|
HC LEAD QUARTET 86CM MRI
|
Facility
OP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$8,972.78
|
| Rate for Payer: Aetna Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,645.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,034.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,859.14
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Centivo All Commercial |
$5,421.94
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Humana Medicare |
$5,421.94
|
| Rate for Payer: Lucent All Commercial |
$5,421.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,146.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,036.56
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
| Rate for Payer: United Healthcare Medicare |
$3,508.31
|
|
|
HC LEAD QUARTET 86CM MRI
|
Facility
IP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,973.44 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$9,185.40
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
|
|
HC LEAD QUARTET DBL BEND 86CM MRI
|
Facility
OP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$8,972.78
|
| Rate for Payer: Aetna Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,645.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,034.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,859.14
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Centivo All Commercial |
$5,421.94
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Humana Medicare |
$5,421.94
|
| Rate for Payer: Lucent All Commercial |
$5,421.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,146.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,036.56
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
| Rate for Payer: United Healthcare Medicare |
$3,508.31
|
|
|
HC LEAD QUARTET DBL BEND 86CM MRI
|
Facility
IP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,973.44 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$9,185.40
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
|
|
HC LEAD QUARTET SMALL-S 86CM MRI
|
Facility
OP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$8,972.78
|
| Rate for Payer: Aetna Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,645.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,034.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,859.14
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Centivo All Commercial |
$5,421.94
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Humana Medicare |
$5,421.94
|
| Rate for Payer: Lucent All Commercial |
$5,421.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,146.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,036.56
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
| Rate for Payer: United Healthcare Medicare |
$3,508.31
|
|
|
HC LEAD QUARTET SMALL-S 86CM MRI
|
Facility
IP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,973.44 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$9,185.40
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
|
|
HC LEAD QUART WIDE SPAC 86CM MRI
|
Facility
OP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$8,972.78
|
| Rate for Payer: Aetna Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,508.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,645.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,034.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,859.14
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Centivo All Commercial |
$5,421.94
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Humana Medicare |
$5,421.94
|
| Rate for Payer: Lucent All Commercial |
$5,421.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,146.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,036.56
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
| Rate for Payer: United Healthcare Medicare |
$3,508.31
|
|
|
HC LEAD QUART WIDE SPAC 86CM MRI
|
Facility
IP
|
$10,631.25
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,973.44 |
| Max. Negotiated Rate |
$9,887.06 |
| Rate for Payer: Aetna Commercial |
$9,185.40
|
| Rate for Payer: Cash Price |
$6,591.38
|
| Rate for Payer: Cigna All Commercial |
$9,174.77
|
| Rate for Payer: CORVEL All Commercial |
$9,887.06
|
| Rate for Payer: Coventry All Commercial |
$9,355.50
|
| Rate for Payer: Encore All Commercial |
$9,786.07
|
| Rate for Payer: Frontpath All Commercial |
$9,780.75
|
| Rate for Payer: Humana ChoiceCare |
$9,182.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,568.12
|
| Rate for Payer: PHCS All Commercial |
$7,973.44
|
| Rate for Payer: PHP All Commercial |
$8,062.74
|
| Rate for Payer: Sagamore Health Network All Products |
$8,207.32
|
| Rate for Payer: Signature Care EPO |
$8,823.94
|
| Rate for Payer: Signature Care PPO |
$9,355.50
|
| Rate for Payer: United Healthcare Commercial |
$8,377.42
|
|
|
HC LEEP BALL ELECTRODE
|
Facility
OP
|
$158.76
|
|
| Hospital Charge Code |
41601927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$147.65 |
| Rate for Payer: Aetna Commercial |
$133.99
|
| Rate for Payer: Aetna Medicare |
$52.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.63
|
| Rate for Payer: Cash Price |
$98.43
|
| Rate for Payer: Cash Price |
$98.43
|
| Rate for Payer: Centivo All Commercial |
$80.97
|
| Rate for Payer: Cigna All Commercial |
$137.01
|
| Rate for Payer: CORVEL All Commercial |
$147.65
|
| Rate for Payer: Coventry All Commercial |
$139.71
|
| Rate for Payer: Encore All Commercial |
$146.14
|
| Rate for Payer: Frontpath All Commercial |
$146.06
|
| Rate for Payer: Humana ChoiceCare |
$137.12
|
| Rate for Payer: Humana Medicare |
$80.97
|
| Rate for Payer: Lucent All Commercial |
$80.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$119.07
|
| Rate for Payer: PHP All Commercial |
$120.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.92
|
| Rate for Payer: Sagamore Health Network All Products |
$122.56
|
| Rate for Payer: Signature Care EPO |
$131.77
|
| Rate for Payer: Signature Care PPO |
$139.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134.95
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Medicare |
$52.39
|
|
|
HC LEEP BALL ELECTRODE
|
Facility
IP
|
$158.76
|
|
| Hospital Charge Code |
41601927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$147.65 |
| Rate for Payer: Aetna Commercial |
$137.17
|
| Rate for Payer: Cash Price |
$98.43
|
| Rate for Payer: Cigna All Commercial |
$137.01
|
| Rate for Payer: CORVEL All Commercial |
$147.65
|
| Rate for Payer: Coventry All Commercial |
$139.71
|
| Rate for Payer: Encore All Commercial |
$146.14
|
| Rate for Payer: Frontpath All Commercial |
$146.06
|
| Rate for Payer: Humana ChoiceCare |
$137.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.88
|
| Rate for Payer: PHCS All Commercial |
$119.07
|
| Rate for Payer: PHP All Commercial |
$120.40
|
| Rate for Payer: Sagamore Health Network All Products |
$122.56
|
| Rate for Payer: Signature Care EPO |
$131.77
|
| Rate for Payer: Signature Care PPO |
$139.71
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
HC LEEP ELECTRODE 1.0 CM
|
Facility
IP
|
$79.22
|
|
| Hospital Charge Code |
41601928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.42 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$68.45
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna All Commercial |
$68.37
|
| Rate for Payer: CORVEL All Commercial |
$73.67
|
| Rate for Payer: Coventry All Commercial |
$69.71
|
| Rate for Payer: Encore All Commercial |
$72.92
|
| Rate for Payer: Frontpath All Commercial |
$72.88
|
| Rate for Payer: Humana ChoiceCare |
$68.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.30
|
| Rate for Payer: PHCS All Commercial |
$59.42
|
| Rate for Payer: PHP All Commercial |
$60.08
|
| Rate for Payer: Sagamore Health Network All Products |
$61.16
|
| Rate for Payer: Signature Care EPO |
$65.75
|
| Rate for Payer: Signature Care PPO |
$69.71
|
| Rate for Payer: United Healthcare Commercial |
$62.43
|
|
|
HC LEEP ELECTRODE 1.0 CM
|
Facility
OP
|
$79.22
|
|
| Hospital Charge Code |
41601928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: Aetna Medicare |
$26.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.76
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Centivo All Commercial |
$40.40
|
| Rate for Payer: Cigna All Commercial |
$68.37
|
| Rate for Payer: CORVEL All Commercial |
$73.67
|
| Rate for Payer: Coventry All Commercial |
$69.71
|
| Rate for Payer: Encore All Commercial |
$72.92
|
| Rate for Payer: Frontpath All Commercial |
$72.88
|
| Rate for Payer: Humana ChoiceCare |
$68.42
|
| Rate for Payer: Humana Medicare |
$40.40
|
| Rate for Payer: Lucent All Commercial |
$40.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$59.42
|
| Rate for Payer: PHP All Commercial |
$60.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.90
|
| Rate for Payer: Sagamore Health Network All Products |
$61.16
|
| Rate for Payer: Signature Care EPO |
$65.75
|
| Rate for Payer: Signature Care PPO |
$69.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.34
|
| Rate for Payer: United Healthcare Commercial |
$62.43
|
| Rate for Payer: United Healthcare Medicare |
$26.14
|
|
|
HC LEEP ELECTRODE 2.0 CM
|
Facility
IP
|
$79.22
|
|
| Hospital Charge Code |
41601929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.42 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$68.45
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna All Commercial |
$68.37
|
| Rate for Payer: CORVEL All Commercial |
$73.67
|
| Rate for Payer: Coventry All Commercial |
$69.71
|
| Rate for Payer: Encore All Commercial |
$72.92
|
| Rate for Payer: Frontpath All Commercial |
$72.88
|
| Rate for Payer: Humana ChoiceCare |
$68.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.30
|
| Rate for Payer: PHCS All Commercial |
$59.42
|
| Rate for Payer: PHP All Commercial |
$60.08
|
| Rate for Payer: Sagamore Health Network All Products |
$61.16
|
| Rate for Payer: Signature Care EPO |
$65.75
|
| Rate for Payer: Signature Care PPO |
$69.71
|
| Rate for Payer: United Healthcare Commercial |
$62.43
|
|
|
HC LEEP ELECTRODE 2.0 CM
|
Facility
OP
|
$79.22
|
|
| Hospital Charge Code |
41601929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: Aetna Medicare |
$26.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.76
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Centivo All Commercial |
$40.40
|
| Rate for Payer: Cigna All Commercial |
$68.37
|
| Rate for Payer: CORVEL All Commercial |
$73.67
|
| Rate for Payer: Coventry All Commercial |
$69.71
|
| Rate for Payer: Encore All Commercial |
$72.92
|
| Rate for Payer: Frontpath All Commercial |
$72.88
|
| Rate for Payer: Humana ChoiceCare |
$68.42
|
| Rate for Payer: Humana Medicare |
$40.40
|
| Rate for Payer: Lucent All Commercial |
$40.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$59.42
|
| Rate for Payer: PHP All Commercial |
$60.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.90
|
| Rate for Payer: Sagamore Health Network All Products |
$61.16
|
| Rate for Payer: Signature Care EPO |
$65.75
|
| Rate for Payer: Signature Care PPO |
$69.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.34
|
| Rate for Payer: United Healthcare Commercial |
$62.43
|
| Rate for Payer: United Healthcare Medicare |
$26.14
|
|
|
HC LEGIONELLA
|
Facility
IP
|
$168.62
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63001958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.46 |
| Max. Negotiated Rate |
$156.81 |
| Rate for Payer: Aetna Commercial |
$145.68
|
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Cigna All Commercial |
$145.52
|
| Rate for Payer: CORVEL All Commercial |
$156.81
|
| Rate for Payer: Coventry All Commercial |
$148.38
|
| Rate for Payer: Encore All Commercial |
$155.21
|
| Rate for Payer: Frontpath All Commercial |
$155.13
|
| Rate for Payer: Humana ChoiceCare |
$145.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.75
|
| Rate for Payer: PHCS All Commercial |
$126.46
|
| Rate for Payer: PHP All Commercial |
$127.88
|
| Rate for Payer: Sagamore Health Network All Products |
$130.17
|
| Rate for Payer: Signature Care EPO |
$139.95
|
| Rate for Payer: Signature Care PPO |
$148.38
|
| Rate for Payer: United Healthcare Commercial |
$132.87
|
|
|
HC LEGIONELLA
|
Facility
OP
|
$168.62
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63001958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$156.81 |
| Rate for Payer: Aetna Commercial |
$142.31
|
| Rate for Payer: Aetna Medicare |
$55.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.21
|
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Centivo All Commercial |
$85.99
|
| Rate for Payer: Cigna All Commercial |
$145.52
|
| Rate for Payer: CORVEL All Commercial |
$156.81
|
| Rate for Payer: Coventry All Commercial |
$148.38
|
| Rate for Payer: Encore All Commercial |
$155.21
|
| Rate for Payer: Frontpath All Commercial |
$155.13
|
| Rate for Payer: Humana ChoiceCare |
$145.63
|
| Rate for Payer: Humana Medicare |
$85.99
|
| Rate for Payer: Lucent All Commercial |
$85.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.75
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$126.46
|
| Rate for Payer: PHP All Commercial |
$127.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.76
|
| Rate for Payer: Sagamore Health Network All Products |
$130.17
|
| Rate for Payer: Signature Care EPO |
$139.95
|
| Rate for Payer: Signature Care PPO |
$148.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.32
|
| Rate for Payer: United Healthcare Commercial |
$132.87
|
| Rate for Payer: United Healthcare Medicare |
$55.64
|
|
|
HC LEGIONELLA PNEUMOPHILA ABS
|
Facility
OP
|
$51.02
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63001959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.52
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Centivo All Commercial |
$26.02
|
| Rate for Payer: Cigna All Commercial |
$44.03
|
| Rate for Payer: CORVEL All Commercial |
$47.45
|
| Rate for Payer: Coventry All Commercial |
$44.90
|
| Rate for Payer: Encore All Commercial |
$46.96
|
| Rate for Payer: Frontpath All Commercial |
$46.94
|
| Rate for Payer: Humana ChoiceCare |
$44.07
|
| Rate for Payer: Humana Medicare |
$26.02
|
| Rate for Payer: Lucent All Commercial |
$26.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.92
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$38.27
|
| Rate for Payer: PHP All Commercial |
$38.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.90
|
| Rate for Payer: Sagamore Health Network All Products |
$39.39
|
| Rate for Payer: Signature Care EPO |
$42.35
|
| Rate for Payer: Signature Care PPO |
$44.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.37
|
| Rate for Payer: United Healthcare Commercial |
$40.20
|
| Rate for Payer: United Healthcare Medicare |
$16.84
|
|
|
HC LEGIONELLA PNEUMOPHILA ABS
|
Facility
IP
|
$51.02
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63001959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.27 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Commercial |
$44.08
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cigna All Commercial |
$44.03
|
| Rate for Payer: CORVEL All Commercial |
$47.45
|
| Rate for Payer: Coventry All Commercial |
$44.90
|
| Rate for Payer: Encore All Commercial |
$46.96
|
| Rate for Payer: Frontpath All Commercial |
$46.94
|
| Rate for Payer: Humana ChoiceCare |
$44.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.92
|
| Rate for Payer: PHCS All Commercial |
$38.27
|
| Rate for Payer: PHP All Commercial |
$38.69
|
| Rate for Payer: Sagamore Health Network All Products |
$39.39
|
| Rate for Payer: Signature Care EPO |
$42.35
|
| Rate for Payer: Signature Care PPO |
$44.90
|
| Rate for Payer: United Healthcare Commercial |
$40.20
|
|
|
HC LEGIONELLA PNEUMOPHILA ANTIBODY (TYPES 1-6), IGG BY IFA
|
Facility
OP
|
$71.15
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63044057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$66.16 |
| Rate for Payer: Aetna Commercial |
$60.05
|
| Rate for Payer: Aetna Medicare |
$23.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.83
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Centivo All Commercial |
$36.28
|
| Rate for Payer: Cigna All Commercial |
$61.40
|
| Rate for Payer: CORVEL All Commercial |
$66.16
|
| Rate for Payer: Coventry All Commercial |
$62.61
|
| Rate for Payer: Encore All Commercial |
$65.49
|
| Rate for Payer: Frontpath All Commercial |
$65.45
|
| Rate for Payer: Humana ChoiceCare |
$61.45
|
| Rate for Payer: Humana Medicare |
$36.28
|
| Rate for Payer: Lucent All Commercial |
$36.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.03
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$53.36
|
| Rate for Payer: PHP All Commercial |
$53.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.75
|
| Rate for Payer: Sagamore Health Network All Products |
$54.92
|
| Rate for Payer: Signature Care EPO |
$59.05
|
| Rate for Payer: Signature Care PPO |
$62.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.47
|
| Rate for Payer: United Healthcare Commercial |
$56.06
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
|
|
HC LEGIONELLA PNEUMOPHILA ANTIBODY (TYPES 1-6), IGG BY IFA
|
Facility
IP
|
$71.15
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63044057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$66.16 |
| Rate for Payer: Aetna Commercial |
$61.47
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cigna All Commercial |
$61.40
|
| Rate for Payer: CORVEL All Commercial |
$66.16
|
| Rate for Payer: Coventry All Commercial |
$62.61
|
| Rate for Payer: Encore All Commercial |
$65.49
|
| Rate for Payer: Frontpath All Commercial |
$65.45
|
| Rate for Payer: Humana ChoiceCare |
$61.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.03
|
| Rate for Payer: PHCS All Commercial |
$53.36
|
| Rate for Payer: PHP All Commercial |
$53.96
|
| Rate for Payer: Sagamore Health Network All Products |
$54.92
|
| Rate for Payer: Signature Care EPO |
$59.05
|
| Rate for Payer: Signature Care PPO |
$62.61
|
| Rate for Payer: United Healthcare Commercial |
$56.06
|
|
|
HC LEGIONELLA PNEUMOPHILA ANTIBODY (TYPES 1-6), IGM BY IFA
|
Facility
OP
|
$71.15
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63044058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$66.16 |
| Rate for Payer: Aetna Commercial |
$60.05
|
| Rate for Payer: Aetna Medicare |
$23.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.83
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Centivo All Commercial |
$36.28
|
| Rate for Payer: Cigna All Commercial |
$61.40
|
| Rate for Payer: CORVEL All Commercial |
$66.16
|
| Rate for Payer: Coventry All Commercial |
$62.61
|
| Rate for Payer: Encore All Commercial |
$65.49
|
| Rate for Payer: Frontpath All Commercial |
$65.45
|
| Rate for Payer: Humana ChoiceCare |
$61.45
|
| Rate for Payer: Humana Medicare |
$36.28
|
| Rate for Payer: Lucent All Commercial |
$36.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.03
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$53.36
|
| Rate for Payer: PHP All Commercial |
$53.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.75
|
| Rate for Payer: Sagamore Health Network All Products |
$54.92
|
| Rate for Payer: Signature Care EPO |
$59.05
|
| Rate for Payer: Signature Care PPO |
$62.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.47
|
| Rate for Payer: United Healthcare Commercial |
$56.06
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
|
|
HC LEGIONELLA PNEUMOPHILA ANTIBODY (TYPES 1-6), IGM BY IFA
|
Facility
IP
|
$71.15
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
63044058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$66.16 |
| Rate for Payer: Aetna Commercial |
$61.47
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cigna All Commercial |
$61.40
|
| Rate for Payer: CORVEL All Commercial |
$66.16
|
| Rate for Payer: Coventry All Commercial |
$62.61
|
| Rate for Payer: Encore All Commercial |
$65.49
|
| Rate for Payer: Frontpath All Commercial |
$65.45
|
| Rate for Payer: Humana ChoiceCare |
$61.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.03
|
| Rate for Payer: PHCS All Commercial |
$53.36
|
| Rate for Payer: PHP All Commercial |
$53.96
|
| Rate for Payer: Sagamore Health Network All Products |
$54.92
|
| Rate for Payer: Signature Care EPO |
$59.05
|
| Rate for Payer: Signature Care PPO |
$62.61
|
| Rate for Payer: United Healthcare Commercial |
$56.06
|
|
|
HC LEGION PNEUMO AG UR
|
Facility
OP
|
$247.82
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
63001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$230.47 |
| Rate for Payer: Aetna Commercial |
$209.16
|
| Rate for Payer: Aetna Medicare |
$81.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$113.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.96
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Centivo All Commercial |
$126.39
|
| Rate for Payer: Cigna All Commercial |
$213.87
|
| Rate for Payer: CORVEL All Commercial |
$230.47
|
| Rate for Payer: Coventry All Commercial |
$218.08
|
| Rate for Payer: Encore All Commercial |
$228.12
|
| Rate for Payer: Frontpath All Commercial |
$227.99
|
| Rate for Payer: Humana ChoiceCare |
$214.04
|
| Rate for Payer: Humana Medicare |
$126.39
|
| Rate for Payer: Lucent All Commercial |
$126.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.04
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$185.86
|
| Rate for Payer: PHP All Commercial |
$187.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.65
|
| Rate for Payer: Sagamore Health Network All Products |
$191.32
|
| Rate for Payer: Signature Care EPO |
$205.69
|
| Rate for Payer: Signature Care PPO |
$218.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$210.65
|
| Rate for Payer: United Healthcare Commercial |
$195.28
|
| Rate for Payer: United Healthcare Medicare |
$81.78
|
|
|
HC LEGION PNEUMO AG UR
|
Facility
IP
|
$247.82
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
63001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.86 |
| Max. Negotiated Rate |
$230.47 |
| Rate for Payer: Aetna Commercial |
$214.12
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cigna All Commercial |
$213.87
|
| Rate for Payer: CORVEL All Commercial |
$230.47
|
| Rate for Payer: Coventry All Commercial |
$218.08
|
| Rate for Payer: Encore All Commercial |
$228.12
|
| Rate for Payer: Frontpath All Commercial |
$227.99
|
| Rate for Payer: Humana ChoiceCare |
$214.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.04
|
| Rate for Payer: PHCS All Commercial |
$185.86
|
| Rate for Payer: PHP All Commercial |
$187.95
|
| Rate for Payer: Sagamore Health Network All Products |
$191.32
|
| Rate for Payer: Signature Care EPO |
$205.69
|
| Rate for Payer: Signature Care PPO |
$218.08
|
| Rate for Payer: United Healthcare Commercial |
$195.28
|
|
|
HC LEUKEMIA/LYMPHOMA - FLOW CYTOMETRY
|
Facility
IP
|
$140.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63002066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.19 |
| Max. Negotiated Rate |
$130.43 |
| Rate for Payer: Aetna Commercial |
$121.18
|
| Rate for Payer: Cash Price |
$86.96
|
| Rate for Payer: Cigna All Commercial |
$121.04
|
| Rate for Payer: CORVEL All Commercial |
$130.43
|
| Rate for Payer: Coventry All Commercial |
$123.42
|
| Rate for Payer: Encore All Commercial |
$129.10
|
| Rate for Payer: Frontpath All Commercial |
$129.03
|
| Rate for Payer: Humana ChoiceCare |
$121.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.22
|
| Rate for Payer: PHCS All Commercial |
$105.19
|
| Rate for Payer: PHP All Commercial |
$106.37
|
| Rate for Payer: Sagamore Health Network All Products |
$108.27
|
| Rate for Payer: Signature Care EPO |
$116.41
|
| Rate for Payer: Signature Care PPO |
$123.42
|
| Rate for Payer: United Healthcare Commercial |
$110.52
|
|
