|
HC EYE - CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001988
|
|
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 |
$69.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.82
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Centivo All Commercial |
$118.72
|
| 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 |
$69.84
|
| Rate for Payer: Lucent All Commercial |
$118.72
|
| 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 |
$69.84
|
|
|
HC EYE - CULTURE
|
Facility
|
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001988
|
|
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 |
$130.94
|
| 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 FACTOR II ACTIVITY
|
Facility
|
OP
|
$212.71
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
63001732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$197.82 |
| Rate for Payer: Aetna Commercial |
$179.53
|
| Rate for Payer: Aetna Medicare |
$68.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.87
|
| Rate for Payer: Cash Price |
$127.63
|
| Rate for Payer: Cash Price |
$127.63
|
| Rate for Payer: Centivo All Commercial |
$115.71
|
| Rate for Payer: Cigna All Commercial |
$183.57
|
| Rate for Payer: CORVEL All Commercial |
$197.82
|
| Rate for Payer: Coventry All Commercial |
$187.18
|
| Rate for Payer: Encore All Commercial |
$195.80
|
| Rate for Payer: Frontpath All Commercial |
$195.69
|
| Rate for Payer: Humana ChoiceCare |
$183.72
|
| Rate for Payer: Humana Medicare |
$68.07
|
| Rate for Payer: Lucent All Commercial |
$115.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.44
|
| Rate for Payer: Managed Health Services Medicaid |
$12.98
|
| Rate for Payer: MDWise Medicaid |
$12.98
|
| Rate for Payer: PHCS All Commercial |
$159.53
|
| Rate for Payer: PHP All Commercial |
$161.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.96
|
| Rate for Payer: Sagamore Health Network All Products |
$164.21
|
| Rate for Payer: Signature Care EPO |
$176.55
|
| Rate for Payer: Signature Care PPO |
$187.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.80
|
| Rate for Payer: United Healthcare Commercial |
$167.62
|
| Rate for Payer: United Healthcare Medicare |
$68.07
|
|
|
HC FACTOR II ACTIVITY
|
Facility
|
IP
|
$212.71
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
63001732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.53 |
| Max. Negotiated Rate |
$197.82 |
| Rate for Payer: Aetna Commercial |
$183.78
|
| Rate for Payer: Cash Price |
$127.63
|
| Rate for Payer: Cigna All Commercial |
$183.57
|
| Rate for Payer: CORVEL All Commercial |
$197.82
|
| Rate for Payer: Coventry All Commercial |
$187.18
|
| Rate for Payer: Encore All Commercial |
$195.80
|
| Rate for Payer: Frontpath All Commercial |
$195.69
|
| Rate for Payer: Humana ChoiceCare |
$183.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.44
|
| Rate for Payer: PHCS All Commercial |
$159.53
|
| Rate for Payer: PHP All Commercial |
$161.32
|
| Rate for Payer: Sagamore Health Network All Products |
$164.21
|
| Rate for Payer: Signature Care EPO |
$176.55
|
| Rate for Payer: Signature Care PPO |
$187.18
|
| Rate for Payer: United Healthcare Commercial |
$167.62
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
IP
|
$257.43
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
63001733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.07 |
| Max. Negotiated Rate |
$239.41 |
| Rate for Payer: Aetna Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cigna All Commercial |
$222.16
|
| Rate for Payer: CORVEL All Commercial |
$239.41
|
| Rate for Payer: Coventry All Commercial |
$226.54
|
| Rate for Payer: Encore All Commercial |
$236.96
|
| Rate for Payer: Frontpath All Commercial |
$236.84
|
| Rate for Payer: Humana ChoiceCare |
$222.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.69
|
| Rate for Payer: PHCS All Commercial |
$193.07
|
| Rate for Payer: PHP All Commercial |
$195.23
|
| Rate for Payer: Sagamore Health Network All Products |
$198.74
|
| Rate for Payer: Signature Care EPO |
$213.67
|
| Rate for Payer: Signature Care PPO |
$226.54
|
| Rate for Payer: United Healthcare Commercial |
$202.85
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
OP
|
$257.43
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
63001733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$239.41 |
| Rate for Payer: Aetna Commercial |
$217.27
|
| Rate for Payer: Aetna Medicare |
$82.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.62
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Centivo All Commercial |
$140.04
|
| Rate for Payer: Cigna All Commercial |
$222.16
|
| Rate for Payer: CORVEL All Commercial |
$239.41
|
| Rate for Payer: Coventry All Commercial |
$226.54
|
| Rate for Payer: Encore All Commercial |
$236.96
|
| Rate for Payer: Frontpath All Commercial |
$236.84
|
| Rate for Payer: Humana ChoiceCare |
$222.34
|
| Rate for Payer: Humana Medicare |
$82.38
|
| Rate for Payer: Lucent All Commercial |
$140.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.69
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$193.07
|
| Rate for Payer: PHP All Commercial |
$195.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.40
|
| Rate for Payer: Sagamore Health Network All Products |
$198.74
|
| Rate for Payer: Signature Care EPO |
$213.67
|
| Rate for Payer: Signature Care PPO |
$226.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$218.82
|
| Rate for Payer: United Healthcare Commercial |
$202.85
|
| Rate for Payer: United Healthcare Medicare |
$82.38
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$267.73
|
| Rate for Payer: Cash Price |
$185.92
|
| Rate for Payer: Cigna All Commercial |
$267.42
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.69
|
| Rate for Payer: Encore All Commercial |
$285.24
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.01
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.69
|
| Rate for Payer: United Healthcare Commercial |
$244.18
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$261.53
|
| Rate for Payer: Aetna Medicare |
$99.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$142.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.07
|
| Rate for Payer: Cash Price |
$185.92
|
| Rate for Payer: Cash Price |
$185.92
|
| Rate for Payer: Centivo All Commercial |
$168.57
|
| Rate for Payer: Cigna All Commercial |
$267.42
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.69
|
| Rate for Payer: Encore All Commercial |
$285.24
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Humana Medicare |
$99.16
|
| Rate for Payer: Lucent All Commercial |
$168.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.85
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263.39
|
| Rate for Payer: United Healthcare Commercial |
$244.18
|
| Rate for Payer: United Healthcare Medicare |
$99.16
|
|
|
HC FACTOR V LEIDEN GENE ANALYSIS
|
Facility
|
IP
|
$940.75
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
63001145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$705.56 |
| Max. Negotiated Rate |
$874.90 |
| Rate for Payer: Aetna Commercial |
$812.81
|
| Rate for Payer: Cash Price |
$564.45
|
| Rate for Payer: Cigna All Commercial |
$811.87
|
| Rate for Payer: CORVEL All Commercial |
$874.90
|
| Rate for Payer: Coventry All Commercial |
$827.86
|
| Rate for Payer: Encore All Commercial |
$865.96
|
| Rate for Payer: Frontpath All Commercial |
$865.49
|
| Rate for Payer: Humana ChoiceCare |
$812.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$846.67
|
| Rate for Payer: PHCS All Commercial |
$705.56
|
| Rate for Payer: PHP All Commercial |
$713.46
|
| Rate for Payer: Sagamore Health Network All Products |
$726.26
|
| Rate for Payer: Signature Care EPO |
$780.82
|
| Rate for Payer: Signature Care PPO |
$827.86
|
| Rate for Payer: United Healthcare Commercial |
$741.31
|
|
|
HC FACTOR V LEIDEN GENE ANALYSIS
|
Facility
|
OP
|
$940.75
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
63001145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$874.90 |
| Rate for Payer: Aetna Commercial |
$793.99
|
| Rate for Payer: Aetna Medicare |
$301.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$432.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$432.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.14
|
| Rate for Payer: Cash Price |
$564.45
|
| Rate for Payer: Cash Price |
$564.45
|
| Rate for Payer: Centivo All Commercial |
$511.77
|
| Rate for Payer: Cigna All Commercial |
$811.87
|
| Rate for Payer: CORVEL All Commercial |
$874.90
|
| Rate for Payer: Coventry All Commercial |
$827.86
|
| Rate for Payer: Encore All Commercial |
$865.96
|
| Rate for Payer: Frontpath All Commercial |
$865.49
|
| Rate for Payer: Humana ChoiceCare |
$812.53
|
| Rate for Payer: Humana Medicare |
$301.04
|
| Rate for Payer: Lucent All Commercial |
$511.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$846.67
|
| Rate for Payer: Managed Health Services Medicaid |
$73.37
|
| Rate for Payer: MDWise Medicaid |
$73.37
|
| Rate for Payer: PHCS All Commercial |
$705.56
|
| Rate for Payer: PHP All Commercial |
$713.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$366.89
|
| Rate for Payer: Sagamore Health Network All Products |
$726.26
|
| Rate for Payer: Signature Care EPO |
$780.82
|
| Rate for Payer: Signature Care PPO |
$827.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$799.64
|
| Rate for Payer: United Healthcare Commercial |
$741.31
|
| Rate for Payer: United Healthcare Medicare |
$301.04
|
|
|
HC FACTOR X ACTIVITY
|
Facility
|
IP
|
$580.60
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
63001738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$435.45 |
| Max. Negotiated Rate |
$539.96 |
| Rate for Payer: Aetna Commercial |
$501.64
|
| Rate for Payer: Cash Price |
$348.36
|
| Rate for Payer: Cigna All Commercial |
$501.06
|
| Rate for Payer: CORVEL All Commercial |
$539.96
|
| Rate for Payer: Coventry All Commercial |
$510.93
|
| Rate for Payer: Encore All Commercial |
$534.44
|
| Rate for Payer: Frontpath All Commercial |
$534.15
|
| Rate for Payer: Humana ChoiceCare |
$501.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.54
|
| Rate for Payer: PHCS All Commercial |
$435.45
|
| Rate for Payer: PHP All Commercial |
$440.33
|
| Rate for Payer: Sagamore Health Network All Products |
$448.22
|
| Rate for Payer: Signature Care EPO |
$481.90
|
| Rate for Payer: Signature Care PPO |
$510.93
|
| Rate for Payer: United Healthcare Commercial |
$457.51
|
|
|
HC FACTOR X ACTIVITY
|
Facility
|
OP
|
$580.60
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
63001738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$539.96 |
| Rate for Payer: Aetna Commercial |
$490.03
|
| Rate for Payer: Aetna Medicare |
$185.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$266.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$266.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.37
|
| Rate for Payer: Cash Price |
$348.36
|
| Rate for Payer: Cash Price |
$348.36
|
| Rate for Payer: Centivo All Commercial |
$315.85
|
| Rate for Payer: Cigna All Commercial |
$501.06
|
| Rate for Payer: CORVEL All Commercial |
$539.96
|
| Rate for Payer: Coventry All Commercial |
$510.93
|
| Rate for Payer: Encore All Commercial |
$534.44
|
| Rate for Payer: Frontpath All Commercial |
$534.15
|
| Rate for Payer: Humana ChoiceCare |
$501.46
|
| Rate for Payer: Humana Medicare |
$185.79
|
| Rate for Payer: Lucent All Commercial |
$315.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.54
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$435.45
|
| Rate for Payer: PHP All Commercial |
$440.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.43
|
| Rate for Payer: Sagamore Health Network All Products |
$448.22
|
| Rate for Payer: Signature Care EPO |
$481.90
|
| Rate for Payer: Signature Care PPO |
$510.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$493.51
|
| Rate for Payer: United Healthcare Commercial |
$457.51
|
| Rate for Payer: United Healthcare Medicare |
$185.79
|
|
|
HC FASTLOAD DUAL SYRINGE SP PACK
|
Facility
|
OP
|
$99.54
|
|
| Hospital Charge Code |
41601351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$92.57 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$31.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$57.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.04
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Centivo All Commercial |
$54.15
|
| Rate for Payer: Cigna All Commercial |
$85.90
|
| Rate for Payer: CORVEL All Commercial |
$92.57
|
| Rate for Payer: Coventry All Commercial |
$87.60
|
| Rate for Payer: Encore All Commercial |
$91.63
|
| Rate for Payer: Frontpath All Commercial |
$91.58
|
| Rate for Payer: Humana ChoiceCare |
$85.97
|
| Rate for Payer: Humana Medicare |
$31.85
|
| Rate for Payer: Lucent All Commercial |
$54.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.59
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$74.66
|
| Rate for Payer: PHP All Commercial |
$75.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.82
|
| Rate for Payer: Sagamore Health Network All Products |
$76.84
|
| Rate for Payer: Signature Care EPO |
$82.62
|
| Rate for Payer: Signature Care PPO |
$87.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.61
|
| Rate for Payer: United Healthcare Commercial |
$78.44
|
| Rate for Payer: United Healthcare Medicare |
$31.85
|
|
|
HC FASTLOAD DUAL SYRINGE SP PACK
|
Facility
|
IP
|
$99.54
|
|
| Hospital Charge Code |
41601351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$92.57 |
| Rate for Payer: Aetna Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Cigna All Commercial |
$85.90
|
| Rate for Payer: CORVEL All Commercial |
$92.57
|
| Rate for Payer: Coventry All Commercial |
$87.60
|
| Rate for Payer: Encore All Commercial |
$91.63
|
| Rate for Payer: Frontpath All Commercial |
$91.58
|
| Rate for Payer: Humana ChoiceCare |
$85.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.59
|
| Rate for Payer: PHCS All Commercial |
$74.66
|
| Rate for Payer: PHP All Commercial |
$75.49
|
| Rate for Payer: Sagamore Health Network All Products |
$76.84
|
| Rate for Payer: Signature Care EPO |
$82.62
|
| Rate for Payer: Signature Care PPO |
$87.60
|
| Rate for Payer: United Healthcare Commercial |
$78.44
|
|
|
HC FECAL FAT, QUALITATIVE
|
Facility
|
OP
|
$105.92
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
63044044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$98.51 |
| Rate for Payer: Aetna Commercial |
$89.40
|
| Rate for Payer: Aetna Medicare |
$33.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.28
|
| Rate for Payer: Cash Price |
$63.55
|
| Rate for Payer: Cash Price |
$63.55
|
| Rate for Payer: Centivo All Commercial |
$57.62
|
| Rate for Payer: Cigna All Commercial |
$91.41
|
| Rate for Payer: CORVEL All Commercial |
$98.51
|
| Rate for Payer: Coventry All Commercial |
$93.21
|
| Rate for Payer: Encore All Commercial |
$97.50
|
| Rate for Payer: Frontpath All Commercial |
$97.45
|
| Rate for Payer: Humana ChoiceCare |
$91.48
|
| Rate for Payer: Humana Medicare |
$33.89
|
| Rate for Payer: Lucent All Commercial |
$57.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.33
|
| Rate for Payer: Managed Health Services Medicaid |
$5.10
|
| Rate for Payer: MDWise Medicaid |
$5.10
|
| Rate for Payer: PHCS All Commercial |
$79.44
|
| Rate for Payer: PHP All Commercial |
$80.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.31
|
| Rate for Payer: Sagamore Health Network All Products |
$81.77
|
| Rate for Payer: Signature Care EPO |
$87.91
|
| Rate for Payer: Signature Care PPO |
$93.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.03
|
| Rate for Payer: United Healthcare Commercial |
$83.46
|
| Rate for Payer: United Healthcare Medicare |
$33.89
|
|
|
HC FECAL FAT, QUALITATIVE
|
Facility
|
IP
|
$105.92
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
63044044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$98.51 |
| Rate for Payer: Aetna Commercial |
$91.51
|
| Rate for Payer: Cash Price |
$63.55
|
| Rate for Payer: Cigna All Commercial |
$91.41
|
| Rate for Payer: CORVEL All Commercial |
$98.51
|
| Rate for Payer: Coventry All Commercial |
$93.21
|
| Rate for Payer: Encore All Commercial |
$97.50
|
| Rate for Payer: Frontpath All Commercial |
$97.45
|
| Rate for Payer: Humana ChoiceCare |
$91.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.33
|
| Rate for Payer: PHCS All Commercial |
$79.44
|
| Rate for Payer: PHP All Commercial |
$80.33
|
| Rate for Payer: Sagamore Health Network All Products |
$81.77
|
| Rate for Payer: Signature Care EPO |
$87.91
|
| Rate for Payer: Signature Care PPO |
$93.21
|
| Rate for Payer: United Healthcare Commercial |
$83.46
|
|
|
HC FENTANYL MS UR
|
Facility
|
IP
|
$227.30
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$211.39 |
| Rate for Payer: Aetna Commercial |
$196.39
|
| Rate for Payer: Cash Price |
$136.38
|
| Rate for Payer: Cigna All Commercial |
$196.16
|
| Rate for Payer: CORVEL All Commercial |
$211.39
|
| Rate for Payer: Coventry All Commercial |
$200.02
|
| Rate for Payer: Encore All Commercial |
$209.23
|
| Rate for Payer: Frontpath All Commercial |
$209.12
|
| Rate for Payer: Humana ChoiceCare |
$196.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.57
|
| Rate for Payer: PHCS All Commercial |
$170.47
|
| Rate for Payer: PHP All Commercial |
$172.38
|
| Rate for Payer: Sagamore Health Network All Products |
$175.48
|
| Rate for Payer: Signature Care EPO |
$188.66
|
| Rate for Payer: Signature Care PPO |
$200.02
|
| Rate for Payer: United Healthcare Commercial |
$179.11
|
|
|
HC FENTANYL MS UR
|
Facility
|
OP
|
$227.30
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$211.39 |
| Rate for Payer: Aetna Commercial |
$191.84
|
| Rate for Payer: Aetna Medicare |
$72.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$104.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.01
|
| Rate for Payer: Cash Price |
$136.38
|
| Rate for Payer: Cash Price |
$136.38
|
| Rate for Payer: Centivo All Commercial |
$123.65
|
| Rate for Payer: Cigna All Commercial |
$196.16
|
| Rate for Payer: CORVEL All Commercial |
$211.39
|
| Rate for Payer: Coventry All Commercial |
$200.02
|
| Rate for Payer: Encore All Commercial |
$209.23
|
| Rate for Payer: Frontpath All Commercial |
$209.12
|
| Rate for Payer: Humana ChoiceCare |
$196.32
|
| Rate for Payer: Humana Medicare |
$72.74
|
| Rate for Payer: Lucent All Commercial |
$123.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.57
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$170.47
|
| Rate for Payer: PHP All Commercial |
$172.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.65
|
| Rate for Payer: Sagamore Health Network All Products |
$175.48
|
| Rate for Payer: Signature Care EPO |
$188.66
|
| Rate for Payer: Signature Care PPO |
$200.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$193.21
|
| Rate for Payer: United Healthcare Commercial |
$179.11
|
| Rate for Payer: United Healthcare Medicare |
$72.74
|
|
|
HC FENTANYL MS UR
|
Facility
|
OP
|
$227.30
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
63001420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$211.39 |
| Rate for Payer: Aetna Commercial |
$191.84
|
| Rate for Payer: Aetna Medicare |
$72.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$104.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.01
|
| Rate for Payer: Cash Price |
$136.38
|
| Rate for Payer: Centivo All Commercial |
$123.65
|
| Rate for Payer: Cigna All Commercial |
$196.16
|
| Rate for Payer: CORVEL All Commercial |
$211.39
|
| Rate for Payer: Coventry All Commercial |
$200.02
|
| Rate for Payer: Encore All Commercial |
$209.23
|
| Rate for Payer: Frontpath All Commercial |
$209.12
|
| Rate for Payer: Humana ChoiceCare |
$196.32
|
| Rate for Payer: Humana Medicare |
$72.74
|
| Rate for Payer: Lucent All Commercial |
$123.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.57
|
| Rate for Payer: PHCS All Commercial |
$170.47
|
| Rate for Payer: PHP All Commercial |
$172.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.65
|
| Rate for Payer: Sagamore Health Network All Products |
$175.48
|
| Rate for Payer: Signature Care EPO |
$188.66
|
| Rate for Payer: Signature Care PPO |
$200.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$193.21
|
| Rate for Payer: United Healthcare Commercial |
$179.11
|
| Rate for Payer: United Healthcare Medicare |
$72.74
|
|
|
HC FENTANYL MS UR
|
Facility
|
IP
|
$227.30
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
63001420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$211.39 |
| Rate for Payer: Aetna Commercial |
$196.39
|
| Rate for Payer: Cash Price |
$136.38
|
| Rate for Payer: Cigna All Commercial |
$196.16
|
| Rate for Payer: CORVEL All Commercial |
$211.39
|
| Rate for Payer: Coventry All Commercial |
$200.02
|
| Rate for Payer: Encore All Commercial |
$209.23
|
| Rate for Payer: Frontpath All Commercial |
$209.12
|
| Rate for Payer: Humana ChoiceCare |
$196.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.57
|
| Rate for Payer: PHCS All Commercial |
$170.47
|
| Rate for Payer: PHP All Commercial |
$172.38
|
| Rate for Payer: Sagamore Health Network All Products |
$175.48
|
| Rate for Payer: Signature Care EPO |
$188.66
|
| Rate for Payer: Signature Care PPO |
$200.02
|
| Rate for Payer: United Healthcare Commercial |
$179.11
|
|
|
HC FERRITIN
|
Facility
|
OP
|
$208.30
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
63001307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$175.81
|
| Rate for Payer: Aetna Medicare |
$66.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.32
|
| Rate for Payer: Cash Price |
$124.98
|
| Rate for Payer: Cash Price |
$124.98
|
| Rate for Payer: Centivo All Commercial |
$113.32
|
| Rate for Payer: Cigna All Commercial |
$179.76
|
| Rate for Payer: CORVEL All Commercial |
$193.72
|
| Rate for Payer: Coventry All Commercial |
$183.30
|
| Rate for Payer: Encore All Commercial |
$191.74
|
| Rate for Payer: Frontpath All Commercial |
$191.64
|
| Rate for Payer: Humana ChoiceCare |
$179.91
|
| Rate for Payer: Humana Medicare |
$66.66
|
| Rate for Payer: Lucent All Commercial |
$113.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.47
|
| Rate for Payer: Managed Health Services Medicaid |
$13.63
|
| Rate for Payer: MDWise Medicaid |
$13.63
|
| Rate for Payer: PHCS All Commercial |
$156.22
|
| Rate for Payer: PHP All Commercial |
$157.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.24
|
| Rate for Payer: Sagamore Health Network All Products |
$160.81
|
| Rate for Payer: Signature Care EPO |
$172.89
|
| Rate for Payer: Signature Care PPO |
$183.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.06
|
| Rate for Payer: United Healthcare Commercial |
$164.14
|
| Rate for Payer: United Healthcare Medicare |
$66.66
|
|
|
HC FERRITIN
|
Facility
|
IP
|
$208.30
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
63001307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.22 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$179.97
|
| Rate for Payer: Cash Price |
$124.98
|
| Rate for Payer: Cigna All Commercial |
$179.76
|
| Rate for Payer: CORVEL All Commercial |
$193.72
|
| Rate for Payer: Coventry All Commercial |
$183.30
|
| Rate for Payer: Encore All Commercial |
$191.74
|
| Rate for Payer: Frontpath All Commercial |
$191.64
|
| Rate for Payer: Humana ChoiceCare |
$179.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.47
|
| Rate for Payer: PHCS All Commercial |
$156.22
|
| Rate for Payer: PHP All Commercial |
$157.97
|
| Rate for Payer: Sagamore Health Network All Products |
$160.81
|
| Rate for Payer: Signature Care EPO |
$172.89
|
| Rate for Payer: Signature Care PPO |
$183.30
|
| Rate for Payer: United Healthcare Commercial |
$164.14
|
|
|
HC FETAL BIOPHYSICAL PROFILE W/ NON-STRESS TESTING
|
Facility
|
IP
|
$976.18
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
1646818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$732.13 |
| Max. Negotiated Rate |
$907.85 |
| Rate for Payer: Aetna Commercial |
$843.42
|
| Rate for Payer: Cash Price |
$585.71
|
| Rate for Payer: Cigna All Commercial |
$842.44
|
| Rate for Payer: CORVEL All Commercial |
$907.85
|
| Rate for Payer: Coventry All Commercial |
$859.04
|
| Rate for Payer: Encore All Commercial |
$898.57
|
| Rate for Payer: Frontpath All Commercial |
$898.09
|
| Rate for Payer: Humana ChoiceCare |
$843.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$878.56
|
| Rate for Payer: PHCS All Commercial |
$732.13
|
| Rate for Payer: PHP All Commercial |
$740.33
|
| Rate for Payer: Sagamore Health Network All Products |
$753.61
|
| Rate for Payer: Signature Care EPO |
$810.23
|
| Rate for Payer: Signature Care PPO |
$859.04
|
| Rate for Payer: United Healthcare Commercial |
$769.23
|
|
|
HC FETAL BIOPHYSICAL PROFILE W/ NON-STRESS TESTING
|
Facility
|
OP
|
$976.18
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
1646818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.22 |
| Max. Negotiated Rate |
$907.85 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Aetna Medicare |
$312.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$48.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$302.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$560.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$610.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$359.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.62
|
| Rate for Payer: Cash Price |
$585.71
|
| Rate for Payer: Cash Price |
$585.71
|
| Rate for Payer: Centivo All Commercial |
$531.04
|
| Rate for Payer: Cigna All Commercial |
$842.44
|
| Rate for Payer: CORVEL All Commercial |
$907.85
|
| Rate for Payer: Coventry All Commercial |
$859.04
|
| Rate for Payer: Encore All Commercial |
$898.57
|
| Rate for Payer: Frontpath All Commercial |
$898.09
|
| Rate for Payer: Humana ChoiceCare |
$843.13
|
| Rate for Payer: Humana Medicare |
$312.38
|
| Rate for Payer: Lucent All Commercial |
$531.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$878.56
|
| Rate for Payer: Managed Health Services Medicaid |
$48.22
|
| Rate for Payer: MDWise Medicaid |
$48.22
|
| Rate for Payer: PHCS All Commercial |
$732.13
|
| Rate for Payer: PHP All Commercial |
$740.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$380.71
|
| Rate for Payer: Sagamore Health Network All Products |
$753.61
|
| Rate for Payer: Signature Care EPO |
$810.23
|
| Rate for Payer: Signature Care PPO |
$859.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$829.75
|
| Rate for Payer: United Healthcare Commercial |
$769.23
|
| Rate for Payer: United Healthcare Medicare |
$312.38
|
|
|
HC FETAL CONTRACTION STRESS TEST
|
Facility
|
IP
|
$635.42
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
1229020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$476.56 |
| Max. Negotiated Rate |
$590.94 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Cash Price |
$381.25
|
| Rate for Payer: Cigna All Commercial |
$548.37
|
| Rate for Payer: CORVEL All Commercial |
$590.94
|
| Rate for Payer: Coventry All Commercial |
$559.17
|
| Rate for Payer: Encore All Commercial |
$584.90
|
| Rate for Payer: Frontpath All Commercial |
$584.59
|
| Rate for Payer: Humana ChoiceCare |
$548.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$571.88
|
| Rate for Payer: PHCS All Commercial |
$476.56
|
| Rate for Payer: PHP All Commercial |
$481.90
|
| Rate for Payer: Sagamore Health Network All Products |
$490.54
|
| Rate for Payer: Signature Care EPO |
$527.40
|
| Rate for Payer: Signature Care PPO |
$559.17
|
| Rate for Payer: United Healthcare Commercial |
$500.71
|
|
