|
HC MRI-UPPER EXT JOINT W/WO CON L
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
1573223
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,238.29
|
| Rate for Payer: Aetna Medicare |
$848.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$262.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$822.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,523.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,657.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$262.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.50
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Centivo All Commercial |
$1,442.69
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Humana Medicare |
$848.64
|
| Rate for Payer: Lucent All Commercial |
$1,442.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: Managed Health Services Medicaid |
$262.00
|
| Rate for Payer: MDWise Medicaid |
$262.00
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,254.20
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
| Rate for Payer: United Healthcare Medicare |
$848.64
|
|
|
HC MRI-UPPER EXT JOINT W/WO CON L
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
1573223
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
|
|
HC MRI-UPPER EXT JOINT W/WO CON R
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
11573223
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,238.29
|
| Rate for Payer: Aetna Medicare |
$848.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$262.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$822.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,523.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,657.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$262.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.50
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Centivo All Commercial |
$1,442.69
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Humana Medicare |
$848.64
|
| Rate for Payer: Lucent All Commercial |
$1,442.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: Managed Health Services Medicaid |
$262.00
|
| Rate for Payer: MDWise Medicaid |
$262.00
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,254.20
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
| Rate for Payer: United Healthcare Medicare |
$848.64
|
|
|
HC MRI-UPPER EXT JOINT W/WO CON R
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
11573223
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
|
|
HC MRI-UPPER EXTREMITY W/O CON LT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
1573220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$208.99 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$208.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$208.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$208.99
|
| Rate for Payer: MDWise Medicaid |
$208.99
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$652.47
|
|
|
HC MRI-UPPER EXTREMITY W/O CON LT
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
1573220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC MRI-UPPER EXTREMITY W/O CON RT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
11573220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$208.99 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$208.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$208.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$208.99
|
| Rate for Payer: MDWise Medicaid |
$208.99
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$652.47
|
|
|
HC MRI-UPPER EXTREMITY W/O CON RT
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
11573220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC MRI-UPPER EXTREMITY W/WO CON B
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
CPT 73220 50
|
| Hospital Charge Code |
21574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.25 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,745.44
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
|
|
HC MRI-UPPER EXTREMITY W/WO CON B
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
CPT 73220 50
|
| Hospital Charge Code |
21574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$282.31 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,658.74
|
| Rate for Payer: Aetna Medicare |
$1,387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$282.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,343.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$282.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,595.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,525.92
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Centivo All Commercial |
$2,358.24
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Humana Medicare |
$1,387.20
|
| Rate for Payer: Lucent All Commercial |
$2,358.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: Managed Health Services Medicaid |
$282.31
|
| Rate for Payer: MDWise Medicaid |
$282.31
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.65
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,684.75
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
| Rate for Payer: United Healthcare Medicare |
$1,387.20
|
|
|
HC MRI-UPPER EXTREMITY W/WO CON L
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
1574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
|
|
HC MRI-UPPER EXTREMITY W/WO CON L
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
1574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$282.31 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,152.20
|
| Rate for Payer: Aetna Medicare |
$816.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$282.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$790.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$282.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$938.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$897.60
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Centivo All Commercial |
$1,387.20
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Humana Medicare |
$816.00
|
| Rate for Payer: Lucent All Commercial |
$1,387.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: Managed Health Services Medicaid |
$282.31
|
| Rate for Payer: MDWise Medicaid |
$282.31
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,167.50
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
| Rate for Payer: United Healthcare Medicare |
$816.00
|
|
|
HC MRI-UPPER EXTREMITY W/WO CON R
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
11574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$282.31 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,238.29
|
| Rate for Payer: Aetna Medicare |
$848.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$282.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$822.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$282.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.50
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Centivo All Commercial |
$1,442.69
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Humana Medicare |
$848.64
|
| Rate for Payer: Lucent All Commercial |
$1,442.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: Managed Health Services Medicaid |
$282.31
|
| Rate for Payer: MDWise Medicaid |
$282.31
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,254.20
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
| Rate for Payer: United Healthcare Medicare |
$848.64
|
|
|
HC MRI-UPPER EXTREMITY W/WO CON R
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
11574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
|
|
HC MRSA CULTURE - O/P
|
Facility
|
IP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.51 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$119.24
|
| Rate for Payer: Cash Price |
$82.81
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.04
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: PHCS All Commercial |
$103.51
|
| Rate for Payer: PHP All Commercial |
$104.67
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.55
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
|
|
HC MRSA CULTURE - O/P
|
Facility
|
OP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$116.48
|
| Rate for Payer: Aetna Medicare |
$44.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.58
|
| Rate for Payer: Cash Price |
$82.81
|
| Rate for Payer: Cash Price |
$82.81
|
| Rate for Payer: Centivo All Commercial |
$75.08
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.04
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Humana Medicare |
$44.16
|
| Rate for Payer: Lucent All Commercial |
$75.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: Managed Health Services Medicaid |
$6.63
|
| Rate for Payer: MDWise Medicaid |
$6.63
|
| Rate for Payer: PHCS All Commercial |
$103.51
|
| Rate for Payer: PHP All Commercial |
$104.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.82
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.55
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.31
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$44.16
|
|
|
HC MRSA PCR
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
63001168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$205.09
|
| Rate for Payer: Aetna Medicare |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.54
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Centivo All Commercial |
$132.19
|
| Rate for Payer: Cigna All Commercial |
$209.71
|
| Rate for Payer: CORVEL All Commercial |
$225.99
|
| Rate for Payer: Coventry All Commercial |
$213.84
|
| Rate for Payer: Encore All Commercial |
$223.68
|
| Rate for Payer: Frontpath All Commercial |
$223.56
|
| Rate for Payer: Humana ChoiceCare |
$209.88
|
| Rate for Payer: Humana Medicare |
$77.76
|
| Rate for Payer: Lucent All Commercial |
$132.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$218.70
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$182.25
|
| Rate for Payer: PHP All Commercial |
$184.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.77
|
| Rate for Payer: Sagamore Health Network All Products |
$187.60
|
| Rate for Payer: Signature Care EPO |
$201.69
|
| Rate for Payer: Signature Care PPO |
$213.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.55
|
| Rate for Payer: United Healthcare Commercial |
$191.48
|
| Rate for Payer: United Healthcare Medicare |
$77.76
|
|
|
HC MRSA PCR
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
63001168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna All Commercial |
$209.71
|
| Rate for Payer: CORVEL All Commercial |
$225.99
|
| Rate for Payer: Coventry All Commercial |
$213.84
|
| Rate for Payer: Encore All Commercial |
$223.68
|
| Rate for Payer: Frontpath All Commercial |
$223.56
|
| Rate for Payer: Humana ChoiceCare |
$209.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$218.70
|
| Rate for Payer: PHCS All Commercial |
$182.25
|
| Rate for Payer: PHP All Commercial |
$184.29
|
| Rate for Payer: Sagamore Health Network All Products |
$187.60
|
| Rate for Payer: Signature Care EPO |
$201.69
|
| Rate for Payer: Signature Care PPO |
$213.84
|
| Rate for Payer: United Healthcare Commercial |
$191.48
|
|
|
HC MSLT <4 NAP RECORDING
|
Facility
|
IP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805 52
|
| Hospital Charge Code |
1365805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,192.96 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,830.29
|
| Rate for Payer: Cash Price |
$3,354.37
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
|
|
HC MSLT <4 NAP RECORDING
|
Facility
|
OP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805 52
|
| Hospital Charge Code |
1365805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,718.47
|
| Rate for Payer: Aetna Medicare |
$1,789.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$200.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,733.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,210.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,494.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$200.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,057.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,967.89
|
| Rate for Payer: Cash Price |
$3,354.37
|
| Rate for Payer: Cash Price |
$3,354.37
|
| Rate for Payer: Centivo All Commercial |
$3,041.29
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Humana Medicare |
$1,789.00
|
| Rate for Payer: Lucent All Commercial |
$3,041.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: Managed Health Services Medicaid |
$200.10
|
| Rate for Payer: MDWise Medicaid |
$200.10
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,180.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,752.02
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
| Rate for Payer: United Healthcare Medicare |
$1,789.00
|
|
|
HC MSLT 4+ NAP RECORDINGS
|
Facility
|
IP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
1520012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,192.96 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,830.29
|
| Rate for Payer: Cash Price |
$3,354.37
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
|
|
HC MSLT 4+ NAP RECORDINGS
|
Facility
|
OP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
1520012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,718.47
|
| Rate for Payer: Aetna Medicare |
$1,789.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$200.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,733.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,210.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,494.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$200.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,057.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,967.89
|
| Rate for Payer: Cash Price |
$3,354.37
|
| Rate for Payer: Cash Price |
$3,354.37
|
| Rate for Payer: Centivo All Commercial |
$3,041.29
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Humana Medicare |
$1,789.00
|
| Rate for Payer: Lucent All Commercial |
$3,041.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: Managed Health Services Medicaid |
$200.10
|
| Rate for Payer: MDWise Medicaid |
$200.10
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,180.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,752.02
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
| Rate for Payer: United Healthcare Medicare |
$1,789.00
|
|
|
HC MUMPS IGG AB
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
63001960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.98 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Aetna Commercial |
$116.33
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cigna All Commercial |
$116.19
|
| Rate for Payer: CORVEL All Commercial |
$125.22
|
| Rate for Payer: Coventry All Commercial |
$118.48
|
| Rate for Payer: Encore All Commercial |
$123.94
|
| Rate for Payer: Frontpath All Commercial |
$123.87
|
| Rate for Payer: Humana ChoiceCare |
$116.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.18
|
| Rate for Payer: PHCS All Commercial |
$100.98
|
| Rate for Payer: PHP All Commercial |
$102.11
|
| Rate for Payer: Sagamore Health Network All Products |
$103.94
|
| Rate for Payer: Signature Care EPO |
$111.75
|
| Rate for Payer: Signature Care PPO |
$118.48
|
| Rate for Payer: United Healthcare Commercial |
$106.10
|
|
|
HC MUMPS IGG AB
|
Facility
|
OP
|
$134.64
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
63001960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Aetna Commercial |
$113.64
|
| Rate for Payer: Aetna Medicare |
$43.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.39
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Centivo All Commercial |
$73.24
|
| Rate for Payer: Cigna All Commercial |
$116.19
|
| Rate for Payer: CORVEL All Commercial |
$125.22
|
| Rate for Payer: Coventry All Commercial |
$118.48
|
| Rate for Payer: Encore All Commercial |
$123.94
|
| Rate for Payer: Frontpath All Commercial |
$123.87
|
| Rate for Payer: Humana ChoiceCare |
$116.29
|
| Rate for Payer: Humana Medicare |
$43.08
|
| Rate for Payer: Lucent All Commercial |
$73.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.18
|
| Rate for Payer: Managed Health Services Medicaid |
$13.05
|
| Rate for Payer: MDWise Medicaid |
$13.05
|
| Rate for Payer: PHCS All Commercial |
$100.98
|
| Rate for Payer: PHP All Commercial |
$102.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.51
|
| Rate for Payer: Sagamore Health Network All Products |
$103.94
|
| Rate for Payer: Signature Care EPO |
$111.75
|
| Rate for Payer: Signature Care PPO |
$118.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.44
|
| Rate for Payer: United Healthcare Commercial |
$106.10
|
| Rate for Payer: United Healthcare Medicare |
$43.08
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE, NAA WITHOUT CAP-MANDATED CULTURE
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63044069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
|
