928.72
|
| Rate for Payer: Centivo All Commercial |
$763.94
|
| Rate for Payer: Cigna All Commercial |
$1,292.71
|
| Rate for Payer: CORVEL All Commercial |
$1,393.08
|
| Rate for Payer: Coventry All Commercial |
$1,318.18
|
| Rate for Payer: Encore All Commercial |
$1,378.85
|
| Rate for Payer: Frontpath All Commercial |
$1,378.10
|
| Rate for Payer: Humana ChoiceCare |
$1,293.76
|
| Rate for Payer: Humana Medicare |
$763.94
|
| Rate for Payer: Lucent All Commercial |
$763.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,348.14
|
| Rate for Payer: Managed Health Services Medicaid |
$826.96
|
| Rate for Payer: MDWise Medicaid |
$826.96
|
| Rate for Payer: PHCS All Commercial |
$1,123.45
|
| Rate for Payer: PHP All Commercial |
$1,136.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$584.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.40
|
| Rate for Payer: Signature Care EPO |
$1,243.28
|
| Rate for Payer: Signature Care PPO |
$1,318.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,273.24
|
| Rate for Payer: United Healthcare Commercial |
$1,180.37
|
| Rate for Payer: United Healthcare Medicare |
$494.32
|
|
|
HC GLIADIN IGA
|
Facility
IP
|
$130.86
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63001581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC GLIADIN IGA
|
Facility
OP
|
$130.86
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63001581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC GLIADIN IGA & IGG
|
Facility
OP
|
$183.05
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63002190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$170.24 |
| Rate for Payer: Aetna Commercial |
$154.49
|
| Rate for Payer: Aetna Medicare |
$60.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.45
|
| Rate for Payer: Cash Price |
$113.49
|
| Rate for Payer: Cash Price |
$113.49
|
| Rate for Payer: Centivo All Commercial |
$93.36
|
| Rate for Payer: Cigna All Commercial |
$157.97
|
| Rate for Payer: CORVEL All Commercial |
$170.24
|
| Rate for Payer: Coventry All Commercial |
$161.08
|
| Rate for Payer: Encore All Commercial |
$168.50
|
| Rate for Payer: Frontpath All Commercial |
$168.41
|
| Rate for Payer: Humana ChoiceCare |
$158.10
|
| Rate for Payer: Humana Medicare |
$93.36
|
| Rate for Payer: Lucent All Commercial |
$93.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.74
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$137.29
|
| Rate for Payer: PHP All Commercial |
$138.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.39
|
| Rate for Payer: Sagamore Health Network All Products |
$141.31
|
| Rate for Payer: Signature Care EPO |
$151.93
|
| Rate for Payer: Signature Care PPO |
$161.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155.59
|
| Rate for Payer: United Healthcare Commercial |
$144.24
|
| Rate for Payer: United Healthcare Medicare |
$60.41
|
|
|
HC GLIADIN IGA & IGG
|
Facility
IP
|
$183.05
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63002190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.29 |
| Max. Negotiated Rate |
$170.24 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Cash Price |
$113.49
|
| Rate for Payer: Cigna All Commercial |
$157.97
|
| Rate for Payer: CORVEL All Commercial |
$170.24
|
| Rate for Payer: Coventry All Commercial |
$161.08
|
| Rate for Payer: Encore All Commercial |
$168.50
|
| Rate for Payer: Frontpath All Commercial |
$168.41
|
| Rate for Payer: Humana ChoiceCare |
$158.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.74
|
| Rate for Payer: PHCS All Commercial |
$137.29
|
| Rate for Payer: PHP All Commercial |
$138.82
|
| Rate for Payer: Sagamore Health Network All Products |
$141.31
|
| Rate for Payer: Signature Care EPO |
$151.93
|
| Rate for Payer: Signature Care PPO |
$161.08
|
| Rate for Payer: United Healthcare Commercial |
$144.24
|
|
|
HC GLIADIN IGG
|
Facility
IP
|
$130.86
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC GLIADIN IGG
|
Facility
OP
|
$130.86
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC GLIDESCOPE VIDEO LOPRO S1
|
Facility
OP
|
$334.88
|
|
| Hospital Charge Code |
41607722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.51 |
| Max. Negotiated Rate |
$311.44 |
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Aetna Medicare |
$110.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$192.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$209.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.56
|
| Rate for Payer: Cash Price |
$207.63
|
| Rate for Payer: Cash Price |
$207.63
|
| Rate for Payer: Centivo All Commercial |
$170.79
|
| Rate for Payer: Cigna All Commercial |
$289.00
|
| Rate for Payer: CORVEL All Commercial |
$311.44
|
| Rate for Payer: Coventry All Commercial |
$294.69
|
| Rate for Payer: Encore All Commercial |
$308.26
|
| Rate for Payer: Frontpath All Commercial |
$308.09
|
| Rate for Payer: Humana ChoiceCare |
$289.24
|
| Rate for Payer: Humana Medicare |
$170.79
|
| Rate for Payer: Lucent All Commercial |
$170.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$251.16
|
| Rate for Payer: PHP All Commercial |
$253.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.60
|
| Rate for Payer: Sagamore Health Network All Products |
$258.53
|
| Rate for Payer: Signature Care EPO |
$277.95
|
| Rate for Payer: Signature Care PPO |
$294.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$284.65
|
| Rate for Payer: United Healthcare Commercial |
$263.89
|
| Rate for Payer: United Healthcare Medicare |
$110.51
|
|
|
HC GLIDESCOPE VIDEO LOPRO S1
|
Facility
IP
|
$334.88
|
|
| Hospital Charge Code |
41607722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$311.44 |
| Rate for Payer: Aetna Commercial |
$289.34
|
| Rate for Payer: Cash Price |
$207.63
|
| Rate for Payer: Cigna All Commercial |
$289.00
|
| Rate for Payer: CORVEL All Commercial |
$311.44
|
| Rate for Payer: Coventry All Commercial |
$294.69
|
| Rate for Payer: Encore All Commercial |
$308.26
|
| Rate for Payer: Frontpath All Commercial |
$308.09
|
| Rate for Payer: Humana ChoiceCare |
$289.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.39
|
| Rate for Payer: PHCS All Commercial |
$251.16
|
| Rate for Payer: PHP All Commercial |
$253.97
|
| Rate for Payer: Sagamore Health Network All Products |
$258.53
|
| Rate for Payer: Signature Care EPO |
$277.95
|
| Rate for Payer: Signature Care PPO |
$294.69
|
| Rate for Payer: United Healthcare Commercial |
$263.89
|
|
|
HC GLIDESCOPE VIDEO LOPRO S2
|
Facility
IP
|
$334.88
|
|
| Hospital Charge Code |
41607723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$311.44 |
| Rate for Payer: Aetna Commercial |
$289.34
|
| Rate for Payer: Cash Price |
$207.63
|
| Rate for Payer: Cigna All Commercial |
$289.00
|
| Rate for Payer: CORVEL All Commercial |
$311.44
|
| Rate for Payer: Coventry All Commercial |
$294.69
|
| Rate for Payer: Encore All Commercial |
$308.26
|
| Rate for Payer: Frontpath All Commercial |
$308.09
|
| Rate for Payer: Humana ChoiceCare |
$289.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.39
|
| Rate for Payer: PHCS All Commercial |
$251.16
|
| Rate for Payer: PHP All Commercial |
$253.97
|
| Rate for Payer: Sagamore Health Network All Products |
$258.53
|
| Rate for Payer: Signature Care EPO |
$277.95
|
| Rate for Payer: Signature Care PPO |
$294.69
|
| Rate for Payer: United Healthcare Commercial |
$263.89
|
|
|
HC GLIDESCOPE VIDEO LOPRO S2
|
Facility
OP
|
$334.88
|
|
| Hospital Charge Code |
41607723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.51 |
| Max. Negotiated Rate |
$311.44 |
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Aetna Medicare |
$110.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$192.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$209.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.56
|
| Rate for Payer: Cash Price |
$207.63
|
| Rate for Payer: Cash Price |
$207.63
|
| Rate for Payer: Centivo All Commercial |
$170.79
|
| Rate for Payer: Cigna All Commercial |
$289.00
|
| Rate for Payer: CORVEL All Commercial |
$311.44
|
| Rate for Payer: Coventry All Commercial |
$294.69
|
| Rate for Payer: Encore All Commercial |
$308.26
|
| Rate for Payer: Frontpath All Commercial |
$308.09
|
| Rate for Payer: Humana ChoiceCare |
$289.24
|
| Rate for Payer: Humana Medicare |
$170.79
|
| Rate for Payer: Lucent All Commercial |
$170.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$251.16
|
| Rate for Payer: PHP All Commercial |
$253.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.60
|
| Rate for Payer: Sagamore Health Network All Products |
$258.53
|
| Rate for Payer: Signature Care EPO |
$277.95
|
| Rate for Payer: Signature Care PPO |
$294.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$284.65
|
| Rate for Payer: United Healthcare Commercial |
$263.89
|
| Rate for Payer: United Healthcare Medicare |
$110.51
|
|
|
HC GLIDEWIRE 0.35 180CM ANGLE TIP
|
Facility
OP
|
$302.40
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.79 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$255.23
|
| Rate for Payer: Aetna Medicare |
$99.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$173.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.77
|
| Rate for Payer: Cash Price |
$187.49
|
| Rate for Payer: Cash Price |
$187.49
|
| Rate for Payer: Centivo All Commercial |
$154.22
|
| Rate for Payer: Cigna All Commercial |
$260.97
|
| Rate for Payer: CORVEL All Commercial |
$281.23
|
| Rate for Payer: Coventry All Commercial |
$266.11
|
| Rate for Payer: Encore All Commercial |
$278.36
|
| Rate for Payer: Frontpath All Commercial |
$278.21
|
| Rate for Payer: Humana ChoiceCare |
$261.18
|
| Rate for Payer: Humana Medicare |
$154.22
|
| Rate for Payer: Lucent All Commercial |
$154.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$272.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$226.80
|
| Rate for Payer: PHP All Commercial |
$229.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.94
|
| Rate for Payer: Sagamore Health Network All Products |
$233.45
|
| Rate for Payer: Signature Care EPO |
$250.99
|
| Rate for Payer: Signature Care PPO |
$266.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$238.29
|
| Rate for Payer: United Healthcare Medicare |
$99.79
|
|
|
HC GLIDEWIRE 0.35 180CM ANGLE TIP
|
Facility
IP
|
$302.40
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$261.27
|
| Rate for Payer: Cash Price |
$187.49
|
| Rate for Payer: Cigna All Commercial |
$260.97
|
| Rate for Payer: CORVEL All Commercial |
$281.23
|
| Rate for Payer: Coventry All Commercial |
$266.11
|
| Rate for Payer: Encore All Commercial |
$278.36
|
| Rate for Payer: Frontpath All Commercial |
$278.21
|
| Rate for Payer: Humana ChoiceCare |
$261.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$272.16
|
| Rate for Payer: PHCS All Commercial |
$226.80
|
| Rate for Payer: PHP All Commercial |
$229.34
|
| Rate for Payer: Sagamore Health Network All Products |
$233.45
|
| Rate for Payer: Signature Care EPO |
$250.99
|
| Rate for Payer: Signature Care PPO |
$266.11
|
| Rate for Payer: United Healthcare Commercial |
$238.29
|
|
|
HC GLOVE ISOTONER ARM FULL
|
Facility
IP
|
$50.54
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603871
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$43.67
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cigna All Commercial |
$43.62
|
| Rate for Payer: CORVEL All Commercial |
$47.00
|
| Rate for Payer: Coventry All Commercial |
$44.48
|
| Rate for Payer: Encore All Commercial |
$46.52
|
| Rate for Payer: Frontpath All Commercial |
$46.50
|
| Rate for Payer: Humana ChoiceCare |
$43.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.49
|
| Rate for Payer: PHCS All Commercial |
$37.90
|
| Rate for Payer: PHP All Commercial |
$38.33
|
| Rate for Payer: Sagamore Health Network All Products |
$39.02
|
| Rate for Payer: Signature Care EPO |
$41.95
|
| Rate for Payer: Signature Care PPO |
$44.48
|
| Rate for Payer: United Healthcare Commercial |
$39.83
|
|
|
HC GLOVE ISOTONER ARM FULL
|
Facility
OP
|
$50.54
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603871
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.66
|
| Rate for Payer: Aetna Medicare |
$16.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.35
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Centivo All Commercial |
$25.78
|
| Rate for Payer: Cigna All Commercial |
$43.62
|
| Rate for Payer: CORVEL All Commercial |
$47.00
|
| Rate for Payer: Coventry All Commercial |
$44.48
|
| Rate for Payer: Encore All Commercial |
$46.52
|
| Rate for Payer: Frontpath All Commercial |
$46.50
|
| Rate for Payer: Humana ChoiceCare |
$43.65
|
| Rate for Payer: Humana Medicare |
$25.78
|
| Rate for Payer: Lucent All Commercial |
$25.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.49
|
| Rate for Payer: PHCS All Commercial |
$37.90
|
| Rate for Payer: PHP All Commercial |
$38.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.71
|
| Rate for Payer: Sagamore Health Network All Products |
$39.02
|
| Rate for Payer: Signature Care EPO |
$41.95
|
| Rate for Payer: Signature Care PPO |
$44.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.96
|
| Rate for Payer: United Healthcare Commercial |
$39.83
|
| Rate for Payer: United Healthcare Medicare |
$16.68
|
|
|
HC GLOVE ISOTONER LT/L
|
Facility
OP
|
$41.79
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Centivo All Commercial |
$21.31
|
| Rate for Payer: Cigna All Commercial |
$36.06
|
| Rate for Payer: CORVEL All Commercial |
$38.86
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.47
|
| Rate for Payer: Frontpath All Commercial |
$38.45
|
| Rate for Payer: Humana ChoiceCare |
$36.09
|
| Rate for Payer: Humana Medicare |
$21.31
|
| Rate for Payer: Lucent All Commercial |
$21.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.61
|
| Rate for Payer: PHCS All Commercial |
$31.34
|
| Rate for Payer: PHP All Commercial |
$31.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.26
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.52
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC GLOVE ISOTONER LT/L
|
Facility
IP
|
$41.79
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41603873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$36.11
|
| Rate for Payer: Cash Price |
$25.91
|
| Rate for Payer: Cigna All Commercial |
$36.06
|
| Rate for Payer: CORVEL All Commercial |
$38.86
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.47
|
| Rate for Payer: Frontpath All Commercial |
$38.45
|
| Rate for Payer: Humana ChoiceCare |
$36.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.61
|
| Rate for Payer: PHCS All Commercial |
$31.34
|
| Rate for Payer: PHP All Commercial |
$31.69
|
| Rate for Payer: Sagamore Health Network All Products |
$32.26
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
|
