|
HC LIPOPROTEIN A QT
|
Facility
|
OP
|
$173.35
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
63001623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$161.22 |
| Rate for Payer: Aetna Commercial |
$146.31
|
| Rate for Payer: Aetna Medicare |
$55.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.02
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Centivo All Commercial |
$94.30
|
| Rate for Payer: Cigna All Commercial |
$149.60
|
| Rate for Payer: CORVEL All Commercial |
$161.22
|
| Rate for Payer: Coventry All Commercial |
$152.55
|
| Rate for Payer: Encore All Commercial |
$159.57
|
| Rate for Payer: Frontpath All Commercial |
$159.48
|
| Rate for Payer: Humana ChoiceCare |
$149.72
|
| Rate for Payer: Humana Medicare |
$55.47
|
| Rate for Payer: Lucent All Commercial |
$94.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.01
|
| Rate for Payer: Managed Health Services Medicaid |
$14.32
|
| Rate for Payer: MDWise Medicaid |
$14.32
|
| Rate for Payer: PHCS All Commercial |
$130.01
|
| Rate for Payer: PHP All Commercial |
$131.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.61
|
| Rate for Payer: Sagamore Health Network All Products |
$133.83
|
| Rate for Payer: Signature Care EPO |
$143.88
|
| Rate for Payer: Signature Care PPO |
$152.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.35
|
| Rate for Payer: United Healthcare Commercial |
$136.60
|
| Rate for Payer: United Healthcare Medicare |
$55.47
|
|
|
HC LIPOPROTEIN A QT
|
Facility
|
IP
|
$173.35
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
63001623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.01 |
| Max. Negotiated Rate |
$161.22 |
| Rate for Payer: Aetna Commercial |
$149.77
|
| Rate for Payer: Cash Price |
$104.01
|
| Rate for Payer: Cigna All Commercial |
$149.60
|
| Rate for Payer: CORVEL All Commercial |
$161.22
|
| Rate for Payer: Coventry All Commercial |
$152.55
|
| Rate for Payer: Encore All Commercial |
$159.57
|
| Rate for Payer: Frontpath All Commercial |
$159.48
|
| Rate for Payer: Humana ChoiceCare |
$149.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.01
|
| Rate for Payer: PHCS All Commercial |
$130.01
|
| Rate for Payer: PHP All Commercial |
$131.47
|
| Rate for Payer: Sagamore Health Network All Products |
$133.83
|
| Rate for Payer: Signature Care EPO |
$143.88
|
| Rate for Payer: Signature Care PPO |
$152.55
|
| Rate for Payer: United Healthcare Commercial |
$136.60
|
|
|
HC LIPOPROTEIN BLD BY NMR
|
Facility
|
OP
|
$119.68
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63001041
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Aetna Commercial |
$101.01
|
| Rate for Payer: Aetna Medicare |
$38.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$55.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.13
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Centivo All Commercial |
$65.11
|
| Rate for Payer: Cigna All Commercial |
$103.28
|
| Rate for Payer: CORVEL All Commercial |
$111.30
|
| Rate for Payer: Coventry All Commercial |
$105.32
|
| Rate for Payer: Encore All Commercial |
$110.17
|
| Rate for Payer: Frontpath All Commercial |
$110.11
|
| Rate for Payer: Humana ChoiceCare |
$103.37
|
| Rate for Payer: Humana Medicare |
$38.30
|
| Rate for Payer: Lucent All Commercial |
$65.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.71
|
| Rate for Payer: Managed Health Services Medicaid |
$34.19
|
| Rate for Payer: MDWise Medicaid |
$34.19
|
| Rate for Payer: PHCS All Commercial |
$89.76
|
| Rate for Payer: PHP All Commercial |
$90.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.68
|
| Rate for Payer: Sagamore Health Network All Products |
$92.39
|
| Rate for Payer: Signature Care EPO |
$99.33
|
| Rate for Payer: Signature Care PPO |
$105.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.73
|
| Rate for Payer: United Healthcare Commercial |
$94.31
|
| Rate for Payer: United Healthcare Medicare |
$38.30
|
|
|
HC LIPOPROTEIN BLD BY NMR
|
Facility
|
IP
|
$119.68
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63001041
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Aetna Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cigna All Commercial |
$103.28
|
| Rate for Payer: CORVEL All Commercial |
$111.30
|
| Rate for Payer: Coventry All Commercial |
$105.32
|
| Rate for Payer: Encore All Commercial |
$110.17
|
| Rate for Payer: Frontpath All Commercial |
$110.11
|
| Rate for Payer: Humana ChoiceCare |
$103.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.71
|
| Rate for Payer: PHCS All Commercial |
$89.76
|
| Rate for Payer: PHP All Commercial |
$90.77
|
| Rate for Payer: Sagamore Health Network All Products |
$92.39
|
| Rate for Payer: Signature Care EPO |
$99.33
|
| Rate for Payer: Signature Care PPO |
$105.32
|
| Rate for Payer: United Healthcare Commercial |
$94.31
|
|
|
HC LIPOPROTEIN ELECT
|
Facility
|
IP
|
$142.14
|
|
|
Service Code
|
CPT 83700 90
|
| Hospital Charge Code |
63002152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.61 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$122.81
|
| Rate for Payer: Cash Price |
$85.28
|
| Rate for Payer: Cigna All Commercial |
$122.67
|
| Rate for Payer: CORVEL All Commercial |
$132.19
|
| Rate for Payer: Coventry All Commercial |
$125.08
|
| Rate for Payer: Encore All Commercial |
$130.84
|
| Rate for Payer: Frontpath All Commercial |
$130.77
|
| Rate for Payer: Humana ChoiceCare |
$122.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.93
|
| Rate for Payer: PHCS All Commercial |
$106.61
|
| Rate for Payer: PHP All Commercial |
$107.80
|
| Rate for Payer: Sagamore Health Network All Products |
$109.73
|
| Rate for Payer: Signature Care EPO |
$117.98
|
| Rate for Payer: Signature Care PPO |
$125.08
|
| Rate for Payer: United Healthcare Commercial |
$112.01
|
|
|
HC LIPOPROTEIN ELECT
|
Facility
|
OP
|
$142.14
|
|
|
Service Code
|
CPT 83700 90
|
| Hospital Charge Code |
63002152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$119.97
|
| Rate for Payer: Aetna Medicare |
$45.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.03
|
| Rate for Payer: Cash Price |
$85.28
|
| Rate for Payer: Cash Price |
$85.28
|
| Rate for Payer: Centivo All Commercial |
$77.32
|
| Rate for Payer: Cigna All Commercial |
$122.67
|
| Rate for Payer: CORVEL All Commercial |
$132.19
|
| Rate for Payer: Coventry All Commercial |
$125.08
|
| Rate for Payer: Encore All Commercial |
$130.84
|
| Rate for Payer: Frontpath All Commercial |
$130.77
|
| Rate for Payer: Humana ChoiceCare |
$122.77
|
| Rate for Payer: Humana Medicare |
$45.48
|
| Rate for Payer: Lucent All Commercial |
$77.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.93
|
| Rate for Payer: Managed Health Services Medicaid |
$11.26
|
| Rate for Payer: MDWise Medicaid |
$11.26
|
| Rate for Payer: PHCS All Commercial |
$106.61
|
| Rate for Payer: PHP All Commercial |
$107.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.43
|
| Rate for Payer: Sagamore Health Network All Products |
$109.73
|
| Rate for Payer: Signature Care EPO |
$117.98
|
| Rate for Payer: Signature Care PPO |
$125.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.82
|
| Rate for Payer: United Healthcare Commercial |
$112.01
|
| Rate for Payer: United Healthcare Medicare |
$45.48
|
|
|
HC LITHIUM
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
63001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.92 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$128.93
|
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Cigna All Commercial |
$128.79
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.37
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.31
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.21
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
|
|
HC LITHIUM
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
63001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$125.95
|
| Rate for Payer: Aetna Medicare |
$47.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$68.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.53
|
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Centivo All Commercial |
$81.18
|
| Rate for Payer: Cigna All Commercial |
$128.79
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.37
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Humana Medicare |
$47.75
|
| Rate for Payer: Lucent All Commercial |
$81.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.31
|
| Rate for Payer: Managed Health Services Medicaid |
$6.61
|
| Rate for Payer: MDWise Medicaid |
$6.61
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.20
|
| Rate for Payer: Sagamore Health Network All Products |
$115.21
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.85
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
| Rate for Payer: United Healthcare Medicare |
$47.75
|
|
|
HC LIVER FUNCTION PANEL
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
63001154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$77.65
|
| Rate for Payer: Aetna Medicare |
$29.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.38
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Centivo All Commercial |
$50.05
|
| Rate for Payer: Cigna All Commercial |
$79.40
|
| Rate for Payer: CORVEL All Commercial |
$85.56
|
| Rate for Payer: Coventry All Commercial |
$80.96
|
| Rate for Payer: Encore All Commercial |
$84.69
|
| Rate for Payer: Frontpath All Commercial |
$84.64
|
| Rate for Payer: Humana ChoiceCare |
$79.46
|
| Rate for Payer: Humana Medicare |
$29.44
|
| Rate for Payer: Lucent All Commercial |
$50.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.80
|
| Rate for Payer: Managed Health Services Medicaid |
$8.17
|
| Rate for Payer: MDWise Medicaid |
$8.17
|
| Rate for Payer: PHCS All Commercial |
$69.00
|
| Rate for Payer: PHP All Commercial |
$69.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.88
|
| Rate for Payer: Sagamore Health Network All Products |
$71.02
|
| Rate for Payer: Signature Care EPO |
$76.36
|
| Rate for Payer: Signature Care PPO |
$80.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.20
|
| Rate for Payer: United Healthcare Commercial |
$72.50
|
| Rate for Payer: United Healthcare Medicare |
$29.44
|
|
|
HC LIVER FUNCTION PANEL
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
63001154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$79.49
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna All Commercial |
$79.40
|
| Rate for Payer: CORVEL All Commercial |
$85.56
|
| Rate for Payer: Coventry All Commercial |
$80.96
|
| Rate for Payer: Encore All Commercial |
$84.69
|
| Rate for Payer: Frontpath All Commercial |
$84.64
|
| Rate for Payer: Humana ChoiceCare |
$79.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.80
|
| Rate for Payer: PHCS All Commercial |
$69.00
|
| Rate for Payer: PHP All Commercial |
$69.77
|
| Rate for Payer: Sagamore Health Network All Products |
$71.02
|
| Rate for Payer: Signature Care EPO |
$76.36
|
| Rate for Payer: Signature Care PPO |
$80.96
|
| Rate for Payer: United Healthcare Commercial |
$72.50
|
|
|
HC LIVER IMAGE; STATIC ONLY
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 78201
|
| Hospital Charge Code |
1638201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$116.67 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,325.92
|
| Rate for Payer: Aetna Medicare |
$502.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$116.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$487.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$902.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$982.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$578.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$552.99
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Centivo All Commercial |
$854.62
|
| Rate for Payer: Cigna All Commercial |
$1,355.77
|
| Rate for Payer: CORVEL All Commercial |
$1,461.03
|
| Rate for Payer: Coventry All Commercial |
$1,382.48
|
| Rate for Payer: Encore All Commercial |
$1,446.11
|
| Rate for Payer: Frontpath All Commercial |
$1,445.32
|
| Rate for Payer: Humana ChoiceCare |
$1,356.87
|
| Rate for Payer: Humana Medicare |
$502.72
|
| Rate for Payer: Lucent All Commercial |
$854.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,413.90
|
| Rate for Payer: Managed Health Services Medicaid |
$116.67
|
| Rate for Payer: MDWise Medicaid |
$116.67
|
| Rate for Payer: PHCS All Commercial |
$1,178.25
|
| Rate for Payer: PHP All Commercial |
$1,191.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,212.81
|
| Rate for Payer: Signature Care EPO |
$1,303.93
|
| Rate for Payer: Signature Care PPO |
$1,382.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,335.35
|
| Rate for Payer: United Healthcare Commercial |
$1,237.95
|
| Rate for Payer: United Healthcare Medicare |
$502.72
|
|
|
HC LIVER IMAGE; STATIC ONLY
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 78201
|
| Hospital Charge Code |
1638201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,178.25 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,357.34
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna All Commercial |
$1,355.77
|
| Rate for Payer: CORVEL All Commercial |
$1,461.03
|
| Rate for Payer: Coventry All Commercial |
$1,382.48
|
| Rate for Payer: Encore All Commercial |
$1,446.11
|
| Rate for Payer: Frontpath All Commercial |
$1,445.32
|
| Rate for Payer: Humana ChoiceCare |
$1,356.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,413.90
|
| Rate for Payer: PHCS All Commercial |
$1,178.25
|
| Rate for Payer: PHP All Commercial |
$1,191.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,212.81
|
| Rate for Payer: Signature Care EPO |
$1,303.93
|
| Rate for Payer: Signature Care PPO |
$1,382.48
|
| Rate for Payer: United Healthcare Commercial |
$1,237.95
|
|
|
HC LIVER IMAGING (SPECT)
|
Facility
|
OP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
1638205
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.13 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,880.50
|
| Rate for Payer: Aetna Medicare |
$1,092.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$203.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,058.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,960.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,133.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$203.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,255.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,201.35
|
| Rate for Payer: Cash Price |
$2,047.75
|
| Rate for Payer: Cash Price |
$2,047.75
|
| Rate for Payer: Centivo All Commercial |
$1,856.63
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Humana Medicare |
$1,092.13
|
| Rate for Payer: Lucent All Commercial |
$1,856.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: Managed Health Services Medicaid |
$203.13
|
| Rate for Payer: MDWise Medicaid |
$203.13
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,331.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,900.98
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
| Rate for Payer: United Healthcare Medicare |
$1,092.13
|
|
|
HC LIVER IMAGING (SPECT)
|
Facility
|
IP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
1638205
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,559.69 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,948.76
|
| Rate for Payer: Cash Price |
$2,047.75
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
|
|
HC LIVER-KIDNEY MICROSOME IGG
|
Facility
|
OP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$153.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: Aetna Medicare |
$52.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.07
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Centivo All Commercial |
$89.74
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.42
|
| Rate for Payer: Coventry All Commercial |
$145.17
|
| Rate for Payer: Encore All Commercial |
$151.85
|
| Rate for Payer: Frontpath All Commercial |
$151.77
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Humana Medicare |
$52.79
|
| Rate for Payer: Lucent All Commercial |
$89.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.47
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: MDWise Medicaid |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.34
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.22
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
| Rate for Payer: United Healthcare Medicare |
$52.79
|
|
|
HC LIVER-KIDNEY MICROSOME IGG
|
Facility
|
IP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$153.42 |
| Rate for Payer: Aetna Commercial |
$142.53
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.42
|
| Rate for Payer: Coventry All Commercial |
$145.17
|
| Rate for Payer: Encore All Commercial |
$151.85
|
| Rate for Payer: Frontpath All Commercial |
$151.77
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.47
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.11
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.17
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
|
|
HC LIVER SPLEEN SCAN
|
Facility
|
OP
|
$1,772.84
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
1638351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.14 |
| Max. Negotiated Rate |
$1,648.74 |
| Rate for Payer: Aetna Commercial |
$1,496.28
|
| Rate for Payer: Aetna Medicare |
$567.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$120.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$549.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,018.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,108.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$120.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$652.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$624.04
|
| Rate for Payer: Cash Price |
$1,063.70
|
| Rate for Payer: Cash Price |
$1,063.70
|
| Rate for Payer: Centivo All Commercial |
$964.42
|
| Rate for Payer: Cigna All Commercial |
$1,529.96
|
| Rate for Payer: CORVEL All Commercial |
$1,648.74
|
| Rate for Payer: Coventry All Commercial |
$1,560.10
|
| Rate for Payer: Encore All Commercial |
$1,631.90
|
| Rate for Payer: Frontpath All Commercial |
$1,631.01
|
| Rate for Payer: Humana ChoiceCare |
$1,531.20
|
| Rate for Payer: Humana Medicare |
$567.31
|
| Rate for Payer: Lucent All Commercial |
$964.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,595.56
|
| Rate for Payer: Managed Health Services Medicaid |
$120.14
|
| Rate for Payer: MDWise Medicaid |
$120.14
|
| Rate for Payer: PHCS All Commercial |
$1,329.63
|
| Rate for Payer: PHP All Commercial |
$1,344.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$691.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,368.63
|
| Rate for Payer: Signature Care EPO |
$1,471.46
|
| Rate for Payer: Signature Care PPO |
$1,560.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,506.91
|
| Rate for Payer: United Healthcare Commercial |
$1,397.00
|
| Rate for Payer: United Healthcare Medicare |
$567.31
|
|
|
HC LIVER SPLEEN SCAN
|
Facility
|
IP
|
$1,772.84
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
1638351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,329.63 |
| Max. Negotiated Rate |
$1,648.74 |
| Rate for Payer: Aetna Commercial |
$1,531.73
|
| Rate for Payer: Cash Price |
$1,063.70
|
| Rate for Payer: Cigna All Commercial |
$1,529.96
|
| Rate for Payer: CORVEL All Commercial |
$1,648.74
|
| Rate for Payer: Coventry All Commercial |
$1,560.10
|
| Rate for Payer: Encore All Commercial |
$1,631.90
|
| Rate for Payer: Frontpath All Commercial |
$1,631.01
|
| Rate for Payer: Humana ChoiceCare |
$1,531.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,595.56
|
| Rate for Payer: PHCS All Commercial |
$1,329.63
|
| Rate for Payer: PHP All Commercial |
$1,344.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,368.63
|
| Rate for Payer: Signature Care EPO |
$1,471.46
|
| Rate for Payer: Signature Care PPO |
$1,560.10
|
| Rate for Payer: United Healthcare Commercial |
$1,397.00
|
|
|
HC LOCAL ANESTH EA ADD MIN
|
Facility
|
IP
|
$6.98
|
|
| Hospital Charge Code |
1246659
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Aetna Commercial |
$6.03
|
| Rate for Payer: Cash Price |
$4.19
|
| Rate for Payer: Cigna All Commercial |
$6.02
|
| Rate for Payer: CORVEL All Commercial |
$6.49
|
| Rate for Payer: Coventry All Commercial |
$6.14
|
| Rate for Payer: Encore All Commercial |
$6.43
|
| Rate for Payer: Frontpath All Commercial |
$6.42
|
| Rate for Payer: Humana ChoiceCare |
$6.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.28
|
| Rate for Payer: PHCS All Commercial |
$5.24
|
| Rate for Payer: PHP All Commercial |
$5.29
|
| Rate for Payer: Sagamore Health Network All Products |
$5.39
|
| Rate for Payer: Signature Care EPO |
$5.79
|
| Rate for Payer: Signature Care PPO |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$5.50
|
|
|
HC LOCAL ANESTH EA ADD MIN
|
Facility
|
OP
|
$6.98
|
|
| Hospital Charge Code |
1246659
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$5.89
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.46
|
| Rate for Payer: Cash Price |
$4.19
|
| Rate for Payer: Cash Price |
$4.19
|
| Rate for Payer: Centivo All Commercial |
$3.80
|
| Rate for Payer: Cigna All Commercial |
$6.02
|
| Rate for Payer: CORVEL All Commercial |
$6.49
|
| Rate for Payer: Coventry All Commercial |
$6.14
|
| Rate for Payer: Encore All Commercial |
$6.43
|
| Rate for Payer: Frontpath All Commercial |
$6.42
|
| Rate for Payer: Humana ChoiceCare |
$6.03
|
| Rate for Payer: Humana Medicare |
$2.23
|
| Rate for Payer: Lucent All Commercial |
$3.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.28
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$5.24
|
| Rate for Payer: PHP All Commercial |
$5.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.72
|
| Rate for Payer: Sagamore Health Network All Products |
$5.39
|
| Rate for Payer: Signature Care EPO |
$5.79
|
| Rate for Payer: Signature Care PPO |
$6.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.93
|
| Rate for Payer: United Healthcare Commercial |
$5.50
|
| Rate for Payer: United Healthcare Medicare |
$2.23
|
|
|
HC LOCAL ANESTH INITIAL 15 MIN
|
Facility
|
IP
|
$116.38
|
|
| Hospital Charge Code |
1246658
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$87.28 |
| Max. Negotiated Rate |
$108.23 |
| Rate for Payer: Aetna Commercial |
$100.55
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.23
|
| Rate for Payer: Coventry All Commercial |
$102.41
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: PHCS All Commercial |
$87.28
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.41
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
|
|
HC LOCAL ANESTH INITIAL 15 MIN
|
Facility
|
OP
|
$116.38
|
|
| Hospital Charge Code |
1246658
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$108.23 |
| Rate for Payer: Aetna Commercial |
$98.22
|
| Rate for Payer: Aetna Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.97
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Centivo All Commercial |
$63.31
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.23
|
| Rate for Payer: Coventry All Commercial |
$102.41
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Humana Medicare |
$37.24
|
| Rate for Payer: Lucent All Commercial |
$63.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$87.28
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.39
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.92
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
| Rate for Payer: United Healthcare Medicare |
$37.24
|
|
|
HC LOOP ELECTRODE 10X10MM
|
Facility
|
IP
|
$90.27
|
|
| Hospital Charge Code |
41608390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$83.95 |
| Rate for Payer: Aetna Commercial |
$77.99
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Cigna All Commercial |
$77.90
|
| Rate for Payer: CORVEL All Commercial |
$83.95
|
| Rate for Payer: Coventry All Commercial |
$79.44
|
| Rate for Payer: Encore All Commercial |
$83.09
|
| Rate for Payer: Frontpath All Commercial |
$83.05
|
| Rate for Payer: Humana ChoiceCare |
$77.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.24
|
| Rate for Payer: PHCS All Commercial |
$67.70
|
| Rate for Payer: PHP All Commercial |
$68.46
|
| Rate for Payer: Sagamore Health Network All Products |
$69.69
|
| Rate for Payer: Signature Care EPO |
$74.92
|
| Rate for Payer: Signature Care PPO |
$79.44
|
| Rate for Payer: United Healthcare Commercial |
$71.13
|
|
|
HC LOOP ELECTRODE 10X10MM
|
Facility
|
OP
|
$90.27
|
|
| Hospital Charge Code |
41608390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$83.95 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare |
$28.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.78
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Centivo All Commercial |
$49.11
|
| Rate for Payer: Cigna All Commercial |
$77.90
|
| Rate for Payer: CORVEL All Commercial |
$83.95
|
| Rate for Payer: Coventry All Commercial |
$79.44
|
| Rate for Payer: Encore All Commercial |
$83.09
|
| Rate for Payer: Frontpath All Commercial |
$83.05
|
| Rate for Payer: Humana ChoiceCare |
$77.97
|
| Rate for Payer: Humana Medicare |
$28.89
|
| Rate for Payer: Lucent All Commercial |
$49.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.24
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$67.70
|
| Rate for Payer: PHP All Commercial |
$68.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.21
|
| Rate for Payer: Sagamore Health Network All Products |
$69.69
|
| Rate for Payer: Signature Care EPO |
$74.92
|
| Rate for Payer: Signature Care PPO |
$79.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.73
|
| Rate for Payer: United Healthcare Commercial |
$71.13
|
| Rate for Payer: United Healthcare Medicare |
$28.89
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$663.00
|
|
| Hospital Charge Code |
1682011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.25 |
| Max. Negotiated Rate |
$616.59 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna All Commercial |
$572.17
|
| Rate for Payer: CORVEL All Commercial |
$616.59
|
| Rate for Payer: Coventry All Commercial |
$583.44
|
| Rate for Payer: Encore All Commercial |
$610.29
|
| Rate for Payer: Frontpath All Commercial |
$609.96
|
| Rate for Payer: Humana ChoiceCare |
$572.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.70
|
| Rate for Payer: PHCS All Commercial |
$497.25
|
| Rate for Payer: PHP All Commercial |
$502.82
|
| Rate for Payer: Sagamore Health Network All Products |
$511.84
|
| Rate for Payer: Signature Care EPO |
$550.29
|
| Rate for Payer: Signature Care PPO |
$583.44
|
| Rate for Payer: United Healthcare Commercial |
$522.44
|
|
