|
HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR
|
Facility
|
OP
|
$491.09
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
63081596
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.24 |
| Max. Negotiated Rate |
$456.71 |
| Rate for Payer: Aetna Commercial |
$414.48
|
| Rate for Payer: Aetna Medicare |
$157.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$225.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.86
|
| Rate for Payer: Cash Price |
$294.65
|
| Rate for Payer: Centivo All Commercial |
$267.15
|
| Rate for Payer: Cigna All Commercial |
$423.81
|
| Rate for Payer: CORVEL All Commercial |
$456.71
|
| Rate for Payer: Coventry All Commercial |
$432.16
|
| Rate for Payer: Encore All Commercial |
$452.05
|
| Rate for Payer: Frontpath All Commercial |
$451.80
|
| Rate for Payer: Humana ChoiceCare |
$424.15
|
| Rate for Payer: Humana Medicare |
$157.15
|
| Rate for Payer: Lucent All Commercial |
$267.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.98
|
| Rate for Payer: PHCS All Commercial |
$368.32
|
| Rate for Payer: PHP All Commercial |
$372.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.53
|
| Rate for Payer: Sagamore Health Network All Products |
$379.12
|
| Rate for Payer: Signature Care EPO |
$407.60
|
| Rate for Payer: Signature Care PPO |
$432.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$417.43
|
| Rate for Payer: United Healthcare Commercial |
$386.98
|
| Rate for Payer: United Healthcare Medicare |
$157.15
|
|
|
HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR
|
Facility
|
IP
|
$491.09
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
63081596
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$368.32 |
| Max. Negotiated Rate |
$456.71 |
| Rate for Payer: Aetna Commercial |
$424.30
|
| Rate for Payer: Cash Price |
$294.65
|
| Rate for Payer: Cigna All Commercial |
$423.81
|
| Rate for Payer: CORVEL All Commercial |
$456.71
|
| Rate for Payer: Coventry All Commercial |
$432.16
|
| Rate for Payer: Encore All Commercial |
$452.05
|
| Rate for Payer: Frontpath All Commercial |
$451.80
|
| Rate for Payer: Humana ChoiceCare |
$424.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.98
|
| Rate for Payer: PHCS All Commercial |
$368.32
|
| Rate for Payer: PHP All Commercial |
$372.44
|
| Rate for Payer: Sagamore Health Network All Products |
$379.12
|
| Rate for Payer: Signature Care EPO |
$407.60
|
| Rate for Payer: Signature Care PPO |
$432.16
|
| Rate for Payer: United Healthcare Commercial |
$386.98
|
|
|
HC NG ANTI REFLUX VALVE
|
Facility
|
OP
|
$21.58
|
|
| Hospital Charge Code |
41601198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna Medicare |
$6.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Centivo All Commercial |
$11.74
|
| Rate for Payer: Cigna All Commercial |
$18.62
|
| Rate for Payer: CORVEL All Commercial |
$20.07
|
| Rate for Payer: Coventry All Commercial |
$18.99
|
| Rate for Payer: Encore All Commercial |
$19.86
|
| Rate for Payer: Frontpath All Commercial |
$19.85
|
| Rate for Payer: Humana ChoiceCare |
$18.64
|
| Rate for Payer: Humana Medicare |
$6.91
|
| Rate for Payer: Lucent All Commercial |
$11.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.42
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$16.18
|
| Rate for Payer: PHP All Commercial |
$16.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.42
|
| Rate for Payer: Sagamore Health Network All Products |
$16.66
|
| Rate for Payer: Signature Care EPO |
$17.91
|
| Rate for Payer: Signature Care PPO |
$18.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.34
|
| Rate for Payer: United Healthcare Commercial |
$17.01
|
| Rate for Payer: United Healthcare Medicare |
$6.91
|
|
|
HC NG ANTI REFLUX VALVE
|
Facility
|
IP
|
$21.58
|
|
| Hospital Charge Code |
41601198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna Commercial |
$18.65
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cigna All Commercial |
$18.62
|
| Rate for Payer: CORVEL All Commercial |
$20.07
|
| Rate for Payer: Coventry All Commercial |
$18.99
|
| Rate for Payer: Encore All Commercial |
$19.86
|
| Rate for Payer: Frontpath All Commercial |
$19.85
|
| Rate for Payer: Humana ChoiceCare |
$18.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.42
|
| Rate for Payer: PHCS All Commercial |
$16.18
|
| Rate for Payer: PHP All Commercial |
$16.37
|
| Rate for Payer: Sagamore Health Network All Products |
$16.66
|
| Rate for Payer: Signature Care EPO |
$17.91
|
| Rate for Payer: Signature Care PPO |
$18.99
|
| Rate for Payer: United Healthcare Commercial |
$17.01
|
|
|
HC N GONORRHOEAE-AMP PROBE
|
Facility
|
IP
|
$137.70
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
|
|
HC N GONORRHOEAE-AMP PROBE
|
Facility
|
OP
|
$137.70
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$116.22
|
| Rate for Payer: Aetna Medicare |
$44.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.47
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Centivo All Commercial |
$74.91
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Humana Medicare |
$44.06
|
| Rate for Payer: Lucent All Commercial |
$74.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.70
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.05
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
| Rate for Payer: United Healthcare Medicare |
$44.06
|
|
|
HC NG TUBE GUARD
|
Facility
|
OP
|
$15.31
|
|
| Hospital Charge Code |
41601189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: Aetna Medicare |
$4.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.39
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Centivo All Commercial |
$8.33
|
| Rate for Payer: Cigna All Commercial |
$13.21
|
| Rate for Payer: CORVEL All Commercial |
$14.24
|
| Rate for Payer: Coventry All Commercial |
$13.47
|
| Rate for Payer: Encore All Commercial |
$14.09
|
| Rate for Payer: Frontpath All Commercial |
$14.09
|
| Rate for Payer: Humana ChoiceCare |
$13.22
|
| Rate for Payer: Humana Medicare |
$4.90
|
| Rate for Payer: Lucent All Commercial |
$8.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.78
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.48
|
| Rate for Payer: PHP All Commercial |
$11.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.97
|
| Rate for Payer: Sagamore Health Network All Products |
$11.82
|
| Rate for Payer: Signature Care EPO |
$12.71
|
| Rate for Payer: Signature Care PPO |
$13.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.01
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
| Rate for Payer: United Healthcare Medicare |
$4.90
|
|
|
HC NG TUBE GUARD
|
Facility
|
IP
|
$15.31
|
|
| Hospital Charge Code |
41601189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: Aetna Commercial |
$13.23
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cigna All Commercial |
$13.21
|
| Rate for Payer: CORVEL All Commercial |
$14.24
|
| Rate for Payer: Coventry All Commercial |
$13.47
|
| Rate for Payer: Encore All Commercial |
$14.09
|
| Rate for Payer: Frontpath All Commercial |
$14.09
|
| Rate for Payer: Humana ChoiceCare |
$13.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.78
|
| Rate for Payer: PHCS All Commercial |
$11.48
|
| Rate for Payer: PHP All Commercial |
$11.61
|
| Rate for Payer: Sagamore Health Network All Products |
$11.82
|
| Rate for Payer: Signature Care EPO |
$12.71
|
| Rate for Payer: Signature Care PPO |
$13.47
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
|
|
HC NICOTINE & METABOLITES
|
Facility
|
OP
|
$187.75
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$174.61 |
| Rate for Payer: Aetna Commercial |
$158.46
|
| Rate for Payer: Aetna Medicare |
$60.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.09
|
| Rate for Payer: Cash Price |
$112.65
|
| Rate for Payer: Cash Price |
$112.65
|
| Rate for Payer: Centivo All Commercial |
$102.14
|
| Rate for Payer: Cigna All Commercial |
$162.03
|
| Rate for Payer: CORVEL All Commercial |
$174.61
|
| Rate for Payer: Coventry All Commercial |
$165.22
|
| Rate for Payer: Encore All Commercial |
$172.82
|
| Rate for Payer: Frontpath All Commercial |
$172.73
|
| Rate for Payer: Humana ChoiceCare |
$162.16
|
| Rate for Payer: Humana Medicare |
$60.08
|
| Rate for Payer: Lucent All Commercial |
$102.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.97
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$140.81
|
| Rate for Payer: PHP All Commercial |
$142.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.22
|
| Rate for Payer: Sagamore Health Network All Products |
$144.94
|
| Rate for Payer: Signature Care EPO |
$155.83
|
| Rate for Payer: Signature Care PPO |
$165.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.59
|
| Rate for Payer: United Healthcare Commercial |
$147.95
|
| Rate for Payer: United Healthcare Medicare |
$60.08
|
|
|
HC NICOTINE & METABOLITES
|
Facility
|
IP
|
$187.75
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
63001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.81 |
| Max. Negotiated Rate |
$174.61 |
| Rate for Payer: Aetna Commercial |
$162.22
|
| Rate for Payer: Cash Price |
$112.65
|
| Rate for Payer: Cigna All Commercial |
$162.03
|
| Rate for Payer: CORVEL All Commercial |
$174.61
|
| Rate for Payer: Coventry All Commercial |
$165.22
|
| Rate for Payer: Encore All Commercial |
$172.82
|
| Rate for Payer: Frontpath All Commercial |
$172.73
|
| Rate for Payer: Humana ChoiceCare |
$162.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.97
|
| Rate for Payer: PHCS All Commercial |
$140.81
|
| Rate for Payer: PHP All Commercial |
$142.39
|
| Rate for Payer: Sagamore Health Network All Products |
$144.94
|
| Rate for Payer: Signature Care EPO |
$155.83
|
| Rate for Payer: Signature Care PPO |
$165.22
|
| Rate for Payer: United Healthcare Commercial |
$147.95
|
|
|
HC NICOTINE & METABOLITES
|
Facility
|
IP
|
$187.75
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.81 |
| Max. Negotiated Rate |
$174.61 |
| Rate for Payer: Aetna Commercial |
$162.22
|
| Rate for Payer: Cash Price |
$112.65
|
| Rate for Payer: Cigna All Commercial |
$162.03
|
| Rate for Payer: CORVEL All Commercial |
$174.61
|
| Rate for Payer: Coventry All Commercial |
$165.22
|
| Rate for Payer: Encore All Commercial |
$172.82
|
| Rate for Payer: Frontpath All Commercial |
$172.73
|
| Rate for Payer: Humana ChoiceCare |
$162.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.97
|
| Rate for Payer: PHCS All Commercial |
$140.81
|
| Rate for Payer: PHP All Commercial |
$142.39
|
| Rate for Payer: Sagamore Health Network All Products |
$144.94
|
| Rate for Payer: Signature Care EPO |
$155.83
|
| Rate for Payer: Signature Care PPO |
$165.22
|
| Rate for Payer: United Healthcare Commercial |
$147.95
|
|
|
HC NICOTINE & METABOLITES
|
Facility
|
OP
|
$187.75
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
63001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$174.61 |
| Rate for Payer: Aetna Commercial |
$158.46
|
| Rate for Payer: Aetna Medicare |
$60.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.09
|
| Rate for Payer: Cash Price |
$112.65
|
| Rate for Payer: Centivo All Commercial |
$102.14
|
| Rate for Payer: Cigna All Commercial |
$162.03
|
| Rate for Payer: CORVEL All Commercial |
$174.61
|
| Rate for Payer: Coventry All Commercial |
$165.22
|
| Rate for Payer: Encore All Commercial |
$172.82
|
| Rate for Payer: Frontpath All Commercial |
$172.73
|
| Rate for Payer: Humana ChoiceCare |
$162.16
|
| Rate for Payer: Humana Medicare |
$60.08
|
| Rate for Payer: Lucent All Commercial |
$102.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.97
|
| Rate for Payer: PHCS All Commercial |
$140.81
|
| Rate for Payer: PHP All Commercial |
$142.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.22
|
| Rate for Payer: Sagamore Health Network All Products |
$144.94
|
| Rate for Payer: Signature Care EPO |
$155.83
|
| Rate for Payer: Signature Care PPO |
$165.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.59
|
| Rate for Payer: United Healthcare Commercial |
$147.95
|
| Rate for Payer: United Healthcare Medicare |
$60.08
|
|
|
HC N-INVAS EST C FFR SW ALY CTA
|
Facility
|
OP
|
$4,126.00
|
|
|
Service Code
|
CPT 75580
|
| Hospital Charge Code |
1665580
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$996.18 |
| Max. Negotiated Rate |
$3,837.18 |
| Rate for Payer: Aetna Commercial |
$3,482.34
|
| Rate for Payer: Aetna Medicare |
$1,320.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$996.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,279.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,369.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,579.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$996.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,518.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,452.35
|
| Rate for Payer: Cash Price |
$2,475.60
|
| Rate for Payer: Cash Price |
$2,475.60
|
| Rate for Payer: Centivo All Commercial |
$2,244.54
|
| Rate for Payer: Cigna All Commercial |
$3,560.74
|
| Rate for Payer: CORVEL All Commercial |
$3,837.18
|
| Rate for Payer: Coventry All Commercial |
$3,630.88
|
| Rate for Payer: Encore All Commercial |
$3,797.98
|
| Rate for Payer: Frontpath All Commercial |
$3,795.92
|
| Rate for Payer: Humana ChoiceCare |
$3,563.63
|
| Rate for Payer: Humana Medicare |
$1,320.32
|
| Rate for Payer: Lucent All Commercial |
$2,244.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,713.40
|
| Rate for Payer: Managed Health Services Medicaid |
$996.18
|
| Rate for Payer: MDWise Medicaid |
$996.18
|
| Rate for Payer: PHCS All Commercial |
$3,094.50
|
| Rate for Payer: PHP All Commercial |
$3,129.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,609.14
|
| Rate for Payer: Sagamore Health Network All Products |
$3,185.27
|
| Rate for Payer: Signature Care EPO |
$3,424.58
|
| Rate for Payer: Signature Care PPO |
$3,630.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,507.10
|
| Rate for Payer: United Healthcare Commercial |
$3,251.29
|
| Rate for Payer: United Healthcare Medicare |
$1,320.32
|
|
|
HC N-INVAS EST C FFR SW ALY CTA
|
Facility
|
IP
|
$4,126.00
|
|
|
Service Code
|
CPT 75580
|
| Hospital Charge Code |
1665580
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,094.50 |
| Max. Negotiated Rate |
$3,837.18 |
| Rate for Payer: Aetna Commercial |
$3,564.86
|
| Rate for Payer: Cash Price |
$2,475.60
|
| Rate for Payer: Cigna All Commercial |
$3,560.74
|
| Rate for Payer: CORVEL All Commercial |
$3,837.18
|
| Rate for Payer: Coventry All Commercial |
$3,630.88
|
| Rate for Payer: Encore All Commercial |
$3,797.98
|
| Rate for Payer: Frontpath All Commercial |
$3,795.92
|
| Rate for Payer: Humana ChoiceCare |
$3,563.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,713.40
|
| Rate for Payer: PHCS All Commercial |
$3,094.50
|
| Rate for Payer: PHP All Commercial |
$3,129.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,185.27
|
| Rate for Payer: Signature Care EPO |
$3,424.58
|
| Rate for Payer: Signature Care PPO |
$3,630.88
|
| Rate for Payer: United Healthcare Commercial |
$3,251.29
|
|
|
HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Facility
|
OP
|
$3,055.50
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
1610430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.57 |
| Max. Negotiated Rate |
$2,841.61 |
| Rate for Payer: Aetna Commercial |
$2,578.84
|
| Rate for Payer: Aetna Medicare |
$977.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$488.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$947.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,754.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,909.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$488.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,124.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,075.54
|
| Rate for Payer: Cash Price |
$1,833.30
|
| Rate for Payer: Cash Price |
$1,833.30
|
| Rate for Payer: Centivo All Commercial |
$1,662.19
|
| Rate for Payer: Cigna All Commercial |
$2,636.90
|
| Rate for Payer: CORVEL All Commercial |
$2,841.61
|
| Rate for Payer: Coventry All Commercial |
$2,688.84
|
| Rate for Payer: Encore All Commercial |
$2,812.59
|
| Rate for Payer: Frontpath All Commercial |
$2,811.06
|
| Rate for Payer: Humana ChoiceCare |
$2,639.04
|
| Rate for Payer: Humana Medicare |
$977.76
|
| Rate for Payer: Lucent All Commercial |
$1,662.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,749.95
|
| Rate for Payer: Managed Health Services Medicaid |
$488.57
|
| Rate for Payer: MDWise Medicaid |
$488.57
|
| Rate for Payer: PHCS All Commercial |
$2,291.62
|
| Rate for Payer: PHP All Commercial |
$2,317.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,191.64
|
| Rate for Payer: Sagamore Health Network All Products |
$2,358.85
|
| Rate for Payer: Signature Care EPO |
$2,536.07
|
| Rate for Payer: Signature Care PPO |
$2,688.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,597.18
|
| Rate for Payer: United Healthcare Commercial |
$2,407.73
|
| Rate for Payer: United Healthcare Medicare |
$977.76
|
|
|
HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Facility
|
IP
|
$3,055.50
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
1610430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,291.62 |
| Max. Negotiated Rate |
$2,841.61 |
| Rate for Payer: Aetna Commercial |
$2,639.95
|
| Rate for Payer: Cash Price |
$1,833.30
|
| Rate for Payer: Cigna All Commercial |
$2,636.90
|
| Rate for Payer: CORVEL All Commercial |
$2,841.61
|
| Rate for Payer: Coventry All Commercial |
$2,688.84
|
| Rate for Payer: Encore All Commercial |
$2,812.59
|
| Rate for Payer: Frontpath All Commercial |
$2,811.06
|
| Rate for Payer: Humana ChoiceCare |
$2,639.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,749.95
|
| Rate for Payer: PHCS All Commercial |
$2,291.62
|
| Rate for Payer: PHP All Commercial |
$2,317.29
|
| Rate for Payer: Sagamore Health Network All Products |
$2,358.85
|
| Rate for Payer: Signature Care EPO |
$2,536.07
|
| Rate for Payer: Signature Care PPO |
$2,688.84
|
| Rate for Payer: United Healthcare Commercial |
$2,407.73
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)
|
Facility
|
IP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63044059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.93 |
| Max. Negotiated Rate |
$118.96 |
| Rate for Payer: Aetna Commercial |
$110.51
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Cigna All Commercial |
$110.39
|
| Rate for Payer: CORVEL All Commercial |
$118.96
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Sagamore Health Network All Products |
$98.75
|
| Rate for Payer: Signature Care EPO |
$106.17
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)
|
Facility
|
OP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63044059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$118.96 |
| Rate for Payer: Aetna Commercial |
$107.96
|
| Rate for Payer: Aetna Medicare |
$40.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.02
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Centivo All Commercial |
$69.58
|
| Rate for Payer: Cigna All Commercial |
$110.39
|
| Rate for Payer: CORVEL All Commercial |
$118.96
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.48
|
| Rate for Payer: Humana Medicare |
$40.93
|
| Rate for Payer: Lucent All Commercial |
$69.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.88
|
| Rate for Payer: Sagamore Health Network All Products |
$98.75
|
| Rate for Payer: Signature Care EPO |
$106.17
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.72
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
| Rate for Payer: United Healthcare Medicare |
$40.93
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)-B
|
Facility
|
OP
|
$216.07
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$200.95 |
| Rate for Payer: Aetna Commercial |
$182.36
|
| Rate for Payer: Aetna Medicare |
$69.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.06
|
| Rate for Payer: Cash Price |
$129.64
|
| Rate for Payer: Cash Price |
$129.64
|
| Rate for Payer: Centivo All Commercial |
$117.54
|
| Rate for Payer: Cigna All Commercial |
$186.47
|
| Rate for Payer: CORVEL All Commercial |
$200.95
|
| Rate for Payer: Coventry All Commercial |
$190.14
|
| Rate for Payer: Encore All Commercial |
$198.89
|
| Rate for Payer: Frontpath All Commercial |
$198.78
|
| Rate for Payer: Humana ChoiceCare |
$186.62
|
| Rate for Payer: Humana Medicare |
$69.14
|
| Rate for Payer: Lucent All Commercial |
$117.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.46
|
| Rate for Payer: Managed Health Services Medicaid |
$34.19
|
| Rate for Payer: MDWise Medicaid |
$34.19
|
| Rate for Payer: PHCS All Commercial |
$162.05
|
| Rate for Payer: PHP All Commercial |
$163.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.27
|
| Rate for Payer: Sagamore Health Network All Products |
$166.81
|
| Rate for Payer: Signature Care EPO |
$179.34
|
| Rate for Payer: Signature Care PPO |
$190.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.66
|
| Rate for Payer: United Healthcare Commercial |
$170.26
|
| Rate for Payer: United Healthcare Medicare |
$69.14
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)-B
|
Facility
|
IP
|
$216.07
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$200.95 |
| Rate for Payer: Aetna Commercial |
$186.68
|
| Rate for Payer: Cash Price |
$129.64
|
| Rate for Payer: Cigna All Commercial |
$186.47
|
| Rate for Payer: CORVEL All Commercial |
$200.95
|
| Rate for Payer: Coventry All Commercial |
$190.14
|
| Rate for Payer: Encore All Commercial |
$198.89
|
| Rate for Payer: Frontpath All Commercial |
$198.78
|
| Rate for Payer: Humana ChoiceCare |
$186.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.46
|
| Rate for Payer: PHCS All Commercial |
$162.05
|
| Rate for Payer: PHP All Commercial |
$163.87
|
| Rate for Payer: Sagamore Health Network All Products |
$166.81
|
| Rate for Payer: Signature Care EPO |
$179.34
|
| Rate for Payer: Signature Care PPO |
$190.14
|
| Rate for Payer: United Healthcare Commercial |
$170.26
|
|
|
HC NON SP GEN AAC TX
|
Facility
|
OP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
1742606
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$118.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$130.13
|
| Rate for Payer: Cash Price |
$221.81
|
| Rate for Payer: Cash Price |
$221.81
|
| Rate for Payer: Centivo All Commercial |
$201.11
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$118.30
|
| Rate for Payer: Lucent All Commercial |
$201.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.32
|
| Rate for Payer: United Healthcare Medicare |
$118.30
|
|
|
HC NON SP GEN AAC TX
|
Facility
|
IP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
1742606
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$221.81
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.32
|
|
|
HC NOROVIRUS, BY EIA, FECES
|
Facility
|
OP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63002033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$144.42
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.23
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Centivo All Commercial |
$93.08
|
| Rate for Payer: Cigna All Commercial |
$147.67
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.58
|
| Rate for Payer: Encore All Commercial |
$157.51
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.79
|
| Rate for Payer: Humana Medicare |
$54.76
|
| Rate for Payer: Lucent All Commercial |
$93.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.73
|
| Rate for Payer: Sagamore Health Network All Products |
$132.10
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.44
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
| Rate for Payer: United Healthcare Medicare |
$54.76
|
|
|
HC NOROVIRUS, BY EIA, FECES
|
Facility
|
IP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63002033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cigna All Commercial |
$147.67
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.58
|
| Rate for Payer: Encore All Commercial |
$157.51
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Sagamore Health Network All Products |
$132.10
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.58
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
|
|
HC NOSE CULTURE
|
Facility
|
IP
|
$139.98
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$130.18 |
| Rate for Payer: Aetna Commercial |
$120.94
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cigna All Commercial |
$120.80
|
| Rate for Payer: CORVEL All Commercial |
$130.18
|
| Rate for Payer: Coventry All Commercial |
$123.18
|
| Rate for Payer: Encore All Commercial |
$128.85
|
| Rate for Payer: Frontpath All Commercial |
$128.78
|
| Rate for Payer: Humana ChoiceCare |
$120.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.98
|
| Rate for Payer: PHCS All Commercial |
$104.98
|
| Rate for Payer: PHP All Commercial |
$106.16
|
| Rate for Payer: Sagamore Health Network All Products |
$108.06
|
| Rate for Payer: Signature Care EPO |
$116.18
|
| Rate for Payer: Signature Care PPO |
$123.18
|
| Rate for Payer: United Healthcare Commercial |
$110.30
|
|
