|
HC LIGASURE 5MM BLUNT
|
Facility
IP
|
$2,212.15
|
|
| Hospital Charge Code |
41603084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,659.11 |
| Max. Negotiated Rate |
$2,057.30 |
| Rate for Payer: Aetna Commercial |
$1,911.30
|
| Rate for Payer: Cash Price |
$1,371.53
|
| Rate for Payer: Cigna All Commercial |
$1,909.09
|
| Rate for Payer: CORVEL All Commercial |
$2,057.30
|
| Rate for Payer: Coventry All Commercial |
$1,946.69
|
| Rate for Payer: Encore All Commercial |
$2,036.28
|
| Rate for Payer: Frontpath All Commercial |
$2,035.18
|
| Rate for Payer: Humana ChoiceCare |
$1,910.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,990.94
|
| Rate for Payer: PHCS All Commercial |
$1,659.11
|
| Rate for Payer: PHP All Commercial |
$1,677.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,707.78
|
| Rate for Payer: Signature Care EPO |
$1,836.08
|
| Rate for Payer: Signature Care PPO |
$1,946.69
|
| Rate for Payer: United Healthcare Commercial |
$1,743.17
|
|
|
HC LIGASURE ADVANCE
|
Facility
IP
|
$2,391.98
|
|
| Hospital Charge Code |
41601070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,793.98 |
| Max. Negotiated Rate |
$2,224.54 |
| Rate for Payer: Aetna Commercial |
$2,066.67
|
| Rate for Payer: Cash Price |
$1,483.03
|
| Rate for Payer: Cigna All Commercial |
$2,064.28
|
| Rate for Payer: CORVEL All Commercial |
$2,224.54
|
| Rate for Payer: Coventry All Commercial |
$2,104.94
|
| Rate for Payer: Encore All Commercial |
$2,201.82
|
| Rate for Payer: Frontpath All Commercial |
$2,200.62
|
| Rate for Payer: Humana ChoiceCare |
$2,065.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,152.78
|
| Rate for Payer: PHCS All Commercial |
$1,793.98
|
| Rate for Payer: PHP All Commercial |
$1,814.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,846.61
|
| Rate for Payer: Signature Care EPO |
$1,985.34
|
| Rate for Payer: Signature Care PPO |
$2,104.94
|
| Rate for Payer: United Healthcare Commercial |
$1,884.88
|
|
|
HC LIGASURE ADVANCE
|
Facility
OP
|
$2,391.98
|
|
| Hospital Charge Code |
41601070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,224.54 |
| Rate for Payer: Aetna Commercial |
$2,018.83
|
| Rate for Payer: Aetna Medicare |
$789.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$789.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,373.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,495.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$907.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$868.29
|
| Rate for Payer: Cash Price |
$1,483.03
|
| Rate for Payer: Cash Price |
$1,483.03
|
| Rate for Payer: Centivo All Commercial |
$1,219.91
|
| Rate for Payer: Cigna All Commercial |
$2,064.28
|
| Rate for Payer: CORVEL All Commercial |
$2,224.54
|
| Rate for Payer: Coventry All Commercial |
$2,104.94
|
| Rate for Payer: Encore All Commercial |
$2,201.82
|
| Rate for Payer: Frontpath All Commercial |
$2,200.62
|
| Rate for Payer: Humana ChoiceCare |
$2,065.95
|
| Rate for Payer: Humana Medicare |
$1,219.91
|
| Rate for Payer: Lucent All Commercial |
$1,219.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,152.78
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,793.98
|
| Rate for Payer: PHP All Commercial |
$1,814.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$932.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,846.61
|
| Rate for Payer: Signature Care EPO |
$1,985.34
|
| Rate for Payer: Signature Care PPO |
$2,104.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,033.18
|
| Rate for Payer: United Healthcare Commercial |
$1,884.88
|
| Rate for Payer: United Healthcare Medicare |
$789.35
|
|
|
HC LIGASURE ATLAS 10MM
|
Facility
IP
|
$2,029.45
|
|
| Hospital Charge Code |
41601071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,522.09 |
| Max. Negotiated Rate |
$1,887.39 |
| Rate for Payer: Aetna Commercial |
$1,753.44
|
| Rate for Payer: Cash Price |
$1,258.26
|
| Rate for Payer: Cigna All Commercial |
$1,751.42
|
| Rate for Payer: CORVEL All Commercial |
$1,887.39
|
| Rate for Payer: Coventry All Commercial |
$1,785.92
|
| Rate for Payer: Encore All Commercial |
$1,868.11
|
| Rate for Payer: Frontpath All Commercial |
$1,867.09
|
| Rate for Payer: Humana ChoiceCare |
$1,752.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,826.50
|
| Rate for Payer: PHCS All Commercial |
$1,522.09
|
| Rate for Payer: PHP All Commercial |
$1,539.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,566.74
|
| Rate for Payer: Signature Care EPO |
$1,684.44
|
| Rate for Payer: Signature Care PPO |
$1,785.92
|
| Rate for Payer: United Healthcare Commercial |
$1,599.21
|
|
|
HC LIGASURE ATLAS 10MM
|
Facility
OP
|
$2,029.45
|
|
| Hospital Charge Code |
41601071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,887.39 |
| Rate for Payer: Aetna Commercial |
$1,712.86
|
| Rate for Payer: Aetna Medicare |
$669.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$669.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,165.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,268.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$770.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$736.69
|
| Rate for Payer: Cash Price |
$1,258.26
|
| Rate for Payer: Cash Price |
$1,258.26
|
| Rate for Payer: Centivo All Commercial |
$1,035.02
|
| Rate for Payer: Cigna All Commercial |
$1,751.42
|
| Rate for Payer: CORVEL All Commercial |
$1,887.39
|
| Rate for Payer: Coventry All Commercial |
$1,785.92
|
| Rate for Payer: Encore All Commercial |
$1,868.11
|
| Rate for Payer: Frontpath All Commercial |
$1,867.09
|
| Rate for Payer: Humana ChoiceCare |
$1,752.84
|
| Rate for Payer: Humana Medicare |
$1,035.02
|
| Rate for Payer: Lucent All Commercial |
$1,035.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,826.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,522.09
|
| Rate for Payer: PHP All Commercial |
$1,539.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$791.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,566.74
|
| Rate for Payer: Signature Care EPO |
$1,684.44
|
| Rate for Payer: Signature Care PPO |
$1,785.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,725.03
|
| Rate for Payer: United Healthcare Commercial |
$1,599.21
|
| Rate for Payer: United Healthcare Medicare |
$669.72
|
|
|
HC LIGASURE IMPACT
|
Facility
OP
|
$2,179.55
|
|
| Hospital Charge Code |
41601072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,026.98 |
| Rate for Payer: Aetna Commercial |
$1,839.54
|
| Rate for Payer: Aetna Medicare |
$719.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$719.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,251.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,362.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$827.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$791.18
|
| Rate for Payer: Cash Price |
$1,351.32
|
| Rate for Payer: Cash Price |
$1,351.32
|
| Rate for Payer: Centivo All Commercial |
$1,111.57
|
| Rate for Payer: Cigna All Commercial |
$1,880.95
|
| Rate for Payer: CORVEL All Commercial |
$2,026.98
|
| Rate for Payer: Coventry All Commercial |
$1,918.00
|
| Rate for Payer: Encore All Commercial |
$2,006.28
|
| Rate for Payer: Frontpath All Commercial |
$2,005.19
|
| Rate for Payer: Humana ChoiceCare |
$1,882.48
|
| Rate for Payer: Humana Medicare |
$1,111.57
|
| Rate for Payer: Lucent All Commercial |
$1,111.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,634.66
|
| Rate for Payer: PHP All Commercial |
$1,652.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$850.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,682.61
|
| Rate for Payer: Signature Care EPO |
$1,809.03
|
| Rate for Payer: Signature Care PPO |
$1,918.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,852.62
|
| Rate for Payer: United Healthcare Commercial |
$1,717.49
|
| Rate for Payer: United Healthcare Medicare |
$719.25
|
|
|
HC LIGASURE IMPACT
|
Facility
IP
|
$2,179.55
|
|
| Hospital Charge Code |
41601072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,634.66 |
| Max. Negotiated Rate |
$2,026.98 |
| Rate for Payer: Aetna Commercial |
$1,883.13
|
| Rate for Payer: Cash Price |
$1,351.32
|
| Rate for Payer: Cigna All Commercial |
$1,880.95
|
| Rate for Payer: CORVEL All Commercial |
$2,026.98
|
| Rate for Payer: Coventry All Commercial |
$1,918.00
|
| Rate for Payer: Encore All Commercial |
$2,006.28
|
| Rate for Payer: Frontpath All Commercial |
$2,005.19
|
| Rate for Payer: Humana ChoiceCare |
$1,882.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,961.60
|
| Rate for Payer: PHCS All Commercial |
$1,634.66
|
| Rate for Payer: PHP All Commercial |
$1,652.97
|
| Rate for Payer: Sagamore Health Network All Products |
$1,682.61
|
| Rate for Payer: Signature Care EPO |
$1,809.03
|
| Rate for Payer: Signature Care PPO |
$1,918.00
|
| Rate for Payer: United Healthcare Commercial |
$1,717.49
|
|
|
HC LIGASURE MARYLAND LF1937
|
Facility
IP
|
$2,433.35
|
|
| Hospital Charge Code |
41603889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,825.01 |
| Max. Negotiated Rate |
$2,263.02 |
| Rate for Payer: Aetna Commercial |
$2,102.41
|
| Rate for Payer: Cash Price |
$1,508.68
|
| Rate for Payer: Cigna All Commercial |
$2,099.98
|
| Rate for Payer: CORVEL All Commercial |
$2,263.02
|
| Rate for Payer: Coventry All Commercial |
$2,141.35
|
| Rate for Payer: Encore All Commercial |
$2,239.90
|
| Rate for Payer: Frontpath All Commercial |
$2,238.68
|
| Rate for Payer: Humana ChoiceCare |
$2,101.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,190.02
|
| Rate for Payer: PHCS All Commercial |
$1,825.01
|
| Rate for Payer: PHP All Commercial |
$1,845.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,878.55
|
| Rate for Payer: Signature Care EPO |
$2,019.68
|
| Rate for Payer: Signature Care PPO |
$2,141.35
|
| Rate for Payer: United Healthcare Commercial |
$1,917.48
|
|
|
HC LIGASURE MARYLAND LF1937
|
Facility
OP
|
$2,433.35
|
|
| Hospital Charge Code |
41603889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,263.02 |
| Rate for Payer: Aetna Commercial |
$2,053.75
|
| Rate for Payer: Aetna Medicare |
$803.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$803.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,397.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,521.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$923.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$883.31
|
| Rate for Payer: Cash Price |
$1,508.68
|
| Rate for Payer: Cash Price |
$1,508.68
|
| Rate for Payer: Centivo All Commercial |
$1,241.01
|
| Rate for Payer: Cigna All Commercial |
$2,099.98
|
| Rate for Payer: CORVEL All Commercial |
$2,263.02
|
| Rate for Payer: Coventry All Commercial |
$2,141.35
|
| Rate for Payer: Encore All Commercial |
$2,239.90
|
| Rate for Payer: Frontpath All Commercial |
$2,238.68
|
| Rate for Payer: Humana ChoiceCare |
$2,101.68
|
| Rate for Payer: Humana Medicare |
$1,241.01
|
| Rate for Payer: Lucent All Commercial |
$1,241.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,190.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,825.01
|
| Rate for Payer: PHP All Commercial |
$1,845.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$949.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,878.55
|
| Rate for Payer: Signature Care EPO |
$2,019.68
|
| Rate for Payer: Signature Care PPO |
$2,141.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,068.35
|
| Rate for Payer: United Healthcare Commercial |
$1,917.48
|
| Rate for Payer: United Healthcare Medicare |
$803.01
|
|
|
HC LIGASURE SMALL JAW
|
Facility
IP
|
$2,177.90
|
|
| Hospital Charge Code |
41601073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,633.42 |
| Max. Negotiated Rate |
$2,025.45 |
| Rate for Payer: Aetna Commercial |
$1,881.71
|
| Rate for Payer: Cash Price |
$1,350.30
|
| Rate for Payer: Cigna All Commercial |
$1,879.53
|
| Rate for Payer: CORVEL All Commercial |
$2,025.45
|
| Rate for Payer: Coventry All Commercial |
$1,916.55
|
| Rate for Payer: Encore All Commercial |
$2,004.76
|
| Rate for Payer: Frontpath All Commercial |
$2,003.67
|
| Rate for Payer: Humana ChoiceCare |
$1,881.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,960.11
|
| Rate for Payer: PHCS All Commercial |
$1,633.42
|
| Rate for Payer: PHP All Commercial |
$1,651.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,681.34
|
| Rate for Payer: Signature Care EPO |
$1,807.66
|
| Rate for Payer: Signature Care PPO |
$1,916.55
|
| Rate for Payer: United Healthcare Commercial |
$1,716.19
|
|
|
HC LIGASURE SMALL JAW
|
Facility
OP
|
$2,177.90
|
|
| Hospital Charge Code |
41601073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,025.45 |
| Rate for Payer: Aetna Commercial |
$1,838.15
|
| Rate for Payer: Aetna Medicare |
$718.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$718.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,250.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,361.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$826.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$790.58
|
| Rate for Payer: Cash Price |
$1,350.30
|
| Rate for Payer: Cash Price |
$1,350.30
|
| Rate for Payer: Centivo All Commercial |
$1,110.73
|
| Rate for Payer: Cigna All Commercial |
$1,879.53
|
| Rate for Payer: CORVEL All Commercial |
$2,025.45
|
| Rate for Payer: Coventry All Commercial |
$1,916.55
|
| Rate for Payer: Encore All Commercial |
$2,004.76
|
| Rate for Payer: Frontpath All Commercial |
$2,003.67
|
| Rate for Payer: Humana ChoiceCare |
$1,881.05
|
| Rate for Payer: Humana Medicare |
$1,110.73
|
| Rate for Payer: Lucent All Commercial |
$1,110.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,960.11
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,633.42
|
| Rate for Payer: PHP All Commercial |
$1,651.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$849.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,681.34
|
| Rate for Payer: Signature Care EPO |
$1,807.66
|
| Rate for Payer: Signature Care PPO |
$1,916.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,851.22
|
| Rate for Payer: United Healthcare Commercial |
$1,716.19
|
| Rate for Payer: United Healthcare Medicare |
$718.71
|
|
|
HC LIPASE
|
Facility
OP
|
$171.67
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$144.89
|
| Rate for Payer: Aetna Medicare |
$56.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.31
|
| Rate for Payer: Cash Price |
$106.43
|
| Rate for Payer: Cash Price |
$106.43
|
| Rate for Payer: Centivo All Commercial |
$87.55
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.93
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Humana Medicare |
$87.55
|
| Rate for Payer: Lucent All Commercial |
$87.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.95
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.48
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.92
|
| Rate for Payer: United Healthcare Commercial |
$135.27
|
| Rate for Payer: United Healthcare Medicare |
$56.65
|
|
|
HC LIPASE
|
Facility
IP
|
$171.67
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$148.32
|
| Rate for Payer: Cash Price |
$106.43
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.93
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.48
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: United Healthcare Commercial |
$135.27
|
|
|
HC LIPASE
|
Facility
OP
|
$120.87
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$112.41 |
| Rate for Payer: Aetna Commercial |
$102.01
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.88
|
| Rate for Payer: Cash Price |
$74.94
|
| Rate for Payer: Cash Price |
$74.94
|
| Rate for Payer: Centivo All Commercial |
$61.64
|
| Rate for Payer: Cigna All Commercial |
$104.31
|
| Rate for Payer: CORVEL All Commercial |
$112.41
|
| Rate for Payer: Coventry All Commercial |
$106.37
|
| Rate for Payer: Encore All Commercial |
$111.26
|
| Rate for Payer: Frontpath All Commercial |
$111.20
|
| Rate for Payer: Humana ChoiceCare |
$104.40
|
| Rate for Payer: Humana Medicare |
$61.64
|
| Rate for Payer: Lucent All Commercial |
$61.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.78
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$90.65
|
| Rate for Payer: PHP All Commercial |
$91.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.14
|
| Rate for Payer: Sagamore Health Network All Products |
$93.31
|
| Rate for Payer: Signature Care EPO |
$100.32
|
| Rate for Payer: Signature Care PPO |
$106.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.74
|
| Rate for Payer: United Healthcare Commercial |
$95.25
|
| Rate for Payer: United Healthcare Medicare |
$39.89
|
|
|
HC LIPASE
|
Facility
IP
|
$120.87
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$112.41 |
| Rate for Payer: Aetna Commercial |
$104.43
|
| Rate for Payer: Cash Price |
$74.94
|
| Rate for Payer: Cigna All Commercial |
$104.31
|
| Rate for Payer: CORVEL All Commercial |
$112.41
|
| Rate for Payer: Coventry All Commercial |
$106.37
|
| Rate for Payer: Encore All Commercial |
$111.26
|
| Rate for Payer: Frontpath All Commercial |
$111.20
|
| Rate for Payer: Humana ChoiceCare |
$104.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.78
|
| Rate for Payer: PHCS All Commercial |
$90.65
|
| Rate for Payer: PHP All Commercial |
$91.67
|
| Rate for Payer: Sagamore Health Network All Products |
$93.31
|
| Rate for Payer: Signature Care EPO |
$100.32
|
| Rate for Payer: Signature Care PPO |
$106.37
|
| Rate for Payer: United Healthcare Commercial |
$95.25
|
|
|
HC LIPID FOR LIPOPROFILE
|
Facility
OP
|
$56.31
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$52.37 |
| Rate for Payer: Aetna Commercial |
$47.53
|
| Rate for Payer: Aetna Medicare |
$18.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.44
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Centivo All Commercial |
$28.72
|
| Rate for Payer: Cigna All Commercial |
$48.60
|
| Rate for Payer: CORVEL All Commercial |
$52.37
|
| Rate for Payer: Coventry All Commercial |
$49.56
|
| Rate for Payer: Encore All Commercial |
$51.84
|
| Rate for Payer: Frontpath All Commercial |
$51.81
|
| Rate for Payer: Humana ChoiceCare |
$48.64
|
| Rate for Payer: Humana Medicare |
$28.72
|
| Rate for Payer: Lucent All Commercial |
$28.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.68
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$42.24
|
| Rate for Payer: PHP All Commercial |
$42.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.96
|
| Rate for Payer: Sagamore Health Network All Products |
$43.47
|
| Rate for Payer: Signature Care EPO |
$46.74
|
| Rate for Payer: Signature Care PPO |
$49.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.87
|
| Rate for Payer: United Healthcare Commercial |
$44.38
|
| Rate for Payer: United Healthcare Medicare |
$18.58
|
|
|
HC LIPID FOR LIPOPROFILE
|
Facility
IP
|
$56.31
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$52.37 |
| Rate for Payer: Aetna Commercial |
$48.66
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Cigna All Commercial |
$48.60
|
| Rate for Payer: CORVEL All Commercial |
$52.37
|
| Rate for Payer: Coventry All Commercial |
$49.56
|
| Rate for Payer: Encore All Commercial |
$51.84
|
| Rate for Payer: Frontpath All Commercial |
$51.81
|
| Rate for Payer: Humana ChoiceCare |
$48.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.68
|
| Rate for Payer: PHCS All Commercial |
$42.24
|
| Rate for Payer: PHP All Commercial |
$42.71
|
| Rate for Payer: Sagamore Health Network All Products |
$43.47
|
| Rate for Payer: Signature Care EPO |
$46.74
|
| Rate for Payer: Signature Care PPO |
$49.56
|
| Rate for Payer: United Healthcare Commercial |
$44.38
|
|
|
HC LIPID PANEL
|
Facility
OP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$107.95
|
| Rate for Payer: Aetna Medicare |
$42.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.43
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Centivo All Commercial |
$65.23
|
| Rate for Payer: Cigna All Commercial |
$110.38
|
| Rate for Payer: CORVEL All Commercial |
$118.95
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.47
|
| Rate for Payer: Humana Medicare |
$65.23
|
| Rate for Payer: Lucent All Commercial |
$65.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.88
|
| Rate for Payer: Sagamore Health Network All Products |
$98.74
|
| Rate for Payer: Signature Care EPO |
$106.16
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.72
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
| Rate for Payer: United Healthcare Medicare |
$42.21
|
|
|
HC LIPID PANEL
|
Facility
IP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.93 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$110.51
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cigna All Commercial |
$110.38
|
| Rate for Payer: CORVEL All Commercial |
$118.95
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Sagamore Health Network All Products |
$98.74
|
| Rate for Payer: Signature Care EPO |
$106.16
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
|
|
HC LIPO-ASSOC PHOSPHOLIP A2
|
Facility
IP
|
$381.15
|
|
|
Service Code
|
CPT 83698
|
| Hospital Charge Code |
63001624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.87 |
| Max. Negotiated Rate |
$354.47 |
| Rate for Payer: Aetna Commercial |
$329.32
|
| Rate for Payer: Cash Price |
$236.32
|
| Rate for Payer: Cigna All Commercial |
$328.94
|
| Rate for Payer: CORVEL All Commercial |
$354.47
|
| Rate for Payer: Coventry All Commercial |
$335.42
|
| Rate for Payer: Encore All Commercial |
$350.85
|
| Rate for Payer: Frontpath All Commercial |
$350.66
|
| Rate for Payer: Humana ChoiceCare |
$329.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.04
|
| Rate for Payer: PHCS All Commercial |
$285.87
|
| Rate for Payer: PHP All Commercial |
$289.07
|
| Rate for Payer: Sagamore Health Network All Products |
$294.25
|
| Rate for Payer: Signature Care EPO |
$316.36
|
| Rate for Payer: Signature Care PPO |
$335.42
|
| Rate for Payer: United Healthcare Commercial |
$300.35
|
|
|
HC LIPO-ASSOC PHOSPHOLIP A2
|
Facility
OP
|
$381.15
|
|
|
Service Code
|
CPT 83698
|
| Hospital Charge Code |
63001624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.51 |
| Max. Negotiated Rate |
$354.47 |
| Rate for Payer: Aetna Commercial |
$321.69
|
| Rate for Payer: Aetna Medicare |
$125.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$218.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$39.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.36
|
| Rate for Payer: Cash Price |
$236.32
|
| Rate for Payer: Cash Price |
$236.32
|
| Rate for Payer: Centivo All Commercial |
$194.39
|
| Rate for Payer: Cigna All Commercial |
$328.94
|
| Rate for Payer: CORVEL All Commercial |
$354.47
|
| Rate for Payer: Coventry All Commercial |
$335.42
|
| Rate for Payer: Encore All Commercial |
$350.85
|
| Rate for Payer: Frontpath All Commercial |
$350.66
|
| Rate for Payer: Humana ChoiceCare |
$329.20
|
| Rate for Payer: Humana Medicare |
$194.39
|
| Rate for Payer: Lucent All Commercial |
$194.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.04
|
| Rate for Payer: Managed Health Services Medicaid |
$39.51
|
| Rate for Payer: MDWise Medicaid |
$39.51
|
| Rate for Payer: PHCS All Commercial |
$285.87
|
| Rate for Payer: PHP All Commercial |
$289.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.65
|
| Rate for Payer: Sagamore Health Network All Products |
$294.25
|
| Rate for Payer: Signature Care EPO |
$316.36
|
| Rate for Payer: Signature Care PPO |
$335.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$323.98
|
| Rate for Payer: United Healthcare Commercial |
$300.35
|
| Rate for Payer: United Healthcare Medicare |
$125.78
|
|
|
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 |
$161.21 |
| Rate for Payer: Aetna Commercial |
$146.31
|
| Rate for Payer: Aetna Medicare |
$57.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.93
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Centivo All Commercial |
$88.41
|
| Rate for Payer: Cigna All Commercial |
$149.60
|
| Rate for Payer: CORVEL All Commercial |
$161.21
|
| 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 |
$88.41
|
| Rate for Payer: Lucent All Commercial |
$88.41
|
| 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 |
$57.21
|
|
|
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 |
$161.21 |
| Rate for Payer: Aetna Commercial |
$149.77
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cigna All Commercial |
$149.60
|
| Rate for Payer: CORVEL All Commercial |
$161.21
|
| 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 |
$39.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.44
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Centivo All Commercial |
$61.04
|
| 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 |
$110.16
|
| Rate for Payer: Frontpath All Commercial |
$110.10
|
| Rate for Payer: Humana ChoiceCare |
$103.36
|
| Rate for Payer: Humana Medicare |
$61.04
|
| Rate for Payer: Lucent All Commercial |
$61.04
|
| 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 |
$90.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.67
|
| 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 |
$39.49
|
|
|
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 |
$74.20
|
| 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 |
$110.16
|
| Rate for Payer: Frontpath All Commercial |
$110.10
|
| Rate for Payer: Humana ChoiceCare |
$103.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.71
|
| Rate for Payer: PHCS All Commercial |
$89.76
|
| Rate for Payer: PHP All Commercial |
$90.76
|
| 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
|
|
