|
HC MICROALBUMIN 24H
|
Facility
OP
|
$97.92
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
63001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$82.64
|
| Rate for Payer: Aetna Medicare |
$32.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.54
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Centivo All Commercial |
$49.94
|
| Rate for Payer: Cigna All Commercial |
$84.50
|
| Rate for Payer: CORVEL All Commercial |
$91.07
|
| Rate for Payer: Coventry All Commercial |
$86.17
|
| Rate for Payer: Encore All Commercial |
$90.14
|
| Rate for Payer: Frontpath All Commercial |
$90.09
|
| Rate for Payer: Humana ChoiceCare |
$84.57
|
| Rate for Payer: Humana Medicare |
$49.94
|
| Rate for Payer: Lucent All Commercial |
$49.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.13
|
| Rate for Payer: Managed Health Services Medicaid |
$5.78
|
| Rate for Payer: MDWise Medicaid |
$5.78
|
| Rate for Payer: PHCS All Commercial |
$73.44
|
| Rate for Payer: PHP All Commercial |
$74.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.19
|
| Rate for Payer: Sagamore Health Network All Products |
$75.59
|
| Rate for Payer: Signature Care EPO |
$81.27
|
| Rate for Payer: Signature Care PPO |
$86.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.23
|
| Rate for Payer: United Healthcare Commercial |
$77.16
|
| Rate for Payer: United Healthcare Medicare |
$32.31
|
|
|
HC MICROALBUMIN 24H
|
Facility
IP
|
$97.92
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
63001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cigna All Commercial |
$84.50
|
| Rate for Payer: CORVEL All Commercial |
$91.07
|
| Rate for Payer: Coventry All Commercial |
$86.17
|
| Rate for Payer: Encore All Commercial |
$90.14
|
| Rate for Payer: Frontpath All Commercial |
$90.09
|
| Rate for Payer: Humana ChoiceCare |
$84.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.13
|
| Rate for Payer: PHCS All Commercial |
$73.44
|
| Rate for Payer: PHP All Commercial |
$74.26
|
| Rate for Payer: Sagamore Health Network All Products |
$75.59
|
| Rate for Payer: Signature Care EPO |
$81.27
|
| Rate for Payer: Signature Care PPO |
$86.17
|
| Rate for Payer: United Healthcare Commercial |
$77.16
|
|
|
HC MICRODISSECTION
|
Facility
OP
|
$534.08
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
63002138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$496.70 |
| Rate for Payer: Aetna Commercial |
$450.77
|
| Rate for Payer: Aetna Medicare |
$176.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$176.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$306.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$202.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.87
|
| Rate for Payer: Cash Price |
$331.13
|
| Rate for Payer: Centivo All Commercial |
$272.38
|
| Rate for Payer: Cigna All Commercial |
$460.91
|
| Rate for Payer: CORVEL All Commercial |
$496.70
|
| Rate for Payer: Coventry All Commercial |
$469.99
|
| Rate for Payer: Encore All Commercial |
$491.62
|
| Rate for Payer: Frontpath All Commercial |
$491.36
|
| Rate for Payer: Humana ChoiceCare |
$461.29
|
| Rate for Payer: Humana Medicare |
$272.38
|
| Rate for Payer: Lucent All Commercial |
$272.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$480.67
|
| Rate for Payer: PHCS All Commercial |
$400.56
|
| Rate for Payer: PHP All Commercial |
$405.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$208.29
|
| Rate for Payer: Sagamore Health Network All Products |
$412.31
|
| Rate for Payer: Signature Care EPO |
$443.29
|
| Rate for Payer: Signature Care PPO |
$469.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$453.97
|
| Rate for Payer: United Healthcare Commercial |
$420.86
|
| Rate for Payer: United Healthcare Medicare |
$176.25
|
|
|
HC MICRODISSECTION
|
Facility
IP
|
$534.08
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
63002138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$400.56 |
| Max. Negotiated Rate |
$496.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Cash Price |
$331.13
|
| Rate for Payer: Cigna All Commercial |
$460.91
|
| Rate for Payer: CORVEL All Commercial |
$496.70
|
| Rate for Payer: Coventry All Commercial |
$469.99
|
| Rate for Payer: Encore All Commercial |
$491.62
|
| Rate for Payer: Frontpath All Commercial |
$491.36
|
| Rate for Payer: Humana ChoiceCare |
$461.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$480.67
|
| Rate for Payer: PHCS All Commercial |
$400.56
|
| Rate for Payer: PHP All Commercial |
$405.05
|
| Rate for Payer: Sagamore Health Network All Products |
$412.31
|
| Rate for Payer: Signature Care EPO |
$443.29
|
| Rate for Payer: Signature Care PPO |
$469.99
|
| Rate for Payer: United Healthcare Commercial |
$420.86
|
|
|
HC MIDLINE CATH INSERT BS
|
Facility
OP
|
$1,749.26
|
|
| Hospital Charge Code |
01684001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,476.37
|
| Rate for Payer: Aetna Medicare |
$577.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$577.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,004.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,093.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$159.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$663.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$634.98
|
| Rate for Payer: Cash Price |
$1,084.54
|
| Rate for Payer: Cash Price |
$1,084.54
|
| Rate for Payer: Centivo All Commercial |
$892.12
|
| Rate for Payer: Cigna All Commercial |
$1,509.61
|
| Rate for Payer: CORVEL All Commercial |
$1,626.81
|
| Rate for Payer: Coventry All Commercial |
$1,539.35
|
| Rate for Payer: Encore All Commercial |
$1,610.19
|
| Rate for Payer: Frontpath All Commercial |
$1,609.32
|
| Rate for Payer: Humana ChoiceCare |
$1,510.84
|
| Rate for Payer: Humana Medicare |
$892.12
|
| Rate for Payer: Lucent All Commercial |
$892.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,574.33
|
| Rate for Payer: Managed Health Services Medicaid |
$159.12
|
| Rate for Payer: MDWise Medicaid |
$159.12
|
| Rate for Payer: PHCS All Commercial |
$1,311.94
|
| Rate for Payer: PHP All Commercial |
$1,326.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$682.21
|
| Rate for Payer: Sagamore Health Network All Products |
$1,350.43
|
| Rate for Payer: Signature Care EPO |
$1,451.89
|
| Rate for Payer: Signature Care PPO |
$1,539.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,486.87
|
| Rate for Payer: United Healthcare Commercial |
$1,378.42
|
| Rate for Payer: United Healthcare Medicare |
$577.26
|
|
|
HC MIDLINE CATH INSERT BS
|
Facility
IP
|
$1,749.26
|
|
| Hospital Charge Code |
01684001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,311.94 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,511.36
|
| Rate for Payer: Cash Price |
$1,084.54
|
| Rate for Payer: Cigna All Commercial |
$1,509.61
|
| Rate for Payer: CORVEL All Commercial |
$1,626.81
|
| Rate for Payer: Coventry All Commercial |
$1,539.35
|
| Rate for Payer: Encore All Commercial |
$1,610.19
|
| Rate for Payer: Frontpath All Commercial |
$1,609.32
|
| Rate for Payer: Humana ChoiceCare |
$1,510.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,574.33
|
| Rate for Payer: PHCS All Commercial |
$1,311.94
|
| Rate for Payer: PHP All Commercial |
$1,326.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,350.43
|
| Rate for Payer: Signature Care EPO |
$1,451.89
|
| Rate for Payer: Signature Care PPO |
$1,539.35
|
| Rate for Payer: United Healthcare Commercial |
$1,378.42
|
|
|
HC MIDLINE SINGLE LUMEN 4FR
|
Facility
IP
|
$977.55
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$733.16 |
| Max. Negotiated Rate |
$909.12 |
| Rate for Payer: Aetna Commercial |
$844.60
|
| Rate for Payer: Cash Price |
$606.08
|
| Rate for Payer: Cigna All Commercial |
$843.63
|
| Rate for Payer: CORVEL All Commercial |
$909.12
|
| Rate for Payer: Coventry All Commercial |
$860.24
|
| Rate for Payer: Encore All Commercial |
$899.83
|
| Rate for Payer: Frontpath All Commercial |
$899.35
|
| Rate for Payer: Humana ChoiceCare |
$844.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$879.80
|
| Rate for Payer: PHCS All Commercial |
$733.16
|
| Rate for Payer: PHP All Commercial |
$741.37
|
| Rate for Payer: Sagamore Health Network All Products |
$754.67
|
| Rate for Payer: Signature Care EPO |
$811.37
|
| Rate for Payer: Signature Care PPO |
$860.24
|
| Rate for Payer: United Healthcare Commercial |
$770.31
|
|
|
HC MIDLINE SINGLE LUMEN 4FR
|
Facility
OP
|
$977.55
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$909.12 |
| Rate for Payer: Aetna Commercial |
$825.05
|
| Rate for Payer: Aetna Medicare |
$322.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$322.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$561.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$611.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$370.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$354.85
|
| Rate for Payer: Cash Price |
$606.08
|
| Rate for Payer: Cash Price |
$606.08
|
| Rate for Payer: Centivo All Commercial |
$498.55
|
| Rate for Payer: Cigna All Commercial |
$843.63
|
| Rate for Payer: CORVEL All Commercial |
$909.12
|
| Rate for Payer: Coventry All Commercial |
$860.24
|
| Rate for Payer: Encore All Commercial |
$899.83
|
| Rate for Payer: Frontpath All Commercial |
$899.35
|
| Rate for Payer: Humana ChoiceCare |
$844.31
|
| Rate for Payer: Humana Medicare |
$498.55
|
| Rate for Payer: Lucent All Commercial |
$498.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$879.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$733.16
|
| Rate for Payer: PHP All Commercial |
$741.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$381.24
|
| Rate for Payer: Sagamore Health Network All Products |
$754.67
|
| Rate for Payer: Signature Care EPO |
$811.37
|
| Rate for Payer: Signature Care PPO |
$860.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$830.92
|
| Rate for Payer: United Healthcare Commercial |
$770.31
|
| Rate for Payer: United Healthcare Medicare |
$322.59
|
|
|
HC MILOOP LENS DEVICE
|
Facility
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41607879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC MILOOP LENS DEVICE
|
Facility
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41607879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC MINOR SURGICAL PROCEDURE
|
Facility
IP
|
$988.70
|
|
| Hospital Charge Code |
01206668
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$741.52 |
| Max. Negotiated Rate |
$919.49 |
| Rate for Payer: Aetna Commercial |
$854.23
|
| Rate for Payer: Cash Price |
$612.99
|
| Rate for Payer: Cigna All Commercial |
$853.24
|
| Rate for Payer: CORVEL All Commercial |
$919.49
|
| Rate for Payer: Coventry All Commercial |
$870.05
|
| Rate for Payer: Encore All Commercial |
$910.09
|
| Rate for Payer: Frontpath All Commercial |
$909.60
|
| Rate for Payer: Humana ChoiceCare |
$853.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$889.83
|
| Rate for Payer: PHCS All Commercial |
$741.52
|
| Rate for Payer: PHP All Commercial |
$749.83
|
| Rate for Payer: Sagamore Health Network All Products |
$763.27
|
| Rate for Payer: Signature Care EPO |
$820.62
|
| Rate for Payer: Signature Care PPO |
$870.05
|
| Rate for Payer: United Healthcare Commercial |
$779.09
|
|
|
HC MINOR SURGICAL PROCEDURE
|
Facility
OP
|
$988.70
|
|
| Hospital Charge Code |
01206668
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$326.27 |
| Max. Negotiated Rate |
$919.49 |
| Rate for Payer: Aetna Commercial |
$834.46
|
| Rate for Payer: Aetna Medicare |
$326.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$567.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$358.90
|
| Rate for Payer: Cash Price |
$612.99
|
| Rate for Payer: Centivo All Commercial |
$504.24
|
| Rate for Payer: Cigna All Commercial |
$853.24
|
| Rate for Payer: CORVEL All Commercial |
$919.49
|
| Rate for Payer: Coventry All Commercial |
$870.05
|
| Rate for Payer: Encore All Commercial |
$910.09
|
| Rate for Payer: Frontpath All Commercial |
$909.60
|
| Rate for Payer: Humana ChoiceCare |
$853.94
|
| Rate for Payer: Humana Medicare |
$504.24
|
| Rate for Payer: Lucent All Commercial |
$504.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$889.83
|
| Rate for Payer: PHCS All Commercial |
$741.52
|
| Rate for Payer: PHP All Commercial |
$749.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$385.59
|
| Rate for Payer: Sagamore Health Network All Products |
$763.27
|
| Rate for Payer: Signature Care EPO |
$820.62
|
| Rate for Payer: Signature Care PPO |
$870.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$840.39
|
| Rate for Payer: United Healthcare Commercial |
$779.09
|
| Rate for Payer: United Healthcare Medicare |
$326.27
|
|
|
HC MINOR SURGICAL PROCEDURE MISC
|
Facility
IP
|
$817.86
|
|
| Hospital Charge Code |
01660361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$760.61 |
| Rate for Payer: Aetna Commercial |
$706.63
|
| Rate for Payer: Cash Price |
$507.07
|
| Rate for Payer: Cigna All Commercial |
$705.81
|
| Rate for Payer: CORVEL All Commercial |
$760.61
|
| Rate for Payer: Coventry All Commercial |
$719.71
|
| Rate for Payer: Encore All Commercial |
$752.84
|
| Rate for Payer: Frontpath All Commercial |
$752.43
|
| Rate for Payer: Humana ChoiceCare |
$706.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$736.07
|
| Rate for Payer: PHCS All Commercial |
$613.39
|
| Rate for Payer: PHP All Commercial |
$620.26
|
| Rate for Payer: Sagamore Health Network All Products |
$631.39
|
| Rate for Payer: Signature Care EPO |
$678.82
|
| Rate for Payer: Signature Care PPO |
$719.71
|
| Rate for Payer: United Healthcare Commercial |
$644.47
|
|
|
HC MINOR SURGICAL PROCEDURE MISC
|
Facility
OP
|
$817.86
|
|
| Hospital Charge Code |
01660361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$269.89 |
| Max. Negotiated Rate |
$760.61 |
| Rate for Payer: Aetna Commercial |
$690.27
|
| Rate for Payer: Aetna Medicare |
$269.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$469.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$511.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$310.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.88
|
| Rate for Payer: Cash Price |
$507.07
|
| Rate for Payer: Centivo All Commercial |
$417.11
|
| Rate for Payer: Cigna All Commercial |
$705.81
|
| Rate for Payer: CORVEL All Commercial |
$760.61
|
| Rate for Payer: Coventry All Commercial |
$719.71
|
| Rate for Payer: Encore All Commercial |
$752.84
|
| Rate for Payer: Frontpath All Commercial |
$752.43
|
| Rate for Payer: Humana ChoiceCare |
$706.38
|
| Rate for Payer: Humana Medicare |
$417.11
|
| Rate for Payer: Lucent All Commercial |
$417.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$736.07
|
| Rate for Payer: PHCS All Commercial |
$613.39
|
| Rate for Payer: PHP All Commercial |
$620.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.96
|
| Rate for Payer: Sagamore Health Network All Products |
$631.39
|
| Rate for Payer: Signature Care EPO |
$678.82
|
| Rate for Payer: Signature Care PPO |
$719.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$695.18
|
| Rate for Payer: United Healthcare Commercial |
$644.47
|
| Rate for Payer: United Healthcare Medicare |
$269.89
|
|
|
HC MITOCHONDRIAL TITER
|
Facility
OP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.55
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Centivo All Commercial |
$99.12
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Humana Medicare |
$99.12
|
| Rate for Payer: Lucent All Commercial |
$99.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.80
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.21
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
| Rate for Payer: United Healthcare Medicare |
$64.14
|
|
|
HC MITOCHONDRIAL TITER
|
Facility
IP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$167.93
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
|
|
HC MLC DEVICE FOR IMRT
|
Facility
IP
|
$3,076.32
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
01547338
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,307.24 |
| Max. Negotiated Rate |
$2,860.98 |
| Rate for Payer: Aetna Commercial |
$2,657.94
|
| Rate for Payer: Cash Price |
$1,907.32
|
| Rate for Payer: Cigna All Commercial |
$2,654.86
|
| Rate for Payer: CORVEL All Commercial |
$2,860.98
|
| Rate for Payer: Coventry All Commercial |
$2,707.16
|
| Rate for Payer: Encore All Commercial |
$2,831.75
|
| Rate for Payer: Frontpath All Commercial |
$2,830.21
|
| Rate for Payer: Humana ChoiceCare |
$2,657.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,768.69
|
| Rate for Payer: PHCS All Commercial |
$2,307.24
|
| Rate for Payer: PHP All Commercial |
$2,333.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2,374.92
|
| Rate for Payer: Signature Care EPO |
$2,553.35
|
| Rate for Payer: Signature Care PPO |
$2,707.16
|
| Rate for Payer: United Healthcare Commercial |
$2,424.14
|
|
|
HC MLC DEVICE FOR IMRT
|
Facility
OP
|
$3,076.32
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
01547338
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$750.32 |
| Max. Negotiated Rate |
$2,860.98 |
| Rate for Payer: Aetna Commercial |
$2,596.41
|
| Rate for Payer: Aetna Medicare |
$1,015.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,015.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,766.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,923.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$750.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,167.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,116.70
|
| Rate for Payer: Cash Price |
$1,907.32
|
| Rate for Payer: Cash Price |
$1,907.32
|
| Rate for Payer: Centivo All Commercial |
$1,568.92
|
| Rate for Payer: Cigna All Commercial |
$2,654.86
|
| Rate for Payer: CORVEL All Commercial |
$2,860.98
|
| Rate for Payer: Coventry All Commercial |
$2,707.16
|
| Rate for Payer: Encore All Commercial |
$2,831.75
|
| Rate for Payer: Frontpath All Commercial |
$2,830.21
|
| Rate for Payer: Humana ChoiceCare |
$2,657.02
|
| Rate for Payer: Humana Medicare |
$1,568.92
|
| Rate for Payer: Lucent All Commercial |
$1,568.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,768.69
|
| Rate for Payer: Managed Health Services Medicaid |
$750.32
|
| Rate for Payer: MDWise Medicaid |
$750.32
|
| Rate for Payer: PHCS All Commercial |
$2,307.24
|
| Rate for Payer: PHP All Commercial |
$2,333.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,199.76
|
| Rate for Payer: Sagamore Health Network All Products |
$2,374.92
|
| Rate for Payer: Signature Care EPO |
$2,553.35
|
| Rate for Payer: Signature Care PPO |
$2,707.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,614.87
|
| Rate for Payer: United Healthcare Commercial |
$2,424.14
|
| Rate for Payer: United Healthcare Medicare |
$1,015.19
|
|
|
HC MOBILE DEV MYLUX PAT
|
Facility
OP
|
$746.25
|
|
| Hospital Charge Code |
41607244
|
|
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 MOBILE DEV MYLUX PAT
|
Facility
IP
|
$746.25
|
|
| Hospital Charge Code |
41607244
|
|
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 MOD BARIUM SWALLOW EV - OT
|
Facility
IP
|
$617.26
|
|
|
Service Code
|
CPT 92611 GO
|
| Hospital Charge Code |
01732004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$462.95 |
| Max. Negotiated Rate |
$574.05 |
| Rate for Payer: Aetna Commercial |
$533.32
|
| Rate for Payer: Cash Price |
$382.70
|
| Rate for Payer: Cigna All Commercial |
$532.70
|
| Rate for Payer: CORVEL All Commercial |
$574.05
|
| Rate for Payer: Coventry All Commercial |
$543.19
|
| Rate for Payer: Encore All Commercial |
$568.19
|
| Rate for Payer: Frontpath All Commercial |
$567.88
|
| Rate for Payer: Humana ChoiceCare |
$533.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.54
|
| Rate for Payer: PHCS All Commercial |
$462.95
|
| Rate for Payer: PHP All Commercial |
$468.13
|
| Rate for Payer: Sagamore Health Network All Products |
$476.53
|
| Rate for Payer: Signature Care EPO |
$512.33
|
| Rate for Payer: Signature Care PPO |
$543.19
|
| Rate for Payer: United Healthcare Commercial |
$486.40
|
|
|
HC MOD BARIUM SWALLOW EV - OT
|
Facility
OP
|
$617.26
|
|
|
Service Code
|
CPT 92611 GO
|
| Hospital Charge Code |
01732004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$574.05 |
| Rate for Payer: Aetna Commercial |
$520.97
|
| Rate for Payer: Aetna Medicare |
$203.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$224.07
|
| Rate for Payer: Cash Price |
$382.70
|
| Rate for Payer: Centivo All Commercial |
$314.80
|
| Rate for Payer: Cigna All Commercial |
$532.70
|
| Rate for Payer: CORVEL All Commercial |
$574.05
|
| Rate for Payer: Coventry All Commercial |
$543.19
|
| Rate for Payer: Encore All Commercial |
$568.19
|
| Rate for Payer: Frontpath All Commercial |
$567.88
|
| Rate for Payer: Humana ChoiceCare |
$533.13
|
| Rate for Payer: Humana Medicare |
$314.80
|
| Rate for Payer: Lucent All Commercial |
$314.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.54
|
| Rate for Payer: PHCS All Commercial |
$462.95
|
| Rate for Payer: PHP All Commercial |
$468.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.73
|
| Rate for Payer: Sagamore Health Network All Products |
$476.53
|
| Rate for Payer: Signature Care EPO |
$512.33
|
| Rate for Payer: Signature Care PPO |
$543.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.67
|
| Rate for Payer: United Healthcare Commercial |
$486.40
|
| Rate for Payer: United Healthcare Medicare |
$203.70
|
|
|
HC MOLECULAR CYTOGENICS DNA PROBE EA
|
Facility
OP
|
$122.69
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$114.10 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.53
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Centivo All Commercial |
$62.57
|
| Rate for Payer: Cigna All Commercial |
$105.88
|
| Rate for Payer: CORVEL All Commercial |
$114.10
|
| Rate for Payer: Coventry All Commercial |
$107.96
|
| Rate for Payer: Encore All Commercial |
$112.93
|
| Rate for Payer: Frontpath All Commercial |
$112.87
|
| Rate for Payer: Humana ChoiceCare |
$105.96
|
| Rate for Payer: Humana Medicare |
$62.57
|
| Rate for Payer: Lucent All Commercial |
$62.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.42
|
| Rate for Payer: Managed Health Services Medicaid |
$19.70
|
| Rate for Payer: MDWise Medicaid |
$19.70
|
| Rate for Payer: PHCS All Commercial |
$92.01
|
| Rate for Payer: PHP All Commercial |
$93.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.85
|
| Rate for Payer: Sagamore Health Network All Products |
$94.71
|
| Rate for Payer: Signature Care EPO |
$101.83
|
| Rate for Payer: Signature Care PPO |
$107.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.28
|
| Rate for Payer: United Healthcare Commercial |
$96.68
|
| Rate for Payer: United Healthcare Medicare |
$40.49
|
|
|
HC MOLECULAR CYTOGENICS DNA PROBE EA
|
Facility
IP
|
$122.69
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.01 |
| Max. Negotiated Rate |
$114.10 |
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Cigna All Commercial |
$105.88
|
| Rate for Payer: CORVEL All Commercial |
$114.10
|
| Rate for Payer: Coventry All Commercial |
$107.96
|
| Rate for Payer: Encore All Commercial |
$112.93
|
| Rate for Payer: Frontpath All Commercial |
$112.87
|
| Rate for Payer: Humana ChoiceCare |
$105.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.42
|
| Rate for Payer: PHCS All Commercial |
$92.01
|
| Rate for Payer: PHP All Commercial |
$93.04
|
| Rate for Payer: Sagamore Health Network All Products |
$94.71
|
| Rate for Payer: Signature Care EPO |
$101.83
|
| Rate for Payer: Signature Care PPO |
$107.96
|
| Rate for Payer: United Healthcare Commercial |
$96.68
|
|
|
HC MOLECULAR INTERP
|
Facility
OP
|
$351.09
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
63002096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$326.52 |
| Rate for Payer: Aetna Commercial |
$296.32
|
| Rate for Payer: Aetna Medicare |
$115.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$219.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.45
|
| Rate for Payer: Cash Price |
$217.68
|
| Rate for Payer: Cash Price |
$217.68
|
| Rate for Payer: Centivo All Commercial |
$179.06
|
| Rate for Payer: Cigna All Commercial |
$302.99
|
| Rate for Payer: CORVEL All Commercial |
$326.52
|
| Rate for Payer: Coventry All Commercial |
$308.96
|
| Rate for Payer: Encore All Commercial |
$323.18
|
| Rate for Payer: Frontpath All Commercial |
$323.01
|
| Rate for Payer: Humana ChoiceCare |
$303.24
|
| Rate for Payer: Humana Medicare |
$179.06
|
| Rate for Payer: Lucent All Commercial |
$179.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.98
|
| Rate for Payer: Managed Health Services Medicaid |
$21.61
|
| Rate for Payer: MDWise Medicaid |
$21.61
|
| Rate for Payer: PHCS All Commercial |
$263.32
|
| Rate for Payer: PHP All Commercial |
$266.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.93
|
| Rate for Payer: Sagamore Health Network All Products |
$271.04
|
| Rate for Payer: Signature Care EPO |
$291.41
|
| Rate for Payer: Signature Care PPO |
$308.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$298.43
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$115.86
|
|
