|
HC LIPOPROTEIN ELECT
|
Facility
OP
|
$142.14
|
|
|
Service Code
|
CPT 83700 90
|
| Hospital Charge Code |
63002152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$119.96
|
| Rate for Payer: Aetna Medicare |
$46.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$81.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.60
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Centivo All Commercial |
$72.49
|
| Rate for Payer: Cigna All Commercial |
$122.66
|
| Rate for Payer: CORVEL All Commercial |
$132.19
|
| Rate for Payer: Coventry All Commercial |
$125.08
|
| Rate for Payer: Encore All Commercial |
$130.84
|
| Rate for Payer: Frontpath All Commercial |
$130.77
|
| Rate for Payer: Humana ChoiceCare |
$122.76
|
| Rate for Payer: Humana Medicare |
$72.49
|
| Rate for Payer: Lucent All Commercial |
$72.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.92
|
| Rate for Payer: PHCS All Commercial |
$106.60
|
| Rate for Payer: PHP All Commercial |
$107.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.43
|
| Rate for Payer: Sagamore Health Network All Products |
$109.73
|
| Rate for Payer: Signature Care EPO |
$117.97
|
| Rate for Payer: Signature Care PPO |
$125.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.82
|
| Rate for Payer: United Healthcare Commercial |
$112.00
|
| Rate for Payer: United Healthcare Medicare |
$46.91
|
|
|
HC LIPOPROTEIN ELECT
|
Facility
IP
|
$142.14
|
|
|
Service Code
|
CPT 83700 90
|
| Hospital Charge Code |
63002152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$122.81
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cigna All Commercial |
$122.66
|
| Rate for Payer: CORVEL All Commercial |
$132.19
|
| Rate for Payer: Coventry All Commercial |
$125.08
|
| Rate for Payer: Encore All Commercial |
$130.84
|
| Rate for Payer: Frontpath All Commercial |
$130.77
|
| Rate for Payer: Humana ChoiceCare |
$122.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.92
|
| Rate for Payer: PHCS All Commercial |
$106.60
|
| Rate for Payer: PHP All Commercial |
$107.80
|
| Rate for Payer: Sagamore Health Network All Products |
$109.73
|
| Rate for Payer: Signature Care EPO |
$117.97
|
| Rate for Payer: Signature Care PPO |
$125.08
|
| Rate for Payer: United Healthcare Commercial |
$112.00
|
|
|
HC LIPOPROTEIN HIGH RES
|
Facility
OP
|
$504.21
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
63001626
|
|
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 LIPOPROTEIN HIGH RES
|
Facility
IP
|
$504.21
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
63001626
|
|
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 LITHIUM
|
Facility
IP
|
$149.23
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
63001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.92 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$128.93
|
| Rate for Payer: Cash Price |
$92.52
|
| Rate for Payer: Cigna All Commercial |
$128.78
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.36
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.30
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.17
|
| Rate for Payer: Sagamore Health Network All Products |
$115.20
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
|
|
HC LITHIUM
|
Facility
OP
|
$149.23
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
63001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$125.95
|
| Rate for Payer: Aetna Medicare |
$49.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.17
|
| Rate for Payer: Cash Price |
$92.52
|
| Rate for Payer: Cash Price |
$92.52
|
| Rate for Payer: Centivo All Commercial |
$76.11
|
| Rate for Payer: Cigna All Commercial |
$128.78
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.36
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Humana Medicare |
$76.11
|
| Rate for Payer: Lucent All Commercial |
$76.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.30
|
| Rate for Payer: Managed Health Services Medicaid |
$6.61
|
| Rate for Payer: MDWise Medicaid |
$6.61
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.20
|
| Rate for Payer: Sagamore Health Network All Products |
$115.20
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.84
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
| Rate for Payer: United Healthcare Medicare |
$49.24
|
|
|
HC LIVER FUNCTION PANEL
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
63001154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$77.65
|
| Rate for Payer: Aetna Medicare |
$30.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.40
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Centivo All Commercial |
$46.92
|
| Rate for Payer: Cigna All Commercial |
$79.40
|
| Rate for Payer: CORVEL All Commercial |
$85.56
|
| Rate for Payer: Coventry All Commercial |
$80.96
|
| Rate for Payer: Encore All Commercial |
$84.69
|
| Rate for Payer: Frontpath All Commercial |
$84.64
|
| Rate for Payer: Humana ChoiceCare |
$79.46
|
| Rate for Payer: Humana Medicare |
$46.92
|
| Rate for Payer: Lucent All Commercial |
$46.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.80
|
| Rate for Payer: Managed Health Services Medicaid |
$8.17
|
| Rate for Payer: MDWise Medicaid |
$8.17
|
| Rate for Payer: PHCS All Commercial |
$69.00
|
| Rate for Payer: PHP All Commercial |
$69.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.88
|
| Rate for Payer: Sagamore Health Network All Products |
$71.03
|
| Rate for Payer: Signature Care EPO |
$76.36
|
| Rate for Payer: Signature Care PPO |
$80.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.20
|
| Rate for Payer: United Healthcare Commercial |
$72.50
|
| Rate for Payer: United Healthcare Medicare |
$30.36
|
|
|
HC LIVER FUNCTION PANEL
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
63001154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$79.49
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Cigna All Commercial |
$79.40
|
| Rate for Payer: CORVEL All Commercial |
$85.56
|
| Rate for Payer: Coventry All Commercial |
$80.96
|
| Rate for Payer: Encore All Commercial |
$84.69
|
| Rate for Payer: Frontpath All Commercial |
$84.64
|
| Rate for Payer: Humana ChoiceCare |
$79.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.80
|
| Rate for Payer: PHCS All Commercial |
$69.00
|
| Rate for Payer: PHP All Commercial |
$69.78
|
| Rate for Payer: Sagamore Health Network All Products |
$71.03
|
| Rate for Payer: Signature Care EPO |
$76.36
|
| Rate for Payer: Signature Care PPO |
$80.96
|
| Rate for Payer: United Healthcare Commercial |
$72.50
|
|
|
HC LIVER IMAGE; STATIC ONLY
|
Facility
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 78201
|
| Hospital Charge Code |
01638201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,178.25 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,357.35
|
| Rate for Payer: Cash Price |
$974.02
|
| Rate for Payer: Cigna All Commercial |
$1,355.78
|
| Rate for Payer: CORVEL All Commercial |
$1,461.03
|
| Rate for Payer: Coventry All Commercial |
$1,382.48
|
| Rate for Payer: Encore All Commercial |
$1,446.11
|
| Rate for Payer: Frontpath All Commercial |
$1,445.32
|
| Rate for Payer: Humana ChoiceCare |
$1,356.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,413.90
|
| Rate for Payer: PHCS All Commercial |
$1,178.25
|
| Rate for Payer: PHP All Commercial |
$1,191.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,212.82
|
| Rate for Payer: Signature Care EPO |
$1,303.93
|
| Rate for Payer: Signature Care PPO |
$1,382.48
|
| Rate for Payer: United Healthcare Commercial |
$1,237.95
|
|
|
HC LIVER IMAGE; STATIC ONLY
|
Facility
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 78201
|
| Hospital Charge Code |
01638201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$455.01 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,325.93
|
| Rate for Payer: Aetna Medicare |
$518.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$518.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$902.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$982.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$455.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$596.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$570.27
|
| Rate for Payer: Cash Price |
$974.02
|
| Rate for Payer: Cash Price |
$974.02
|
| Rate for Payer: Centivo All Commercial |
$801.21
|
| Rate for Payer: Cigna All Commercial |
$1,355.78
|
| Rate for Payer: CORVEL All Commercial |
$1,461.03
|
| Rate for Payer: Coventry All Commercial |
$1,382.48
|
| Rate for Payer: Encore All Commercial |
$1,446.11
|
| Rate for Payer: Frontpath All Commercial |
$1,445.32
|
| Rate for Payer: Humana ChoiceCare |
$1,356.88
|
| Rate for Payer: Humana Medicare |
$801.21
|
| Rate for Payer: Lucent All Commercial |
$801.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,413.90
|
| Rate for Payer: Managed Health Services Medicaid |
$455.01
|
| Rate for Payer: MDWise Medicaid |
$455.01
|
| Rate for Payer: PHCS All Commercial |
$1,178.25
|
| Rate for Payer: PHP All Commercial |
$1,191.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,212.82
|
| Rate for Payer: Signature Care EPO |
$1,303.93
|
| Rate for Payer: Signature Care PPO |
$1,382.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,335.35
|
| Rate for Payer: United Healthcare Commercial |
$1,237.95
|
| Rate for Payer: United Healthcare Medicare |
$518.43
|
|
|
HC LIVER IMAGING (SPECT)
|
Facility
IP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
01638205
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,559.69 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,948.76
|
| Rate for Payer: Cash Price |
$2,116.01
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
|
|
HC LIVER IMAGING (SPECT)
|
Facility
OP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
01638205
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.21 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,880.50
|
| Rate for Payer: Aetna Medicare |
$1,126.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,126.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,960.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,133.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$792.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,295.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,238.89
|
| Rate for Payer: Cash Price |
$2,116.01
|
| Rate for Payer: Cash Price |
$2,116.01
|
| Rate for Payer: Centivo All Commercial |
$1,740.59
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Humana Medicare |
$1,740.59
|
| Rate for Payer: Lucent All Commercial |
$1,740.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: Managed Health Services Medicaid |
$792.21
|
| Rate for Payer: MDWise Medicaid |
$792.21
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,331.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,900.98
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
| Rate for Payer: United Healthcare Medicare |
$1,126.26
|
|
|
HC LIVER-KIDNEY MICROSOME IGG
|
Facility
IP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$153.43 |
| Rate for Payer: Aetna Commercial |
$142.54
|
| Rate for Payer: Cash Price |
$102.28
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.43
|
| Rate for Payer: Coventry All Commercial |
$145.18
|
| Rate for Payer: Encore All Commercial |
$151.86
|
| Rate for Payer: Frontpath All Commercial |
$151.78
|
| Rate for Payer: Humana ChoiceCare |
$142.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.48
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.12
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.18
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
|
|
HC LIVER-KIDNEY MICROSOME IGG
|
Facility
OP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$153.43 |
| Rate for Payer: Aetna Commercial |
$139.24
|
| Rate for Payer: Aetna Medicare |
$54.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.89
|
| Rate for Payer: Cash Price |
$102.28
|
| Rate for Payer: Cash Price |
$102.28
|
| Rate for Payer: Centivo All Commercial |
$84.14
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.43
|
| Rate for Payer: Coventry All Commercial |
$145.18
|
| Rate for Payer: Encore All Commercial |
$151.86
|
| Rate for Payer: Frontpath All Commercial |
$151.78
|
| Rate for Payer: Humana ChoiceCare |
$142.49
|
| Rate for Payer: Humana Medicare |
$84.14
|
| Rate for Payer: Lucent All Commercial |
$84.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.48
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: MDWise Medicaid |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.34
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.23
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
| Rate for Payer: United Healthcare Medicare |
$54.44
|
|
|
HC LIVER SPLEEN SCAN
|
Facility
OP
|
$1,772.84
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
01638351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$468.55 |
| Max. Negotiated Rate |
$1,648.74 |
| Rate for Payer: Aetna Commercial |
$1,496.28
|
| Rate for Payer: Aetna Medicare |
$585.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$585.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,018.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,108.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$468.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$672.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$643.54
|
| Rate for Payer: Cash Price |
$1,099.16
|
| Rate for Payer: Cash Price |
$1,099.16
|
| Rate for Payer: Centivo All Commercial |
$904.15
|
| Rate for Payer: Cigna All Commercial |
$1,529.96
|
| Rate for Payer: CORVEL All Commercial |
$1,648.74
|
| Rate for Payer: Coventry All Commercial |
$1,560.10
|
| Rate for Payer: Encore All Commercial |
$1,631.90
|
| Rate for Payer: Frontpath All Commercial |
$1,631.01
|
| Rate for Payer: Humana ChoiceCare |
$1,531.20
|
| Rate for Payer: Humana Medicare |
$904.15
|
| Rate for Payer: Lucent All Commercial |
$904.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,595.56
|
| Rate for Payer: Managed Health Services Medicaid |
$468.55
|
| Rate for Payer: MDWise Medicaid |
$468.55
|
| Rate for Payer: PHCS All Commercial |
$1,329.63
|
| Rate for Payer: PHP All Commercial |
$1,344.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$691.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,368.63
|
| Rate for Payer: Signature Care EPO |
$1,471.46
|
| Rate for Payer: Signature Care PPO |
$1,560.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,506.92
|
| Rate for Payer: United Healthcare Commercial |
$1,397.00
|
| Rate for Payer: United Healthcare Medicare |
$585.04
|
|
|
HC LIVER SPLEEN SCAN
|
Facility
IP
|
$1,772.84
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
01638351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,329.63 |
| Max. Negotiated Rate |
$1,648.74 |
| Rate for Payer: Aetna Commercial |
$1,531.74
|
| Rate for Payer: Cash Price |
$1,099.16
|
| Rate for Payer: Cigna All Commercial |
$1,529.96
|
| Rate for Payer: CORVEL All Commercial |
$1,648.74
|
| Rate for Payer: Coventry All Commercial |
$1,560.10
|
| Rate for Payer: Encore All Commercial |
$1,631.90
|
| Rate for Payer: Frontpath All Commercial |
$1,631.01
|
| Rate for Payer: Humana ChoiceCare |
$1,531.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,595.56
|
| Rate for Payer: PHCS All Commercial |
$1,329.63
|
| Rate for Payer: PHP All Commercial |
$1,344.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,368.63
|
| Rate for Payer: Signature Care EPO |
$1,471.46
|
| Rate for Payer: Signature Care PPO |
$1,560.10
|
| Rate for Payer: United Healthcare Commercial |
$1,397.00
|
|
|
HC LOCAL ANESTH EA ADD MIN
|
Facility
OP
|
$6.98
|
|
| Hospital Charge Code |
01246659
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$5.89
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.53
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Centivo All Commercial |
$3.56
|
| Rate for Payer: Cigna All Commercial |
$6.02
|
| Rate for Payer: CORVEL All Commercial |
$6.49
|
| Rate for Payer: Coventry All Commercial |
$6.14
|
| Rate for Payer: Encore All Commercial |
$6.42
|
| Rate for Payer: Frontpath All Commercial |
$6.42
|
| Rate for Payer: Humana ChoiceCare |
$6.03
|
| Rate for Payer: Humana Medicare |
$3.56
|
| Rate for Payer: Lucent All Commercial |
$3.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.28
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$5.23
|
| Rate for Payer: PHP All Commercial |
$5.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.72
|
| Rate for Payer: Sagamore Health Network All Products |
$5.39
|
| Rate for Payer: Signature Care EPO |
$5.79
|
| Rate for Payer: Signature Care PPO |
$6.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.93
|
| Rate for Payer: United Healthcare Commercial |
$5.50
|
| Rate for Payer: United Healthcare Medicare |
$2.30
|
|
|
HC LOCAL ANESTH EA ADD MIN
|
Facility
IP
|
$6.98
|
|
| Hospital Charge Code |
01246659
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Aetna Commercial |
$6.03
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cigna All Commercial |
$6.02
|
| Rate for Payer: CORVEL All Commercial |
$6.49
|
| Rate for Payer: Coventry All Commercial |
$6.14
|
| Rate for Payer: Encore All Commercial |
$6.42
|
| Rate for Payer: Frontpath All Commercial |
$6.42
|
| Rate for Payer: Humana ChoiceCare |
$6.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.28
|
| Rate for Payer: PHCS All Commercial |
$5.23
|
| Rate for Payer: PHP All Commercial |
$5.29
|
| Rate for Payer: Sagamore Health Network All Products |
$5.39
|
| Rate for Payer: Signature Care EPO |
$5.79
|
| Rate for Payer: Signature Care PPO |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$5.50
|
|
|
HC LOCAL ANESTH INITIAL 15 MIN
|
Facility
OP
|
$116.38
|
|
| Hospital Charge Code |
01246658
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$38.41 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$98.23
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.25
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Centivo All Commercial |
$59.35
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.24
|
| Rate for Payer: Coventry All Commercial |
$102.42
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Lucent All Commercial |
$59.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$87.29
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.39
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.92
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
| Rate for Payer: United Healthcare Medicare |
$38.41
|
|
|
HC LOCAL ANESTH INITIAL 15 MIN
|
Facility
IP
|
$116.38
|
|
| Hospital Charge Code |
01246658
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$87.29 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$100.55
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.24
|
| Rate for Payer: Coventry All Commercial |
$102.42
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: PHCS All Commercial |
$87.29
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.42
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
|
|
HC LOOP REC LUX DX
|
Facility
IP
|
$17,625.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
41607243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,218.75 |
| Max. Negotiated Rate |
$16,391.25 |
| Rate for Payer: Aetna Commercial |
$15,228.00
|
| Rate for Payer: Cash Price |
$10,927.50
|
| Rate for Payer: Cigna All Commercial |
$15,210.38
|
| Rate for Payer: CORVEL All Commercial |
$16,391.25
|
| Rate for Payer: Coventry All Commercial |
$15,510.00
|
| Rate for Payer: Encore All Commercial |
$16,223.81
|
| Rate for Payer: Frontpath All Commercial |
$16,215.00
|
| Rate for Payer: Humana ChoiceCare |
$15,222.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,862.50
|
| Rate for Payer: PHCS All Commercial |
$13,218.75
|
| Rate for Payer: PHP All Commercial |
$13,366.80
|
| Rate for Payer: Sagamore Health Network All Products |
$13,606.50
|
| Rate for Payer: Signature Care EPO |
$14,628.75
|
| Rate for Payer: Signature Care PPO |
$15,510.00
|
| Rate for Payer: United Healthcare Commercial |
$13,888.50
|
|
|
HC LOOP REC LUX DX
|
Facility
OP
|
$17,625.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
41607243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$16,391.25 |
| Rate for Payer: Aetna Commercial |
$14,875.50
|
| Rate for Payer: Aetna Medicare |
$5,816.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,816.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10,122.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,017.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,688.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,397.88
|
| Rate for Payer: Cash Price |
$10,927.50
|
| Rate for Payer: Cash Price |
$10,927.50
|
| Rate for Payer: Centivo All Commercial |
$8,988.75
|
| Rate for Payer: Cigna All Commercial |
$15,210.38
|
| Rate for Payer: CORVEL All Commercial |
$16,391.25
|
| Rate for Payer: Coventry All Commercial |
$15,510.00
|
| Rate for Payer: Encore All Commercial |
$16,223.81
|
| Rate for Payer: Frontpath All Commercial |
$16,215.00
|
| Rate for Payer: Humana ChoiceCare |
$15,222.71
|
| Rate for Payer: Humana Medicare |
$8,988.75
|
| Rate for Payer: Lucent All Commercial |
$8,988.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,862.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$13,218.75
|
| Rate for Payer: PHP All Commercial |
$13,366.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,873.75
|
| Rate for Payer: Sagamore Health Network All Products |
$13,606.50
|
| Rate for Payer: Signature Care EPO |
$14,628.75
|
| Rate for Payer: Signature Care PPO |
$15,510.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,981.25
|
| Rate for Payer: United Healthcare Commercial |
$13,888.50
|
| Rate for Payer: United Healthcare Medicare |
$5,816.25
|
|
|
HC LUMBAR PUNCTURE
|
Facility
OP
|
$663.00
|
|
| Hospital Charge Code |
01682011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.79 |
| Max. Negotiated Rate |
$616.59 |
| Rate for Payer: Aetna Commercial |
$559.57
|
| Rate for Payer: Aetna Medicare |
$218.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$218.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$380.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$414.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$251.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$240.67
|
| Rate for Payer: Cash Price |
$411.06
|
| Rate for Payer: Centivo All Commercial |
$338.13
|
| Rate for Payer: Cigna All Commercial |
$572.17
|
| Rate for Payer: CORVEL All Commercial |
$616.59
|
| Rate for Payer: Coventry All Commercial |
$583.44
|
| Rate for Payer: Encore All Commercial |
$610.29
|
| Rate for Payer: Frontpath All Commercial |
$609.96
|
| Rate for Payer: Humana ChoiceCare |
$572.63
|
| Rate for Payer: Humana Medicare |
$338.13
|
| Rate for Payer: Lucent All Commercial |
$338.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.70
|
| Rate for Payer: PHCS All Commercial |
$497.25
|
| Rate for Payer: PHP All Commercial |
$502.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$258.57
|
| Rate for Payer: Sagamore Health Network All Products |
$511.84
|
| Rate for Payer: Signature Care EPO |
$550.29
|
| Rate for Payer: Signature Care PPO |
$583.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$563.55
|
| Rate for Payer: United Healthcare Commercial |
$522.44
|
| Rate for Payer: United Healthcare Medicare |
$218.79
|
|
|
HC LUMBAR PUNCTURE
|
Facility
IP
|
$663.00
|
|
| Hospital Charge Code |
01682011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.25 |
| Max. Negotiated Rate |
$616.59 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Cash Price |
$411.06
|
| Rate for Payer: Cigna All Commercial |
$572.17
|
| Rate for Payer: CORVEL All Commercial |
$616.59
|
| Rate for Payer: Coventry All Commercial |
$583.44
|
| Rate for Payer: Encore All Commercial |
$610.29
|
| Rate for Payer: Frontpath All Commercial |
$609.96
|
| Rate for Payer: Humana ChoiceCare |
$572.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.70
|
| Rate for Payer: PHCS All Commercial |
$497.25
|
| Rate for Payer: PHP All Commercial |
$502.82
|
| Rate for Payer: Sagamore Health Network All Products |
$511.84
|
| Rate for Payer: Signature Care EPO |
$550.29
|
| Rate for Payer: Signature Care PPO |
$583.44
|
| Rate for Payer: United Healthcare Commercial |
$522.44
|
|
|
HC LUMB PUNC KIT
|
Facility
IP
|
$52.15
|
|
| Hospital Charge Code |
41601068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.11 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna Commercial |
$45.06
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cigna All Commercial |
$45.01
|
| Rate for Payer: CORVEL All Commercial |
$48.50
|
| Rate for Payer: Coventry All Commercial |
$45.89
|
| Rate for Payer: Encore All Commercial |
$48.00
|
| Rate for Payer: Frontpath All Commercial |
$47.98
|
| Rate for Payer: Humana ChoiceCare |
$45.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.94
|
| Rate for Payer: PHCS All Commercial |
$39.11
|
| Rate for Payer: PHP All Commercial |
$39.55
|
| Rate for Payer: Sagamore Health Network All Products |
$40.26
|
| Rate for Payer: Signature Care EPO |
$43.28
|
| Rate for Payer: Signature Care PPO |
$45.89
|
| Rate for Payer: United Healthcare Commercial |
$41.09
|
|
