|
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
|
|
|
HC LUMB PUNC PED KIT
|
Facility
OP
|
$198.22
|
|
| Hospital Charge Code |
41601069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$184.34 |
| Rate for Payer: Aetna Commercial |
$167.30
|
| Rate for Payer: Aetna Medicare |
$65.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$113.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.95
|
| Rate for Payer: Cash Price |
$122.90
|
| Rate for Payer: Cash Price |
$122.90
|
| Rate for Payer: Centivo All Commercial |
$101.09
|
| Rate for Payer: Cigna All Commercial |
$171.06
|
| Rate for Payer: CORVEL All Commercial |
$184.34
|
| Rate for Payer: Coventry All Commercial |
$174.43
|
| Rate for Payer: Encore All Commercial |
$182.46
|
| Rate for Payer: Frontpath All Commercial |
$182.36
|
| Rate for Payer: Humana ChoiceCare |
$171.20
|
| Rate for Payer: Humana Medicare |
$101.09
|
| Rate for Payer: Lucent All Commercial |
$101.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$148.66
|
| Rate for Payer: PHP All Commercial |
$150.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.31
|
| Rate for Payer: Sagamore Health Network All Products |
$153.03
|
| Rate for Payer: Signature Care EPO |
$164.52
|
| Rate for Payer: Signature Care PPO |
$174.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$168.49
|
| Rate for Payer: United Healthcare Commercial |
$156.20
|
| Rate for Payer: United Healthcare Medicare |
$65.41
|
|
|
HC LUMB PUNC PED KIT
|
Facility
IP
|
$198.22
|
|
| Hospital Charge Code |
41601069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.66 |
| Max. Negotiated Rate |
$184.34 |
| Rate for Payer: Aetna Commercial |
$171.26
|
| Rate for Payer: Cash Price |
$122.90
|
| Rate for Payer: Cigna All Commercial |
$171.06
|
| Rate for Payer: CORVEL All Commercial |
$184.34
|
| Rate for Payer: Coventry All Commercial |
$174.43
|
| Rate for Payer: Encore All Commercial |
$182.46
|
| Rate for Payer: Frontpath All Commercial |
$182.36
|
| Rate for Payer: Humana ChoiceCare |
$171.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.40
|
| Rate for Payer: PHCS All Commercial |
$148.66
|
| Rate for Payer: PHP All Commercial |
$150.33
|
| Rate for Payer: Sagamore Health Network All Products |
$153.03
|
| Rate for Payer: Signature Care EPO |
$164.52
|
| Rate for Payer: Signature Care PPO |
$174.43
|
| Rate for Payer: United Healthcare Commercial |
$156.20
|
|
|
HC LUNG SCAN PERFUSION
|
Facility
OP
|
$1,921.84
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
01638360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$1,787.31 |
| Rate for Payer: Aetna Commercial |
$1,622.04
|
| Rate for Payer: Aetna Medicare |
$634.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$634.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,103.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,201.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$558.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$729.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$697.63
|
| Rate for Payer: Cash Price |
$1,191.54
|
| Rate for Payer: Cash Price |
$1,191.54
|
| Rate for Payer: Centivo All Commercial |
$980.14
|
| Rate for Payer: Cigna All Commercial |
$1,658.55
|
| Rate for Payer: CORVEL All Commercial |
$1,787.31
|
| Rate for Payer: Coventry All Commercial |
$1,691.22
|
| Rate for Payer: Encore All Commercial |
$1,769.06
|
| Rate for Payer: Frontpath All Commercial |
$1,768.10
|
| Rate for Payer: Humana ChoiceCare |
$1,659.90
|
| Rate for Payer: Humana Medicare |
$980.14
|
| Rate for Payer: Lucent All Commercial |
$980.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,729.66
|
| Rate for Payer: Managed Health Services Medicaid |
$558.40
|
| Rate for Payer: MDWise Medicaid |
$558.40
|
| Rate for Payer: PHCS All Commercial |
$1,441.38
|
| Rate for Payer: PHP All Commercial |
$1,457.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$749.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,483.66
|
| Rate for Payer: Signature Care EPO |
$1,595.13
|
| Rate for Payer: Signature Care PPO |
$1,691.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,633.57
|
| Rate for Payer: United Healthcare Commercial |
$1,514.41
|
| Rate for Payer: United Healthcare Medicare |
$634.21
|
|
|
HC LUNG SCAN PERFUSION
|
Facility
IP
|
$1,921.84
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
01638360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,441.38 |
| Max. Negotiated Rate |
$1,787.31 |
| Rate for Payer: Aetna Commercial |
$1,660.47
|
| Rate for Payer: Cash Price |
$1,191.54
|
| Rate for Payer: Cigna All Commercial |
$1,658.55
|
| Rate for Payer: CORVEL All Commercial |
$1,787.31
|
| Rate for Payer: Coventry All Commercial |
$1,691.22
|
| Rate for Payer: Encore All Commercial |
$1,769.06
|
| Rate for Payer: Frontpath All Commercial |
$1,768.10
|
| Rate for Payer: Humana ChoiceCare |
$1,659.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,729.66
|
| Rate for Payer: PHCS All Commercial |
$1,441.38
|
| Rate for Payer: PHP All Commercial |
$1,457.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,483.66
|
| Rate for Payer: Signature Care EPO |
$1,595.13
|
| Rate for Payer: Signature Care PPO |
$1,691.22
|
| Rate for Payer: United Healthcare Commercial |
$1,514.41
|
|
|
HC LUNG VENTILATION IMAGING
|
Facility
OP
|
$1,174.72
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
01638579
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$1,092.49 |
| Rate for Payer: Aetna Commercial |
$991.47
|
| Rate for Payer: Aetna Medicare |
$387.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$387.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$674.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$734.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$447.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$426.42
|
| Rate for Payer: Cash Price |
$728.33
|
| Rate for Payer: Cash Price |
$728.33
|
| Rate for Payer: Centivo All Commercial |
$599.11
|
| Rate for Payer: Cigna All Commercial |
$1,013.79
|
| Rate for Payer: CORVEL All Commercial |
$1,092.49
|
| Rate for Payer: Coventry All Commercial |
$1,033.76
|
| Rate for Payer: Encore All Commercial |
$1,081.33
|
| Rate for Payer: Frontpath All Commercial |
$1,080.75
|
| Rate for Payer: Humana ChoiceCare |
$1,014.61
|
| Rate for Payer: Humana Medicare |
$599.11
|
| Rate for Payer: Lucent All Commercial |
$599.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.25
|
| Rate for Payer: Managed Health Services Medicaid |
$447.60
|
| Rate for Payer: MDWise Medicaid |
$447.60
|
| Rate for Payer: PHCS All Commercial |
$881.04
|
| Rate for Payer: PHP All Commercial |
$890.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$458.14
|
| Rate for Payer: Sagamore Health Network All Products |
$906.89
|
| Rate for Payer: Signature Care EPO |
$975.02
|
| Rate for Payer: Signature Care PPO |
$1,033.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$998.52
|
| Rate for Payer: United Healthcare Commercial |
$925.68
|
| Rate for Payer: United Healthcare Medicare |
$387.66
|
|
|
HC LUNG VENTILATION IMAGING
|
Facility
IP
|
$1,174.72
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
01638579
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$881.04 |
| Max. Negotiated Rate |
$1,092.49 |
| Rate for Payer: Aetna Commercial |
$1,014.96
|
| Rate for Payer: Cash Price |
$728.33
|
| Rate for Payer: Cigna All Commercial |
$1,013.79
|
| Rate for Payer: CORVEL All Commercial |
$1,092.49
|
| Rate for Payer: Coventry All Commercial |
$1,033.76
|
| Rate for Payer: Encore All Commercial |
$1,081.33
|
| Rate for Payer: Frontpath All Commercial |
$1,080.75
|
| Rate for Payer: Humana ChoiceCare |
$1,014.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.25
|
| Rate for Payer: PHCS All Commercial |
$881.04
|
| Rate for Payer: PHP All Commercial |
$890.91
|
| Rate for Payer: Sagamore Health Network All Products |
$906.89
|
| Rate for Payer: Signature Care EPO |
$975.02
|
| Rate for Payer: Signature Care PPO |
$1,033.76
|
| Rate for Payer: United Healthcare Commercial |
$925.68
|
|
|
HC LUNG VENTILAT&PERFUS IMAGING
|
Facility
OP
|
$2,955.50
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
01638582
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$779.65 |
| Max. Negotiated Rate |
$2,748.62 |
| Rate for Payer: Aetna Commercial |
$2,494.44
|
| Rate for Payer: Aetna Medicare |
$975.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$975.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,697.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,847.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$779.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,121.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,072.85
|
| Rate for Payer: Cash Price |
$1,832.41
|
| Rate for Payer: Cash Price |
$1,832.41
|
| Rate for Payer: Centivo All Commercial |
$1,507.31
|
| Rate for Payer: Cigna All Commercial |
$2,550.60
|
| Rate for Payer: CORVEL All Commercial |
$2,748.62
|
| Rate for Payer: Coventry All Commercial |
$2,600.84
|
| Rate for Payer: Encore All Commercial |
$2,720.54
|
| Rate for Payer: Frontpath All Commercial |
$2,719.06
|
| Rate for Payer: Humana ChoiceCare |
$2,552.67
|
| Rate for Payer: Humana Medicare |
$1,507.31
|
| Rate for Payer: Lucent All Commercial |
$1,507.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,659.95
|
| Rate for Payer: Managed Health Services Medicaid |
$779.65
|
| Rate for Payer: MDWise Medicaid |
$779.65
|
| Rate for Payer: PHCS All Commercial |
$2,216.63
|
| Rate for Payer: PHP All Commercial |
$2,241.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,152.65
|
| Rate for Payer: Sagamore Health Network All Products |
$2,281.65
|
| Rate for Payer: Signature Care EPO |
$2,453.07
|
| Rate for Payer: Signature Care PPO |
$2,600.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,512.18
|
| Rate for Payer: United Healthcare Commercial |
$2,328.93
|
| Rate for Payer: United Healthcare Medicare |
$975.32
|
|
|
HC LUNG VENTILAT&PERFUS IMAGING
|
Facility
IP
|
$2,955.50
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
01638582
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,216.63 |
| Max. Negotiated Rate |
$2,748.62 |
| Rate for Payer: Aetna Commercial |
$2,553.55
|
| Rate for Payer: Cash Price |
$1,832.41
|
| Rate for Payer: Cigna All Commercial |
$2,550.60
|
| Rate for Payer: CORVEL All Commercial |
$2,748.62
|
| Rate for Payer: Coventry All Commercial |
$2,600.84
|
| Rate for Payer: Encore All Commercial |
$2,720.54
|
| Rate for Payer: Frontpath All Commercial |
$2,719.06
|
| Rate for Payer: Humana ChoiceCare |
$2,552.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,659.95
|
| Rate for Payer: PHCS All Commercial |
$2,216.63
|
| Rate for Payer: PHP All Commercial |
$2,241.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,281.65
|
| Rate for Payer: Signature Care EPO |
$2,453.07
|
| Rate for Payer: Signature Care PPO |
$2,600.84
|
| Rate for Payer: United Healthcare Commercial |
$2,328.93
|
|
|
HC LUPUS PANEL CHARGE
|
Facility
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.48
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Centivo All Commercial |
$79.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$79.35
|
| Rate for Payer: Lucent All Commercial |
$79.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
| Rate for Payer: United Healthcare Medicare |
$51.34
|
|
|
HC LUPUS PANEL CHARGE
|
Facility
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
|
|
HC LUPUS PANEL CHARGE 1 ST
|
Facility
OP
|
$57.22
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.77
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Centivo All Commercial |
$29.18
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$29.18
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$13.74
|
| Rate for Payer: MDWise Medicaid |
$13.74
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.88
|
|
|
HC LUPUS PANEL CHARGE 1 ST
|
Facility
IP
|
$57.22
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC LUX DX CLINIC ASSIST
|
Facility
IP
|
$746.25
|
|
| Hospital Charge Code |
41607245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.69 |
| Max. Negotiated Rate |
$694.01 |
| Rate for Payer: Aetna Commercial |
$644.76
|
| Rate for Payer: Cash Price |
$462.68
|
| Rate for Payer: Cigna All Commercial |
$644.01
|
| Rate for Payer: CORVEL All Commercial |
$694.01
|
| Rate for Payer: Coventry All Commercial |
$656.70
|
| Rate for Payer: Encore All Commercial |
$686.92
|
| Rate for Payer: Frontpath All Commercial |
$686.55
|
| Rate for Payer: Humana ChoiceCare |
$644.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$671.62
|
| Rate for Payer: PHCS All Commercial |
$559.69
|
| Rate for Payer: PHP All Commercial |
$565.96
|
| Rate for Payer: Sagamore Health Network All Products |
$576.10
|
| Rate for Payer: Signature Care EPO |
$619.39
|
| Rate for Payer: Signature Care PPO |
$656.70
|
| Rate for Payer: United Healthcare Commercial |
$588.04
|
|
|
HC LUX DX CLINIC ASSIST
|
Facility
OP
|
$746.25
|
|
| Hospital Charge Code |
41607245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$694.01 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Aetna Medicare |
$246.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$246.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$428.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$466.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$270.89
|
| Rate for Payer: Cash Price |
$462.68
|
| Rate for Payer: Cash Price |
$462.68
|
| Rate for Payer: Centivo All Commercial |
$380.59
|
| Rate for Payer: Cigna All Commercial |
$644.01
|
| Rate for Payer: CORVEL All Commercial |
$694.01
|
| Rate for Payer: Coventry All Commercial |
$656.70
|
| Rate for Payer: Encore All Commercial |
$686.92
|
| Rate for Payer: Frontpath All Commercial |
$686.55
|
| Rate for Payer: Humana ChoiceCare |
$644.54
|
| Rate for Payer: Humana Medicare |
$380.59
|
| Rate for Payer: Lucent All Commercial |
$380.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$671.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$559.69
|
| Rate for Payer: PHP All Commercial |
$565.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$291.04
|
| Rate for Payer: Sagamore Health Network All Products |
$576.10
|
| Rate for Payer: Signature Care EPO |
$619.39
|
| Rate for Payer: Signature Care PPO |
$656.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$634.31
|
| Rate for Payer: United Healthcare Commercial |
$588.04
|
| Rate for Payer: United Healthcare Medicare |
$246.26
|
|
|
HC LYME DISEASE
|
Facility
IP
|
$214.26
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
63001039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.70 |
| Max. Negotiated Rate |
$199.26 |
| Rate for Payer: Aetna Commercial |
$185.12
|
| Rate for Payer: Cash Price |
$132.84
|
| Rate for Payer: Cigna All Commercial |
$184.91
|
| Rate for Payer: CORVEL All Commercial |
$199.26
|
| Rate for Payer: Coventry All Commercial |
$188.55
|
| Rate for Payer: Encore All Commercial |
$197.23
|
| Rate for Payer: Frontpath All Commercial |
$197.12
|
| Rate for Payer: Humana ChoiceCare |
$185.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.84
|
| Rate for Payer: PHCS All Commercial |
$160.70
|
| Rate for Payer: PHP All Commercial |
$162.50
|
| Rate for Payer: Sagamore Health Network All Products |
$165.41
|
| Rate for Payer: Signature Care EPO |
$177.84
|
| Rate for Payer: Signature Care PPO |
$188.55
|
| Rate for Payer: United Healthcare Commercial |
$168.84
|
|
|
HC LYME DISEASE
|
Facility
OP
|
$214.26
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
63001039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$199.26 |
| Rate for Payer: Aetna Commercial |
$180.84
|
| Rate for Payer: Aetna Medicare |
$70.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$123.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.78
|
| Rate for Payer: Cash Price |
$132.84
|
| Rate for Payer: Cash Price |
$132.84
|
| Rate for Payer: Centivo All Commercial |
$109.27
|
| Rate for Payer: Cigna All Commercial |
$184.91
|
| Rate for Payer: CORVEL All Commercial |
$199.26
|
| Rate for Payer: Coventry All Commercial |
$188.55
|
| Rate for Payer: Encore All Commercial |
$197.23
|
| Rate for Payer: Frontpath All Commercial |
$197.12
|
| Rate for Payer: Humana ChoiceCare |
$185.06
|
| Rate for Payer: Humana Medicare |
$109.27
|
| Rate for Payer: Lucent All Commercial |
$109.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.84
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$160.70
|
| Rate for Payer: PHP All Commercial |
$162.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.56
|
| Rate for Payer: Sagamore Health Network All Products |
$165.41
|
| Rate for Payer: Signature Care EPO |
$177.84
|
| Rate for Payer: Signature Care PPO |
$188.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.12
|
| Rate for Payer: United Healthcare Commercial |
$168.84
|
| Rate for Payer: United Healthcare Medicare |
$70.71
|
|
|
HC LYME DISEASE IGG WESTERN BLOT
|
Facility
OP
|
$206.74
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
63001925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$192.27 |
| Rate for Payer: Aetna Commercial |
$174.49
|
| Rate for Payer: Aetna Medicare |
$68.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.05
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Centivo All Commercial |
$105.44
|
| Rate for Payer: Cigna All Commercial |
$178.42
|
| Rate for Payer: CORVEL All Commercial |
$192.27
|
| Rate for Payer: Coventry All Commercial |
$181.93
|
| Rate for Payer: Encore All Commercial |
$190.31
|
| Rate for Payer: Frontpath All Commercial |
$190.20
|
| Rate for Payer: Humana ChoiceCare |
$178.56
|
| Rate for Payer: Humana Medicare |
$105.44
|
| Rate for Payer: Lucent All Commercial |
$105.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.07
|
| Rate for Payer: Managed Health Services Medicaid |
$15.49
|
| Rate for Payer: MDWise Medicaid |
$15.49
|
| Rate for Payer: PHCS All Commercial |
$155.06
|
| Rate for Payer: PHP All Commercial |
$156.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.63
|
| Rate for Payer: Sagamore Health Network All Products |
$159.61
|
| Rate for Payer: Signature Care EPO |
$171.60
|
| Rate for Payer: Signature Care PPO |
$181.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.73
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$68.23
|
|
|
HC LYME DISEASE IGG WESTERN BLOT
|
Facility
IP
|
$206.74
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
63001925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$192.27 |
| Rate for Payer: Aetna Commercial |
$178.63
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cigna All Commercial |
$178.42
|
| Rate for Payer: CORVEL All Commercial |
$192.27
|
| Rate for Payer: Coventry All Commercial |
$181.93
|
| Rate for Payer: Encore All Commercial |
$190.31
|
| Rate for Payer: Frontpath All Commercial |
$190.20
|
| Rate for Payer: Humana ChoiceCare |
$178.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.07
|
| Rate for Payer: PHCS All Commercial |
$155.06
|
| Rate for Payer: PHP All Commercial |
$156.79
|
| Rate for Payer: Sagamore Health Network All Products |
$159.61
|
| Rate for Payer: Signature Care EPO |
$171.60
|
| Rate for Payer: Signature Care PPO |
$181.93
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
|
|
HC LYME DISEASE IGM WESTERN BLOT
|
Facility
OP
|
$206.74
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
63001926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$192.27 |
| Rate for Payer: Aetna Commercial |
$174.49
|
| Rate for Payer: Aetna Medicare |
$68.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.05
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Centivo All Commercial |
$105.44
|
| Rate for Payer: Cigna All Commercial |
$178.42
|
| Rate for Payer: CORVEL All Commercial |
$192.27
|
| Rate for Payer: Coventry All Commercial |
$181.93
|
| Rate for Payer: Encore All Commercial |
$190.31
|
| Rate for Payer: Frontpath All Commercial |
$190.20
|
| Rate for Payer: Humana ChoiceCare |
$178.56
|
| Rate for Payer: Humana Medicare |
$105.44
|
| Rate for Payer: Lucent All Commercial |
$105.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.07
|
| Rate for Payer: Managed Health Services Medicaid |
$15.49
|
| Rate for Payer: MDWise Medicaid |
$15.49
|
| Rate for Payer: PHCS All Commercial |
$155.06
|
| Rate for Payer: PHP All Commercial |
$156.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.63
|
| Rate for Payer: Sagamore Health Network All Products |
$159.61
|
| Rate for Payer: Signature Care EPO |
$171.60
|
| Rate for Payer: Signature Care PPO |
$181.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.73
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$68.23
|
|
|
HC LYME DISEASE IGM WESTERN BLOT
|
Facility
IP
|
$206.74
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
63001926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$192.27 |
| Rate for Payer: Aetna Commercial |
$178.63
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cigna All Commercial |
$178.42
|
| Rate for Payer: CORVEL All Commercial |
$192.27
|
| Rate for Payer: Coventry All Commercial |
$181.93
|
| Rate for Payer: Encore All Commercial |
$190.31
|
| Rate for Payer: Frontpath All Commercial |
$190.20
|
| Rate for Payer: Humana ChoiceCare |
$178.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.07
|
| Rate for Payer: PHCS All Commercial |
$155.06
|
| Rate for Payer: PHP All Commercial |
$156.79
|
| Rate for Payer: Sagamore Health Network All Products |
$159.61
|
| Rate for Payer: Signature Care EPO |
$171.60
|
| Rate for Payer: Signature Care PPO |
$181.93
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
|
|
HC LYMPHOSCINTIGRAPHY
|
Facility
IP
|
$2,126.41
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
01638195
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,594.81 |
| Max. Negotiated Rate |
$1,977.57 |
| Rate for Payer: Aetna Commercial |
$1,837.22
|
| Rate for Payer: Cash Price |
$1,318.38
|
| Rate for Payer: Cigna All Commercial |
$1,835.10
|
| Rate for Payer: CORVEL All Commercial |
$1,977.57
|
| Rate for Payer: Coventry All Commercial |
$1,871.24
|
| Rate for Payer: Encore All Commercial |
$1,957.36
|
| Rate for Payer: Frontpath All Commercial |
$1,956.30
|
| Rate for Payer: Humana ChoiceCare |
$1,836.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,913.77
|
| Rate for Payer: PHCS All Commercial |
$1,594.81
|
| Rate for Payer: PHP All Commercial |
$1,612.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,641.59
|
| Rate for Payer: Signature Care EPO |
$1,764.92
|
| Rate for Payer: Signature Care PPO |
$1,871.24
|
| Rate for Payer: United Healthcare Commercial |
$1,675.61
|
|
|
HC LYMPHOSCINTIGRAPHY
|
Facility
OP
|
$2,126.41
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
01638195
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$701.72 |
| Max. Negotiated Rate |
$1,977.57 |
| Rate for Payer: Aetna Commercial |
$1,794.69
|
| Rate for Payer: Aetna Medicare |
$701.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$701.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,221.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,329.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$820.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$806.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$771.89
|
| Rate for Payer: Cash Price |
$1,318.38
|
| Rate for Payer: Cash Price |
$1,318.38
|
| Rate for Payer: Centivo All Commercial |
$1,084.47
|
| Rate for Payer: Cigna All Commercial |
$1,835.10
|
| Rate for Payer: CORVEL All Commercial |
$1,977.57
|
| Rate for Payer: Coventry All Commercial |
$1,871.24
|
| Rate for Payer: Encore All Commercial |
$1,957.36
|
| Rate for Payer: Frontpath All Commercial |
$1,956.30
|
| Rate for Payer: Humana ChoiceCare |
$1,836.58
|
| Rate for Payer: Humana Medicare |
$1,084.47
|
| Rate for Payer: Lucent All Commercial |
$1,084.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,913.77
|
| Rate for Payer: Managed Health Services Medicaid |
$820.21
|
| Rate for Payer: MDWise Medicaid |
$820.21
|
| Rate for Payer: PHCS All Commercial |
$1,594.81
|
| Rate for Payer: PHP All Commercial |
$1,612.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$829.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,641.59
|
| Rate for Payer: Signature Care EPO |
$1,764.92
|
| Rate for Payer: Signature Care PPO |
$1,871.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,807.45
|
| Rate for Payer: United Healthcare Commercial |
$1,675.61
|
| Rate for Payer: United Healthcare Medicare |
$701.72
|
|
|
HC MAGNESIUM
|
Facility
OP
|
$108.49
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
63001197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$35.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.38
|
| Rate for Payer: Cash Price |
$67.26
|
| Rate for Payer: Cash Price |
$67.26
|
| Rate for Payer: Centivo All Commercial |
$55.33
|
| Rate for Payer: Cigna All Commercial |
$93.62
|
| Rate for Payer: CORVEL All Commercial |
$100.89
|
| Rate for Payer: Coventry All Commercial |
$95.47
|
| Rate for Payer: Encore All Commercial |
$99.86
|
| Rate for Payer: Frontpath All Commercial |
$99.81
|
| Rate for Payer: Humana ChoiceCare |
$93.70
|
| Rate for Payer: Humana Medicare |
$55.33
|
| Rate for Payer: Lucent All Commercial |
$55.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.64
|
| Rate for Payer: Managed Health Services Medicaid |
$6.70
|
| Rate for Payer: MDWise Medicaid |
$6.70
|
| Rate for Payer: PHCS All Commercial |
$81.37
|
| Rate for Payer: PHP All Commercial |
$82.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.31
|
| Rate for Payer: Sagamore Health Network All Products |
$83.75
|
| Rate for Payer: Signature Care EPO |
$90.04
|
| Rate for Payer: Signature Care PPO |
$95.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.21
|
| Rate for Payer: United Healthcare Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare |
$35.80
|
|
|
HC MAGNESIUM
|
Facility
IP
|
$108.49
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
63001197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.37 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$93.73
|
| Rate for Payer: Cash Price |
$67.26
|
| Rate for Payer: Cigna All Commercial |
$93.62
|
| Rate for Payer: CORVEL All Commercial |
$100.89
|
| Rate for Payer: Coventry All Commercial |
$95.47
|
| Rate for Payer: Encore All Commercial |
$99.86
|
| Rate for Payer: Frontpath All Commercial |
$99.81
|
| Rate for Payer: Humana ChoiceCare |
$93.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.64
|
| Rate for Payer: PHCS All Commercial |
$81.37
|
| Rate for Payer: PHP All Commercial |
$82.28
|
| Rate for Payer: Sagamore Health Network All Products |
$83.75
|
| Rate for Payer: Signature Care EPO |
$90.04
|
| Rate for Payer: Signature Care PPO |
$95.47
|
| Rate for Payer: United Healthcare Commercial |
$85.49
|
|
