|
HC FETAL CONTRACTION STRESS TEST
|
Facility
|
OP
|
$635.42
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
1229020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$590.94 |
| Rate for Payer: Aetna Commercial |
$536.29
|
| Rate for Payer: Aetna Medicare |
$203.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$364.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$397.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$233.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.67
|
| Rate for Payer: Cash Price |
$381.25
|
| Rate for Payer: Centivo All Commercial |
$345.67
|
| Rate for Payer: Cigna All Commercial |
$548.37
|
| Rate for Payer: CORVEL All Commercial |
$590.94
|
| Rate for Payer: Coventry All Commercial |
$559.17
|
| Rate for Payer: Encore All Commercial |
$584.90
|
| Rate for Payer: Frontpath All Commercial |
$584.59
|
| Rate for Payer: Humana ChoiceCare |
$548.81
|
| Rate for Payer: Humana Medicare |
$203.33
|
| Rate for Payer: Lucent All Commercial |
$345.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$571.88
|
| Rate for Payer: PHCS All Commercial |
$476.56
|
| Rate for Payer: PHP All Commercial |
$481.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$247.81
|
| Rate for Payer: Sagamore Health Network All Products |
$490.54
|
| Rate for Payer: Signature Care EPO |
$527.40
|
| Rate for Payer: Signature Care PPO |
$559.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$540.11
|
| Rate for Payer: United Healthcare Commercial |
$500.71
|
| Rate for Payer: United Healthcare Medicare |
$203.33
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$921.19
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
63001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$856.71 |
| Rate for Payer: Aetna Commercial |
$777.48
|
| Rate for Payer: Aetna Medicare |
$294.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$64.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$423.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$423.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$64.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$339.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$324.26
|
| Rate for Payer: Cash Price |
$552.71
|
| Rate for Payer: Cash Price |
$552.71
|
| Rate for Payer: Centivo All Commercial |
$501.13
|
| Rate for Payer: Cigna All Commercial |
$794.99
|
| Rate for Payer: CORVEL All Commercial |
$856.71
|
| Rate for Payer: Coventry All Commercial |
$810.65
|
| Rate for Payer: Encore All Commercial |
$847.96
|
| Rate for Payer: Frontpath All Commercial |
$847.49
|
| Rate for Payer: Humana ChoiceCare |
$795.63
|
| Rate for Payer: Humana Medicare |
$294.78
|
| Rate for Payer: Lucent All Commercial |
$501.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$829.07
|
| Rate for Payer: Managed Health Services Medicaid |
$64.41
|
| Rate for Payer: MDWise Medicaid |
$64.41
|
| Rate for Payer: PHCS All Commercial |
$690.89
|
| Rate for Payer: PHP All Commercial |
$698.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$359.26
|
| Rate for Payer: Sagamore Health Network All Products |
$711.16
|
| Rate for Payer: Signature Care EPO |
$764.59
|
| Rate for Payer: Signature Care PPO |
$810.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$783.01
|
| Rate for Payer: United Healthcare Commercial |
$725.90
|
| Rate for Payer: United Healthcare Medicare |
$294.78
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$921.19
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
63001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$690.89 |
| Max. Negotiated Rate |
$856.71 |
| Rate for Payer: Aetna Commercial |
$795.91
|
| Rate for Payer: Cash Price |
$552.71
|
| Rate for Payer: Cigna All Commercial |
$794.99
|
| Rate for Payer: CORVEL All Commercial |
$856.71
|
| Rate for Payer: Coventry All Commercial |
$810.65
|
| Rate for Payer: Encore All Commercial |
$847.96
|
| Rate for Payer: Frontpath All Commercial |
$847.49
|
| Rate for Payer: Humana ChoiceCare |
$795.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$829.07
|
| Rate for Payer: PHCS All Commercial |
$690.89
|
| Rate for Payer: PHP All Commercial |
$698.63
|
| Rate for Payer: Sagamore Health Network All Products |
$711.16
|
| Rate for Payer: Signature Care EPO |
$764.59
|
| Rate for Payer: Signature Care PPO |
$810.65
|
| Rate for Payer: United Healthcare Commercial |
$725.90
|
|
|
HC FETAL MATERN BLEED QL
|
Facility
|
IP
|
$159.10
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
63001345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.33 |
| Max. Negotiated Rate |
$147.96 |
| Rate for Payer: Aetna Commercial |
$137.46
|
| Rate for Payer: Cash Price |
$95.46
|
| Rate for Payer: Cigna All Commercial |
$137.30
|
| Rate for Payer: CORVEL All Commercial |
$147.96
|
| Rate for Payer: Coventry All Commercial |
$140.01
|
| Rate for Payer: Encore All Commercial |
$146.45
|
| Rate for Payer: Frontpath All Commercial |
$146.37
|
| Rate for Payer: Humana ChoiceCare |
$137.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.19
|
| Rate for Payer: PHCS All Commercial |
$119.33
|
| Rate for Payer: PHP All Commercial |
$120.66
|
| Rate for Payer: Sagamore Health Network All Products |
$122.83
|
| Rate for Payer: Signature Care EPO |
$132.05
|
| Rate for Payer: Signature Care PPO |
$140.01
|
| Rate for Payer: United Healthcare Commercial |
$125.37
|
|
|
HC FETAL MATERN BLEED QL
|
Facility
|
OP
|
$159.10
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
63001345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$147.96 |
| Rate for Payer: Aetna Commercial |
$134.28
|
| Rate for Payer: Aetna Medicare |
$50.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.00
|
| Rate for Payer: Cash Price |
$95.46
|
| Rate for Payer: Cash Price |
$95.46
|
| Rate for Payer: Centivo All Commercial |
$86.55
|
| Rate for Payer: Cigna All Commercial |
$137.30
|
| Rate for Payer: CORVEL All Commercial |
$147.96
|
| Rate for Payer: Coventry All Commercial |
$140.01
|
| Rate for Payer: Encore All Commercial |
$146.45
|
| Rate for Payer: Frontpath All Commercial |
$146.37
|
| Rate for Payer: Humana ChoiceCare |
$137.41
|
| Rate for Payer: Humana Medicare |
$50.91
|
| Rate for Payer: Lucent All Commercial |
$86.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.19
|
| Rate for Payer: Managed Health Services Medicaid |
$9.36
|
| Rate for Payer: MDWise Medicaid |
$9.36
|
| Rate for Payer: PHCS All Commercial |
$119.33
|
| Rate for Payer: PHP All Commercial |
$120.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.05
|
| Rate for Payer: Sagamore Health Network All Products |
$122.83
|
| Rate for Payer: Signature Care EPO |
$132.05
|
| Rate for Payer: Signature Care PPO |
$140.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.24
|
| Rate for Payer: United Healthcare Commercial |
$125.37
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$635.42
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
1229025
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$590.94 |
| Rate for Payer: Aetna Commercial |
$536.29
|
| Rate for Payer: Aetna Medicare |
$203.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$364.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$397.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$233.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.67
|
| Rate for Payer: Cash Price |
$381.25
|
| Rate for Payer: Centivo All Commercial |
$345.67
|
| Rate for Payer: Cigna All Commercial |
$548.37
|
| Rate for Payer: CORVEL All Commercial |
$590.94
|
| Rate for Payer: Coventry All Commercial |
$559.17
|
| Rate for Payer: Encore All Commercial |
$584.90
|
| Rate for Payer: Frontpath All Commercial |
$584.59
|
| Rate for Payer: Humana ChoiceCare |
$548.81
|
| Rate for Payer: Humana Medicare |
$203.33
|
| Rate for Payer: Lucent All Commercial |
$345.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$571.88
|
| Rate for Payer: PHCS All Commercial |
$476.56
|
| Rate for Payer: PHP All Commercial |
$481.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$247.81
|
| Rate for Payer: Sagamore Health Network All Products |
$490.54
|
| Rate for Payer: Signature Care EPO |
$527.40
|
| Rate for Payer: Signature Care PPO |
$559.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$540.11
|
| Rate for Payer: United Healthcare Commercial |
$500.71
|
| Rate for Payer: United Healthcare Medicare |
$203.33
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
IP
|
$635.42
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
1229025
|
|
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
|
|
|
HC FIAPC CIRCUM PROBE
|
Facility
|
OP
|
$1,158.50
|
|
| Hospital Charge Code |
41608214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,077.40 |
| Rate for Payer: Aetna Commercial |
$977.77
|
| Rate for Payer: Aetna Medicare |
$370.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$359.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$665.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$724.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$426.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$407.79
|
| Rate for Payer: Cash Price |
$695.10
|
| Rate for Payer: Cash Price |
$695.10
|
| Rate for Payer: Centivo All Commercial |
$630.22
|
| Rate for Payer: Cigna All Commercial |
$999.79
|
| Rate for Payer: CORVEL All Commercial |
$1,077.40
|
| Rate for Payer: Coventry All Commercial |
$1,019.48
|
| Rate for Payer: Encore All Commercial |
$1,066.40
|
| Rate for Payer: Frontpath All Commercial |
$1,065.82
|
| Rate for Payer: Humana ChoiceCare |
$1,000.60
|
| Rate for Payer: Humana Medicare |
$370.72
|
| Rate for Payer: Lucent All Commercial |
$630.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,042.65
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$868.88
|
| Rate for Payer: PHP All Commercial |
$878.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$451.81
|
| Rate for Payer: Sagamore Health Network All Products |
$894.36
|
| Rate for Payer: Signature Care EPO |
$961.55
|
| Rate for Payer: Signature Care PPO |
$1,019.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$984.73
|
| Rate for Payer: United Healthcare Commercial |
$912.90
|
| Rate for Payer: United Healthcare Medicare |
$370.72
|
|
|
HC FIAPC CIRCUM PROBE
|
Facility
|
IP
|
$1,158.50
|
|
| Hospital Charge Code |
41608214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$868.88 |
| Max. Negotiated Rate |
$1,077.40 |
| Rate for Payer: Aetna Commercial |
$1,000.94
|
| Rate for Payer: Cash Price |
$695.10
|
| Rate for Payer: Cigna All Commercial |
$999.79
|
| Rate for Payer: CORVEL All Commercial |
$1,077.40
|
| Rate for Payer: Coventry All Commercial |
$1,019.48
|
| Rate for Payer: Encore All Commercial |
$1,066.40
|
| Rate for Payer: Frontpath All Commercial |
$1,065.82
|
| Rate for Payer: Humana ChoiceCare |
$1,000.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,042.65
|
| Rate for Payer: PHCS All Commercial |
$868.88
|
| Rate for Payer: PHP All Commercial |
$878.61
|
| Rate for Payer: Sagamore Health Network All Products |
$894.36
|
| Rate for Payer: Signature Care EPO |
$961.55
|
| Rate for Payer: Signature Care PPO |
$1,019.48
|
| Rate for Payer: United Healthcare Commercial |
$912.90
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$166.66
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
63001273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$154.99 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna All Commercial |
$143.83
|
| Rate for Payer: CORVEL All Commercial |
$154.99
|
| Rate for Payer: Coventry All Commercial |
$146.66
|
| Rate for Payer: Encore All Commercial |
$153.41
|
| Rate for Payer: Frontpath All Commercial |
$153.33
|
| Rate for Payer: Humana ChoiceCare |
$143.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.99
|
| Rate for Payer: PHCS All Commercial |
$125.00
|
| Rate for Payer: PHP All Commercial |
$126.39
|
| Rate for Payer: Sagamore Health Network All Products |
$128.66
|
| Rate for Payer: Signature Care EPO |
$138.33
|
| Rate for Payer: Signature Care PPO |
$146.66
|
| Rate for Payer: United Healthcare Commercial |
$131.33
|
|
|
HC FIBRINOGEN
|
Facility
|
OP
|
$166.66
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
63001273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$154.99 |
| Rate for Payer: Aetna Commercial |
$140.66
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.66
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Centivo All Commercial |
$90.66
|
| Rate for Payer: Cigna All Commercial |
$143.83
|
| Rate for Payer: CORVEL All Commercial |
$154.99
|
| Rate for Payer: Coventry All Commercial |
$146.66
|
| Rate for Payer: Encore All Commercial |
$153.41
|
| Rate for Payer: Frontpath All Commercial |
$153.33
|
| Rate for Payer: Humana ChoiceCare |
$143.94
|
| Rate for Payer: Humana Medicare |
$53.33
|
| Rate for Payer: Lucent All Commercial |
$90.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.99
|
| Rate for Payer: Managed Health Services Medicaid |
$9.72
|
| Rate for Payer: MDWise Medicaid |
$9.72
|
| Rate for Payer: PHCS All Commercial |
$125.00
|
| Rate for Payer: PHP All Commercial |
$126.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.00
|
| Rate for Payer: Sagamore Health Network All Products |
$128.66
|
| Rate for Payer: Signature Care EPO |
$138.33
|
| Rate for Payer: Signature Care PPO |
$146.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.66
|
| Rate for Payer: United Healthcare Commercial |
$131.33
|
| Rate for Payer: United Healthcare Medicare |
$53.33
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$211.14
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
63001267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$158.35 |
| Max. Negotiated Rate |
$196.36 |
| Rate for Payer: Aetna Commercial |
$182.42
|
| Rate for Payer: Cash Price |
$126.68
|
| Rate for Payer: Cigna All Commercial |
$182.21
|
| Rate for Payer: CORVEL All Commercial |
$196.36
|
| Rate for Payer: Coventry All Commercial |
$185.80
|
| Rate for Payer: Encore All Commercial |
$194.35
|
| Rate for Payer: Frontpath All Commercial |
$194.25
|
| Rate for Payer: Humana ChoiceCare |
$182.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.03
|
| Rate for Payer: PHCS All Commercial |
$158.35
|
| Rate for Payer: PHP All Commercial |
$160.13
|
| Rate for Payer: Sagamore Health Network All Products |
$163.00
|
| Rate for Payer: Signature Care EPO |
$175.25
|
| Rate for Payer: Signature Care PPO |
$185.80
|
| Rate for Payer: United Healthcare Commercial |
$166.38
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$211.14
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
63001267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$196.36 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Medicare |
$67.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$54.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.32
|
| Rate for Payer: Cash Price |
$126.68
|
| Rate for Payer: Cash Price |
$126.68
|
| Rate for Payer: Centivo All Commercial |
$114.86
|
| Rate for Payer: Cigna All Commercial |
$182.21
|
| Rate for Payer: CORVEL All Commercial |
$196.36
|
| Rate for Payer: Coventry All Commercial |
$185.80
|
| Rate for Payer: Encore All Commercial |
$194.35
|
| Rate for Payer: Frontpath All Commercial |
$194.25
|
| Rate for Payer: Humana ChoiceCare |
$182.36
|
| Rate for Payer: Humana Medicare |
$67.56
|
| Rate for Payer: Lucent All Commercial |
$114.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.03
|
| Rate for Payer: Managed Health Services Medicaid |
$54.08
|
| Rate for Payer: MDWise Medicaid |
$54.08
|
| Rate for Payer: PHCS All Commercial |
$158.35
|
| Rate for Payer: PHP All Commercial |
$160.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.34
|
| Rate for Payer: Sagamore Health Network All Products |
$163.00
|
| Rate for Payer: Signature Care EPO |
$175.25
|
| Rate for Payer: Signature Care PPO |
$185.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.47
|
| Rate for Payer: United Healthcare Commercial |
$166.38
|
| Rate for Payer: United Healthcare Medicare |
$67.56
|
|
|
HC FISH INTERPHASE IN SITU
|
Facility
|
OP
|
$966.77
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$899.10 |
| Rate for Payer: Aetna Commercial |
$815.95
|
| Rate for Payer: Aetna Medicare |
$309.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$444.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$444.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$51.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$340.30
|
| Rate for Payer: Cash Price |
$580.06
|
| Rate for Payer: Cash Price |
$580.06
|
| Rate for Payer: Centivo All Commercial |
$525.92
|
| Rate for Payer: Cigna All Commercial |
$834.32
|
| Rate for Payer: CORVEL All Commercial |
$899.10
|
| Rate for Payer: Coventry All Commercial |
$850.76
|
| Rate for Payer: Encore All Commercial |
$889.91
|
| Rate for Payer: Frontpath All Commercial |
$889.43
|
| Rate for Payer: Humana ChoiceCare |
$835.00
|
| Rate for Payer: Humana Medicare |
$309.37
|
| Rate for Payer: Lucent All Commercial |
$525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$870.09
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: MDWise Medicaid |
$51.19
|
| Rate for Payer: PHCS All Commercial |
$725.08
|
| Rate for Payer: PHP All Commercial |
$733.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$377.04
|
| Rate for Payer: Sagamore Health Network All Products |
$746.35
|
| Rate for Payer: Signature Care EPO |
$802.42
|
| Rate for Payer: Signature Care PPO |
$850.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$821.75
|
| Rate for Payer: United Healthcare Commercial |
$761.81
|
| Rate for Payer: United Healthcare Medicare |
$309.37
|
|
|
HC FISH INTERPHASE IN SITU
|
Facility
|
IP
|
$966.77
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$725.08 |
| Max. Negotiated Rate |
$899.10 |
| Rate for Payer: Aetna Commercial |
$835.29
|
| Rate for Payer: Cash Price |
$580.06
|
| Rate for Payer: Cigna All Commercial |
$834.32
|
| Rate for Payer: CORVEL All Commercial |
$899.10
|
| Rate for Payer: Coventry All Commercial |
$850.76
|
| Rate for Payer: Encore All Commercial |
$889.91
|
| Rate for Payer: Frontpath All Commercial |
$889.43
|
| Rate for Payer: Humana ChoiceCare |
$835.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$870.09
|
| Rate for Payer: PHCS All Commercial |
$725.08
|
| Rate for Payer: PHP All Commercial |
$733.20
|
| Rate for Payer: Sagamore Health Network All Products |
$746.35
|
| Rate for Payer: Signature Care EPO |
$802.42
|
| Rate for Payer: Signature Care PPO |
$850.76
|
| Rate for Payer: United Healthcare Commercial |
$761.81
|
|
|
HC FLOURESCENT AB EA
|
Facility
|
IP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.50
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.05
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: United Healthcare Commercial |
$109.15
|
|
|
HC FLOURESCENT AB EA
|
Facility
|
OP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$116.90
|
| Rate for Payer: Aetna Medicare |
$44.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.76
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Centivo All Commercial |
$75.35
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.50
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Humana Medicare |
$44.32
|
| Rate for Payer: Lucent All Commercial |
$75.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.02
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$109.15
|
| Rate for Payer: United Healthcare Medicare |
$44.32
|
|
|
HC FLOW CYTO MARKER 1ST
|
Facility
|
IP
|
$87.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.89 |
| Max. Negotiated Rate |
$81.71 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Cigna All Commercial |
$75.82
|
| Rate for Payer: CORVEL All Commercial |
$81.71
|
| Rate for Payer: Coventry All Commercial |
$77.32
|
| Rate for Payer: Encore All Commercial |
$80.88
|
| Rate for Payer: Frontpath All Commercial |
$80.83
|
| Rate for Payer: Humana ChoiceCare |
$75.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.07
|
| Rate for Payer: PHCS All Commercial |
$65.89
|
| Rate for Payer: PHP All Commercial |
$66.63
|
| Rate for Payer: Sagamore Health Network All Products |
$67.83
|
| Rate for Payer: Signature Care EPO |
$72.92
|
| Rate for Payer: Signature Care PPO |
$77.32
|
| Rate for Payer: United Healthcare Commercial |
$69.23
|
|
|
HC FLOW CYTO MARKER 1ST
|
Facility
|
OP
|
$87.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.24 |
| Max. Negotiated Rate |
$81.71 |
| Rate for Payer: Aetna Commercial |
$74.15
|
| Rate for Payer: Aetna Medicare |
$28.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.93
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Centivo All Commercial |
$47.80
|
| Rate for Payer: Cigna All Commercial |
$75.82
|
| Rate for Payer: CORVEL All Commercial |
$81.71
|
| Rate for Payer: Coventry All Commercial |
$77.32
|
| Rate for Payer: Encore All Commercial |
$80.88
|
| Rate for Payer: Frontpath All Commercial |
$80.83
|
| Rate for Payer: Humana ChoiceCare |
$75.88
|
| Rate for Payer: Humana Medicare |
$28.12
|
| Rate for Payer: Lucent All Commercial |
$47.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.07
|
| Rate for Payer: Managed Health Services Medicaid |
$34.47
|
| Rate for Payer: MDWise Medicaid |
$34.47
|
| Rate for Payer: PHCS All Commercial |
$65.89
|
| Rate for Payer: PHP All Commercial |
$66.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.27
|
| Rate for Payer: Sagamore Health Network All Products |
$67.83
|
| Rate for Payer: Signature Care EPO |
$72.92
|
| Rate for Payer: Signature Care PPO |
$77.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.68
|
| Rate for Payer: United Healthcare Commercial |
$69.23
|
| Rate for Payer: United Healthcare Medicare |
$28.12
|
|
|
HC FLOW CYTO MKR EA ADD X1
|
Facility
|
OP
|
$163.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
63001058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Aetna Commercial |
$137.81
|
| Rate for Payer: Aetna Medicare |
$52.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.47
|
| Rate for Payer: Cash Price |
$97.97
|
| Rate for Payer: Cash Price |
$97.97
|
| Rate for Payer: Centivo All Commercial |
$88.82
|
| Rate for Payer: Cigna All Commercial |
$140.91
|
| Rate for Payer: CORVEL All Commercial |
$151.85
|
| Rate for Payer: Coventry All Commercial |
$143.69
|
| Rate for Payer: Encore All Commercial |
$150.30
|
| Rate for Payer: Frontpath All Commercial |
$150.22
|
| Rate for Payer: Humana ChoiceCare |
$141.02
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$88.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.95
|
| Rate for Payer: Managed Health Services Medicaid |
$16.87
|
| Rate for Payer: MDWise Medicaid |
$16.87
|
| Rate for Payer: PHCS All Commercial |
$122.46
|
| Rate for Payer: PHP All Commercial |
$123.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.68
|
| Rate for Payer: Sagamore Health Network All Products |
$126.05
|
| Rate for Payer: Signature Care EPO |
$135.52
|
| Rate for Payer: Signature Care PPO |
$143.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.79
|
| Rate for Payer: United Healthcare Commercial |
$128.66
|
| Rate for Payer: United Healthcare Medicare |
$52.25
|
|
|
HC FLOW CYTO MKR EA ADD X1
|
Facility
|
IP
|
$163.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
63001058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Aetna Commercial |
$141.07
|
| Rate for Payer: Cash Price |
$97.97
|
| Rate for Payer: Cigna All Commercial |
$140.91
|
| Rate for Payer: CORVEL All Commercial |
$151.85
|
| Rate for Payer: Coventry All Commercial |
$143.69
|
| Rate for Payer: Encore All Commercial |
$150.30
|
| Rate for Payer: Frontpath All Commercial |
$150.22
|
| Rate for Payer: Humana ChoiceCare |
$141.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.95
|
| Rate for Payer: PHCS All Commercial |
$122.46
|
| Rate for Payer: PHP All Commercial |
$123.83
|
| Rate for Payer: Sagamore Health Network All Products |
$126.05
|
| Rate for Payer: Signature Care EPO |
$135.52
|
| Rate for Payer: Signature Care PPO |
$143.69
|
| Rate for Payer: United Healthcare Commercial |
$128.66
|
|
|
HC FLUID CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$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 FLUID CULTURE
|
Facility
|
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$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 FLUIDOTHERAPY-OT
|
Facility
|
OP
|
$119.66
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
1738026
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$111.28 |
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$68.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.12
|
| Rate for Payer: Cash Price |
$71.80
|
| Rate for Payer: Cash Price |
$71.80
|
| Rate for Payer: Centivo All Commercial |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$103.27
|
| Rate for Payer: CORVEL All Commercial |
$111.28
|
| Rate for Payer: Coventry All Commercial |
$105.30
|
| Rate for Payer: Encore All Commercial |
$110.15
|
| Rate for Payer: Frontpath All Commercial |
$110.09
|
| Rate for Payer: Humana ChoiceCare |
$103.35
|
| Rate for Payer: Humana Medicare |
$38.29
|
| Rate for Payer: Lucent All Commercial |
$65.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.69
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$89.75
|
| Rate for Payer: PHP All Commercial |
$90.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.67
|
| Rate for Payer: Sagamore Health Network All Products |
$92.38
|
| Rate for Payer: Signature Care EPO |
$99.32
|
| Rate for Payer: Signature Care PPO |
$105.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.71
|
| Rate for Payer: United Healthcare Commercial |
$94.29
|
| Rate for Payer: United Healthcare Medicare |
$38.29
|
|
|
HC FLUIDOTHERAPY-OT
|
Facility
|
IP
|
$119.66
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
1738026
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.75 |
| Max. Negotiated Rate |
$111.28 |
| Rate for Payer: Aetna Commercial |
$103.39
|
| Rate for Payer: Cash Price |
$71.80
|
| Rate for Payer: Cigna All Commercial |
$103.27
|
| Rate for Payer: CORVEL All Commercial |
$111.28
|
| Rate for Payer: Coventry All Commercial |
$105.30
|
| Rate for Payer: Encore All Commercial |
$110.15
|
| Rate for Payer: Frontpath All Commercial |
$110.09
|
| Rate for Payer: Humana ChoiceCare |
$103.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.69
|
| Rate for Payer: PHCS All Commercial |
$89.75
|
| Rate for Payer: PHP All Commercial |
$90.75
|
| Rate for Payer: Sagamore Health Network All Products |
$92.38
|
| Rate for Payer: Signature Care EPO |
$99.32
|
| Rate for Payer: Signature Care PPO |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$94.29
|
|
