|
HC MOLECULAR INTERP
|
Facility
IP
|
$351.09
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
63002096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$326.52 |
| Rate for Payer: Aetna Commercial |
$303.35
|
| Rate for Payer: Cash Price |
$217.68
|
| 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: Lutheran Preferred All Commercial |
$315.98
|
| Rate for Payer: PHCS All Commercial |
$263.32
|
| Rate for Payer: PHP All Commercial |
$266.27
|
| 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: United Healthcare Commercial |
$276.66
|
|
|
HC MOLYBDENUM SERUM
|
Facility
IP
|
$225.85
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.39 |
| Max. Negotiated Rate |
$210.04 |
| Rate for Payer: Aetna Commercial |
$195.13
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cigna All Commercial |
$194.91
|
| Rate for Payer: CORVEL All Commercial |
$210.04
|
| Rate for Payer: Coventry All Commercial |
$198.75
|
| Rate for Payer: Encore All Commercial |
$207.89
|
| Rate for Payer: Frontpath All Commercial |
$207.78
|
| Rate for Payer: Humana ChoiceCare |
$195.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.26
|
| Rate for Payer: PHCS All Commercial |
$169.39
|
| Rate for Payer: PHP All Commercial |
$171.28
|
| Rate for Payer: Sagamore Health Network All Products |
$174.35
|
| Rate for Payer: Signature Care EPO |
$187.45
|
| Rate for Payer: Signature Care PPO |
$198.75
|
| Rate for Payer: United Healthcare Commercial |
$177.97
|
|
|
HC MOLYBDENUM SERUM
|
Facility
OP
|
$225.85
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$210.04 |
| Rate for Payer: Aetna Commercial |
$190.62
|
| Rate for Payer: Aetna Medicare |
$74.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$103.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.98
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Centivo All Commercial |
$115.18
|
| Rate for Payer: Cigna All Commercial |
$194.91
|
| Rate for Payer: CORVEL All Commercial |
$210.04
|
| Rate for Payer: Coventry All Commercial |
$198.75
|
| Rate for Payer: Encore All Commercial |
$207.89
|
| Rate for Payer: Frontpath All Commercial |
$207.78
|
| Rate for Payer: Humana ChoiceCare |
$195.07
|
| Rate for Payer: Humana Medicare |
$115.18
|
| Rate for Payer: Lucent All Commercial |
$115.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.26
|
| Rate for Payer: Managed Health Services Medicaid |
$12.48
|
| Rate for Payer: MDWise Medicaid |
$12.48
|
| Rate for Payer: PHCS All Commercial |
$169.39
|
| Rate for Payer: PHP All Commercial |
$171.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.08
|
| Rate for Payer: Sagamore Health Network All Products |
$174.35
|
| Rate for Payer: Signature Care EPO |
$187.45
|
| Rate for Payer: Signature Care PPO |
$198.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.97
|
| Rate for Payer: United Healthcare Commercial |
$177.97
|
| Rate for Payer: United Healthcare Medicare |
$74.53
|
|
|
HC MONITORED ANESTH EA ADD MIN
|
Facility
IP
|
$13.34
|
|
| Hospital Charge Code |
01246655
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.53
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna All Commercial |
$11.51
|
| Rate for Payer: CORVEL All Commercial |
$12.41
|
| Rate for Payer: Coventry All Commercial |
$11.74
|
| Rate for Payer: Encore All Commercial |
$12.28
|
| Rate for Payer: Frontpath All Commercial |
$12.27
|
| Rate for Payer: Humana ChoiceCare |
$11.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.01
|
| Rate for Payer: PHCS All Commercial |
$10.01
|
| Rate for Payer: PHP All Commercial |
$10.12
|
| Rate for Payer: Sagamore Health Network All Products |
$10.30
|
| Rate for Payer: Signature Care EPO |
$11.07
|
| Rate for Payer: Signature Care PPO |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
|
|
HC MONITORED ANESTH EA ADD MIN
|
Facility
OP
|
$13.34
|
|
| Hospital Charge Code |
01246655
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$11.26
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.84
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Centivo All Commercial |
$6.80
|
| Rate for Payer: Cigna All Commercial |
$11.51
|
| Rate for Payer: CORVEL All Commercial |
$12.41
|
| Rate for Payer: Coventry All Commercial |
$11.74
|
| Rate for Payer: Encore All Commercial |
$12.28
|
| Rate for Payer: Frontpath All Commercial |
$12.27
|
| Rate for Payer: Humana ChoiceCare |
$11.52
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: Lucent All Commercial |
$6.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.01
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$10.01
|
| Rate for Payer: PHP All Commercial |
$10.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.20
|
| Rate for Payer: Sagamore Health Network All Products |
$10.30
|
| Rate for Payer: Signature Care EPO |
$11.07
|
| Rate for Payer: Signature Care PPO |
$11.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.34
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$4.40
|
|
|
HC MONITORED ANESTH INITIAL 15 MIN
|
Facility
IP
|
$196.43
|
|
| Hospital Charge Code |
01246654
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$147.32 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$169.72
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Cigna All Commercial |
$169.52
|
| Rate for Payer: CORVEL All Commercial |
$182.68
|
| Rate for Payer: Coventry All Commercial |
$172.86
|
| Rate for Payer: Encore All Commercial |
$180.82
|
| Rate for Payer: Frontpath All Commercial |
$180.72
|
| Rate for Payer: Humana ChoiceCare |
$169.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.79
|
| Rate for Payer: PHCS All Commercial |
$147.32
|
| Rate for Payer: PHP All Commercial |
$148.97
|
| Rate for Payer: Sagamore Health Network All Products |
$151.65
|
| Rate for Payer: Signature Care EPO |
$163.04
|
| Rate for Payer: Signature Care PPO |
$172.86
|
| Rate for Payer: United Healthcare Commercial |
$154.79
|
|
|
HC MONITORED ANESTH INITIAL 15 MIN
|
Facility
OP
|
$196.43
|
|
| Hospital Charge Code |
01246654
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$64.82 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$64.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.30
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Centivo All Commercial |
$100.18
|
| Rate for Payer: Cigna All Commercial |
$169.52
|
| Rate for Payer: CORVEL All Commercial |
$182.68
|
| Rate for Payer: Coventry All Commercial |
$172.86
|
| Rate for Payer: Encore All Commercial |
$180.82
|
| Rate for Payer: Frontpath All Commercial |
$180.72
|
| Rate for Payer: Humana ChoiceCare |
$169.66
|
| Rate for Payer: Humana Medicare |
$100.18
|
| Rate for Payer: Lucent All Commercial |
$100.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.79
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$147.32
|
| Rate for Payer: PHP All Commercial |
$148.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.61
|
| Rate for Payer: Sagamore Health Network All Products |
$151.65
|
| Rate for Payer: Signature Care EPO |
$163.04
|
| Rate for Payer: Signature Care PPO |
$172.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$166.97
|
| Rate for Payer: United Healthcare Commercial |
$154.79
|
| Rate for Payer: United Healthcare Medicare |
$64.82
|
|
|
HC MONO SPOT TEST
|
Facility
OP
|
$135.76
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
63001277
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$126.26 |
| Rate for Payer: Aetna Commercial |
$114.58
|
| Rate for Payer: Aetna Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.28
|
| Rate for Payer: Cash Price |
$84.17
|
| Rate for Payer: Cash Price |
$84.17
|
| Rate for Payer: Centivo All Commercial |
$69.24
|
| Rate for Payer: Cigna All Commercial |
$117.16
|
| Rate for Payer: CORVEL All Commercial |
$126.26
|
| Rate for Payer: Coventry All Commercial |
$119.47
|
| Rate for Payer: Encore All Commercial |
$124.97
|
| Rate for Payer: Frontpath All Commercial |
$124.90
|
| Rate for Payer: Humana ChoiceCare |
$117.26
|
| Rate for Payer: Humana Medicare |
$69.24
|
| Rate for Payer: Lucent All Commercial |
$69.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.19
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$101.82
|
| Rate for Payer: PHP All Commercial |
$102.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.95
|
| Rate for Payer: Sagamore Health Network All Products |
$104.81
|
| Rate for Payer: Signature Care EPO |
$112.68
|
| Rate for Payer: Signature Care PPO |
$119.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.40
|
| Rate for Payer: United Healthcare Commercial |
$106.98
|
| Rate for Payer: United Healthcare Medicare |
$44.80
|
|
|
HC MONO SPOT TEST
|
Facility
IP
|
$135.76
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
63001277
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$126.26 |
| Rate for Payer: Aetna Commercial |
$117.30
|
| Rate for Payer: Cash Price |
$84.17
|
| Rate for Payer: Cigna All Commercial |
$117.16
|
| Rate for Payer: CORVEL All Commercial |
$126.26
|
| Rate for Payer: Coventry All Commercial |
$119.47
|
| Rate for Payer: Encore All Commercial |
$124.97
|
| Rate for Payer: Frontpath All Commercial |
$124.90
|
| Rate for Payer: Humana ChoiceCare |
$117.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.19
|
| Rate for Payer: PHCS All Commercial |
$101.82
|
| Rate for Payer: PHP All Commercial |
$102.96
|
| Rate for Payer: Sagamore Health Network All Products |
$104.81
|
| Rate for Payer: Signature Care EPO |
$112.68
|
| Rate for Payer: Signature Care PPO |
$119.47
|
| Rate for Payer: United Healthcare Commercial |
$106.98
|
|
|
HC MORGAN LENS
|
Facility
IP
|
$209.65
|
|
| Hospital Charge Code |
41601388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.24 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: Aetna Commercial |
$181.14
|
| Rate for Payer: Cash Price |
$129.98
|
| Rate for Payer: Cigna All Commercial |
$180.93
|
| Rate for Payer: CORVEL All Commercial |
$194.97
|
| Rate for Payer: Coventry All Commercial |
$184.49
|
| Rate for Payer: Encore All Commercial |
$192.98
|
| Rate for Payer: Frontpath All Commercial |
$192.88
|
| Rate for Payer: Humana ChoiceCare |
$181.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.68
|
| Rate for Payer: PHCS All Commercial |
$157.24
|
| Rate for Payer: PHP All Commercial |
$159.00
|
| Rate for Payer: Sagamore Health Network All Products |
$161.85
|
| Rate for Payer: Signature Care EPO |
$174.01
|
| Rate for Payer: Signature Care PPO |
$184.49
|
| Rate for Payer: United Healthcare Commercial |
$165.20
|
|
|
HC MORGAN LENS
|
Facility
OP
|
$209.65
|
|
| Hospital Charge Code |
41601388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.18 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: Aetna Commercial |
$176.94
|
| Rate for Payer: Aetna Medicare |
$69.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.10
|
| Rate for Payer: Cash Price |
$129.98
|
| Rate for Payer: Cash Price |
$129.98
|
| Rate for Payer: Centivo All Commercial |
$106.92
|
| Rate for Payer: Cigna All Commercial |
$180.93
|
| Rate for Payer: CORVEL All Commercial |
$194.97
|
| Rate for Payer: Coventry All Commercial |
$184.49
|
| Rate for Payer: Encore All Commercial |
$192.98
|
| Rate for Payer: Frontpath All Commercial |
$192.88
|
| Rate for Payer: Humana ChoiceCare |
$181.07
|
| Rate for Payer: Humana Medicare |
$106.92
|
| Rate for Payer: Lucent All Commercial |
$106.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$157.24
|
| Rate for Payer: PHP All Commercial |
$159.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.76
|
| Rate for Payer: Sagamore Health Network All Products |
$161.85
|
| Rate for Payer: Signature Care EPO |
$174.01
|
| Rate for Payer: Signature Care PPO |
$184.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$165.20
|
| Rate for Payer: United Healthcare Medicare |
$69.18
|
|
|
HC MORGAN LENS DELIVERY SET
|
Facility
IP
|
$63.70
|
|
| Hospital Charge Code |
41601868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$59.24 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Cash Price |
$39.49
|
| Rate for Payer: Cigna All Commercial |
$54.97
|
| Rate for Payer: CORVEL All Commercial |
$59.24
|
| Rate for Payer: Coventry All Commercial |
$56.06
|
| Rate for Payer: Encore All Commercial |
$58.64
|
| Rate for Payer: Frontpath All Commercial |
$58.60
|
| Rate for Payer: Humana ChoiceCare |
$55.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.33
|
| Rate for Payer: PHCS All Commercial |
$47.78
|
| Rate for Payer: PHP All Commercial |
$48.31
|
| Rate for Payer: Sagamore Health Network All Products |
$49.18
|
| Rate for Payer: Signature Care EPO |
$52.87
|
| Rate for Payer: Signature Care PPO |
$56.06
|
| Rate for Payer: United Healthcare Commercial |
$50.20
|
|
|
HC MORGAN LENS DELIVERY SET
|
Facility
OP
|
$63.70
|
|
| Hospital Charge Code |
41601868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: Aetna Medicare |
$21.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.12
|
| Rate for Payer: Cash Price |
$39.49
|
| Rate for Payer: Cash Price |
$39.49
|
| Rate for Payer: Centivo All Commercial |
$32.49
|
| Rate for Payer: Cigna All Commercial |
$54.97
|
| Rate for Payer: CORVEL All Commercial |
$59.24
|
| Rate for Payer: Coventry All Commercial |
$56.06
|
| Rate for Payer: Encore All Commercial |
$58.64
|
| Rate for Payer: Frontpath All Commercial |
$58.60
|
| Rate for Payer: Humana ChoiceCare |
$55.02
|
| Rate for Payer: Humana Medicare |
$32.49
|
| Rate for Payer: Lucent All Commercial |
$32.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$47.78
|
| Rate for Payer: PHP All Commercial |
$48.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.84
|
| Rate for Payer: Sagamore Health Network All Products |
$49.18
|
| Rate for Payer: Signature Care EPO |
$52.87
|
| Rate for Payer: Signature Care PPO |
$56.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.14
|
| Rate for Payer: United Healthcare Commercial |
$50.20
|
| Rate for Payer: United Healthcare Medicare |
$21.02
|
|
|
HC M. PNEUMONIAE, AMPLIFIED PROBE
|
Facility
OP
|
$66.66
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
63002045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$56.26
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.20
|
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Centivo All Commercial |
$34.00
|
| Rate for Payer: Cigna All Commercial |
$57.52
|
| Rate for Payer: CORVEL All Commercial |
$61.99
|
| Rate for Payer: Coventry All Commercial |
$58.66
|
| Rate for Payer: Encore All Commercial |
$61.36
|
| Rate for Payer: Frontpath All Commercial |
$61.32
|
| Rate for Payer: Humana ChoiceCare |
$57.57
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: Lucent All Commercial |
$34.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.99
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$49.99
|
| Rate for Payer: PHP All Commercial |
$50.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.00
|
| Rate for Payer: Sagamore Health Network All Products |
$51.46
|
| Rate for Payer: Signature Care EPO |
$55.33
|
| Rate for Payer: Signature Care PPO |
$58.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.66
|
| Rate for Payer: United Healthcare Commercial |
$52.53
|
| Rate for Payer: United Healthcare Medicare |
$22.00
|
|
|
HC M. PNEUMONIAE, AMPLIFIED PROBE
|
Facility
IP
|
$66.66
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
63002045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Cigna All Commercial |
$57.52
|
| Rate for Payer: CORVEL All Commercial |
$61.99
|
| Rate for Payer: Coventry All Commercial |
$58.66
|
| Rate for Payer: Encore All Commercial |
$61.36
|
| Rate for Payer: Frontpath All Commercial |
$61.32
|
| Rate for Payer: Humana ChoiceCare |
$57.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.99
|
| Rate for Payer: PHCS All Commercial |
$49.99
|
| Rate for Payer: PHP All Commercial |
$50.55
|
| Rate for Payer: Sagamore Health Network All Products |
$51.46
|
| Rate for Payer: Signature Care EPO |
$55.33
|
| Rate for Payer: Signature Care PPO |
$58.66
|
| Rate for Payer: United Healthcare Commercial |
$52.53
|
|
|
HC MPO/PR3(ANCA) ABS
|
Facility
OP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC MPO/PR3(ANCA) ABS
|
Facility
IP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC MRA ABDOMEN W/WO
|
Facility
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
01579949
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA ABDOMEN W/WO
|
Facility
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
01579949
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$901.06 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,583.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,583.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$901.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$901.06
|
| Rate for Payer: MDWise Medicaid |
$901.06
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
|
HC MRA CHEST W/WO
|
Facility
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
01571555
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA CHEST W/WO
|
Facility
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
01571555
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$883.66 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$883.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$883.66
|
| Rate for Payer: MDWise Medicaid |
$883.66
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
|
HC MRA-HEAD W/CONTRAST
|
Facility
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
01570545
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,683.00 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,938.82
|
| Rate for Payer: Cash Price |
$1,391.28
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
|
|
HC MRA-HEAD W/CONTRAST
|
Facility
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
01570545
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$740.52 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,893.94
|
| Rate for Payer: Aetna Medicare |
$740.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$740.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,288.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,402.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$922.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$851.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$814.57
|
| Rate for Payer: Cash Price |
$1,391.28
|
| Rate for Payer: Cash Price |
$1,391.28
|
| Rate for Payer: Centivo All Commercial |
$1,144.44
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Humana Medicare |
$1,144.44
|
| Rate for Payer: Lucent All Commercial |
$1,144.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: Managed Health Services Medicaid |
$922.31
|
| Rate for Payer: MDWise Medicaid |
$922.31
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$875.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,907.40
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
| Rate for Payer: United Healthcare Medicare |
$740.52
|
|
|
HC MRA; HEAD W CONTRAST LTD
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70545 52
|
| Hospital Charge Code |
01575245
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC MRA; HEAD W CONTRAST LTD
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70545 52
|
| Hospital Charge Code |
01575245
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
