|
HC LACTOFERRIN - FECES
|
Facility
IP
|
$197.71
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
63001618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.28 |
| Max. Negotiated Rate |
$183.87 |
| Rate for Payer: Aetna Commercial |
$170.82
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cigna All Commercial |
$170.62
|
| Rate for Payer: CORVEL All Commercial |
$183.87
|
| Rate for Payer: Coventry All Commercial |
$173.98
|
| Rate for Payer: Encore All Commercial |
$181.99
|
| Rate for Payer: Frontpath All Commercial |
$181.89
|
| Rate for Payer: Humana ChoiceCare |
$170.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.94
|
| Rate for Payer: PHCS All Commercial |
$148.28
|
| Rate for Payer: PHP All Commercial |
$149.94
|
| Rate for Payer: Sagamore Health Network All Products |
$152.63
|
| Rate for Payer: Signature Care EPO |
$164.10
|
| Rate for Payer: Signature Care PPO |
$173.98
|
| Rate for Payer: United Healthcare Commercial |
$155.79
|
|
|
HC LACTOSE TOLERANCE
|
Facility
OP
|
$104.06
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
63001177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$96.78 |
| Rate for Payer: Aetna Commercial |
$87.83
|
| Rate for Payer: Aetna Medicare |
$34.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.77
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Centivo All Commercial |
$53.07
|
| Rate for Payer: Cigna All Commercial |
$89.80
|
| Rate for Payer: CORVEL All Commercial |
$96.78
|
| Rate for Payer: Coventry All Commercial |
$91.57
|
| Rate for Payer: Encore All Commercial |
$95.79
|
| Rate for Payer: Frontpath All Commercial |
$95.74
|
| Rate for Payer: Humana ChoiceCare |
$89.88
|
| Rate for Payer: Humana Medicare |
$53.07
|
| Rate for Payer: Lucent All Commercial |
$53.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.65
|
| Rate for Payer: Managed Health Services Medicaid |
$12.87
|
| Rate for Payer: MDWise Medicaid |
$12.87
|
| Rate for Payer: PHCS All Commercial |
$78.05
|
| Rate for Payer: PHP All Commercial |
$78.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.58
|
| Rate for Payer: Sagamore Health Network All Products |
$80.33
|
| Rate for Payer: Signature Care EPO |
$86.37
|
| Rate for Payer: Signature Care PPO |
$91.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.45
|
| Rate for Payer: United Healthcare Commercial |
$82.00
|
| Rate for Payer: United Healthcare Medicare |
$34.34
|
|
|
HC LACTOSE TOLERANCE
|
Facility
IP
|
$104.06
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
63001177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.05 |
| Max. Negotiated Rate |
$96.78 |
| Rate for Payer: Aetna Commercial |
$89.91
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cigna All Commercial |
$89.80
|
| Rate for Payer: CORVEL All Commercial |
$96.78
|
| Rate for Payer: Coventry All Commercial |
$91.57
|
| Rate for Payer: Encore All Commercial |
$95.79
|
| Rate for Payer: Frontpath All Commercial |
$95.74
|
| Rate for Payer: Humana ChoiceCare |
$89.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.65
|
| Rate for Payer: PHCS All Commercial |
$78.05
|
| Rate for Payer: PHP All Commercial |
$78.92
|
| Rate for Payer: Sagamore Health Network All Products |
$80.33
|
| Rate for Payer: Signature Care EPO |
$86.37
|
| Rate for Payer: Signature Care PPO |
$91.57
|
| Rate for Payer: United Healthcare Commercial |
$82.00
|
|
|
HC LAMELLAR BODY COUNTS, AMNIOTIC FLUID
|
Facility
IP
|
$175.29
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
63001188
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.47 |
| Max. Negotiated Rate |
$163.02 |
| Rate for Payer: Aetna Commercial |
$151.45
|
| Rate for Payer: Cash Price |
$108.68
|
| Rate for Payer: Cigna All Commercial |
$151.27
|
| Rate for Payer: CORVEL All Commercial |
$163.02
|
| Rate for Payer: Coventry All Commercial |
$154.25
|
| Rate for Payer: Encore All Commercial |
$161.35
|
| Rate for Payer: Frontpath All Commercial |
$161.26
|
| Rate for Payer: Humana ChoiceCare |
$151.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.76
|
| Rate for Payer: PHCS All Commercial |
$131.47
|
| Rate for Payer: PHP All Commercial |
$132.94
|
| Rate for Payer: Sagamore Health Network All Products |
$135.32
|
| Rate for Payer: Signature Care EPO |
$145.49
|
| Rate for Payer: Signature Care PPO |
$154.25
|
| Rate for Payer: United Healthcare Commercial |
$138.13
|
|
|
HC LAMELLAR BODY COUNTS, AMNIOTIC FLUID
|
Facility
OP
|
$175.29
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
63001188
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$163.02 |
| Rate for Payer: Aetna Commercial |
$147.94
|
| Rate for Payer: Aetna Medicare |
$57.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.63
|
| Rate for Payer: Cash Price |
$108.68
|
| Rate for Payer: Cash Price |
$108.68
|
| Rate for Payer: Centivo All Commercial |
$89.40
|
| Rate for Payer: Cigna All Commercial |
$151.27
|
| Rate for Payer: CORVEL All Commercial |
$163.02
|
| Rate for Payer: Coventry All Commercial |
$154.25
|
| Rate for Payer: Encore All Commercial |
$161.35
|
| Rate for Payer: Frontpath All Commercial |
$161.26
|
| Rate for Payer: Humana ChoiceCare |
$151.40
|
| Rate for Payer: Humana Medicare |
$89.40
|
| Rate for Payer: Lucent All Commercial |
$89.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9.32
|
| Rate for Payer: MDWise Medicaid |
$9.32
|
| Rate for Payer: PHCS All Commercial |
$131.47
|
| Rate for Payer: PHP All Commercial |
$132.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.36
|
| Rate for Payer: Sagamore Health Network All Products |
$135.32
|
| Rate for Payer: Signature Care EPO |
$145.49
|
| Rate for Payer: Signature Care PPO |
$154.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148.99
|
| Rate for Payer: United Healthcare Commercial |
$138.13
|
| Rate for Payer: United Healthcare Medicare |
$57.84
|
|
|
HC LAMELLAR BODY DENSITY
|
Facility
OP
|
$194.41
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
63001006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$180.80 |
| Rate for Payer: Aetna Commercial |
$164.08
|
| Rate for Payer: Aetna Medicare |
$64.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.57
|
| Rate for Payer: Cash Price |
$120.54
|
| Rate for Payer: Cash Price |
$120.54
|
| Rate for Payer: Centivo All Commercial |
$99.15
|
| Rate for Payer: Cigna All Commercial |
$167.78
|
| Rate for Payer: CORVEL All Commercial |
$180.80
|
| Rate for Payer: Coventry All Commercial |
$171.08
|
| Rate for Payer: Encore All Commercial |
$178.96
|
| Rate for Payer: Frontpath All Commercial |
$178.86
|
| Rate for Payer: Humana ChoiceCare |
$167.91
|
| Rate for Payer: Humana Medicare |
$99.15
|
| Rate for Payer: Lucent All Commercial |
$99.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.97
|
| Rate for Payer: Managed Health Services Medicaid |
$4.66
|
| Rate for Payer: MDWise Medicaid |
$4.66
|
| Rate for Payer: PHCS All Commercial |
$145.81
|
| Rate for Payer: PHP All Commercial |
$147.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.82
|
| Rate for Payer: Sagamore Health Network All Products |
$150.09
|
| Rate for Payer: Signature Care EPO |
$161.36
|
| Rate for Payer: Signature Care PPO |
$171.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.25
|
| Rate for Payer: United Healthcare Commercial |
$153.20
|
| Rate for Payer: United Healthcare Medicare |
$64.16
|
|
|
HC LAMELLAR BODY DENSITY
|
Facility
IP
|
$194.41
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
63001006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.81 |
| Max. Negotiated Rate |
$180.80 |
| Rate for Payer: Aetna Commercial |
$167.97
|
| Rate for Payer: Cash Price |
$120.54
|
| Rate for Payer: Cigna All Commercial |
$167.78
|
| Rate for Payer: CORVEL All Commercial |
$180.80
|
| Rate for Payer: Coventry All Commercial |
$171.08
|
| Rate for Payer: Encore All Commercial |
$178.96
|
| Rate for Payer: Frontpath All Commercial |
$178.86
|
| Rate for Payer: Humana ChoiceCare |
$167.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.97
|
| Rate for Payer: PHCS All Commercial |
$145.81
|
| Rate for Payer: PHP All Commercial |
$147.44
|
| Rate for Payer: Sagamore Health Network All Products |
$150.09
|
| Rate for Payer: Signature Care EPO |
$161.36
|
| Rate for Payer: Signature Care PPO |
$171.08
|
| Rate for Payer: United Healthcare Commercial |
$153.20
|
|
|
HC LAMOTRIGINE/LAMI
|
Facility
OP
|
$271.17
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
63001007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$252.19 |
| Rate for Payer: Aetna Commercial |
$228.86
|
| Rate for Payer: Aetna Medicare |
$89.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$155.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$169.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.43
|
| Rate for Payer: Cash Price |
$168.12
|
| Rate for Payer: Cash Price |
$168.12
|
| Rate for Payer: Centivo All Commercial |
$138.30
|
| Rate for Payer: Cigna All Commercial |
$234.02
|
| Rate for Payer: CORVEL All Commercial |
$252.19
|
| Rate for Payer: Coventry All Commercial |
$238.63
|
| Rate for Payer: Encore All Commercial |
$249.61
|
| Rate for Payer: Frontpath All Commercial |
$249.47
|
| Rate for Payer: Humana ChoiceCare |
$234.21
|
| Rate for Payer: Humana Medicare |
$138.30
|
| Rate for Payer: Lucent All Commercial |
$138.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.05
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$203.38
|
| Rate for Payer: PHP All Commercial |
$205.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.76
|
| Rate for Payer: Sagamore Health Network All Products |
$209.34
|
| Rate for Payer: Signature Care EPO |
$225.07
|
| Rate for Payer: Signature Care PPO |
$238.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$230.49
|
| Rate for Payer: United Healthcare Commercial |
$213.68
|
| Rate for Payer: United Healthcare Medicare |
$89.49
|
|
|
HC LAMOTRIGINE/LAMI
|
Facility
IP
|
$271.17
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
63001007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$252.19 |
| Rate for Payer: Aetna Commercial |
$234.29
|
| Rate for Payer: Cash Price |
$168.12
|
| Rate for Payer: Cigna All Commercial |
$234.02
|
| Rate for Payer: CORVEL All Commercial |
$252.19
|
| Rate for Payer: Coventry All Commercial |
$238.63
|
| Rate for Payer: Encore All Commercial |
$249.61
|
| Rate for Payer: Frontpath All Commercial |
$249.47
|
| Rate for Payer: Humana ChoiceCare |
$234.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.05
|
| Rate for Payer: PHCS All Commercial |
$203.38
|
| Rate for Payer: PHP All Commercial |
$205.65
|
| Rate for Payer: Sagamore Health Network All Products |
$209.34
|
| Rate for Payer: Signature Care EPO |
$225.07
|
| Rate for Payer: Signature Care PPO |
$238.63
|
| Rate for Payer: United Healthcare Commercial |
$213.68
|
|
|
HC LATEX IGE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC LATEX IGE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC LDH BF
|
Facility
OP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$91.41
|
| Rate for Payer: Aetna Medicare |
$35.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.31
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Centivo All Commercial |
$55.23
|
| Rate for Payer: Cigna All Commercial |
$93.47
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.31
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Humana Medicare |
$55.23
|
| Rate for Payer: Lucent All Commercial |
$55.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: Managed Health Services Medicaid |
$6.04
|
| Rate for Payer: MDWise Medicaid |
$6.04
|
| Rate for Payer: PHCS All Commercial |
$81.23
|
| Rate for Payer: PHP All Commercial |
$82.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.24
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.06
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
| Rate for Payer: United Healthcare Medicare |
$35.74
|
|
|
HC LDH BF
|
Facility
IP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.23 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Cigna All Commercial |
$93.47
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.31
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: PHCS All Commercial |
$81.23
|
| Rate for Payer: PHP All Commercial |
$82.14
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
|
|
HC LDH BLOOD
|
Facility
OP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$91.41
|
| Rate for Payer: Aetna Medicare |
$35.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.31
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Centivo All Commercial |
$55.23
|
| Rate for Payer: Cigna All Commercial |
$93.47
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.31
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Humana Medicare |
$55.23
|
| Rate for Payer: Lucent All Commercial |
$55.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: Managed Health Services Medicaid |
$6.04
|
| Rate for Payer: MDWise Medicaid |
$6.04
|
| Rate for Payer: PHCS All Commercial |
$81.23
|
| Rate for Payer: PHP All Commercial |
$82.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.24
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.06
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
| Rate for Payer: United Healthcare Medicare |
$35.74
|
|
|
HC LDH BLOOD
|
Facility
IP
|
$108.30
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
63001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.23 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Cigna All Commercial |
$93.47
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.31
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: PHCS All Commercial |
$81.23
|
| Rate for Payer: PHP All Commercial |
$82.14
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
|
|
HC LD HVOPTI DF4 ACT TBP 58CMMRI
|
Facility
OP
|
$11,340.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,546.20 |
| Rate for Payer: Aetna Commercial |
$9,570.96
|
| Rate for Payer: Aetna Medicare |
$3,742.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,742.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,512.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,088.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,303.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,116.42
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Centivo All Commercial |
$5,783.40
|
| Rate for Payer: Cigna All Commercial |
$9,786.42
|
| Rate for Payer: CORVEL All Commercial |
$10,546.20
|
| Rate for Payer: Coventry All Commercial |
$9,979.20
|
| Rate for Payer: Encore All Commercial |
$10,438.47
|
| Rate for Payer: Frontpath All Commercial |
$10,432.80
|
| Rate for Payer: Humana ChoiceCare |
$9,794.36
|
| Rate for Payer: Humana Medicare |
$5,783.40
|
| Rate for Payer: Lucent All Commercial |
$5,783.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,206.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,505.00
|
| Rate for Payer: PHP All Commercial |
$8,600.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,422.60
|
| Rate for Payer: Sagamore Health Network All Products |
$8,754.48
|
| Rate for Payer: Signature Care EPO |
$9,412.20
|
| Rate for Payer: Signature Care PPO |
$9,979.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,639.00
|
| Rate for Payer: United Healthcare Commercial |
$8,935.92
|
| Rate for Payer: United Healthcare Medicare |
$3,742.20
|
|
|
HC LD HVOPTI DF4 ACT TBP 58CMMRI
|
Facility
IP
|
$11,340.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,505.00 |
| Max. Negotiated Rate |
$10,546.20 |
| Rate for Payer: Aetna Commercial |
$9,797.76
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Cigna All Commercial |
$9,786.42
|
| Rate for Payer: CORVEL All Commercial |
$10,546.20
|
| Rate for Payer: Coventry All Commercial |
$9,979.20
|
| Rate for Payer: Encore All Commercial |
$10,438.47
|
| Rate for Payer: Frontpath All Commercial |
$10,432.80
|
| Rate for Payer: Humana ChoiceCare |
$9,794.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,206.00
|
| Rate for Payer: PHCS All Commercial |
$8,505.00
|
| Rate for Payer: PHP All Commercial |
$8,600.26
|
| Rate for Payer: Sagamore Health Network All Products |
$8,754.48
|
| Rate for Payer: Signature Care EPO |
$9,412.20
|
| Rate for Payer: Signature Care PPO |
$9,979.20
|
| Rate for Payer: United Healthcare Commercial |
$8,935.92
|
|
|
HC LD HV OPTI DF4 ACT TBP 65CMMRI
|
Facility
OP
|
$11,340.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,546.20 |
| Rate for Payer: Aetna Commercial |
$9,570.96
|
| Rate for Payer: Aetna Medicare |
$3,742.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,742.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,512.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,088.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,303.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,116.42
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Centivo All Commercial |
$5,783.40
|
| Rate for Payer: Cigna All Commercial |
$9,786.42
|
| Rate for Payer: CORVEL All Commercial |
$10,546.20
|
| Rate for Payer: Coventry All Commercial |
$9,979.20
|
| Rate for Payer: Encore All Commercial |
$10,438.47
|
| Rate for Payer: Frontpath All Commercial |
$10,432.80
|
| Rate for Payer: Humana ChoiceCare |
$9,794.36
|
| Rate for Payer: Humana Medicare |
$5,783.40
|
| Rate for Payer: Lucent All Commercial |
$5,783.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,206.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,505.00
|
| Rate for Payer: PHP All Commercial |
$8,600.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,422.60
|
| Rate for Payer: Sagamore Health Network All Products |
$8,754.48
|
| Rate for Payer: Signature Care EPO |
$9,412.20
|
| Rate for Payer: Signature Care PPO |
$9,979.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,639.00
|
| Rate for Payer: United Healthcare Commercial |
$8,935.92
|
| Rate for Payer: United Healthcare Medicare |
$3,742.20
|
|
|
HC LD HV OPTI DF4 ACT TBP 65CMMRI
|
Facility
IP
|
$11,340.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,505.00 |
| Max. Negotiated Rate |
$10,546.20 |
| Rate for Payer: Aetna Commercial |
$9,797.76
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Cigna All Commercial |
$9,786.42
|
| Rate for Payer: CORVEL All Commercial |
$10,546.20
|
| Rate for Payer: Coventry All Commercial |
$9,979.20
|
| Rate for Payer: Encore All Commercial |
$10,438.47
|
| Rate for Payer: Frontpath All Commercial |
$10,432.80
|
| Rate for Payer: Humana ChoiceCare |
$9,794.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,206.00
|
| Rate for Payer: PHCS All Commercial |
$8,505.00
|
| Rate for Payer: PHP All Commercial |
$8,600.26
|
| Rate for Payer: Sagamore Health Network All Products |
$8,754.48
|
| Rate for Payer: Signature Care EPO |
$9,412.20
|
| Rate for Payer: Signature Care PPO |
$9,979.20
|
| Rate for Payer: United Healthcare Commercial |
$8,935.92
|
|
|
HC LDL, DIRECT
|
Facility
OP
|
$113.25
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
63001142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Aetna Commercial |
$95.58
|
| Rate for Payer: Aetna Medicare |
$37.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.11
|
| Rate for Payer: Cash Price |
$70.22
|
| Rate for Payer: Cash Price |
$70.22
|
| Rate for Payer: Centivo All Commercial |
$57.76
|
| Rate for Payer: Cigna All Commercial |
$97.74
|
| Rate for Payer: CORVEL All Commercial |
$105.32
|
| Rate for Payer: Coventry All Commercial |
$99.66
|
| Rate for Payer: Encore All Commercial |
$104.25
|
| Rate for Payer: Frontpath All Commercial |
$104.19
|
| Rate for Payer: Humana ChoiceCare |
$97.81
|
| Rate for Payer: Humana Medicare |
$57.76
|
| Rate for Payer: Lucent All Commercial |
$57.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.93
|
| Rate for Payer: Managed Health Services Medicaid |
$10.50
|
| Rate for Payer: MDWise Medicaid |
$10.50
|
| Rate for Payer: PHCS All Commercial |
$84.94
|
| Rate for Payer: PHP All Commercial |
$85.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.17
|
| Rate for Payer: Sagamore Health Network All Products |
$87.43
|
| Rate for Payer: Signature Care EPO |
$94.00
|
| Rate for Payer: Signature Care PPO |
$99.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.26
|
| Rate for Payer: United Healthcare Commercial |
$89.24
|
| Rate for Payer: United Healthcare Medicare |
$37.37
|
|
|
HC LDL, DIRECT
|
Facility
IP
|
$113.25
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
63001142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.94 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Cash Price |
$70.22
|
| Rate for Payer: Cigna All Commercial |
$97.74
|
| Rate for Payer: CORVEL All Commercial |
$105.32
|
| Rate for Payer: Coventry All Commercial |
$99.66
|
| Rate for Payer: Encore All Commercial |
$104.25
|
| Rate for Payer: Frontpath All Commercial |
$104.19
|
| Rate for Payer: Humana ChoiceCare |
$97.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.93
|
| Rate for Payer: PHCS All Commercial |
$84.94
|
| Rate for Payer: PHP All Commercial |
$85.89
|
| Rate for Payer: Sagamore Health Network All Products |
$87.43
|
| Rate for Payer: Signature Care EPO |
$94.00
|
| Rate for Payer: Signature Care PPO |
$99.66
|
| Rate for Payer: United Healthcare Commercial |
$89.24
|
|
|
HC LDL FRACTIONS
|
Facility
IP
|
$504.21
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
63001625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$378.15 |
| Max. Negotiated Rate |
$468.91 |
| Rate for Payer: Aetna Commercial |
$435.63
|
| Rate for Payer: Cash Price |
$312.61
|
| Rate for Payer: Cigna All Commercial |
$435.13
|
| Rate for Payer: CORVEL All Commercial |
$468.91
|
| Rate for Payer: Coventry All Commercial |
$443.70
|
| Rate for Payer: Encore All Commercial |
$464.12
|
| Rate for Payer: Frontpath All Commercial |
$463.87
|
| Rate for Payer: Humana ChoiceCare |
$435.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.79
|
| Rate for Payer: PHCS All Commercial |
$378.15
|
| Rate for Payer: PHP All Commercial |
$382.39
|
| Rate for Payer: Sagamore Health Network All Products |
$389.25
|
| Rate for Payer: Signature Care EPO |
$418.49
|
| Rate for Payer: Signature Care PPO |
$443.70
|
| Rate for Payer: United Healthcare Commercial |
$397.31
|
|
|
HC LDL FRACTIONS
|
Facility
OP
|
$504.21
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
63001625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$468.91 |
| Rate for Payer: Aetna Commercial |
$425.55
|
| Rate for Payer: Aetna Medicare |
$166.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$166.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$289.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$315.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.03
|
| Rate for Payer: Cash Price |
$312.61
|
| Rate for Payer: Cash Price |
$312.61
|
| Rate for Payer: Centivo All Commercial |
$257.15
|
| Rate for Payer: Cigna All Commercial |
$435.13
|
| Rate for Payer: CORVEL All Commercial |
$468.91
|
| Rate for Payer: Coventry All Commercial |
$443.70
|
| Rate for Payer: Encore All Commercial |
$464.12
|
| Rate for Payer: Frontpath All Commercial |
$463.87
|
| Rate for Payer: Humana ChoiceCare |
$435.48
|
| Rate for Payer: Humana Medicare |
$257.15
|
| Rate for Payer: Lucent All Commercial |
$257.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.79
|
| Rate for Payer: Managed Health Services Medicaid |
$22.03
|
| Rate for Payer: MDWise Medicaid |
$22.03
|
| Rate for Payer: PHCS All Commercial |
$378.15
|
| Rate for Payer: PHP All Commercial |
$382.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.64
|
| Rate for Payer: Sagamore Health Network All Products |
$389.25
|
| Rate for Payer: Signature Care EPO |
$418.49
|
| Rate for Payer: Signature Care PPO |
$443.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$428.58
|
| Rate for Payer: United Healthcare Commercial |
$397.31
|
| Rate for Payer: United Healthcare Medicare |
$166.39
|
|
|
HC LEAD
|
Facility
IP
|
$84.05
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
63001619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.04 |
| Max. Negotiated Rate |
$78.16 |
| Rate for Payer: Aetna Commercial |
$72.62
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Cigna All Commercial |
$72.53
|
| Rate for Payer: CORVEL All Commercial |
$78.16
|
| Rate for Payer: Coventry All Commercial |
$73.96
|
| Rate for Payer: Encore All Commercial |
$77.37
|
| Rate for Payer: Frontpath All Commercial |
$77.32
|
| Rate for Payer: Humana ChoiceCare |
$72.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.64
|
| Rate for Payer: PHCS All Commercial |
$63.04
|
| Rate for Payer: PHP All Commercial |
$63.74
|
| Rate for Payer: Sagamore Health Network All Products |
$64.89
|
| Rate for Payer: Signature Care EPO |
$69.76
|
| Rate for Payer: Signature Care PPO |
$73.96
|
| Rate for Payer: United Healthcare Commercial |
$66.23
|
|
|
HC LEAD
|
Facility
OP
|
$84.05
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
63001619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$78.16 |
| Rate for Payer: Aetna Commercial |
$70.94
|
| Rate for Payer: Aetna Medicare |
$27.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.51
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Centivo All Commercial |
$42.86
|
| Rate for Payer: Cigna All Commercial |
$72.53
|
| Rate for Payer: CORVEL All Commercial |
$78.16
|
| Rate for Payer: Coventry All Commercial |
$73.96
|
| Rate for Payer: Encore All Commercial |
$77.37
|
| Rate for Payer: Frontpath All Commercial |
$77.32
|
| Rate for Payer: Humana ChoiceCare |
$72.59
|
| Rate for Payer: Humana Medicare |
$42.86
|
| Rate for Payer: Lucent All Commercial |
$42.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12.11
|
| Rate for Payer: MDWise Medicaid |
$12.11
|
| Rate for Payer: PHCS All Commercial |
$63.04
|
| Rate for Payer: PHP All Commercial |
$63.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.78
|
| Rate for Payer: Sagamore Health Network All Products |
$64.89
|
| Rate for Payer: Signature Care EPO |
$69.76
|
| Rate for Payer: Signature Care PPO |
$73.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.44
|
| Rate for Payer: United Healthcare Commercial |
$66.23
|
| Rate for Payer: United Healthcare Medicare |
$27.74
|
|
